PEDS Prep UChapter 4: Growth and Development of the Toddler
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 Explanation: 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.
A nurse observes a child engaged in parallel play in a nursery. Which behavior would the nurse likely observe?
A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks Explanation: 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. The other answers are not examples of parallel play.
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. Explanation: 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 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?
Saying no is your son's way of trying to exert his independence and is expected. Explanation: 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 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?
"A 2-year-old child's behavior can be greatly altered if rituals are not maintained." Explanation: 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
A 3-year-old child is seen at the clinic for a checkup. When collecting information, the child's parent reports concern about the child's stools because sometimes the child passes what appears to be undigested food. What response by the nurse is appropriate?
"At this age, the digestive tract is not completely mature and children may pass undigested food." Explanation: The digestive systems of 3-year-old children 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 parent. When the nurse asks the parent "Why," this is demonstrating poor therapeutic communication skills and will cause the parent to become defensive. The symptoms of pain or straining would be indicative of constipation, not passing undigested food. There is no indication that the diet being ingested is not appropriate
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." Explanation: 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
The nurse is assessing a toddler's fine motor skills. Which finding by the nurse could be a safety concern?
Ability to turn door knobs Explanation: 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
What advice should the nurse provide the parent of a toddler, regarding how to handle temper tantrums?
Appear to ignore the toddler Explanation: 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 assessing 2-year-old twins. The parent states, "My twins will not play together, only alongside each other." Which action will the nurse take first?
Explain that this is normal behavior for toddlers. Explanation: Playing beside one another is parallel play and typical of toddlerhood. The nurse would explain this is normal behavior for the twins and then document the finding. The nurse would not need to observe the twins at play or ask additional questions as this is an expected finding.
During a wellness care visit, the parents of a 2-year-old toddler report that they are struggling to deal with their toddler's daily and increasing number of tantrums. What information should be provided to the parents? Select all that apply. Tantrums at this age can signal the development of an aggression disorder in a toddler. Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum. Tapping the toddler on the hands and voicing displeasure with the toddler's actions can successfully interrupt the behavior.
Tantrums are a common occurrence for a toddler of this age. Maintaining a consistent daily routine can help to reduce tantrums. Ignoring the behavior is often helpful in reducing the duration of the tantrum.
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. Explanation: 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.
In discussing their 2-year-old's behavior with the nurse, which of the parents' statements suggests the child may be ready for toilet teaching?
The child hides behind her bedroom door when defecating. Explanation: Hiding while defecating indicates awareness of this need. Repeating words promotes language development but doesn't indicate readiness for toilet teaching. Walking with a wide, swaying gait is early walking behavior. Steady walking and running signals toileting readiness. Removal of shoes and socks is easily done. Greater fine motor clothing removal skill is needed for toileting.
The nurse is assessing a healthy 2-year-old client. Which assessment finding most concerns the nurse?
The child speaks in one-word sentences. Explanation: A 2-year-old child not using at least two-word sentences is a sign of a potential developmental delay. Normal development for a 2-year-old child is standing on tiptoes and pointing to named body parts. Having difficulty with stairs is considered a potential delay in a 3-year-old, not a 2-year-old child
The home health nurse is visiting a 2-year-old client's home. Which finding will cause the nurse to intervene?
The family's medications are located in a kitchen drawer. Explanation: 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.
The nurse is providing education to a parent about their 20-month-old child's growth. The parent states that their child seems to have such a big head. What information should the nurse include in the response?
The heads of children at this age are large in proportion to the rest of their body. Explanation: Head circumference increases about 1 in (2.5 cm) between 1 and 2 years of age, then increases an average of 0.5 in (1.25 cm) per year until age 5. By 2 years of age, the child's head circumference is approximately 85% of their expected adult head circumference
The nurse is assessing a 2-year-old boy during a well-child visit. The nurse correctly identifies the child's current stage of Erikson's growth and development as:
autonomy versus shame and doubt Explanation: The Erikson 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.
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?
exploring one's body Explanation: 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
A parent tells the nurse that no matter what is asked of the toddler, the toddler says, "No." What suggestion might the nurse make to help the parent handle this situation?
give the toddler secondary, not primary, choices Explanation: Encouraging toddlers to express their opinion aids in developing a sense of autonomy. By allowing secondary choices, it gives the toddler a sense of mastery. Telling the toddler not to say "No" again is unrealistic as this is a favorite word and reaction of the toddler as he or she develops autonomy to find one's "self." Pretending not to hear the toddler only leads to more frustration for the toddler and the parent. It is also unrealistic not to ask the toddler questions. There would not be two-way communication between the parent and the toddler.
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 Explanation: 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.
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." Explanation: 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.
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." Explanation: 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
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. Explanation: 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
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. Explanation: 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 nurse is presenting an in-service training to a group of pediatric nurses on the topic of play. The nurse determines the session is successful when the group correctly chooses which example as best displaying toddlers playing?
Playing independently and are side by side Explanation: Parallel play occurs when the toddler plays alongside other children but not with them. During 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
A mother reports her 2-year-old daughter has gradually eaten more and more poorly since her 1-year-old well-child visit. The nurse assesses the child's growth and development as normal. What concept explains the mother's concern?
physiologic anorexia Explanation: Physiologic anorexia results when the rapid growth of infancy slows in toddlerhood and less food is required for body size. Sugary and fatty snacks as well as role modeling poor eating habits can influence a toddler's food intake negatively. However, this is not what the mother is describing. Iron-deficiency anemia is extremely common among toddlers and could be present in this child, but this is not the reason for her lessened food intake.
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. Explanation: 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 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." Explanation: 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 timeline for acceptance of a new food does not offer a practical reason for making a change in diet.
The parents of a toddler are asking the nurse if their child is lagging behind since the child does not have a very large vocabulary at the present time. Many times their toddler just points to an object and the parents give it to the toddler. Which concepts/statements should the nurse share with this family about language development of a toddler? Select all that apply. A)When the child points to an object, wait and make the child name the object before giving it to him or her. B)Reinforce language by voicing a request, "You want the apple?" C)If the child asks, "Why?" be sure to give him or her a full explanation since the child is showing initiative. D)Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. E)Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you."
A)Reinforce language by voicing a request, "You want the apple?" B)Read aloud to the toddler to help build and strengthen vocabulary by pointing to pictures in the book. C)Since toddlers imitate what they hear, use good grammar and incorporate pronouns like "I" and "you."
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?
Ask the child questions as you read. Explanation: 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.
