2. Health Promotion for the Toddler Flashcards
Growth & Development During Early Childhood
The toddler: __-__ months
> Struggles for autonomy
> Develops a sense of self separate from parents
> Increased motor skills and lack of experience increase the risk for injury
> Egocentric and demanding behaviors
* Temper tantrums
* Negativism
* “terrible two’s”
12-36
Physical Growth & Development
> Birth weight quadrupled by 2-3 years
> Half of adult height between ages 2 and 3 years
> Brain growth slows
> Immature abdominal musculature: “pot-bellied” appearance
> Muscle tissue gradually replaces most adipose tissue (baby fat)
Healthy People 2030 Goals for Toddlers
* Increase proportion of parents who use positive parenting and communicate with their healthcare provider about positive parenting
* Achieve and maintain effective vaccination coverage levels for recommended vaccines
* Prevent an increase in the rate of poisoning deaths
* Increase age-appropriate vehicle restraint system use
* Prevent an increase in the rate of fall-related deaths
* Reduce drowning deaths
* Prevent inappropriate weight gain in children ages 2-5 years
* Reduce the proportion of children ages 3-11 years exposed to secondhand smoke
Motor Development
> Learns to walk well
* Regular beds may replace cribs
> Perfects fine-motor skills
> Hand-eye coordination improves
> Can feed themselves with a spoon, although it’s messy
> Can dress simple items of clothing but can’t differentiate front from back
> Can zip large zippers, put on shoes, wash and dry hands
> Can brush own teeth
Cognitive & Sensory Development
> Consumed with curiosity and boundless energy
> Tremendous cognitive growth
> Piaget’s ___ period
* Learning by trial and error
> ___ stage of cognitive development
> ___ is firmly established
> Uses symbols and words when referring to absent people or objects
> Mimics same-sex parent performing household tasks - ___
> Imitates the parent putting on make-up or shaving after parents leave for work - ___
> Enjoys opening doors and drawers
sensorimotor
Preoperational
Object permanence
domestic mimicry
deferred imitation
> Preoperational stage of cognitive development starts around age 2 and is characterized by
___ - unable to consider other’s point of view
> Takes toy away from another child
___ - believes inert objects are alive
> When tripping over toy scolds toy for “hurting” them
Egocentrism
Animism
___ - cannot process in reverse
> Takes toy apart and cannot put back together
___ - wishes comes true
> Believes wishes come true
___ - focuses on only one aspect of an experience
> Cannot follow more than one direction at a time
Irreversibility
Magical thought
Centration
Language Development
> Most children can communicate verbally by their second birthday
> Between 15- and 24-months language develops rapidly
> Toddlers can understand more than they can say
> By age ___, 60-70% of speech should be understandable
> By 24 months toddler knows 300 or more words
> Encouraged to express needs rather than parents anticipating and providing what they want before they ask
2
Psychosocial Development
> Characterized by the struggle for autonomy
> Develops a sense of self separate from the parent
> __ __ __ __ __ (Erikson)
* Realize they have a will and that they can control others even though they don’t often get what they want
* Learn which behaviors gain approval as opposed to those that lead to censure and discipline
* Right and wrong determined by consequences of actions
* Universal behaviors
> ___ - favorite word “no”
> ___ - routines are important
Autonomy versus shame and doubt
Negativism
Ritualism
* Separation anxiety peaks again
> May use transition objects (favorite blankie) to help with anxiety
> Spends most of the time at play - it is the child’s work
* ___ - play alongside others but not “with” others
* ___ - acting out scenes of everyday life
Paralell play
Symbolic play
Age-Related Activities and Toys for Toddlers
General Activities
> Fills and empties containers
> Begins dramatic play
> Increased use of motor skills
> Enjoys feeling different textures
> Explores the home environment
> Imitates orders
> Likes to be read to
> Looks at books and television programs that are age appropriate
Toys and Specific Types of Play
> Continued exploring of the body part of self and others; mechanical toys; objects with different textures, such as sand and clay and finger paints, large puzzles, trucks, dolls
> Therapeutic play begins
Psychosexual Development
* Gender identity and body image are developing
* Model people important to them
* Sexual curiosity, anatomic exploration, and masturbation are common
* Encourage parents to answer questions simply and honestly
* Children should not be shamed or punished for self-comforting behaviors
Health Promotion - Nutrition
Nutritional Requirements
> Solid foods
* 3 meals and 2 snacks each day
> Age-related challenges
* Limit sugar
* Offer a choice between healthy foods only
* Allow child to participate in shopping
* Be a role model
> Food jags
* Volume varies each day
* One day they like a food and the next day they reject it
> Physiologic anorexia
* Related to growth rate slowing down and appetite decreases
* Limit snacks, milk (16-24 oz/day), and juices
* Focus on weekly intake rather than daily
Nutritious Snacks
* Fresh fruit
* Celery sticks with cheese spread
* Yogurt
* Bagels
* Carrot sticks
* Graham crackers
* Pretzels
* Puddings
Increasing Nutritional Intake
* Limit to 2 nutritious snacks per day and give only at toddler request
* Limit to 4-6 ounces of juice per day
* Introduce finger foods at 8-10 months
* Limit to 16-24 ounces of milk per day
* Keep mealtimes pleasant
* Do not force feed
* Do not feed children who can feed themselves
Health Promotion - Dental Care
* All __ deciduous teeth are present by age 30 mos
* Proper care of these teeth is crucial for the child’s general health and alignment of permanent teeth
* Nurses should teach
> Good oral hygiene
> Adequate fluoride intake
→ 6 mos - 3 years - 0.25 mg daily fluoride supplement
> Regular dental checkups
20
Health Promotion: Sleep & Rest
> 12-14 hours of sleep per day
> Still takes one nap per day
> Often resist causing temper tantrums
* Set firm consistent limits
* Wind down 30 minutes prior to bedtime with quiet activity
* Warm bath
* Bedtime rituals
* Transition objects
* Avoid high carbohydrate snacks before bedtime
Health Promotion: Discipline
> Need and want discipline to feel secure
> Unaware of the consequences of their actions so vigilance and limits are needed for safety
> Firm, consistent discipline helps toddlers learn self-control
> Ignore temper tantrums once safety has been assured
> Positive reinforcement of acceptable behavior
> Use diversion or timeouts (one minute per year of age)
> Discipline must be immediate, realistic, age appropriate
Toddler Safety
Car safety
> Toddlers should be restrained in an upright, rear-facing car seat until they outgrow the manufacturer’s weight or height recommendation
> Car doors should be locked while car is in motion
> Never leave a toddler in an unattended car
> Children younger than 13 years should ride in the back seat
Airplane safety
> Harness needed per aviation guidelines
Fire and burns
> Burns are the __th leading cause of death during early childhood
> Use back burners on the stove and turn pot handles inward toward the middle of the stove
> Do not leave dangling cords from irons and other small appliances accessible to toddlers
> Use guards to limit access to open fires and heaters
> Keep matches and lighters out of reach
> Importance of smoke detectors and escape plans
4th
Preventing falls
> Install guards on stairs and remove furniture from windows
Water safety
> Never leave a child alone in or near a bathtub, pail of water, wading or swimming pool, or any other body of water
> Swimming pools should have climb resistant fences
Preventing poisoning
> Emerging poisons include e-cigarette liquid, hand sanitizer, detergent pods, and cannabis products
> Keep all poisons and medicines out of reach of children
Selected Issues Related to the Toddler
Toilet training
> Readiness cues
> Average toddler is not ready for toilet training to begin until 18 to 24 months of age
> Daytime bladder control occurs before nighttime bladder control
> Do not use punishment in coercive techniques as these may cause feelings of shame and lead to power struggles
Temper tantrums
> A response to anger and frustration
> Anticipate periods of fatigue
> Have snacks ready when child gets too hungry
> Offer choices when possible
> Set appropriate and consistent limits
> Isolate child safely and then ignore tantrum
Sibling rivalry
> Due to toddler egocentrism, they cannot understand that a parent can love more than one child at a time
> They often react by treating the baby roughly damaging property or harming pets
> Regression may occur by asking for a bottle or pacifier or by using baby talk
> Set planned uninterrupted private time with the sibling
Signs of Readiness for Toilet Training
Physical readiness
* Children can remove own clothing
* Child is willing to let go of a toy when asked
* Child is able to sit, squat, and walk well
* Child has been walking for one year
Psychological readiness
* Child notices if diaper is wet
* Child indicates that diaper needs to be changed
* Child indicates need to go to the bathroom
* Child wants to stay dry
Immunizations
__ months
* DTap #4
* IPV #3 (if not given earlier)
* Hepatitis B #3 (if not given earlier)
18 months
__ months
* Hib #3 or #4 (depending on the vaccine and if not given at 12 months)
* MMR #1 (if not given at 1 year)
* Varicella (if not given at 1 year)
* Pneumococcal (if not given at 1 year)
* Hepatitis B #3 (if not given earlier)
* Hepatitis A #1 (if not given at 1 year)
15 months
Immunizations
* Influenza vaccine annually
* Hepatitis A #2 (or 6 months after first dose)
