Exam 2: Toddler 12-36 mo (1-3 yr)

Parallel play

alongside but not with other children; big on imitation play; will include talking while playing. Only interaction with other kids is when they are taking stuff away from them

Sleep

sleep decreases slightly during second year averaging about 11-12 hrs a day. May nap once a day but relinquish this by end of 2nd or 3rd year. -fear is huge during this time might be due to stressors from toilet training, moves, sibling birth, etc.. -sleep waking -refusal to go to bed

Developmental milestones: 24 months physical

-head circumference 49-50 cm (19.5-20") -chest circumference exceed head -weight gain of 1.8-2.7 kg per year (4-6lbs) -height 10-12.5 cm(4-5") age height approx double height at 2 yrs old -16 teeth -demonstrate day time bladder control

Developmental milestones: 18 months physical

-picky eater result from decrease growth and need to assert independence -anterior fontanel closes -physiologically can control sphincter

Developmental milestones: 24 months language

-300 words -use 2 or 3 phrases -use I, me, you -understand directional command -refer to self by first name -verbal needs (toilet, food, drink) -nonstop talking -can remember arbitrary sequences of gestures

Five markers of child's readiness to toilet train

-Physical readiness: voluntary control of anal and urethral sphincter (22-30 months) -Mental readiness: recognize urges to defecate or urinate, know when their diaper is wet, can follow directions -Psychological readiness: express their willingness to please parents, sit on the toilet for 5-8 mins without fussing, curiosity about adult toileting habits, hate soiled diaper and want to be changed immediately -Parental readiness: recognize the child readiness, invest in time, consistency, positive rewards, avoid punishment, the absence of family stress or changes.

Development milestones: 15 months gross motor

-Walk without help (usually since 13 months or so) -Creeps up stairs -Kneel without support -Can't stop suddenly or navigate corner without losing balance -cannot throw a ball without falling -Run clumsily; fall often

Developmental milestones: 15 months sensory motor

-able to identify geometric form; so they can put the right shape in the right hole -binocular vision is developed -can display interest in pictures for a long time

Developmental milestones: 18 months gross

-assume standing position -walk up stairs with one hand held -pushes and pull toy -jump in place with 2 feet -seat self on chair -throw ball without falling

Developmental milestones: 24 months fine

-build 6-7 cubes tower -can align cubes like a train -turn one page at time -can do straight line or circle -turn door knobs and unscrew lids

Development milestones: 15 month fine motor

-constantly casting objects to floor (aka being a dick) -Build tower of two cubes -hold two cubes in one hand -able to put pellet into narrow necked bottle -scribble spontaneously -can use cup but often turn spoon before putting it in their mouth

unintentional injuries

-don't run with scissors -pet biting -never go with strangers -teach them no in uncomfortable situation -teach them their names and address, phone number and where to go to if lost

Developmental milestones: 18 months socialization

-expresses emotions (temper tantrums more evidence) -great mitator -take off accessories -awareness of ownership. MY TOYS!!! -dependence on transitional object such as security blanket

Developmental milestones: 24 months gross

-goes up and down stairs with two feet on each step -run fairly well with wide stance (penguin) -pick up object without failing -can kick ball forward without overbalancing

Management of temper tantrums/discipline

-punishment makes it worst -address the behavior quickly, be close by but ignore them -Give lots of love when they stop -will decrease tantrum once they are in preschool -avoid situation that can cause temper tantrums: hunger, tiredness -avoid giving them a chance to say no; ask them if they will like a green spoon or blue but don't ask them if they want to eat

Piaget theory-preoperational phase of development

-rational judgement-they are starting to understand the casual relations and disovery of objects as objects -preoperational thoughts: egocentrism- only see from their own point of view Narcissm- all about me. It is one of the hardest group to work with at the hospital

Developmental milestones: 24 months socialization

-stage of parallel play -sustained attention span -decrease temper tantrum -pull people to show them things -increase independence from parents -dresses self in simple clothing -develop visual recognition and verbal self-reference such as ME BIG -develop awareness that feelings and desires of others maybe different -explore consequences

MVA

-stay rear-faced (center back seat=safest) up to 35 lbs -don't drive until restrained -they can help buckle and will help unbuckle tat the end -supervise when they are playing outside don't let them near roads -start teaching road safety -lock door with high chains

Burns

-store matches lighters in safe place -teach them what hot is -don't let them in the kitchen while cooking -avoid table cloths since they can pull it down -make sure water heater is not set super high -durn pot handle towards back of stove -put things in the back counter

Developmental milestones: 15 months socialization

-tolerate some separation from parents -less likely to fear stranger -imitate parents (like if they are cleaning) -discard bottle -kisses and hugs parents or anything

Developmental milestones: 15 months language

-use expressive jargon -say 4-6 words including names -ask by pointing -understand simple command -headshake for no -use no even if they mean yes

Toddler age is range from ______ to ________

12-36 mo or 1-3 years

Can start skim milk at what age?

2

Which characterizes the development of a 2-year-old child? A. Engages in parallel play B. Fully dresses self with supervision C. Has a vocabulary of at least 500 words D. Has attained one third of his or her adult height

A. Engages in parallel play Two-year-olds play alongside each other, otherwise known as parallel play. Toddlers need help with dressing because this is a task they are just beginning to learn; learning this extends into the preschool years. A toddler commonly has a vocabulary of 300 words. A toddler has attained one half of his or her adult height.

What should the nurse recommend to the parents to help a toddler cope with the birth of a new sibling? A. Give the toddler a doll with which he or she can imitate the parents. B. Discourage the toddler from helping with care of the new sibling until the baby is much older. C. Prepare the toddler about 1 to 2 weeks before the birth of a new sibling. D. Explain to the toddler that a new playmate will soon come home.

A. Give the toddler a doll with which he or she can imitate the parents. The toddler can participate in the activity of caring for a new family member, which will make him or her feel included and important. The child should be encouraged to participate within his or her capabilities. The toddler should never be discouraged, because this will make him or her feel isolated and left out. Preparation should begin when obvious changes begin to happen to the mother's body and at home. This will establish unrealistic expectations for the toddler. Toddlers take language literally, and therefore will be disappointed when the new baby cannot play when he or she arrives home.

The primary reason for universal screening of young children for lead poisoning is that: A. children with lead poisoning rarely have symptoms. B. water and food in the United States are usually contaminated with lead. C. most children are exposed to lead through herbal products. D. most children in the United States are exposed to toxic amounts of lead.

A. children with lead poisoning rarely have symptoms. In the early stages of lead poisoning, children are asymptomatic. Water and food in the United States are not highly contaminated. Risks are homes painted before 1978, when painting products still had high lead levels. Universal screening will identify children who may receive lead via herbal supplements, if applicable. Universal screening will identify children who may receive lead via environmental exposure, if applicable.

For a toddler with sleep problems, the nurse should suggest that the parents A. use a transitional object at bedtime. B. vary the bedtime ritual. C. restrict stimulating activities throughout the day. D. explain away their fears.

A. use a transitional object at bedtime. Transitional objects may help ease the toddler's anxiety and facilitate sleep. A consistent set of bedtime rituals will facilitate a toddler's sleep. Toddlers should have stimulating physical activity during the daytime in order for them to sleep at night. Toddlers do not understand verbal explanations, so parents cannot explain away their fears.

Drowning

ALWAYS supervise near water they are still very top heavy -close toilet lids and keep bathroom closed -have fence around swimming pool

Falls

After they are 35 inches tall do not put them in cribs put them on a bed -window guards -gates at top and bottom of stairs -remove scattered rugs

Which statement about bottle-mouth caries should be taught to the parents? A. This syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. B. Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. C. This syndrome can be completely prevented by breastfeeding. D. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

B. Giving a bottle of milk or juice at nap time or bedtime predisposes the child to this syndrome. Sweet liquids, or the sugars in milk and even breast milk, pooling in a toddler's mouth during sleep increase the incidence of dental caries. Changes in the positioning of the teeth may result from pacifier use or thumb-sucking and are not related to bottle-mouth caries. Frequent breastfeeding before sleep can cause bottle-mouth caries, since breast milk does contain lactose, which is present in higher concentrations than in cow's milk-based formula. Juice, which contains varying concentrations of sugar, in bottles before sleep contributes to bottle-mouth caries.

A hospitalized toddler clings to a worn, tattered blanket. The toddler screams when anyone tries to take it away. Which is the best explanation for the toddler's attachment to the blanket? A. The blanket encourages immature behavior. B. The blanket is an important transitional object. C. The developmental task of individuation-separation has not been mastered. D. The child and mother have inadequate bonding

B. The blanket is an important transitional object. The blanket is an important transitional object that provides security when the child is separated from parents. Transitional objects are important to help toddlers separate, and attachment to them does not indicate immature behavior. Transitional objects are helpful when a toddler experiences increased stress such as hospitalization. The attachment to the blanket does not reflect inadequate bonding with the mother.

Which statement is most characteristic of the motor skills of a 24-month-old child? A. The toddler walks alone but falls easily. B. The toddler's activities begin to produce purposeful results. C. The toddler is able to grasp small objects but cannot release them at will. D. The toddler's motor skills are fully developed but occur in isolation from the environment.

B. The toddler's activities begin to produce purposeful results Gross and fine motor mastery occurs with other activities that have a purpose, such as walking to a particular location or putting down one toy and picking up a new toy. By 2 years of age, children are able to walk up and down stairs without falling. Grasping small objects without being able to release them is a task of infancy. Interaction with the environment is essential for mastery of both fine and gross motor skills at this age and beyond.

One of the major tasks of toddlerhood is toilet training. In teaching the parents about a child's readiness for toilet training, it is important for the nurse to emphasize that: A. nighttime bladder control develops first, so parents should focus on that in the initial teaching with their toddler. B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first. C. the toddler must have the gross motor skill to climb up to the adult toilet before training is begun. D. the universal age for toilet training to begin is 2 years, and the universal age for completion is 4 years.

B. bowel control is accomplished before bladder control, so the parent should focus on bowel training first.'' Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. The sensation to defecate is stronger than that of urination. The completion of bowel training will give the toddler a sense of accomplishment that can be carried onto bladder training. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. Nighttime bladder control normally takes several months to years after daytime training; therefore, this should not be the initial focus of toilet training with a toddler. There is no universal right age to begin toilet training or an absolute deadline to complete training. One of the nurse's most important responsibilities is to help parents identify the readiness signs in their child.

The nurse should teach parents of toddlers how to prevent poisoning by instructing them to: A. consistently use safety caps. B. store poisonous substances in a locked cabinet. C. keep ipecac in the home. D. store poisonous substances out of reach.

B. store poisonous substances in a locked cabinet. This is an appropriate action to prevent the curious toddler from getting into poisonous substances and products. Not all poisonous substances have safety caps, and safety caps are not always foolproof. Ipecac does not prevent poisoning and is not recommended as a treatment for poisoning. Toddlers can climb and are curious; therefore, storing substances out of reach only does not eliminate the potential for poisoning.

A 2-year-old child has recently started having temper tantrums where breath holding occurs and occasionally fainting. The most appropriate action by the nurse is to: A. Refer the child for a respiratory evaluation B. Refer the child for a psychological evaluation C. Explain to the parent that this is not harmful D. Explain to the parent that the child is spoiled

C. Explain to the parent that this is not harmful The rising carbon dioxide levels restart the breathing process when a child holds his or her breath; therefore, the process is self-limiting and not harmful. A respiratory evaluation is not indicated for this toddler. Temper tantrums are part of this developmental stage as the toddler asserts his or her independence. A psychological evaluation is not warranted. Temper tantrums are part of this developmental stage as the toddler asserts independence. There are no data to indicate that the child is spoiled.

The nurse notices that a toddler is more cooperative taking medicine from a small cup than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning

C. Inability to conserve The smaller cup makes it look like less medicine to the child at this stage of cognitive development. The inability to see situations from other perspectives, besides their own, does not facilitate medication administration. The inability to reverse or undo actions physically initiated does not facilitate medication administration. Focusing on particulars does not explain the cooperation with the smaller medication cup.

The parents of a toddler ask the nurse for suggestions about discipline. When discussing the use of timeouts, which of the following suggestions should the nurse include? A. Send the child to his or her room. B. If the child cries, refuses, or is more disruptive, try another approach. C. Select an area that is safe and nonstimulating, such as a hallway. D. The general rule for length of time is 1 hour per year of age.

C. Select an area that is safe and nonstimulating, such as a hallway. The area must be nonstimulating and safe. The child becomes bored in this environment and then changes his or her behavior to rejoin activities. The child's room may have toys and other forms of amusement that may negate the effect of being separated from family activities. When the child engages in this type of behavior, the timeout begins when the child quiets. The general rule is 1 minute per year. An hour per year is excessive.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which instruction should be included? A. Flossing is not recommended at this age. B. Toddlers are old enough to brush their teeth effectively. C. The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. D. The toddler's toothbrush should be small and have hard, rounded, nylon bristles.

C. The parent should brush the toddler's teeth with plain water if he or she does not like toothpaste. Some toddlers do not like the flavor of toothpaste, so water can be used for teeth brushing at this age. Flossing should be done after brushing to establish it as part of dental care for the toddler. Two-year-olds cannot effectively brush their own teeth; parental assistance is necessary. Soft multitufted bristled toothbrushes are recommended to avoid damaging a toddler's teeth or gums.

Lead screening

Causes neurological damage by the time you see the signs damaged is already done Age 6 months-6 years -any toys before 1950s -check again at 9-12 months and then 18-24 month

Characteristics of physical development of a 30-month-old child are (Select all that apply): A. anterior fontanel is open. B. birth weight has doubled. C. genital fondling is noted. D. sphincter control is achieved. E. primary dentition is complete.

D, E D. sphincter control is achieved. E. primary dentition is complete. Sphincter control in preparation for bowel and bladder control is usually achieved by 30 months of age. Primary dentition is usually completed by 30 months of age. Anterior fontanel closes between 12-18 months of age. Birth weight should double at 5-6 months of age and quadruple by 2½ years of age. Genital fondling is not a characteristic of physical development of this age group. This is part of the development of gender identity.

A parent brings a 2-year-old to the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? A. "We locked all the medicines in the bathroom cabinet." B. "We turned the thermostat down on our hot water heater." C. "We placed gates at the top and bottom of the basement steps." D. "We stopped using the car seat and put our child in the seat belt now that he is older."

D. "We stopped using the car seat and put our child in the seat belt now that he is older." A car seat should be used until the child weighs 18 kilograms (40 pounds) and is approximately 4 years old. Locking up medicines and any other harmful household products is an appropriate action; therefore, there is no need for further instruction. Turning down the thermostat on the hot water heater is an appropriate action; therefore, there is no need for further instruction. Placing gates at the top and bottom of the basement stairs is an appropriate action; therefore, there is no need for further instruction.

The nurse is discussing toddler development with a parent. Which intervention will foster the achievement of autonomy? A. Help the toddler complete tasks. B. Provide opportunities for the toddler to play with other children. C. Help the toddler learn the difference between right and wrong. D. Encourage the toddler to do things for himself or herself when he or she is capable of doing them.

D. Encourage the toddler to do things for himself or herself when he or she is capable of doing them. Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks. Children at this age engage in parallel play. This will not foster autonomy. This concept is too advanced for toddlers and will not contribute to autonomy.

Which statement characterizes toddlers' eating behavior? A. They have increased appetites. B. They have few food preferences. C. Their table manners are predictable. D. They become fussy eaters.

D. They become fussy eaters. Toddlers have physiologic anorexia, which contributes to picky, fussy eating. This usually begins at about 18 months of age. They have a decrease in appetite known as physiologic anorexia at this age. They have strong taste preferences at this age. Use of finger foods contributes to the unpredictable table manners of toddlers.

When explaining the proper restraint of toddlers in motor vehicles to a group of parents, the nurse should include: A. wearing safety belts snugly over the toddler's abdomen. B. placing the car seat in the front passenger seat if there is an airbag. C. using lap and shoulder belts when child is over 3 years of age. D. placing the car seat in the back seat of the car facing forward.

D. placing the car seat in the back seat of the car facing forward. Car seats are required for toddlers to prevent injury in case of a motor vehicle accident. The car seat should be placed in the back seat, forward facing. Safety belts can cause injuries if they are placed over a toddler's abdomen. Car seats should be in rear of the car because airbags can injure the toddler. Three-year-olds should be restrained in car seats.

there is an _________ in accidents due to locomotion

Increase in accidents due to their ability to get to places and get into things. They also lack awareness of danger -Injuries (MVA and poisoning) Well visits start to decrease in frequency to once a year

Milk intake

Milk intake, the chief source of calcium and phosphorus, should average two or three servings (24-30 oz) a day. More than a quart of milk consumption daily considerably limits the intake of solid foods, resulting in a deficiency of dietary iron and other nutrients.

You should never

PUNISH THEM OR SHAME THEM FOR TEMPER TANTRUM

Erikson theory: Autonomy vs. Doubt and shame

Start learning to do things for themselves. Obtain autonomy by mastering skills. Negativism- may respond with no or me do, emotions can be very strong and changes quickly Ritualism- need to maintain the same events and reliability to provide comfort

Poisoning

They pout everything in their mouth toddler and preschoolers are the HIGHEST risk -don't tell kids medication is candy -keep all non food in a secure original container out of reach -have poison control number at all time -watch toys that have lead paint -don't let them eat non-edible plants -don't let them play with trash containers

Dental

They will require supervision. Allow them to do it themselves but go back in and floss and do it for them. Do regular dental exams. -complete set of teeth -fluoride supplementation if water doesn't have it -tell them to say cheese -teach them to sing a song -NO MORE BED TIME SIPPY -treat caries early or big teeth will be thrown off

______________________ is a major task for toddlers

Toilet training -girls usually sooner -daytime before night -achieve bowel before bladder -must be able to recognize the urge and let go and hold on and has to be able to communicate this to parents

Do not Overuse or use

Vitamins or complementary alternative medcaitons herbs that is dangerous -ephedra -comprey -pennyroyal

physiologic anorexia

approximately 18 months of age most toddler decrease their nutritional need and have a decreased appetite. At this point it's quality over quantity. Don't force them. They might go through a phase where they will only eat one food Don't just give milk. It fills them up fast and can cause anemia. Ritualism-where they like same cup, food, spoon

Aspiration

can chew but still choke on meat and hard candy Avoid nuts, fish with bones, round chunks of meat, hot dogs that are long, popcorn, grapes, marshmellowslarge beans, sturdy toys, secure furniture, take doors of the discarded appliance so they can't get in them -install smoke detectors

Their concept of time is very

immature. Can only understand right now and what they are experiencing.

Most body system are relatively....

mature, except brain cells are still developing

Bathing

never leave child unattended -they usually enjoy it -avoid bubble bath for female -be consistent

Separation anxiety

persist through toddlerhood until early preschool -don't do prolonged goodbyes -be a matter of fact " mommy loves you, bye"

Effective discipline technique for toddlers include

reward, ignore or extinction, and time out

Developmental milestones: 18 months language

sensory is the same as 15 months -say 10 words including names -point to common object such as shoes or ball -form word combinations -form gestures (word while pointing) -gesture gesture combination

Nutrition that is established in toddlerhood last until

subsequent years so start them now on good nutritions. COnditions such as obesity and cardiovascular disease can be prevented by teaching healthy eating habits.