Peds Book ?'s Chapter 16: Care of the Toddler

The mother of a toddler asks when she can begin offering her son 2% milk. The nurse responds by saying that she can begin offering it after age ____.

24 Months Whole milk should be given until age 2 years, after which 2% milk can be introduced.

A nurse is talking with the mother of a 2½ -year-old who is starting toilet training. The nurse determines that the child is at the stage of toilet learning when the mother states which of the following? Select all that apply. A. "He says he wants to wear "big-boy" pants" B. "He answers correctly when I ask him if his diaper is wet." C. "He can pull his pants up and down by himself." D. "He practices flushing." E. "He watches as his dad goes to the bathroom sometimes."

A. "He says he wants to wear "big-boy" pants" C. "He can pull his pants up and down by himself." The stage of toilet learning is characterized by showing an interest in wearing "real" underwear and the ability to pull pants up and down by himself. Practicing flushing and answering correctly when the diaper is wet indicate the stage of toilet practice. Watching others going to the bathroom characterizes the first stage, toilet play

A mother asks the nurse about how much television her 3- and 4-year olds should be watching each day. Which of the following would the nurse suggest? A. 1-2 hours B. None C. 4-5 hours D. 2-4 hours

A. 1-2 hours The American Academy of Pediatrics (AAP, 2011) advocates avoiding all forms of television and other entertainment media for children younger than age 2 years. As a general rule, for children and teens, 1 to 2 hours of quality media viewing per day should be the limit (AAP, 2011).

The nurse is caring for a 18-month-old child who has had surgery. The medical record indicates the child weighs 23 pounds (10.45 kg). When monitoring his urinary output the nurse is aware that normal hourly output should be what value? A. 10 mL/hr B. 20 mL/hr C. 15 mL/hr D. 5 mL/hr

A. 10 mL/hr The normal urinary output for a toddler is approximately 1 mL/kg/hr. This child weighs 23 pounds. This is 10.45 kg. This is approximately 10 mL/hr.

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. A. Consistency in the rules is important so the child understands what is expected. B. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. C. Toddlers cannot learn self-control until at least 3 to 4 years of age. D. Even at this young age, children need boundaries. E. If a child hits or bites another child, the parents should scold them, saying such things as "You are very naughty for biting Rachel."

A. Consistency in the rules is important so the child understands what is expected. B. If a child does something wrong, the parent must address the behavior immediately so the child understands what they did wrong. D. Even at this young age, children need boundaries. 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 nurse is preparing a presentation for a group of parents of toddlers and preschoolers. When describing the developmental milestones for this age group, the nurse would include which of the following as typical of a 2-year-old child? A. The child has 16 temporary teeth B. Head circumference equals chest circumference C. The child usually triples birth weight D. The posterior fontanel closes by this age.

A. The child has 16 temporary teeth Developmental milestones associated with a 2-year-old include acquiring 16 temporary teeth. The 12 month-old should triple his birth weight. The anterior fontanel closes at 18-24 months. Head circumference equals chest circumference at 12 months.

A nursing instructor is preparing a teaching plan about the growth and development of toddlers. Which topics would the instructor include in the planned teaching? Select all that apply. A. Wide-stance gait when walking B. Evidence of a prominent abdomen C. Noticeable respirations from the chest D. Average heart rate of 120 beats per minute E. Weight gain of approximately 10 lbs per year

A. Wide-stance gait when walking B. Evidence of a prominent abdomen A toddler typically gains 5 to 6 lbs per year. Toddlers tend to have a prominent abdomen because, although they are walking well, their abdominal muscles are not yet strong enough to support the abdominal contents. Many toddlers usually waddle or walk with a wide-stance gait. Respirations slow slightly but continue to be mainly abdominal. In addition, heart rate slows from about 110 to 90 beats per minute.

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? A. "Has your child displayed any aggressive tendencies toward other children?" B. "It is normal for children to engage in play alongside other children at this age." C. "Does your child have opportunities to socialize much with other children?" D. "Perhaps you should consider a preschool to promote more socialization opportunities."

B. "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 mother of a 2-year-old child tells the nurse that she is constantly scolding the child for having wet pants. The child was toilet trained at 12 months, but since walking, the child wets all of the time. Which nursing diagnosis should the nurse use to guide instruction for the mother? A. Excess fluid volume related to inability to control urination B. Deficient parental knowledge related to inappropriate method for toilet training C. Ineffective coping related to lack of self-control of 2-year-old D. Total urinary incontinence related to delayed toilet training

B. Deficient parental knowledge related to inappropriate method for toilet training The mother is having difficulty understanding the principles of toilet training. The diagnosis of deficient parental knowledge about toilet training is the most appropriate for the nurse to use to guide instruction for the mother. The child is not experiencing total urinary incontinence. The child does not have an excess in fluid volume. The mother is not demonstrating ineffective coping.

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. A. Children can have as many cookies they want if that is the only thing they will eat from breakfast. B. Milk is still important to incorporate in the diet for bone health. C. Try to limit the fat intake to less than 35% of total calories. D. Active, "busy" toddlers may need up to 1,400 cal/day. E. There is no need to worry about the amount of trans fats in a toddler diet.

B. Milk is still important to incorporate in the diet for bone health. C. Try to limit the fat intake to less than 35% of total calories. D. Active, "busy" toddlers may need up to 1,400 cal/day. 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 parents are asking their health care provider to give them some advice on how to start toilet training their toddler. Which information is most appropriate to share with this family? Select all that apply. A. Flush bowel movements right away to keep the child from playing with the stool. B. Praise the child every time the child sits on the potty chair and tries to defecate. C. Don't let the child use the potty chair as a place to sit at the play table since it might confuse the child of its purpose. D. Allow the child to sit on the potty chair for up to 30 minutes until the child actually defecates or urinates. E. Begin training with urination since this is the most frequent and costly part of potty training.

B. Praise the child every time the child sits on the potty chair and tries to defecate. C. Don't let the child use the potty chair as a place to sit at the play table since it might confuse the child of its purpose. Begin with defecation training because this is so much easier to grasp than urination. Sit the child on the potty chair or toilet at the time the child usually defecates. Praise the child if he or she does defecate. Be careful not to flush the toilet while the child is sitting on it because 2-year-old children are unable to realize they will not be flushed away. Encourage the child to flush the toilet independently after getting redressed. Do not allow a child to remain on a potty chair for much longer than 10 minutes (less than that if the child is resistant). Also, do not allow the child to use the chair to eat or as a play table so the child does not become confused as to its purpose.

The nurse is determining a toddler's language development. What is an expected finding for language development in a 2-year-old? A. Speaks 20 nouns and 4 pronouns B. Speaks in two-word sentences using a noun and a verb C. Able to count out loud to 20 D. Speaks two words plus "ma-ma" and "da-da"

B. Speaks in two-word sentences using a noun and a verb A 2-year-old child should be speaking in simple two-word sentences using a noun and a verb. Any 2-year-old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child. The child will not be able to speak 20 nouns and 4 pronouns.

A nurse is instructing a young mother on how to ensure a safe bath time for her 4-year-old son. Which are important suggestions for the nurse to give to the mother? Select all that apply. A. Have the child drink cranberry juice to avoid developing infections from the bath B. Turn down the temperature of the water heater to under 120°F. C. Do not hang a mobile over the tub. D. Do not use bubble bath. E. Do not leave the child unsupervised in the bath tub. F. Assist the child in cleaning under fingernails and around ears.

B. Turn down the temperature of the water heater to under 120°F. E. Do not leave the child unsupervised in the bath tub. F. Assist the child in cleaning under fingernails and around ears. When possible, parents should turn down the temperature of the water heater in their home to under 120°F to help prevent scalds. Although preschoolers certainly sit well in bathtubs, they should still not be left unsupervised at bath time in case they decide to add more hot water or to practice swimming and then be unable to get their head out of the water again. Some girls develop vulvar irritation (and perhaps bladder infection) from exposure to bubble bath so parents shouldn't add such products to the water. Although not well studied, cranberry juice may help prevent these infections the same as in adult women. However, in this case, the child is a boy, so a bubble bath would be fine and cranberry juice not needed. Preschoolers do not clean their fingernails or ears well, so these areas often need "touching up" by a parent or older sibling. Using a nonirritating shampoo and hanging a mobile over the tub so they have a reason to look up while their hair is rinsed helps make hair washing a fun procedure

A 3-year-old child is seen at the clinic for a check up. When collecting information from the child's mother she reports concern about her child's stools. She states he sometimes passes what appears to be undigested food. What response by the nurse is most appropriate? A. "Your child may be eating foods that are too harsh for his digestive system." B. "This is not something to worry about." C. "The digestive tracts of toddlers are not totally mature causing this to happen." D. "A mild stool softener may help with this."

C. "The digestive tracts of toddlers are not totally mature causing this to happen." The digestive systems of toddlers are not fully mature and they may sometimes pass pieces of undigested food. This is a normal occurrence. The reason for this occurrence should be explained to the child's mother. Simply telling her not to worry does not fully address her concerns. There is no indication that the diet being ingested is not appropriate. A stool softener will not help with this phenomena

When providing anticipatory guidance to the parents of a toddler, which of the following would the nurse include as most appropriate for enhancing their child's self-esteem? A. Using negative criticism as well as positive reinforcement B. Avoiding applauding for unsuccessful attempts C. Including the child in activities that interest the adult D. Using belittling techniques as opposed to time-out

C. Including the child in activities that interest the adult Including the child in activities that interest the adult is a good strategy for enhancing self-esteem. Belittling techniques should not be used. Negative criticism should be avoided. Applauding for unsuccessful attempts as well as successes should be reinforced.

The mother of a toddler observes the child play next to another child but not with the child. What should the nurse explain to the mother about this type of play behavior? A. This is premature play and should be stopped. B. This is peer play and is abnormal. C. This is parallel play and is expected. D. This is adjacent play and is only seen in school-age children.

C. This is parallel play and is expected. All during the toddler period, children play beside children next to them, not with them. This side-by-side play called parallel play is not unfriendly but is a normal developmental sequence that occurs during the toddler period. This is not peer, adjacent, or premature play. This behavior is not abnormal, does not need to be stopped, and is not seen in school-age children

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

C. 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.

A mother asks the nurse, "Now that Jimmy is 14-months-old and drinking from a cup, how much milk should he be getting each day?" Which amount would the nurse recommend? A. 24 ounces B. 8 ounces C. 12 ounces D. 16 ounces

D. 16 ounces A young child should receive at least two servings of milk and other dairy products a day and take milk primarily from a cup. More than 16 oz of milk per day will interfere with the amount of solid food that a child can eat and can also contribute to iron-deficiency anemia.

A mother states that her 2-year-old daughter has difficulty falling asleep at night. Upon further assessment, the nurse learns that the toddler takes a 1-hour nap during the late afternoon. Which should the nurse recommend to the mother? A. Integrate the nap into the lunchtime routine B. Add a second nap, typically in the morning C. Allow an 15-30 minute nap after dinnertime D. Omit or shorten the nap during the afternoon

D. Omit or shorten the nap during the afternoon If a child has difficulty falling asleep at night, it may be time to omit or shorten an afternoon nap. Adding a second nap is recommended for toddlers who are short-tempered and tired at dinnertime. Integrating the nap into the lunchtime routine is a recommendation to encourage the toddler to take a nap, which is not needed in this case. Taking a quick nap in the evening is too close to bedtime.

The 18-month-old toddler has most likely attained which gross motor skill? A. The ability to walk up stairs alone. B. The ability to pedal a tricycle. C. The ability to balance on one foot. D. The ability to walk independently.

D. The ability to walk independently. The 18-month-old tocdler can walk alone, but the gait may still be a little unsteady. By 3 years of age, the child can walk heel-to-toe fashion like an adult. The 18-month-old toddler can walk up the stairs with assistance but cannot walk stairs with alternate feet until 36 months. A 3-year-old child can pedal a tricycle and balance on one foot.

A 15-month-old boy has been brought to the clinic because he is pale and listless. Iron deficiency anemia is suspected. The nurse interviews the mother about the child's diet. Which of the following would the nurse identify as a possible contributing factor? A. The child drinks very little fruit juice B. The child eats a vegetarian diet C. The nurse hears a grade 2 heart murmur D. The child drinks 4 cups of milk per day

D. The child drinks 4 cups of milk per day The child is drinking 32 ounces of milk per day which can contribute to iron deficiency anemia. A good vegetarian diet would not cause the child's symptoms. The grade 2 heart murmur is most likely innocent. Eating an acidic fruit or drinking the juice with iron containing foods enhances iron absorption.