Chapter 20: Caring for the Developing Child (Toddler)

Question 1

Age of the Toddler

Answer 1

1- 3 years

Question 2

Physical Development of the Toddler (1 to 3 years)

Answer 2

-by 1 year, physical growth has slowed
-for each year between 1 and 3, the toddler gain 3 to 5 lbs and grows 3 inches taller
-energy directed towards other realms of development
-as the physical growth rate slows, toddler develops physical, cognitive, and emotional skills that help to become more independent
-as develops mobility, explores how things work and senses become more refined
-uses newly acquired gross motor skills to run, jump, and move up and down stairs with increasing ease
-around age 3, may learn to ride a tricycle or slide down a slide without help
>this newfound freedom and movement create many opportunities for danger as the toddler moves quickly from one new experience to another
-fine motor skills continue to develop rapidly
-can hold spoon or a large crayon appropriately
-continues to make artwork that is more representative of the object they are trying to depict
-increasingly able to manipulate smaller toys

Question 3

Cognitive Development

Answer 3

• early toddlerhood corresponds with Piaget’s fifth substage, Tertiary circular reactions, during which the toddler experiments and learns new behaviors
• then transitions into Piaget’s 6th stage, mental combinations, when begins to understand cause and effect and is able to imitate others and problem solve
• loves to imitate the people around them
• much of behavior is replication of what they see and hear
• learns through repetition; this is why toddler may want the same book to read over and over, staying engrossed in the story every time
• likes order and often responds with difficulty to any disruption in routine
• level of response is related to temperament of the child; some may revolt with temper tantrums, other will calmly transition into an experience
• regardless of temperament, most respond favorably to predictable routines

Question 4

Language Development

Answer 4

• increasing cognitive development
• able to listen to and understand short explanations
• time when develops a more understandable language
• language about fulfilling needs: “I do” or “want drink”
• moves from single words to short phrases
• nurse can reassure parents that it is important to assess what the child understands and what the child is able to communicate, with or without words, rather than exact correctness in pronunciation

Question 5

Psychosocial Development

Answer 5

-Freuds anal stage
-begins to develop a sense of self as separate from mother
-task is to move away from primary caregiver while in some way maintaining enough connection to feel secure; process called rapprochement, is healthy and expected
-corresponds with Erikson’s stage of autonomy versus shame and doubt; time when the child makes every effort to “do it myself”; mastery important in this stage
-time of potential hazard
-caregivers must walk the fine line between allowing exploratory independence and “mastery” on one hand and vigilance on the other
-often a time of bumps and “booboos”
-often dubbed as “terrible twos”
-child must begin to internalize behavioral standards at a time when establishing independence is important
>nurse help parents understand that the toddler does not set out to make life miserable; the toddler simply has few internal mechanisms in place to accomplish what needs to be done safely
>the word “no” begins to signify toddler’s simple response to frustrated emotions encountered

Question 6

Moral Development

Answer 6

• still a very concrete thinker and knows that something is “good” or “bad” but does not know why
• identifies good and bad and right an wrong by virtue of whether or not it is rewarded or punished

Question 7

Discipline

Answer 7

-purpose: to teach the child socialization and safety
-responsibility of the parent to provide a firm structure so the toddler can explore the word while offering safe limits
-many test rules, while also unconsciously learning to rely on the security those limits provide
-parents must learn to structure the toddlers surroundings to allow enough enough flexibility to test limits
-needs guidance to determine how to act appropriately; toddler thinks concretely and must rely on others to help give realistic parameters
>some parameters may create a great deal of conflict when what the toddler is allowed to do does not match with what the toddler wants to do which may result in a temper tantrum
-praise is a good component of discipline because most children want to please the parent

Question 8

Temper Tantrums

Answer 8

tantrum is a normal way of working things out internally for the toddler
-normal
-possible for parents to anticipate when tantrums are most apt to occur (e.g. when tired, hungry, or overwhelmed by new situations, reserves are low, and therefore, the toddler may be more likely to explode or “melt down”)
-tantrums must be avoided or minimized if anticipated
>get a tired child to rest or feed a hungry child to decrease frustration level
-nurse teach coping strategies; when child is wailing and thrashing, but not doing any harm, ignore her; but often not possible and may be necessary for the parent to intervene and remove child to a quieter or safer place
>touching and distractions may help soothe a tantrum for one child, another child may need to continue the tantrum under the watchful eye of the parent
-the latter requires that the parent be present but not engaged in direct communication with the child
>goal: the child to feel (and be) safe without being negatively or positively reinforced for having a tantrum

Question 9

“What to Say”- Tips for effective discipline

Answer 9

allow for negotiation and flexibility, which can help build the child’s social skills
-allow the child to experience the consequences of behavior
-speak to the child as you would want to be spoken to if someone were reprimanding you
-never resort to name-calling, yelling, or disrespect
-be clear about what you mean
-be frim and specific
>Whenever possible, the consequences must be delivered immediately, relate to the rule broken, be short enough in duration, and emphasize the positives
>the consequences must be fair and appropriate to the situation and the child’s age

Question 10

Anticipatory Guidance

Answer 10

-keep child safe at all times
-constant supervision
-as toddler actively explores his environment, he does so with little understanding of consequences of his actions
-cabinet doors must have child-safe locks
-mini-blind cords must be secured above the reach of the toddler to prevent asphyxiation
-windows and doors must be locked
-wear a helmet when learning how to ride a bike
-toddler is beginning to learn about rules and consequences; consistency in how those rules and consequences are applied
-discipline must be appropriate to the rule broken
>time-out is effective; choose safe place, such as a chair in a visible area of a room, general rule of thumb is 1 minute per year of age

Question 11

Discipline Strategies for a Toddler

Answer 11

• Distraction: provide a toy to divert the child’s attention
• Time-out: move the child to a “cooling-off” place where the child can calm down
• Removal of Privileges: withhold a favorite toy until the child’s behavior is appropriate
• Verbal Reprimands: give spoken warnings or disapprovals without berating the child or judging the child as “bad”
• Corporal Punishment: (e.g. spanking, swatting, and grabbing); not recommended

Question 12

Developmental Milestones of the Toddler (1 to 3 years)

Answer 12

> Physical Growth:
-Weight: 3-5 pounds/ year
-Height: 3 inches/year
Gross Motor Skills:
-stands without support, walks independently, walks backwards, creeps up stairs, pulls toys while walking, runs with wide stance, jumps in place with both feet, climbs, throws a ball; eventually kicks the ball, rides a tricycle by 3 years of age, begins to stand on one foot momentarily; may be able to hop on one foot, can walk up and down stairs with alternate feet, blows kisses
Fine Motor Skills:
-holds a pencil or a large crayon, makes artwork that is more representative of the object, copies a circle and cross by age 3 years, knows colors, feeds self with spoon and drinks from a cup, constantly throws objects on floor, builds tower of 3 to 4 cubes, eventually building tower of 7 to 8 cubes, screws/unscrews, turns pages in a book one page at a time, turns knobs, removes shoes and socks, learns to undress self, begins toilet training around 3 years of age
Cognitive, Sensory, and Language:
-experiments and learns new behaviors, begins to learn cause and effect, imitates behaviors of parents and caretakers, well-developed vision, can identify geometric objects, intense interest in picture books and listens to stories, distinguishes food preferences based on senses, Language: single words and simple phrases, “I do” or “Want drink”; by 15 months knows 15 words; 20 by 2 years, follows simple instructions
Psychosocial
-increases control of self and environment; explores; learns about safety and boundaries but may test those boundaries; shows affection
Play: parallel play (play alongside another child) helps children make the transition from solitary play to associative play by stimulating sensorimotor and psychosocial development; activities include: matching games, simple puzzles, blowing bubbles, bean bag toss, catching fireflies, ring around the rosy, London Bridge, duck-duck-goose, hide and seek, coloring, drawing

Question 13

Anticipatory Guidance: Nutrition

Answer 13

• family meals
• allow toddler to self-feed and use cup at meal times
• allow child to make food choices
• provide finger foods
• provide 2 to 3 healthy snacks per day
• do not force eating

Question 14

Anticipatory Guidance: Health promotion

Answer 14

• Signs and Symptoms of illness: vomiting, diarrhea, fever, dehydration
• immunizations
• CPR training
• Heimlich maneuver training
• oral health: brushing, routine cleaning

Question 15

Anticipatory Guidance: Focus On Safety

Answer 15

• lower crib mattress
• transition to toddler bed by age 3
• toddler car seat
• lock windows
• secure curtains and mini-blind cords to prevent asphyxiation
• secure doors
• update childproofing home
• use bike helmet
• water safety
• check smoke detectors
• supervise play
• sunscreen

Question 16

Anticipatory Guidance: Sleep-wake pattern

Answer 16

• continue nightmare rituals
• consistent bedtime
• expect nightmare and develop strategies to deal with them

Question 17

Anticipatory Guidance: Cognitive and Emotional Development

Answer 17

• read short stories daily
• provide simple explanations
• respond to child’s verbalizations
• praise accomplishments
• schedule play dates
• teach child how to express feelings
• expect child to test limits
• encourage self expression and self care
• limit tv to 1 to 2 hours a day

Question 18

Anticipatory Guidance: Motor Development

Answer 18

• promote fine motor skills: crayons, blocks
• provide outdoor play with balls, push and pull toys
• play with toddler

Question 19

Anticipatory Guidance: Discipline

Answer 19

• apply rules and consequences consistently

- provide brief time outs