PEDS exam 1 Chapt 26

Masturbation is a normal event

to be done in private. •This is a normal and expected activity best treated matter-of-factly. •Calling attention to the behavior may increase the frequency. •Both girls and boys masturbate •toilet teaching calls attention to the genital area. •Excessive or public masturbation points to stress.

Preschool Recommendation Guidebook

• All staff must receive early childhood development and cardiopulmonary resuscitation. (CPR training) •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.

Teaching Behavior Approach: Toddlers

• Have you tried using "time-outs" for ("no's" )negative behavior?" • "Giving your child choices instead of posing "yes" or "no" questions may decrease the "no" response."(negative behavior) "This is normal for this age. If measures to stop this behavior don't work, you should make the decision for your child and move on with whatever activity is occurring."

Toddler age range

•1 to 3 years of age. •grows about 3 in (7.5 cm) and reaches one-half of the adult height by 2 years of age. •gains about 3 to 5 lb (1.4 to 2.3 kg) per year.

Toddler motor skills

At 12 to 15 months feeding self finger foods and using index finger to point to objects.

"fantasy world"

Magical thinking is a normal part of preschool development. •magical thinking, the preschooler believes that his or her thoughts are all-powerful. •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. •nothing problematic about this type of imagination.

Toddler Play Types

Parallel play : occurs when their alongside other children but not with them. Cooperative play : children play in an organized group with each other, as in team sports. Associative play : occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader—and each child does what she or he wishes. Solitary independent play : means playing apart from others without making an effort to be part of the group or group activity.

Toddler play is characterized by _______

Playing with the plastic vacuum cleaner and pushing it around the room.

Food jags in Toddlers:

is when a child will only eat one food item, or a very small group of food items, meal after meal. Some other common childhood eating behaviors that can concern parents include fear of new foods and refusal to eat what is served.

toddler developing autonomy or independence.

•During the toddler years separation from his or her parents, recognizes one's own individuality and exerts autonomy. Ex.(Being toilet trained) •toddler separates from the parent and recognizes his or her own individuality, and exerts autonomy, very common for the child to display negativism. Ex. saying no all the time. (negativism) •If measures fail the parent needs to calmly make choices for the child. •Offering choices, such as "Do you want the red or blue shirt?" lends to autonomy.

Neurological development

•Ex. (symptom that the toddler does not feel the urge to urinate until the bladder is too full )pre-myelination period •Myelination of the spinal cord is achieved around 2 years of age. •Post myelination toddler can exercise voluntary control over the sphincters. •2-year-old toddler has limited coping skills.

Temperament Theory: Toddler

•Having temper tantrums is a normal response, as it is a way to express frustration of being tired or not being able to accomplish a task. •Toddlers do not behave badly on purpose. •need time and maturity to learn the rules and regulations. •Appear to ignore the toddler : regarding how to handle temper tantrums •During a temper tantrum, 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. •parent needs to use self-control when dealing with a temper tantrum. This is a way to model acceptable behavior for the toddler.

security and emotional needs: Toddlers

•Having the parent pick up the child after the child falls . •Having the same routine for bedtime each night provides security. •toddler begins to play independently, can forget regimented schedule. •Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence.

New infant arrives: toddler focus

•Plan time for the primary caregiver to focus on the toddler while the secondary caregiver focuses on the infant. •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.

social-emotional behaviors: toddler

•Separation anxiety occurs initially in infancy and then reoccurs again during the toddler stage. normal happening for a toddler of 20mos." •will become less upset. •Establishing a routine for saying goodbye is helpful for the toddler •begins to develop an understanding of object constancy, separation anxiety will ease. "while missing the parent, will begin to recognize that the parent will return." •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. •guiding concept~ meaning biting or hitting child only solidifies behavior. "Do as I do concept"! •very common for the child to display negativism. Ex. saying no all the time. •Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem.

Piajet's theory of cognitive development

•Toddler - Object permanence means that the child knows that objects that are out of sight still exist.

Calcium deficiency

•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.

effective toilet training:

•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

Temper tantrums in toddlers

•are a result of natural frustrations they may experience . •continued until feelings are verbalized. •frustration , anger precipitating event of cyanotic breath-holding spell.

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.

Erickson stage of development:

•autonomy versus shame and doubt- Toddler During this period of time the child works to establish independence. •Trust versus mistrust - birth thru infancy. Initiative versus guilt - preschooler. Industry versus inferiority - school-aged children.

Infants and toddlers

•begin walking as early as 8 to 9 months and as late as 18 months of age.

toddler : achieve developmental task?

•best way to aid them : Let them make simple decisions

Temper tantrums in toddlers

•can be a frequent occurrence •Some toddlers are more prone to displaying these behaviors than others. •experiences frequent tantrum outbursts, maintaining a consistent schedule for activities is helpful. •Tantrum-prone toddlers benefit from consistent nap, meal and play periods. •Ignoring the behavior signals to the toddler that the behavior is futile. •Avoiding interaction with the toddler having the tantrum is beneficial. •Discipline such as spanking, swatting or yelling at the toddler does not reduce the episode and may escalate it.

Physical Development: Toddler period

•gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year@ 2y/o. •Prominent abdomen @ 2y/o. •Forward curve of the spine at the sacral area @ 2y/o. •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. •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.

Nutrition Teaching : toddler's

•growth slows abruptly after first year of life,appetite is usually less than an infant's. •Children who ate hungrily 2 months earlier now sit and play with their food. • while the child is still an infant this decline in food intake will occur . •important to educate parents so they will not be concerned when it happens. •actual amount 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. •recommend breastfeeding wean 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. •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 particular food preferences (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. •healthy eating habits, variety plus preferred foods will be most helpful.

Time-outs : Toddlers

•helpful ways of disciplining toddler separates from the parent and recognizes his or her own individuality, and exerts autonomy, very common for the child to display negativism. Ex. saying no all the time. (negativism) •offer choices ,If measures fail the parent needs to calmly make choices for the child. •Spanking is not recommended for any age.

Erikson's psychosocial developmental task

•infants (birth-1)develop a sense of trust. •toddlers (1-3)- achieve autonomy (independence) while overcoming doubt and shame.

•toddlers appropriate toys with most interest plus stimulating to the growth and development?

•kitchen items are usually of most interest since they give opportunity to copy observed parental actions. •items can be used not only to role model but also to stack, nest, make noise, and rearrange in many configurations. • also inexpensive. *****Giving the child bowls, pot, pans, and large spoons ******a toy vacuum cleaner •variety of large stuffed toys •Providing a brightly colored plastic bucket and shovel.

digestive systems of toddlers

•not fully mature and they may sometimes pass pieces of undigested food.

Prevent Choking : toddlers

•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. (Sticky foods like peanut butter alone, gummy candies, and marshmallows) •cooked vegetables listed are safe as are the soft fruits. (Vegetables such as corn, green beans, and peas)

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) •putting the child on the potty chair at regular intervals during the day.

child has an occasional nightmare

•parents should reassure the child that it was just a dream and was not real. •Giving lots of hugs and words of reassurance can be supportive. •The child may want the parent to search the room to reassure that there are no monsters about. •Advise parents to wait until the next morning to talk about the details of the dream, at which time the child should be calmer. •The parent should try to determine if there was a specific event or stressor that may have triggered the nightmare. •In addition, to decrease nightmares, parents should avoid having the child watch television in the hour before bedtime, avoid telling scary bedtime stories, let the child sleep with a nightlight, and examine how to decrease perceived stress in the child's life.

parental anticipatory guidance:

•promotes healthy emotional development • best way to accomplish : by regular routine and rituals will provide stability and security.

toddler years : Assistive measures that aid in gaining autonomy or self-control.

•refinement of motor skills •continuous cognitive growth •acquistion of language skills. •achieves autonomy and self-control. •younger toddler may not achieve dressing alone because the toddler may not have mastered such techniques as buttons, zippers, or tying shoes. •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 •Rewarding the child for accomplishing the task after making the decision is a good way to reinforce self-esteem.

Normal assessment findings of toddlers include:

•respirations slow slightly but continue to be mainly abdominal; respiration rate of 20 bpm, abdominal breathing noted •heart rate slows from 110 to 90 beats/min; •blood pressure increases to about 99/64 mm Hg; •not potty trained until complete myelination of the spinal cord has occurred. •abnormal finding of elevated blood pressure. However, this can occur if the toddler is crying or upset about the assessment.

assessing toddler's speech/ language development

•toddler can understand language •able to follow commands far sooner than can actually use the words. •A 15-month-old can say 4 to 6 words. •By 2 y/o typically speaks in two-word (noun and verb) sentences, vocabulary of about 40 to 50 words, start descriptive words (hungry, hot). •2-y/o say a two-word sentence consists w/noun & verb. most children understand much more than they can clearly repeat. Using two-word sentences is a developmental expectation at this age. • 24 months most will name objects familiar in 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. •A 30-month-old knows his full name and can name one color. •36 mon before using pronouns or plurals in sentences.

Playtime: toddler / preschool/ school age/adolescence

•toddler involves imitation of the people around them such as adults, siblings, and other children. •toddler :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. •school-age child enjoys group activities and making things, such as drawings, paintings, and craft projects. •adolescent enjoys activities they can participate in with their peers.

Erikson defines

•trust versus mistrust as the infancy period •toddler period :time of autonomy versus shame and doubt. •Initiative versus guilt :preschool period. •industry versus inferiority : school age period.

Bathing & Hygiene Suggestions: Toddlers

•young child's increased activity level necessitates bathing daily or every other day. •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.