NUR101 - Chp. 24 - Growth & Development of the Toddler: 1 to 3 Years

Which is the best way for parents to aid a toddler in achieving the developmental task?

Allow the toddler to make simple decisions. ** Allowing the child to make decisions is a good way to help the toddler achieve autonomy and gain independence.

The nurse is preparing a safety program for the parents of children ranging in age from 1 to 4 years. Which of the following would the nurse include as the leading cause of death in this age group?

Automobile accidents. ** Automobile accidents are a leading cause of death in this age group due to the number of children not restrained in car seats and due to unsafe driving practices around areas in which small children are present.

How do batteries pose a hazard to toddlers?

Button batteries especially, can be a cause of poisoning as well as a choking hazard.

Food Jags

Desire for only one kind of food for a while; common.

Ritualism

Helps develop security in young children; involves following routines that make rituals of even simple tasks.

Echolalia

Repeating words heard or phrases out of context .

A nurse is preparing a presentation for a group of parents of toddlers and preschoolers. When describing the developmental milestones for this age group, the nurse would include which of the following as typical of a 2-year-old child?

The child has 16 temporary teeth.

The nurse is observing a 24-month-old boy in a day care center. Which finding suggests delayed motor development?

The child is unable to push a toy lawnmower. ** Children with normal motor development are able to push toys with wheels at 24 months of age. He won't be ready to undress himself, unscrew a jar lid, or bend over without falling until about 36 months of age.

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

The toddler should speak in two-word sentences ("Me go"). ** Noun + verb.

Parents and their nearly 3-year-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.

Dawdling

Wasting time or being idle, serves the purpose of asserting independence.

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.

Parents are asking a pediatric nurse how to deal with separation anxiety every time they try to have an adult night out. Which advice by the nurse sounds like the most appropriate way to handle this situation?

"Inform the child that you are going out but the regular babysitter will care for them and put them to bed." ** Most toddlers react best to separation if a regular babysitter is employed or if the day care center has consistent caregivers. It helps if toddlers have fair warning they will have a babysitter. No matter how well prepared toddlers are, they may cry when the babysitter actually appears or may greet the babysitter warmly only to cry when the parents reach for their coats. It helps if parents say good-bye firmly, repeat the explanation they will be there when the child wakes in the morning, and then leave.

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

"When my child starts getting frustrated and aggressive, I remind the child throwing a fit will end up in a time-out." ** A method for a young 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—1 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.

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.

The parents of a toddler ask the nurse about disciplining their 2-year-old toddler. What suggestions will the nurse provide? Select all that apply.

- "It is better to praise correct behavior than to punish wrong behavior." - "If you allow an unwanted behavior one time at this age, it is difficult to reverse later." - "Try using time-out, assigning 1 minute per year of your toddler's age."

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

"My toddler uses the potty chair and is dry all day long."

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." ** The best response is to tell a child simply that the parent disapproves of the tantrum and then ignore it.

Parents share that their toddler often needs a snack in between meals. Which snack choice is nutritious enough to give the toddler energy but also may help prevent dental caries? Select all that apply.

- Orange Slices - Cheese slices - Yogurt ** Encourage parents to offer fruit (e.g., bananas, pieces of apple, orange slices) or protein foods (e.g., cheese, pieces of chicken) for snacks rather than high-carbohydrate items such as cookies and candy bars to limit exposure of the child's teeth to carbohydrates.

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 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.

Important Aspects of Health Promotion & Maintenance for the Toddler

1. Routine checkups. 2. Family teaching. 3. Accident Prevention

By 3 years of age, how many hours of sleep does the toddler need daily?

10-12 hours.

During the first year of toddlerhood, how many hours of sleep does the toddler need daily?

12-14 hours.

By what age should the child know his/her own gender?

3 years

A nurse is assessing several children between the ages of 1 and 4 years. The nurse would expect which child to know his or her own gender?

3-year-old

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.

The parents of a 30-month-old toddler have brought the toddler into the emergency department because of a seizure. During the health history, the nurse learns that the toddler was frustrated and angry immediately preceding the seizure. The nurse suspects the toddler had a breath-holding spell. Which parental report suggests breath-holding?

A tantrum preceded the event. ** Temper tantrums are the natural result of frustrations that toddlers experience. They continue to occur until the toddler is old enough to verbalize feelings. The fact that there was a precipitating event of frustration and anger points to the likelihood that this is a cyanotic breath-holding spell.

What medications are most commonly involved in cases of childhood poisoning?

Acetaminophen, Salicylates (aspirin), Laxatives, Sedations, Tranquilizers, Analgesics (ibuprofen, opioids), Antihistamines, Cardiac Medications, Cough/Cold Medicines, Birth Control Pills.

A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take?

Explain that children can take their first steps as late as 18 months of age.

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. ** Parallel play.

Daily Nutrition Needs of the 1-3 Year Old

Fruits: 1-1.5 cups Veggies: 1-1.5 cups Grains: 3-5 oz Protein Foods: 2-4 oz Dairy: 2-2.5 cups

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.

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. ** By allowing secondary choices, it gives the toddler a sense of mastery.

Which immunization would you anticipate administering to a 15-month old at a health maintenance visit?

MMR ** Measles-mumps-rubella vaccine cannot be administered before 12 months because antibodies passively acquired across the placenta take this long to fade.

The nurse is designing a nursing care plan for a toddler with lymphoma who is hospitalized for treatment. What is a priority intervention that the nurse should include in this child's nursing plan?

Monitoring the toddler for developmental delays. ** When the toddler is hospitalized, growth and development may be altered. The toddler's primary task is establishing autonomy, and the toddler's focus is mobility and language development. The nurse caring for the hospitalized toddler must use knowledge of normal growth and development to be successful in interactions with the toddler, promote continued development, and recognize delays.

A nurse is assisting the parents of 2-year-old who is having temper tantrums. What would the nurse encourage the parents to do once temper tantrums have started?

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 be ignored. Do not talk excessively about the tantrum because this can negatively impact the child's self-esteem.

The parents of a 2-year-old boy report to the nurse that their child is "such a picky eater." Which recommendation would be most helpful for developing healthy eating habits in this child?

Offering a variety of foods along with the foods the child likes. ** Offering a variety of healthy foods along with foods the child likes will acknowledge preferences while keeping the door open to new foods.

A father and his 12-month-old son are in for an office visit. The son is now walking regularly, and the father asks the nurse for recommendations on shoes. Which of the following should the nurse suggest?

Sneakers. ** As soon as children are up on their feet and walking, they need shoe soles firm enough to provide protection from rough surfaces.

The nurse is assessing a toddler's language development. What finding would the nurse interpret as reflecting expected development for a 2-year-old?

Speaks in two-word sentences using a noun and a verb. ** Any 2-year-old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment to determine the cause because this is beyond a point of normal development. Counting is not an expectation for a 2-year-old child.

The nurse is providing guidance after observing a mother interact with her negative 2-year-old boy. For which interaction will the nurse advise the mother that she is handling the negativism properly?

Telling the child firmly that we don't scream in the office.

A nurse is teaching parents of a 2-year-old child about discipline and limit setting. When describing the use of "time-out," the nurse would inform the parents that the maximum duration of time-out should be how many minutes per each year of age?

1 minute. ** The maximum "time-out" duration should be 1 minute for each year of age, but it may be necessary to start with much shorter time-outs.

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.

After teaching a group of parents about language development in toddlers, which statement by a member of the group indicates successful teaching?

"When my 3-year-old asks 'Why?' all the time, this is completely normal." ** Language development occurs rapidly in a toddler. By age 3 years, the child asks "Why?"

A mother of a 2-year-old girl is asking her friend when she should start potty training the child. The mother expresses concern about the high cost of diapers and training pants and would really like to have her trained as soon as possible. Which advice by the friend would be considered the best response?

"When she is uncomfortable in her wet diaper and brings a clean diaper to you, that's a good indication she is ready for potty training."

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."

A nurse in a busy pediatric clinic is educating a group of parents with toddlers about the nutritional needs of this age group. Which concepts should be addressed in this educational presentation? Select all that apply.

- Active, "busy" toddlers may need up to 1,400 cal/day. - Try to limit the fat intake to less than 35% of total calories. - Milk is still important to incorporate in the diet for bone health.

What are some measures you can reinforce with family caregivers of toddlers to prevent accidents?

- Need to be aware that these tragedies can occur & must take proper precautions at all times. - Need continual reminders about the possibility of childhood poisoning.

The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching?

Advising them to use praise, not scolding. ** The most helpful guidance for toilet teaching is to urge the parents to use only praise throughout the process—never scold. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved.

Temper Tantrums

Aggressive displays of temper during which the child reacts with rebellion to the wishes of the family caregiver, spring from many frustrations that are natural results of a child's urge to be independent.

While awaiting an appointment at the doctor's office for his 20-month-old daughter, a young father is astonished to see his daughter assume a proper stance and swing a toy golf club in the play area of the waiting room. A nurse also observes the behavior, and the father recalls that his daughter saw him practicing his golf swing in their backyard a few days ago. The nurse explains that this is an instance of which of the following?

Deferred imitation ** Children at this stage are able to remember an action and imitate it later (deferred imitation); they can do such things as pretend to drive a car or put a baby to sleep because they have not seen this just previously but at a past time.

The parent of a 2-year-old toddler tells the nurse she needs to constantly scold the toddler for having wet pants. The parent says the toddler was potty trained at 12 months, but since starting to walk, the toddler wets the pants all the time. Which nursing diagnosis would be most applicable?

Deficient parental knowledge related to inappropriate method for toilet training. ** Myelination of the spinal cord is achieved around 2 years of age. When this occurs, the toddler can exercise voluntary control over the sphincters. It is probable that a toddler toilet trained at 12 months of age was not truly trained, because the infant would not be developmentally able to complete the task. It is most likely the parent used a training method of reminding the infant or placing the infant on a toilet frequently during the day. When the toddler begins to play independently, the toddler forgets the regimented schedule.

Autonomy

Independence. ** Erikson's psychosocial developmental task for this age group.

What are the major causes of accidents in toddlers?

Motor vehicle accidents, drowning, burns, & poisoning.

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.

The nurse observing toddlers in a day care center notes that they may be happy and pleasant one moment and overreact to limit setting the next minute by throwing a tantrum. What is the focus of the toddler's developmental task that is driving this behavior?

The need for separation and control.

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 that 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.

The parents of a 2-year-old child born with short-gut syndrome feed their toddler via a feeding tube. Knowing this is a developmental time when children usually feed themselves, the parents are asking the nurses what they can do to help foster the child's independence. Which suggestion would be most appropriate at this time?

Let the child choose what clothing he or she will wear the next day. ** If children are tube fed, they receive no experience at all with finger foods. For these children, parents should try to provide other, comparable experiences in independence, such as letting them choose what toy to take to bed or what clothing to wear.

Negativism

Toddlers test their power by saying "no" - more of an assertion of individuality than of an intention to disobey. * Limit # of questions asked of the toddler - make a statement = helpful in decreasing the # of neg. responses.

Discipline (Teaching, not punishment!)

Train or instruct in order to produce a particular behavior pattern, especially moral or mental improvement, & self-control.

The nurse has completed an examination of a 32-month-old girl with normal gross and fine motor skills. Which observation would suggest the child is experiencing a problem with language development?

Her vocabulary is between 10 and 15 words. ** A 3-year-old child typically has a vocabulary of approximately 900 words, asks many questions, uses complete sentences consisting of 3 to 4 words, and talks incessantly.

The nurse is recommending food items for an 18-month-old girl. Which ones will benefit the child's neurologic system most?

Peanut butter on crackers, cheese, and whole milk ** At 18 months, the child's neurologic system is still developing rapidly and needs dietary fat for myelinization. Peanut butter on crackers, cheese, and whole milk all provide this.

Punishment

Penalizing someone for wrongdoing. ** Different from discipline!

The nurse is teaching parents how to avoid a power struggle with their 2-year-old girl. Which comment indicates that more teaching is needed?

"We will make sure she shares her toys with cousins her age." ** A 2-year-old's thinking is not mature enough to include the concept of "sharing." She sees situations from her point of view (egocentrism). That makes sharing with another beyond what she can accept as an understandable action.

A nurse is providing guidance to the parents of a toddler about way to help the child to achieve the developmental task of autonomy. The nurse determines that the teaching was successful based on which parental statement?

"We'll let our child pick from two choices for what to wear."

A mother is concerned that her 2-year-old child is having seizures. The child holdstheir breath until they pass out when the child wants something the mother does not want the child to have. How should the nurse respond to this mother's concern?

Seizures are not provoked; temper tantrums are.

Developmental Characteristics of Toddlers (2-3yrs)

Self-feeding, toilet training, increased socialization, primary dentition, sleep disturbances.

The parent of a toddler is frustrated because the toddler insists on brushing his own teeth and being left alone in the bathtub. What advice should the nurse provide to the parent about these expectations?

Helping with teeth brushing encourages autonomy. ** Toddlers need a toothbrush they recognize as their own. Toward the end of the toddler period, they can begin to do the brushing themselves under supervision; although, almost all children need some supervision until about age 8 years. It is not unusual for a toddler to have opinions and want to do things

A nurse is discussing oral care with the parents of 4-year-old. The nurse determines that the parents are performing this aspect of their child's care appropriately when they state that they use which amount of toothpaste?

Pea-sized ** The AAPD (2012a) recommends: - "smear" of fluoridated toothpaste in children younger than 2 years of age - "pea-size" amount of fluoridated toothpaste be used on children aged 2 - 5 years

The 18-month-old toddler has most likely attained which gross motor skill?

The ability to walk independently. ** May still be a little unsteady.

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.

A parent is concerned because the toddler refuses to share. What is the nurse's best response to the parent regarding this concern?

This is normal toddler behavior; sharing is learned later.

Parallel Play

Toddler play's alongside other children but not with them.