PEDS: Chapter 4 Growth and Development of the Toddler

A nurse is teaching the parents of a toddler how to handle the child's temper tantrums. The nurse determines that the teaching was successful when the parents state this is as an appropriate response to the tantrum.

"I'll be in the kitchen. When you're done, you can come in, too. The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it. Telling the child that the parent will be in the kitchen and that he or she can come in when the child is done is such an example. Bribery, such as saying that the child can have a cookie or a hug 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 they were successful. Telling the child that the parent can kick as hard as the child can reinforces how the child is responding. page 104

In working with the toddler, which statement would be most appropriate to say to the toddler to decrease the behavior known as negativism?

"It is time for lunch, I am going to put your bib on." Limiting the number of questions asked of the toddler and making a statement, rather than asking a question or giving a choice, is helpful in decreasing the number of negative responses from the child. page 118

The toddler grows about how many inches in height per year?

3 inches The toddler age range is one to three years of age. Each year the toddler grows about 3 inches (7.62 cm). Page 97

When assessing a toddler's language development, what is the standard against which you measure language in a 2-year-old?

He should speak in two-word sentences ("Me go"). By 2 years of age, children typically speak in two-word (noun and verb) sentences. Page 102

The nurse is providing parental anticipatory guidance to promote healthy emotional development in a 12-month-old boy. Which statement best accomplishes this?

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. Page 103

The parents of a 30-month-old girl have brought her into the emergency department because she had a seizure. During the health history, the nurse suspects the child had a breath-holding spell. Which parental report suggests breath-holding?

A tantrum preceded the event. 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. Page 118

The nurse is caring for an 18-month-old child. The nurse is aware that the child is which stage according to Erikson?

Autonomy versus shame and doubt page 98

The nurse is caring for a 16-month-old child on the pediatric unit. The child's mother is a single mother who has two other young children at home. She must leave her 16-month-old daughter overnight in the hospital. Which action by the nurse will be most appropriate in helping the child feel secure and in reassuring this mother?

Encourage the mother to give her daughter 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. Page 104

The nurse is talking to the mother of a 19-month-old girl about setting limits and supervising activities. In which situation will the nurse recommend letting the child do as she pleases?

Exploring her body It is normal for toddlers to explore their genitals when they are undressed. 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. page 103

A toddler's "no" can best be eliminated by asking a question instead of making a statement.

False A toddler's "no" can best be eliminated by limiting the number of questions asked of the child. Making a statement instead of asking a question this way can avoid a great many negative responses. page 98

A toddler insists on brushing his own teeth and being left alone in the bathtub. What advice would you give his parents regarding this?

Helping with his own tooth brushing allows him to experience autonomy. Toddlers are not safe alone in bathtubs; most toddlers have strong opinions; assisting with brushing his own teeth is a good way to express autonomy. Page 98

Once temper tantrums have started, which intervention is appropriate?

Move objects out of the way or move the child to prevent injury. Appropriate interventions include moving objects out of the way or moving the child to prevent injury from occurring during the temper tantrum. The caregiver should not speak to the child and should avoid eye contact until the child has calmed down. The child's behavior should not be engaged. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteem.

The nurse is observing a play group of children of all ages. The toddlers in the group would most likely be doing which activity?

Playing with the plastic vaccum 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. Page 98

The nurse is providing education to a teen mother about her 20-month-old daughter's growth. The teen says her daughter seems to have such a big head. What information should the nurse include in the response?

Share that the heads of children at this age are large in proportion to the rest of their body Head circumference increases about 1 inch between 1 and 2 years of age, then increases an average of a half-inch per year until age 5. The anterior fontanel should be closed by the time the child is 18 months old. Head size becomes more proportional to the rest of the body near the age of 3 years. Page 97

A mother expresses surprise to the nurse that her toddler daughter has begun masturbating. The most important initial nursing response is that:

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. Page 103

A nurse is assessing a 2-year-old's language development. What would the nurse expect to assess?

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. Pave 102

Parents of a 2-year-old girl are having a conversation with the nurse about tantrums. Which technique would the nurse most likely suggest?

Use short "time-outs" and remain calm. The best response to tantrums is to remain calm and use short "time-outs." Responses need to be consistent rather than varied. Telling the child she is bad is negative. Promising a reward for good behavior will result in rewarding bad behavior. Page 118

Parents and their 35-month-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 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. Page 102

The best way for parents to aid a toddler in achieving his developmental task would be to:

allow him to make simple decisions. Making decisions is primary practice toward achieving independence. page 103

The way you would advise a toddler's mother to handle temper tantrums would be to:

appear to ignore them. Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums teaches the child that they are ineffective. Page 118

The developmental task of the toddler period, according to Erikson, is achieving a sense of:

autonomy. Achieving a sense of independence or autonomy is the toddler developmental task. Page 98

A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to:

give him secondary, not primary, choices. Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life.

A toddler's mother tells you that no matter what she asks of her child, he says, "No." A suggestion you might make to help her handle this problem is for her to:

give him secondary, not primary, choices. Encouraging toddlers to express their opinion aids in developing a sense of autonomy; allowing secondary choices encourages this without disrupting family life. p 98

A 2-year-old holds his breath until he passes out when he wants something his mother does not want him to have. You would base your evaluation of whether these temper tantrums are a form of seizure on the basis that:

seizures are not provoked; temper tantrums are. Temper tantrums occur because children are angry or frustrated; seizures occur without respect to provocation. page 118

The parents of an overweight 2-year-old boy admit that their child is a bit "chubby," but argue that he is a picky eater who will eat only junk food. Which response by the nurse is best to facilitate a healthier diet?

"Give him more healthy choices with less junk food available." Suggesting that the parents transition the child to a healthier diet by serving him more healthy choices along with smaller portions of junk food will reassure them that they are not starving their child. The parents would have less success with an abrupt change to healthy foods. Explaining calorie requirements and the time line for acceptance of a new food do not offer a practical reason for making a change in diet. Page 113

The parents of a 3-year-old tell the nurse that their child constantly says "no" to everything and they are very frustrated. They ask the nurse what they should do. Which responses by the nurse are appropriate? Select all that apply.

"Have you tried using "time-outs" for negative behavior?" "Giving your child choices instead of posing "yes" or "no" questions may decrease the "no" response." "This is normal for this age. If measures to stop this behavior don't work, you should make the decision for your child on move on with whatever activity is occurring." As the toddler separates from the parent and recognizes his or her own individuality, and exerts autonomy, it is very common for the child to display negativism. Time-outs are helpful ways of disciplining for this age group. Offering choices, such as "Do you want the red or blue shirt?" lends to autonomy. If measures fail the parent needs to calmly make choices for the child. Spanking is not recommended for any age. Asking the child to explain is not developmentally appropriate for this age. p117

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." 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. Page 101

What statement by the mother of a 20-month-old indicates a need for further teaching about nutrition?

"I give my daughter juice at breakfast and when she is thirsty during the day." High juice intake can contribute to either obesity or appetite suppression. None is needed, but if juice is given limit the amount to 4 to 6 ounces daily. Water should be the choice for thirst. The other statements support good toddler nutrition. Whole milk is needed through age 2 years. Two cups daily is adequate. Nutritious snacks support quality intake when quantity is poor. New foods offered with old ones provide sameness along with the new. page 111

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?

"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. Page 106

A 3 ½-year-old girl is admitted to the hospital with a severe respiratory infection. The parents tell the nurse that they have noticed that their child has been using "baby talk" and has been wetting the bed. The parents are concerned and ask the nurse what they should do. How should the nurse respond?

"It is normal for children to regress during a stressful event like a hospitalization. Just praise her good behavior and don't give attention to the regressive behavior." Regression is very common during any stressful events in a preschool child's life. Praising good behavior and ignoring the regressive behavior tends to be the best way to deal with regression. Once the stressful event has passed the regressive behavior should disappear. Page 119

A 3 ½-year-old girl is admitted to the hospital with a severe respiratory infection. The parents tell the nurse that they have noticed that their child has been using "baby talk" and has been wetting the bed. The parents are concerned and ask the nurse what they should do. How should the nurse respond?

"It is normal for children to regress during a stressful event like a hospitalization. Just praise her good behavior and don't give attention to the regressive behavior." Regression is very common during any stressful events in a preschool child's life. Praising good behavior and ignoring the regressive behavior tends to be the best way to deal with regression. Once the stressful event has passed the regressive behavior should disappear. page 119

A mother is concerned because her 14-month-old son, who had a big appetite when breastfeeding a few months ago, seems uninterested in eating solid food. She still breastfeeds him daily, but is thinking of weaning him soon. How should the nurse respond to this mother?

"It is normal for toddlers to lose their appetites; try starting him with just a tablespoonful of food on his plate." Because growth slows abruptly after the first year of life, a toddler's appetite is usually less than an infant's. Children who ate hungrily 2 months earlier now sit and play with their food. It is important to educate parents while the child is still an infant this decline in food intake will occur so they will not be concerned when it happens. Because the actual amount of food eaten daily varies from one child to another, teach parents to place a small amount of food on a plate and allow their child to eat it and ask for more rather than serve a large portion the child cannot finish. One tablespoonful of each food served is a good start. The nurse should recommend that the mother wean her son gradually to avoid confrontation, not all at once. Most toddlers insist on feeding themselves and generally will resist eating if a parent insists on feeding them. Page 111

After teaching the mother of a 13-month boy old about suggestions for bathing and hygiene, the nurse determines that the teaching was successful when the mother states:

"It might be best to give him a bath in the evening." The young child's increased activity level necessitates bathing daily or every other day. A good time to bathe the child is after eating, either after breakfast or in the evening. Hair is washed two to three times per week with a mild shampoo. Bubble baths should be avoided, to prevent urethral irritation and possible development of cystitis. Some children may have fears associated with bathing such as being afraid of being sucked down the plug hole. In this case, do not drain the tub until the child is out of the room. Page 114

The parents of a toddler ask the nurse about disciplining their son. What would be most helpful for the nurse to suggest? Select all that apply.

"It's better to praise correct behavior than to punish wrong behavior." Parents should begin to instill some sense of discipline early in life because part of it involves safety limits. Two general rules to follow include the need to be consistent and the use of praise for correct behavior rather than punishment for wrong behavior so that the child can learn the rules. Timeout is an effective technique to help children learn that actions have consequences. Having a consistent caregiver is important for reducing separation anxiety. page 116

A nurse is discussing safety measures with the parents of a toddler. What would the nurse emphasize to address the most frequent type of accident in toddlers?

"Keep all cleaning products and drugs out of the reach of your child." Although all the instructions are important, accidental ingestions (poisoning) are the most frequent accident in toddlers. Therefore, it is imperative to focus on keeping all poisonous substances, drugs, and small objects securely out of the reach of children. Burns, motor vehicle accidents, and falls such as from a tricycle occur frequently in toddlers, However, they occur less frequently than poisonings.

Parents are proud of their toddler's fast-developing fine motor skills. Which skill they describe should the nurse point out as a safety risk?

Ability to turn 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 learning and involve lesser safety hazards. Page 101

The parents of a 3-year-old boy tell the nurse that they are having another baby in several months. They ask the nurse for suggestions to help their son adapt to the new baby. What would the nurse suggest?

"Let the child participate in caring for the new baby." Young children who are involved in a newborn's care adapt better than those who are not and thus have fewer feelings of sibling rivalry. During this time, it is wise not to introduce any new developmental tasks such as toilet training, weaning from a nighttime bottle, or changing from a crib to a toddler bed. Encourage parents to spend extra alone time with the child to decrease sibling rivalry. If the child does something to make the new baby cry, the parents should investigate the reason behind the action and talk to the child about it, rather than discipline the child. pg 119

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.

"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 keeping the child to a choice between two options are effective. Using timeout 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 longer lasting for modifying the child's behavior. Page 98

During the toddler years, the child attempts to become autonomous. Which statement by a 3-year-old's caregiver indicates that the child is developing autonomy?

"My child uses the potty chair and is dry all day long." Being toilet trained is an example of the toddler developing autonomy or independence. page 118

The grandmother is the primary caregiver of her 2-year-old granddaughter. She expresses her concern that the child has temper tantrums two or three times a day, often in public places. She explains that she spanked her own children when they did this but now she is worried that spanking is not the best way to handle the situation. Which statement is the mostappropriate regarding dealing with the child who has a temper tantrum?

"Remain calm, pick the child up, and move her to a quiet and neutral place until she gains self-control; don't give in to her demands." Remaining calm is a must. It is not easy to handle a small child who drops to the floor screaming and kicking in rage in the middle of the supermarket or the sidewalk, nor are comments from onlookers at all helpful. The best a caregiver can do is pick up the out-of-control child as calmly as possible and carry him or her to a quiet, neutral place to regain self-control. Reasoning, scolding, or punishing during a tantrum is useless. Do not yield the point or give in to the child's whim. That would tell the child that to get whatever one wants, a person need only throw oneself on the floor and scream. The child would have to learn painfully later in life that people cannot be controlled in this manner. Spanking or other physical punishment usually does not work well because the child is merely taught that hitting or other physical violence is acceptable and a child who is spanked frequently becomes immune to it. Page 118

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?

"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. page 98

The parents of a 3-year-old boy have asked the nurse for advice about a preschool for their child. Which suggestion is most important for the nurse to make?

"The staff should be trained in early childhood development." The nurse would recommend a preschool where the staff is trained in early childhood development and cardiopulmonary resuscitation. Cleanliness and a loving staff are not enough without competence. Good hygiene procedures require that a sick child not be allowed to attend. It is also important that parents are allowed to visit any time without an appointment. Page 108

A mother who is returning to work outside the home has found a day care center close to her office and is eager to have her 15-month-old son placed there so he can be close by. The center will only take children who are potty-trained. The mother asks the nurse for advice about how to persuade her son to use the potty. What would be the most appropriate response for the nurse to give to this mother?

"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 18-24 months.

A group of caregivers of toddlers are discussing the form of discipline in which the child is placed in a "time-out" chair. Which statement made by these caregivers is most appropriate related to this form of discipline?

"When my son starts getting frustrated and aggressive, I remind him that if he throws a fit he will have to go to time out." A method for a 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—one 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 Page 116

The father of a 2-year-old girl tells the nurse that he and his wife would like to begin toilet training their daughter soon. He asks when the right time is to begin this process. What should the nurse say in response?

"When she starts tugging on a wet or dirty diaper, she is letting you know she's ready." The markers of readiness are subtle, but as a rule children are ready for toilet training when they begin to be uncomfortable in wet diapers. They demonstrate this by pulling or tugging at soiled diapers. Because physiologic development is cephalocaudal, the rectal and urethral sphincters are not mature enough for control in most children until at least the end of the first year, when tracts of the spinal cord are myelinated to the anal level. A good way for a parent to know a child's development has reached this point is to wait until the child can walk well independently. Toilet training need not start this early, however, because cognitively and socially, many children do not understand what is being asked of them until they are 2 or even 3 years old. Page 117

The nurse is talking with the parents of a newborn who is being discharged following an uneventful delivery. The parents express their excitement about going home but have concerns about what they need to do to help their 2-year-old adjust to the new baby. Which suggestion would be most appropriate for the nurse to offer these parents?

"You should plan some 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. page 119

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." 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. page 118

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. How should the nurse respond?

"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. page 98

The mother of a preschooler reports that her daughter seems to believe in magic. She voices concern that this "fantasy world" may become a problem. What response by the nurse is indicated? Select all that apply.

"Your daughter is engaging in what we call magical thinking." "This type of thought process allows your daughter to begin to observe the differences in the world." Magical thinking is a normal part of preschool development. In magical thinking, the preschooler believes that his or her thoughts are all-powerful. The fantasy experienced through magical thinking allows the preschooler to make room in his or her world for the actual or the real. Through make-believe and magical thinking, preschool-age children satisfy their curiosity about differences in the world around them. There is nothing problematic about this type of imagination. page 128

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?

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. p 98

The nurse is assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as:

Autonomy versus shame and doubt The Erickson stage of development for the toddler is autonomy versus shame and doubt. During this period of time the child works to establish independence. Trust versus mistrust is the stage of infancy. Initiative versus guilt is the stage for the preschooler. Industry versus inferiority is the stage for school-aged children. Page 108

The nurse is assessing a 2-year-old boy during a well child visit. The nurse correctly identifies the child's current stage of Erickson's growth and development as:

Autonomy versus shame and doubt Page 108

The mother of a 2-year-old tells you she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable?

Deficient parental knowledge related to inappropriate method for toilet training It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the training is no longer effective. Page 117

Nursing students reviewing information about discipline demonstrate a need for additional information when they identify what information as correct?

Discipline and punishment are interchangeable. Discipline and punishment are not interchangeable. Discipline refers to setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from a child's disregard of rules that were learned. p116

A toddler's mother reports that her child will only eat peanut butter and jelly sandwiches for several days in a row. The child will then refuse to eat them for several weeks. Which term would the nurse use to document this behavior?

Food jag During a food jag, the toddler may prefer only one particular food for several days, then not want it for weeks. Physiologic anorexia describes the fact that toddlers do not require as much food intake for their size as they did in infancy. Echolalia is repetition of words and phrases. Egocentrism describes the focus on self that is present in toddlers. Page 112

The nurse finds the diet of a 30-month-old girl to be low in calcium. What suggestion can significantly increase this toddler's calcium intake?

Give her slices of cheddar cheese as a snack. Two and one-half ounces of cheddar cheese provides the toddler's daily requirement of 500 mg of calcium. Chocolate milk provides calcium but the sugar it contains should not be a regular part of a toddler diet. Applesauce provides fiber, not calcium. Spinach and dark greens do contain calcium, but that calcium has limited bioavailability. page 111

The nurse is teaching a mother of a 1-year old girl about weaning her from the bottle and breast. Which recommendation should be part of the nurse's plan?

Give the child an iron-fortified cereal. The nurse would be sure to tell the mother to feed her child iron-fortified cereal and other iron-rich foods when she weans her child off the breast or formula. Weaning from the breast is dependent upon the mother's need and desires with no set time. Weaning from the bottle is recommended at 1 year of age in order to prevent dental caries. Use of a no-spill sippy cup is not recommended because it too is associated with dental caries. page 111

The nurse is teaching the mother of a 2-year-old boy about age-appropriate toys. Which would be of most interest plus stimulating to the growth and development of this child?

Giving the child bowls, pot, pans, and large spoons The kitchen items are usually of most interest since they give opportunity to copy observed parental actions. Also, these items can be used not only to role model but also to stack, nest, make noise, and rearrange in many configurations. They are also inexpensive. However, all the other toys are appropriate and safe for toddlers. page 107

The nurse is observing a 3-year-old boy in a day care center. Which behavior might suggest an emotional problem?

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. Page 104

According to Eric Erikson, the developmental task of the toddler is developing autonomy. What describes Erikson's psychosocial development task for the toddler?

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. Page 99

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?

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. page 105

The caregivers of a 2 ½-year-old tell the nurse that they are working hard to teach her to share and communicate with other children. The nurse recognizes and acknowledges their devotion, but explains to them that a child this age is probably not at a developmental level to play and share with other children. Which activity would the nurse recommend as the most appropriate activity for a 2 ½-year-old?

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 its early stage. Page 107

A mother is concerned because her 2-year-old daughter is not speaking much. What should the nurse suggest to the mother? Select all that apply.

Read books aloud to her. Name aloud the objects that she is playing with. Always answer her questions. Reading aloud is an effective way to strengthen vocabulary. Also, urge parents to encourage language development by naming objects as they play with their child or when they give their toddler something. This helps children grasp the fact words are not meaningless sounds; they apply to people and objects and have uses. Always answering a child's questions is another good way to do this. Watching television promotes little learning as the activity is passive and it is difficult to discern how language caused the action. The American Academy of Pediatrics recommends television viewing should be severely limited until at least 2 years of age. Because children learn language from imitating what they hear, if they are spoken to in baby talk, their enunciation of words can be poor; if they hear examples of bad grammar, they will not use good grammar. Remind parents pronouns are difficult for children to use correctly; many children are 3½ or 4 years of age before they can separate the different uses of "I," "me," "him," and "her." Page 107

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?

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. page 118

A child is refusing to use the potty and is having accidents, even though he has achieved toilet training. This is an example of which type of behavior?

Regression

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.

Round foods such as hot dogs, whole grapes, and cherry tomatoes Hard foods such as nuts, raw carrots, and popcorn Sticky foods like peanut butter alone, gummy candies, and marshmallows To offer soft round foods safely, cut hot dogs in uneven pieces and quarter grapes and cherry tomatoes. 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. Page 112

The father of a toddler reports his son says "no" every time he attempt to correct him. What is the best advice can the nurse offer to the parent?

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. page 98

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 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. Page 101

The nurse is assessing the development of a 15-month-old girl during a well-child visit. Which skill would the nurse expect to see?

Stands alone At 15 months, toddlers have mastered standing and walking alone. The child has yet to develop the ability to feed herself with a spoon, point to her nose and mouth, or run to her mother. pg 101

The nurse is caring for a 17-month-old child admitted to the acute care facility. The child is fretful and becomes calmer when given a tattered blanket from home. What inference can be made about the child's behavior in response to receiving the blanket?

The ability of the child to soothe herself is a positive sign of development. The ability to achieve emotional comfort by self-soothing behaviors demonstrates a positive adaptation in the stages of growth and development. These actions by the child are not consistent with any type of neglect or problem. Page 103

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 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. Page 104

The nurse is examining a 2-year-old girl for speech and language development. Which finding would suggest a delay in speech development?

The child does not use the names of familiar objects. By 24 months most children will name objects familiar to them in their daily lives. Not doing so is strong evidence that a speech delay may exist. Repeating words heard or phrases out of context (echolalia) is normal and a way to practice words and incorporate them in the vocabulary. At 2 years, most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age. page 101

A toddler's father is concerned because his son refuses to share. What is your best response concerning this?

This is normal toddler behavior; sharing is learned later. Sharing is not usually learned until the preschool period; toddlers play parallel to each other. Page 106

A father brings his 2-year-old son in for a well visit. The nurse assesses his growth since the last appointment. Which finding should concern the nurse?

Total weight gain of 15 lb in the past year A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the toddler period, much less than the rate of growth during the infant year. Because the weight gain of the boy in this scenario is so much greater than normal, the nurse should be concerned that the boy is overweight or obese. All of the other findings listed are normal for a 2-year-old p.97

The best way for a parent to handle a temper tantrum by a toddler is to calmly express disapproval and then ignore it.

True Probably the best approach is for parents to tell a child simply they disapprove of the tantrum and then ignore it. They might say, "I'll be in the bedroom. When you're done kicking, you come into the bedroom, too." Children who are left alone in a kitchen this way will usually not continue a tantrum but will stop after 1 or 2 minutes and rejoin their parents. Parents should then accept the child warmly and proceed as if the tantrum had not occurred. This same approach works well for nurses caring for hospitalized toddlers. Page 118

When leaving a child who has separation anxiety, parents should say goodbye firmly, explain that they will return, and then leave promptly.

True Prolonged goodbyes only lead to more crying. Sneaking out prevents crying and may ease the parents' guilt, but it can strengthen fear of abandonment so should be discouraged. Page 104

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?

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-afteroon snack could present significant risk for injury if not supervised. Page 110

A nurse is presenting a class on toilet training to a group of parents with toddlers. Which information would the nurse include in the class? Select all that apply.

Using training pants that slide down easily and quickly Praising the child when he or she urinates or defecates Putting the child on the potty chair at regular intervals during the day For effective toilet training, parents should allow 1 to 2 weeks to psychologically prepare the child for training, using training pants that slide down easily and quickly, praising the child when he or she urinates or defecates, limiting the time spent on the potty chair to no longer than 10 minutes (or less if the child is resistant), and putting the child on the potty chair at regular intervals during the day. Page 118

When childproofing the home for a toddler, the most important thing her parents should consider is to:

put medicine in a locked cupboard. Poisoning is at peak incidence during the toddler period. Special precautions need to be taken against poisoning at this time. page 109

The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents the child is displaying:

object permanence. Object permanence means that the child knows that objects that are out of sight still exist. Page 99