Chapter 26: Growth and Development of the Toddler

The parent of a 2-year-old client states it is the child's naptime. The child is refusing to take a nap and cries, "I have to put my babies to sleep first!" The parent states, "I am so sorry, I do not know what is wrong. My child does not act this way at home. My child has 2 baby dolls we rock to sleep each day at home before nap." Which response by the nurse is most appropriate? "Your child's behavior indicates discipline occurring at home is not consistent." "I am sure your child is just acting out since your child is in the hospital and not at home." "You need to have someone bring the baby dolls to the hospital." "A 2-year-old child's behavior can be greatly altered if rituals are not maintained."

"A 2-year-old child's behavior can be greatly altered if rituals are not maintained." Ritualism employed by the young child to help develop security involves following routines that make rituals of even simple tasks. The child's self-esteem is built through familiarity with the daily routine. When these rituals are interrupted, the child's behavior can be negatively impacted, resulting in temper tantrums for 2-year-old children. The nurse can recommend someone bring the dolls to the hospital; however, the nurse first needs to address the parent's concern. Stating the child is "just acting out" does not address the parent's concern or current situation. There is nothing in the scenario indicating inconsistent discipline.

The nurse is discussing sensory development with the mother of a 2-year-old boy. Which parental comment suggests the child may have a sensory problem? "He doesn't respond if I wave to him." "I dropped a pan behind him and he cried." "He wasn't bothered by the paint smell." "He was licking the dishwashing soap."

"He doesn't respond if I wave to him." The fact that the child does not respond when the mother waves to him suggests he may have a vision problem. The toddler's sense of smell is still developing, so he may not be affected by odors. Their sense of taste is not well developed either, and this allows him to eat or drink poisons without concern. The child's crying at a sudden noise assures the nurse that his hearing is adequate.

Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation? "Note if your child cries as you leave because this may be an indication the babysitter is ignoring the child." "If your child starts crying, stay a little longer and read a story before leaving." "Try to sneak out the back door to avoid the long crying scene at the door." "Inform the child that you are going out but the regular babysitter will care for them and put them to bed."

"Inform the child that you are going out but the regular babysitter will care for them and put them to bed." Most toddlers react best to separation if a regular babysitter is employed or if the day care center has consistent caregivers. It helps if toddlers have fair warning they will have a babysitter. No matter how well prepared toddlers are, they may cry when the babysitter actually appears or may greet the babysitter warmly only to cry when the parents reach for their coats. It helps if parents say good-bye firmly, repeat the explanation they will be there when the child wakes in the morning, and then leave. Prolonged good-byes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen a child's fear of abandonment and so should be discouraged.

The mother of an 18-month-old girl voices concerns about her child's social skills. She reports that the child does not play well with others and seems to ignore other children who are playing at the same time. What response by the nurse is indicated? "Has your child displayed any aggressive tendencies toward other children?" "Perhaps you should consider a preschool to promote more socialization opportunities." "Does your child have opportunities to socialize much with other children?" "It is normal for children to engage in play alongside other children at this age."

"It is normal for children to engage in play alongside other children at this age." The social skills of the toddler at this age include parallel play. During parallel play children will play alongside each other rather than cooperatively. There is no indication that the aggression level of the child needs to be investigated. There is no indication the child needs increased socialization with other children.

The nurse is reviewing sleep and rest activities of a 16-month-old child with the parents. The father states, "I have told my wife it is unhealthy for our child to sleep with us. It's time for him to sleep in his own bed. What do you think?" What is the nurse's best initial response? "Co-sleeping is viewed acceptable by some professionals, but as interfering with the child's independence by others." "It must be difficult for the two of you to both feel strongly about what is best for you and your child." "Have you thought about just trying to let your child sleep in his own bed to see how it goes?" "I will note this in your child's chart for the doctor to see."

"It must be difficult for the two of you to both feel strongly about what is best for you and your child." Acknowledging the difference of opinion between the mother and father allows for open conversation about the sleeping arrangement, which may lead to an acceptable resolution. Stating the views of professionals about co-sleeping, while accurate, does not address the parent's voiced concerns, nor does noting the sleep activities in the chart. Suggesting the child sleep in his own bed is not up to the nurse to do, and it does not address the issue.

During a well-child visit, the nurse observes the child saying "no" to her mother quite frequently. The mother asks the nurse, "How do I deal with her saying no all the time?" What would be appropriate for the nurse to suggest? Select all that apply. "Offer her something she would like, such as ice cream, to distract her." "Make a statement instead of asking a question." "Use time-out every other time she tells you no." "Offer her two options from which to choose." "Limit the number of questions you ask of her."

"Limit the number of questions you ask of her." "Make a statement instead of asking a question." "Offer her two options from which to choose." A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. In addition, using statements instead of asking questions and giving the child a choice of two options are effective. Using time-out is a discipline measure and would be inappropriate to counteract a toddler's negativism. Offering a choice rather than a bribe such as ice cream is more effective and long-lasting for modifying the child's behavior.

The parents of a toddler ask the nurse, "We are so frustrated. It seems like our child has temper tantrums all the time. What can we do?" Which response by the nurse is appropriate? "When your child gets like this, it is best to give into what the child wants." "Stay calm and nearby then once it is over, try to distract your child." "Try reasoning with your child when the tantrum starts." "It is important to show the child who is in control."

"Stay calm and nearby then once it is over, try to distract your child." Temper tantrums, aggressive displays of temper during which the child reacts with rebellion to the wishes of the family caregiver, spring from the many frustrations that are natural results of a child's urge to be independent. Add to this a child's reluctance to leave the scene for necessary rest, and frequently the frustrations become too great. The child is out of control and needs help regaining control. A trusted person who remains calm and patient needs to be nearby until the child gains self-control. In addition, the adult must maintain self-control to reassure the child and provide security. Showing the child who is in control would only further add to the child's frustrations. Trying to reason with the child, scolding the child, or punishing the child during a tantrum is useless. After the tantrum is over, the parent may divert attention with a toy or some other interesting distraction, which can help the child relax. However, the parent should not yield the point or give in to the child's whim.

The parent of a 20-month-old toddler reports the toddler has been becoming distraught when the parent leaves. The parent asks the nurse for advice about what is going on and how to best manage it. What information can be provided? Select all that apply. "This is a normal happening for a toddler of this age." "Your care providers may be frightening to your toddler." "As your toddler begins to learn that you will return the toddler will become less upset." "This is actually a regression for your toddler because separation anxiety normally occurs in infancy." "Establishing a routine for saying goodbye to your toddler will be helpful."

"This is a normal happening for a toddler of this age." "As your toddler begins to learn that you will return the toddler will become less upset." "Establishing a routine for saying goodbye to your toddler will be helpful." Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. Separation anxiety for the toddler is normal. As the toddler begins to develop an understanding of object constancy, separation anxiety will ease. The toddler, while missing the parent, will begin to recognize that the parent will return. Establishing a routine for saying goodbye is helpful for the toddler. There is no indication that the care providers are problematic.

The mother of a 15-month-old son is returning to work and wants to place her son in the day care close to work; however, they will only accept potty-trained children. Which response from the nurse will best address this situation in answering the mother's questions of how best to potty train her son? "Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." "Encourage your son to watch his older siblings use the toilet." "Each time you change his diaper, tell your son how important and fun it is to use the potty chair." "Get your son a potty chair and have him sit on it for a few minutes each day."

"Wait a few more months until your son has more muscle control and shows signs that he's ready to be potty trained." To be able to cooperate in toilet training, the child's anal and urethral sphincter muscles must have developed to the stage where the child can control them. Control of the anal sphincter usually develops first. The child also must be able to postpone the urge to defecate or urinate until reaching the toilet or potty and must be able to signal the need before the event. In addition, before toilet training can occur, the child must have a desire to please the caregiver by holding feces and urine rather than satisfying his/her own immediate need for gratification. This level of maturation seldom takes place before the age of 18 to 24 months.

The nurse is teaching the parents of a 2-year-old child how to handle the child's temper tantrums. The nurse determines that the teaching was successful if the parents make which statement? "We will ignore our child while having the tantrum." "We will attempt to reason with our child to limit tantrums." "We will offer our child a treat to stop having the tantrum." "We will place our child in time-out for 5 minutes after the tantrum."

"We will ignore our child while having the tantrum." The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Bribery, such as saying that the child can have a treat if the behavior stops, is rarely effective because by accepting the child's wishes, the parent is encouraging the child to have more tantrums because he or she was successful. Placing the child in time-out does not deal with the actual tantrum. When a child is placed in time-out, the appropriate length is 1 minute per year of age (2 minutes for this child). Tantrums are a result of the child not being able to appropriately express his or her needs, desires, or frustrations. It is not appropriate to attempt to reason with a upset 2-year-old child.

A group of caregivers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is appropriate related to this form of discipline? "Our time-out chair is in the master bedroom so my child cannot see anyone else in the family." "We use the time-out chair when our child gets tired but does not want to take a nap." "When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." "My child is 3 years old now and I put my child in time-out for 5 to 10 minutes when misbehaving."

"When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." A method for a young child who is not cooperating or who is out of control is to send the child to a "time-out" chair. This should be a place where the child can be alone but observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Caregivers should warn the child in advance of this possibility, but only one warning per event is necessary. The chair should be used for discipline, not because the child will not go take a nap. It can be used for all ages of young children.

A mother of a toddler asks the nurse, "How will I know that my daughter is ready for toilet training?" Which response by the nurse would be most appropriate? "You'll probably notice that your daughter is uncomfortable in wet diapers." "Don't worry, your daughter will probably give you very definite signals." "Most children are ready for toilet training by the time they are 18 months old." "Your daughter can understand holding urine and stool by about 1 year of age."

"You'll probably notice that your daughter is uncomfortable in wet diapers." The markers of readiness for toilet training are subtle, but as a rule, children are ready for toilet training when they begin to be uncomfortable in wet diapers. Although the rectal and urethral sphincters are mature by the end of the first year, children are not cognitively and socially ready. In fact, many children do not understand what is being asked of them until they are 2 or even 3 years old.

While observing a 13-month-old and her parents in the playroom of the hospital unit, the nurse notes that the toddler is using her index finger to point towards a toy. What should the nurse say to the parents? "Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." "I notice your daughter is using her index finger to point. This is something we should tell the doctor." "How long has your daughter used her index finger to point to objects?" "Has your daughter started turning book pages on her own yet."

"Your daughter is demonstrating fine motor skills appropriate to her age by pointing with her index finger." At 12 to 15 months of age the toddler should be feeding herself finger foods and using her index finger to point to objects. Turning the pages of books would not be expected until the age of 18 months.

A pediatric nurse is providing care to several children. The nurse is reviewing the assessment findings for each of the children. Which finding requires the nurse to intervene? 3-year-old preschool-aged child who goes up stairs on hands and knees 9-month-old infant who can pull self up to a standing position 24-month-old toddler who engages in parallel play 14-month-old toddler who walks with a parent's assistance

3-year-old preschool-aged child who goes up stairs on hands and knees At 3 years of age, a child should be able to climb the stairs one step up at a time or using alternating feet. If the child can only go up on hands and knees, further evaluation is needed. At 9 months of age, an infant can pull oneself up to a standing position and sometimes is able to cruise around furniture or even walk. Toddlers begin to walk between 9 and 18 months of age. Toddler at 24 months of age engage in parallel play rather than cooperative play.

The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding? The toddler was lethargic afterward. A tantrum preceded the event. The toddler became unconscious. The event took place during a nap.

A tantrum preceded the event. Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell. Breath-holding spells never occur during sleep, nor do they feature postictal confusion. Unconsciousness is not definitive because it is common to both seizures and breath-holding spells.

The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern? Put shapes into matching openings Ability to turn door knobs Ability to hold a crayon to write Able to use a spoon to self-feed

Ability to turn door knobs Turning knobs opens doors and may allow the child access to the outdoors or unsafe areas within the home. Close to follow will be the ability to unscrew lids, creating poisoning risks. The other abilities promote growth and development and involve lesser safety hazards.

Which is the best way for parents to aid a toddler in achieving the developmental task? Give the toddler small household chores to do Urge the toddler to dress oneself completely alone Allow the toddler to make simple decisions Help the toddler learn to count

Allow the toddler to make simple decisions The toddler years see a refinement of motor skills, continuous cognitive growth, and the acquisition of language skills. During this time the toddler achieves autonomy and self-control. Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence. Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem. A younger toddler may not successfully dress alone because he or she may not have mastered such techniques as buttons, zippers, or tying shoes. A toddler can help with household tasks but these are generally limited because the toddler's attention span and motor skills may not be refined enough to complete the task. Helping the child learn to count is improving cognitive development but does not necessarily help the child with gaining autonomy or self-control.

What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums? Promise the toddler a special activity if the toddler will stop Distract the toddler with a toy when the toddler begins holding the breath Appear to ignore the toddler Mimic the toddler's behavior by also holding the breath

Appear to ignore the toddler Temper tantrums are the natural result of frustration that toddlers have. Toddlers do not behave badly on purpose. They need time and maturity to learn the rules and regulations. During a temper tantrum, the advice is for the parent to ignore the behavior but ensure the toddler is safe. Rewarding temper tantrums can teach the toddler that tantrums are an effective method of interaction. Ignoring tantrums teaches the toddler that tantrums are ineffective. The parent needs to use self-control when dealing with a temper tantrum. This is a way to model acceptable behavior for the toddler.

The nurse is promoting language and cognitive development to the parents of a 3-year-old boy. Which guidance about reading with their child will be most helpful? Keep story time a reward for being good. Have the child sit still during the story. Ask the child questions as you read. Read a different book if he knows the story.

Ask the child questions as you read. Engage the child by asking him questions as he listens. This gives him a chance to contribute to the story. The child does not have to sit still. He may want to move around or even act out part of the story. Story time should happen regularly and not be just a reward. Even if the child can tell the story, he may wish to hear it read again because he enjoys the repetition and familiarity.

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson? Industry versus inferiority Initiative versus guilt Trust versus mistrust Autonomy versus shame and doubt

Autonomy versus shame and doubt Erikson defines the toddler period as a time of autonomy versus shame and doubt. Erikson defines Initiative versus guilt as the preschool period. Erikson defines trust versus mistrust as the infancy period and industry versus inferiority as the school age period.

The parents of a 3-year-old who had bone cancer that resulted in amputation of the lower left leg ask their health care provider about expected behaviors for their child. Which behavior is expected and acceptable during hospitalization for treatments? If the child throws a tantrum, the nurses should also assess for seizures related to the use of pain medication following current treatment modalities. Crawling may be their preferred mode of travel because they may not want to wait for help to put the prosthesis on. Soiling with feces is unacceptable if the child was toilet trained prior to the hospitalization and should be addressed each time it occurs. During hospitalizations, there should be no regression in their toilet training since many staff members are available to take the child to the restroom.

Crawling may be their preferred mode of travel because they may not want to wait for help to put the prosthesis on. A toddler with a long-term illness or who is physically challenged can be expected to exhibit normal toddler behaviors, such as temper tantrums. A child who uses a lower extremity prosthesis, for example, might prefer to crawl somewhere rather than wait for help to put the prosthesis in place. Toilet training is difficult for a child who is hospitalized at periodic intervals because success usually requires a consistent caregiver; in addition, hospitalization can result in regressive behaviors. If a chronically ill child has difficulty with ambulation, soiling accidents may occur beyond the usual age because of an inability to reach a bathroom easily.

The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable? Ineffective coping related to lack of self-control of 2-year-old toddler Deficient parental knowledge related to inappropriate method for toilet training Excess fluid volume related to inability to control urination Total urinary incontinence related to delayed toilet training

Deficient parental knowledge related to inappropriate method for toilet training Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule. This toddler is not toilet trained independently. The toddler does not display total urinary incontinence. The toddler is only incontinent when playing and not reminded to potty. A 2-year-old toddler has limited coping skills. Frequent wetting of the pants does not indicate too much fluid intake. It is a symptom that the toddler does not feel the urge to urinate until the bladder is too full and the toddler cannot get to the toilet on time.

A single mother with three young children is reluctant to leave her crying and upset 16-month-old daughter overnight in the hospital but needs to go home to care for the other children. Which suggestion from the nurse will best address the fears and concerns of both the child and mother? Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." Remind them staying in the hospital now will help the child get well quicker and be home soon, but the other children should not be alone. Distract the child with a special blanket, stuffed animal, or other "lovey" from home while the mother quietly slips out. Tell both the mother and child that the child will be carefully guarded and won't be in as much danger as she might be if she were home exploring her environment.

Encourage the mother to give the child a personal item of the mother's to hold on to until she returns and to tell the child a specific time she will return, such as "when breakfast comes in the morning." When the family caregiver must leave the toddler, it may be helpful for the adult to give the child some personal item to keep until the adult returns. The caregiver can tell the child he or she will return "when the cartoons come on TV" or "when your lunch comes." These are concrete times that the toddler will probably understand. The toddler is too young to understand that staying is important for her recovery. Distracting the child while the mother leaves may increase the child's anxiety when she realizes her mother is gone. Although the child will be watched closely in the hospital setting, toddlers explore their environment wherever they are.

A nurse is presenting a class on discipline for a group of parents of toddlers. What information would be important for the nurse to teach this group? Select all that apply. Toddlers cannot learn self-control until at least 3 to 4 years of age. Even at this young age, children need boundaries. If a child hits or bites another child, the parents should scold them, saying such things as "You are very naughty for biting Rachel." Consistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong.

Even at this young age, children need boundaries. Consistency in the rules is important so the child understands what is expected. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. Discipline for toddlers must have consistency and correct timing. Parents need to come to a consensus on how to discipline their child and do so consistently and in a unified fashion. Also, the toddler needs to receive negative feedback for negative behavior as soon as the infraction occurs so the child understands what they did wrong. Parents should never label the child as bad, just their behavior. Every child needs boundaries—it is just that every family's boundaries may vary. Discipline begins early in life and toddlers can learn self-control.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? Explain that the child could start walking any day. Explain that children can take their first steps as late as 18 months of age. Refer the child to a developmental specialist for evaluation. Ask the parent if the child has been ill recently.

Explain that children can take their first steps as late as 18 months of age. Infants can begin walking as early as 8 to 9 months and as late as 18 months of age. Telling the parent that the child will start walking any day is true but not guaranteed. Asking if the child has been ill recently is an appropriate question during a well-child visit but does not address the parent's concerns. Since the child is on track developmentally, there is no indication to refer the child to a developmental specialist.

A stay-at-home father wants to purchase commercial toddler meals because his 16-month-old girl recently choked on table food. Which food items will the nurse suggest not be given to this child? Select all that apply. Fruits such as peaches, pears, and kiwi Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Round foods such as hot dogs, whole grapes, and cherry tomatoes Vegetables such as corn, green beans, and peas

Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows Round foods such as hot dogs, whole grapes, and cherry tomatoes To offer soft round foods safely, cut hot dogs in uneven pieces and cut grapes and cherry tomatoes into quarters. This prevents food impacting in an airway. Avoid the hard and sticky foods due to aspiration and airway occlusion risks. The cooked vegetables listed are safe as are the soft fruits.

Which action is appropriate to enhance a toddler's self-esteem? Include the child in activities that interest the adult. Utilize belittling techniques as opposed to time-outs. Avoid applauding for unsuccessful attempts. Utilize negative criticism as well as positive reinforcement.

Include the child in activities that interest the adult. Parents who give the toddler love and respect regardless of the child's gender, behavior or capabilities are helping to lay the foundation for self-esteem. Toddlers need familiarity with the daily routine to enhance self-esteem development. Routines and rituals not only help develop self-esteem but help develop a conscience. Strategies for enhancing self-esteem encompass including the child in activities that interest the adult. Belittling techniques should not be used. Negative criticism should be avoided. Applauding for unsuccessful attempts as well as successes should be reinforced.

A mother brings her 2-year-old child to the pediatrician's office, voicing concerns about her toddler's growth over the last year. According to the child's records, the toddler has gained 6 pounds (2.7 kg ) and grown 2.5 in (6.25 cm) since the child's last visit a year ago. How should the nurse respond to this mother's concerns? Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Tell her that her child's growth is less than is expected and gather a nutritional history on the child. Tell the mother that she needs to return to the pediatrician's office in 3 months to re-weigh the child and measure his height for any changes. Ask the mother if there are other small people in her family.

Inform the mother that her toddler's growth is within normal limits and there is nothing to be worried about. Normally, a toddler's growth is 5 to 10 pounds per year and about 3 inches in height. This child falls within the recommended parameters of growth and the mother has nothing to be worried about.

A nursing instructor is leading a class discussion exploring the various aspects of Erikson's theories of the developmental tasks of toddlers. The instructor determines the session is successful when the students correctly choose which task as a priority for toddlers? Learning to act on one's own Learning to trust Learning to speak Learning to understand and respond to discipline

Learning to act on one's own Erikson's psychosocial developmental task for toddlers is to achieve autonomy (independence) while overcoming doubt and shame. Erikson's psychosocial developmental task for infants is to develop a sense of trust. Learning to speak and to understand and respond to discipline are not developmental tasks according to Erikson.

A group of students is reviewing material about ways parents can help to foster a child's self-esteem. The students demonstrate a need for additional studying when they identify which method as promoting self-esteem? Acting as a coach rather than a cheerleader Using positive reinforcement while limiting criticism Limiting the choices and decisions that the child makes Showing respect and support to the child

Limiting the choices and decisions that the child makes To promote self-esteem, parents should praise the child's achievements, show respect and support to the child, allow the child to make decisions, listen to the child, and spend time with the child. The parents need to be a coach to the child rather than just a cheerleader who merely praises accomplishments.

The nurse is educating a parent regarding child safety for the 14-month-old toddler. What would the nurse include in the educational plan? Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach. Utilize a front-facing car seat with appropriate harness straps until at least the age of 24 months. If the child reaches to touch a firearm, gently slap the child's hand and firmly state 'No.' Assure there are no empty buckets in the home/play area that could result in accidental drowning.

Maintain supervision when the child is near stoves, ovens, irons and other hot items the child could reach. Toddlers are more mobile and curious, leading to accidental burns on stoves, ovens, irons etc. They must be supervised when near these objects to avoid burns. If firearms are in the home, they should be unloaded and locked in a secure location. Educating the toddler about firearm safety will not be remembered and is appropriate for a much older child. Buckets are a danger to toddlers (who are top heavy) if they have water in them and could result in a drowning. Empty buckets are not a drowning concern. Children are to be placed in a rear-facing car seat until 2 years of age, not a front-facing one.

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply. Children can have as many cookies they want if that is the only thing they will eat from breakfast. Milk is still important to incorporate in the diet for bone health. Active, "busy" toddlers may need up to 1,400 cal/day. There is no need to worry about the amount of trans fats in a toddler diet. Try to limit the fat intake to less than 35% of total calories.

Milk is still important to incorporate in the diet for bone health. Active, "busy" toddlers may need up to 1,400 cal/day. Try to limit the fat intake to less than 35% of total calories. Active children in this age group may need up to 1,400 kcal daily. Children over 2 years old should have a total fat intake between 30% and 35% of calories, with most fat coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils, the same as adults. Adequate calcium and phosphorus intake is important for bone mineralization. Milk should be whole milk until age 2 years, after which 2% milk can be introduced. Trans fats should be kept to a minimum. Diets high in sugar (like cookies) should be avoided to help prevent toddler obesity.

The caregivers of a 2-year-old are concerned the child is not learning how to share and play well with other children. While acknowledging their concern and devotion, the nurse should point out which activity would be best for this child's developmental level? Throwing a baseball-sized ball Sharing finger paints and painting with the caregiver Looking at large print magazines Mowing the lawn with a toy lawnmower

Mowing the lawn with a toy lawnmower Toddlers enjoy talking on a play telephone. They like pots, pans, and toys such as brooms, dishes, and lawnmowers that help them imitate the adults in their environment and promote socialization. Toys that involve the toddler's new gross motor skills, such as push-pull toys, rocking horses, large blocks, and balls are popular. Fine motor skills are developed by use of thick crayons, modeling clay, finger paints, wooden puzzles with large pieces, toys with pieces that fit into shaped holes, and cloth books. The toddler will not be interested in sharing toys until the later stage of toddlerhood; adults should not make an issue of sharing at this early stage.

The nurse is discussing proper discipline with the parent of a 15-month-old toddler. Which teaching is most important? Physical punishment such as spanking is discouraged. Toddlers are unable to follow instructions easily. Rules and limits should be simple and few. Only use praise after the child has corrected a wrong behavior. SUBMIT ANSWER

Physical punishment such as spanking is discouraged. Because toddlers younger than 18 months of age are at increased risk for physical injury from spanking than other children, the nurse should prioritize discouraging its use. The American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners recommend against corporal or physical punishment, which includes spanking. The other teachings describe toddler characteristics accurately and are basic to good discipline, but are not the most important for this young toddler.

The nurse is supervising a play group of children on the unit. The nurse expects the toddlers will most likely be involved in which activity? Painting pictures in the art corner of the room Watching a movie with other children their age Pretending to be mommies and daddies in the play house Playing with the plastic vacuum cleaner and pushing it around the room

Playing with the plastic vacuum cleaner and pushing it around the room Playtime for the toddler involves imitation of the people around them such as adults, siblings, and other children. Push-pull toys allow them to use their developing gross motor skills. Preschool children have imitative play, pretending to be the mommy, the daddy, a policeman, a cowboy, or other familiar characters. The school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. The adolescent enjoys activities they can participate in with their peers.

Parents of a toddler describe how they handled their child's temper tantrum in a shopping mall. What action of the parents indicates need for additional teaching? Tried to refocus the child's attention as tantrum behavioral cues appeared Made sure the child was rested and not hungry before going to the mall Reasoned with the child to stop the behavior Remained relatively calm even though embarrassed

Reasoned with the child to stop the behavior The child having a tantrum is out of control, making reasoning impossible. Calmly bear hugging the child provides control, especially in a public place. The other actions are helpful in preventing a tantrum.

The nurse is assessing a 2-year-old toddler. Which observation(s) will alert the nurse that the child may be experiencing a developmental delay? Select all that apply. The toddler will not pick up a toy or touch the nose when directed by the nurse. The toddler is unable to stack more than four blocks on top of another. The toddler claps the hands in response to the nurse clapping hands. The toddler's vocabulary consists of the words "ball," "dadda," "mum," "drink," and "up." The toddler pushes and pulls the play vacuum cleaner in the toy room.

The toddler's vocabulary consists of the words "ball," "dadda," "mum," "drink," and "up." The toddler will not pick up a toy or touch the nose when directed by the nurse. The 2-year-old toddler should be speaking in two-word sentences, and should be able to follow simple commands. Imitating the clapping of hands and pushing and pulling objects is expected of a 2-year-old toddler. The child should not be able to stack more than four blocks until the age of 3, so this observation would not be a concern at this age.

A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern? Behavior modification techniques can change the toddler's behavior. This is normal toddler behavior; sharing is learned later. Play time with other toddlers should be cut back until your toddler learns to share. The toddler is probably reacting to some family crisis.

This is normal toddler behavior; sharing is learned later. Play is the major socializing medium for the toddler. Toddlers exhibit parallel play instead of cooperative play. Sharing is not usually learned until the preschool period. Because toddlers have such short attention spans, they change toys and activities frequently. This also is not conducive to sharing. Because parallel play is normal for the toddler, the parent should be assured the toddler is developing normally and no restrictions are needed.

The nurse is explaining safety precautions for toddlers to the mother of a normal 30-month-old boy. Which activity might the nurse suggest may be done without supervision? Turning on the bath water Undressing himself Eating a mid-afternoon snack Playing in the basement

Undressing himself The child would be capable of safely dressing or undressing himself with some success. Turning on the bath water, playing in the basement, or eating a mid-afternoon snack could present significant risk for injury if not supervised.

A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess? Knowledge of full name Use of a two-word noun-verb sentence Verbalization of 4 to 6 words Ability to name one color

Use of a two-word noun-verb sentence A 2-year-old should be able to say a two-word sentence that consists of a noun and verb. A 15-month-old can say 4 to 6 words. A 30-month-old knows his full name and can name one color.

Parents and their nearly 3-year-old child have returned to the clinic for a follow-up appointment. Which of the findings may signal a speech delay? Uses two-word sentences or phrases Half of speech understood by outsider Talks about a past event Asks "why" often

Uses two-word sentences or phrases A child nearly 3 years of age should speak in three- to four-word sentences. The other findings indicate normal expressive language for the age.

A 2-year-old toddler holds his breath until passing out when he wants something the parent does not want him to have. The nurse would decide whether these temper tantrums are a form of seizure based on the fact that: seizures are not provoked; temper tantrums are. with seizures, cyanosis rarely develops. seizures typically occur with fever; temper tantrums do not. seizures rarely occur in toddlers.

seizures are not provoked; temper tantrums are. Temper tantrums are the natural result of toddler frustration. Toddlers are eager to explore new things but their efforts can be thwarted, especially for safety reasons. Toddlers do not behave badly on purpose. Temper tantrums occur out of anger and frustration. Seizures do not. Seizures can occur at any age. The client may or not be febrile. Depending upon how long a seizure lasts, cyanosis can occur.

The nurse is assessing the language development of a 3-year-old girl. Which finding would suggest a problem? speaks in 2- to 3-word sentences tells the nurse her name tells the nurse she saw Na-Na today makes simple conversation

speaks in 2- to 3-word sentences If the child is still speaking telegraphically in only 2- to 3-word sentences, it suggests there is a language development problem. If the child makes simple conversation, tells about something that happened in the past, or tells the nurse her name she is meeting developmental milestones for language.

Which statement by a parent would best prepare the toddler for the parent's return if the parent must leave the hospital? "I will come back when it is time for your bath tonight." "I will be back after you eat your dinner and SpongeBob goes off." "I will be back in the morning. Mommy loves you." "I will be back later this afternoon."

"I will be back after you eat your dinner and SpongeBob goes off." Toddlers have no real concept of time and equate time to events in their lives. So, the best way for the mother to tell the child when she will be back at the hospital is to relate her arrival to events such as the child's dinner and TV programs the child likes.

A nurse is reviewing important concepts related to bathing and tub baths with a parent of a toddler. Which statement by the parent indicates the need for additional teaching? "I will give my toddler a bath every day at the same time." "It's okay to let my toddler take bubble baths and play in the bubbles." "I can let my toddler have toys in the tub during bath time." "I should never leave the toddler alone in the tub at any time."

"It's okay to let my toddler take bubble baths and play in the bubbles." Bubble baths are not recommended for children, especially girls, due to the increased incidence of urinary tract infections associated with the use of bubble bath soap. All other behaviors are appropriate.

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this? Emotions of a 12-month-old are labile. He can move from calm to a temper tantrum rapidly. Aggressive behaviors such as hitting and biting are common in toddlers. A regular routine and rituals will provide stability and security. A sense of control can be provided through offering limited choices.

A regular routine and rituals will provide stability and security. Toddlers benefit most from routines and rituals that help them anticipate events and teach and reinforce expected behaviors. Knowing that a child can move from calm to temper tantrum very quickly, understanding the benefit of limited choices, and realizing that hitting and biting are common behaviors in toddlerhood provide information but not a guiding concept.

The parents of a 2-year-old boy report to the nurse that their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child? Assuring the parents that food jags are normal, and they can be honored safely. Encouraging the parents to eat a variety of wholesome foods themselves. Offering a variety of foods along with the foods the child likes. Advising the parents to minimize distractions at mealtime.

Offering a variety of foods along with the foods the child likes. Toddlers require fewer calories proportionately than infants, and their appetite decreases (physiologic anorexia). Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods. Prolonged preferences for particular foods (food jags) are common. It is also important that mealtime be calm, pleasant, and focused on eating. Toddlers mimic behaviors observed. It is important that parents set a good example with their mealtime behaviors and food choices. All options encourage the development of healthy eating habits, but at this time, variety plus preferred foods will be most helpful.

The nurse is preparing a presentation for a health fair which will illustrate various ways to help introduce siblings to a new member of the family. Which suggestion should the nurse prioritize to help older siblings, especially toddlers, understand the change in the family dynamics? Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. Have a grandparent or another special adult in the child's life take the toddler on an errand or a special visit. Plan time for the secondary caregiver to focus on the toddler while the primary caregiver focuses on the infant. Move the toddler to a new bedroom with a "grown-up-bed."

Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. The secondary caregiver can occasionally take over the care of the new baby while the mother or other primary caregiver devotes herself to the toddler. The primary caregiver might also plan special times with the toddler when the new infant is sleeping and the caregiver has no interruptions. This approach helps the toddler feel special. Moving the older child to a larger bed lets the toddler take pride in being "grown up" now, but it should be done some time before the new baby appears. While acknowledging that time with another adult can be a special time, the main concern is for the toddler to understand they are not being replaced by the newest member of the family.

The father of a toddler reports his son says "no" every time he attempts to correct him. What is the best advice the nurse can offer to the parent? Continue to correct him because he needs discipline. You may need to lessen the amount of correction being given to the child as he seems to be responding to feeling "overly restricted." This is a normal part of toddlerhood. Saying no is your son's way of trying to exert his independence and is expected.

Saying no is your son's way of trying to exert his independence and is expected. It often seems that "no" is a toddler's favorite word. Saying no is his way of beginning to exert his independence. Telling the parent this is a normal happening does not provide the necessary education to the parent. Saying "no" does not indicate the discipline being provided is too restrictive. Telling the father to continue the discipline does not offer the needed education about his child's behavior and stage of development.

The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? The child copies a circle on a piece of paper. The child imitates the nurse in use of a stethoscope. The child demonstrates separation anxiety. The child follows directions when made one at a time.

The child demonstrates separation anxiety. The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.

The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene? The toddler goes to the bathroom alone to urinate. All of the windows in the home are locked. The family's medications are located in a kitchen drawer. The toddler in not allowed in the kitchen while food is being prepared.

The family's medications are located in a kitchen drawer. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. This includes keeping all medications in a high, locked cabinet. It is appropriate for all windows to be locked to prevent a toddler from exiting the home out a window. The toddler may go to the bathroom alone once toilet training is well established. Not allowing the toddler in the kitchen during meal preparation will prevent accidental burns from hot foods and surfaces.

A toddler's parents want to begin toilet training. As a rule, the best instruction the nurse could give them is: all children should be toilet trained by age 2 years. if children can remain dry during the night, they can do so during the day. toilet training is a 12-month process. bowel training is easier than urine training.

bowel training is easier than urine training. Myelination from the spinal cord is complete at age 2. Toilet training can begin somewhere around this period. All children are not the same in their emotional and physical development. Some may be ready before their second birthday and others need a little longer. This time should be positive and nonthreatening if the toddler is to be successful. Bowel training is often easier than urine training because the substance to be evacuated is so much more tangible. The best time for defecation is usually following a meal. Toddlers may need to wear diapers at night during the toilet training process until successful voiding and defecating in the potty is complete. The length of the process for toilet training completion depends upon the child's readiness.

Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply. sugar-free candy bars cheese slices orange slices raisin oatmeal cookies yogurt

cheese slices orange slices yogurt Toddlers often need between-meal snacks. To help prevent dental caries from frequent snacking, encourage parents to offer fruit (e.g., bananas, pieces of apple, orange slices) or protein foods (e.g., cheese, pieces of chicken) for snacks rather than high-carbohydrate items such as cookies and candy bars to limit exposure of the child's teeth to carbohydrates. Calcium (found in large amounts in milk, cheese, and yogurt) is especially important for the development of strong teeth.

The nurse is talking to the parent of a 19-month-old toddler about setting limits and supervising activities. In which situation will the nurse recommend letting the toddler do as he or she pleases? deciding one's bedtime schedule exploring one's body playing on the picnic table choosing one's own foods

exploring one's body Children learn about gender differences during the toddler years. They observe differences between male and female body parts if they are exposed to seeing it. They question their parents about the differences. It is normal for toddlers to explore their genitals as they develop their own sense of self. The parent should allow this and not punish the child. Choosing food and deciding bedtimes need to be done by an adult. Likewise, safety dictates that the picnic table is not a safe play area.

The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem? goes from calm to tantrum suddenly is unable to share toys with others sucks his thumb periodically has persistent separation anxiety

has persistent separation anxiety Separation anxiety should have disappeared or be subsiding by 3 years of age. The fact that it is persistent suggests there might an emotional problem. Emotional lability, self-soothing by thumb sucking, or the inability to share are common for this age.

During a well-child visit to the health care provider, the parent reveals a family struggling with the changes from their "sweet, cuddly 16-month-old child" to that of a negative, more aggressive 2-year-old toddler. After the clinic visit, the nurse will document which priority nursing focus for this visit? potential risk for child abuse malfunctioning family coping ready for enhanced family coping impairment in family's resilience

ready for enhanced family coping The most appropriate nursing focus would be that the family is ready for enhanced family coping related to the parents' ability to adjust to the new needs of the toddler. There is no indication that the other issues require a nursing action.

A mother expresses surprise to the nurse that her daughter has begun masturbating. The most important initial nursing response is that: there may be undue stress in your child's life. toilet teaching places much focus on the genitals. girls as well as boys will masturbate. this is a normal and expected activity best treated matter-of-factly.

this is a normal and expected activity best treated matter-of-factly. Masturbation is a normal event to be done in private. Calling attention to the behavior may increase the frequency. Both girls and boys masturbate, and toilet teaching calls attention to the genital area. These two statements are accurate information but not the best first response. Excessive or public masturbation points to stress.