Toddlerhood Flashcards
Toddlerhood Physical growth (12-23 months)
- from 12-24m, growth slows
- Toddler gains around 5 pounds (quads from birth) and grows around 4-5 inches (doubles by birth)
- By two years, children have reached about half of adult height and 90% of adult head size
Dev tasks: measuring toddler behaviors and milestones - 12 Months
-pulls to stand, cruises, may take steps alone; plays social games; precise pincer grasp; points with index finger; bangs blocks together; says 1-3 words (besides “mama and “dada”); imitates vocalizations; drinks from cup; looks for dropped/hidden objects; waves “bye bye”; feeds self
dev tasks: 15 months
-Says 3-10 words; points to body parts; understands simple commands; walks well, stoops, climbs stairs; stacks 2 blocks; feeds self with fingers; drinks from cup; listens to story; tells what s/he wants by pulling, pointing, or grunting
dev tasks: 18 months
-walks quickly/runs swiftly; throws ball; says 15-20 words; imitates words; uses 2 word phrases; pulls toy; stacks 2-3 blocks; uses spoon and cup; listens to a story, looks at pictures, names objects; shows affection, kisses; follows simple directions; scribbles; dumps object from bottle without demonstrations
dev tasks: 2 years
-goes up and down stairs one step at a time; kciks ball; stacks 5-6 blocks; says at least 20 words; 2-word phrases; follows 2 step commands; makes horizontal and circular strokes with a crayon; imitates adults
dev tasks: 3 years
-jumps in place; kicks ball; rides tricycle; knows name, age, and sex; copies circle, cross; has self-care skills; shows early imaginative behavior
Toddler play
-parallel play; early symbolic (dolls); grabbing, throwing, hitting, stealing toys, ignoring other kids is expected
Toilet training
-the capacity for toilet training rarely develops 18m of age
Toilet training: readiness
- stay dry for at least 2 hours at a time, after naps
- recognize that s/he is urinating or having bowel movement and be able to communicate it
- physical skills critical to toilet training: ability to walk, pull pants up and down, get on/off toilet (with minimal help)
- Child wants to use the toilet. May say s/he wants to wear “big boy/girl” paints or “use the potty like a big kid:
Dental Health
-AAPD recommends: first dental exam at 6-12 mo; then routine dental care every 6-12 months, depending on dental status; parents should assist/monitor brushing until 7-8 years of age (and beyond)
Dental Care
- teeth continue to erupt until 3 years
- focus on developing good oral care habits
- spitting out toothpaste takes practice
- soft brush, use child (non-fluoride) toothpaste until age 3 years
Immunizations
- Vaccination is one of the best way to protect infants, children, teens from 16 potentially harmful disease
- vaccine-preventable diseases can be serious, require hospitalization, cause serious death, especially in infants, young children, immunocomprised
- educate parents/guardians
Injury Prone toddlers
- developmental factors: running, limited knowledge, distracted, curious
- physiologic factors
- physics
- toddlers have limited physical coordination, poor impulse control, no “cause and effect”, they’re “on the go”
Causes of injury and death
- For every 10 toddlers who come to the ER, there is 1 presenting for accidental injury
- Accidental injury: falls, suffocation, poisoning, drowning, burns, firearms, motor vehicle crash
- non accidental cause of injury/death: abuse
Drowning prevention
- adult supervision around pool, bathtub, large water containers - very curious at this age
- swimming pools fenced, gated, locked
- keep bathroom doors closed, lid down on toilet
- swim lessons
Poisons and prevention
- consider the possibilities: medications, baby oil, plants, cleaners
- limit access
- poison control number
Motor Vehicle crashes prevention
-proper car seat: check state laws
Anticipatory guidance
stairs, pot handles turned in, firearms, tide PODS, etc
Abuse prevention
Recognize, report, education, parental support
Preschool Age (3-5 years of age) physical changes
- Between 3-5 years of age: slender: taller and thinner
- Gain around 4.5-6.5 pounds/year
- Grow around 2.5-3.5 inches/year
- average 4 year old: around 40 inches and 40 pounds
preschool age
- more aware of external body parts
- curious about bodies of opposite sex
- very interested in bodily functions
- fear of injury, death mutilation
Preschool dev issues
-developmental delays often become more obvious during this time
Developing self-control
- rules at home vs rules at school
- self-control at school: raising hand, standing in line, staying quiet, listening
Health promotion in preschooler: nutrition
- calcium: 800 mg/d
- juice: 4-6 ounces/day max
- BMI: standard for diagnosis of overweight in children; greater than 2 years old
- plot of appropriate growth chart
Deciduous and Permanent teeth
- primary teeth have all erupted by 2.5 years
- 1st permanent tooth may erupt toward end of preschool age
- 40% have caries by kindergarten
Dental health teaching
- dental issues: pain: chewing probs: poor appetite
- dental caries: 75% of cavities found in 25% of kids
- encourage “detergent” foods
- fluoride toothpaste in kids greater than 3 years
- dental visit every 6 months
- brush twice a day, floss once a day, parent assist until about 7-8 years old (and beyond)
Nursing care for Dental trauma
- if deciduous tooth lost: don’t try to place back in socket; place in milk or saline; if dirt on tooth, gently rinse in milk or saline; don’t dry it off or place in cloth or tissue; may need space place by DDS
- if perm tooth lost: handle only by grown portion; if dirty, wash gently in cold water and reposition in socket; bite on cloth to keep tooth in socket; if not possible to replant, store in cup of cold milk or saline; seek immediate dental treatment
Elimiation
Assess: status of control of micturition and defecation; any problems w bowel or bladder elimination?
-bowel control usually before bladder; daytime control before night time; loss of control often occurs during times of stress or intense play; enuresis or encopresis may occur after toilet training; nocturnal enuresis may persist normally until age 7 years
Teaching for elimination health
- encourage child to take more responsibility for elimination; wipe front to back; water AND soap; anticipating need to eliminate
- parent will still need to monitor urine and stool output
Constipation in preschooler
- Etiologies: functional (chronic idiopathic), environmental, psychosocial, anatomic factors
- CONSTIPATION IS A SYMPTOM
Constipation nursing interventions
- depends on etiology and severity
- environmental/diet changes: establishing regular bowel habits; work w teacher and or school nurse; increase activity level, fluids; diet change
Sleep hygiene edu for parents of PS
- the problem is probably with the environment
- low lighting and quiet; own sleep space; bed time rituals 30-45 min are usual; respect rituals within reasonable limits; resist and ignore repeated requests for attention or may –> manipulation, prolonging; night awakenings are common
- reassure and return to own bed
- restrict watching of scary TV/movies: reinforce difference between real and pretend
- often need transitional object
- Children with regular bedtimes, early or late, have fewer behavioral problems
Common sleep disturbances in preschoolers
-night time fears: may persist until end of preschool; “monsters under the bed”; give them tools for “protections”
Somnambulism
- up to 17% of children
- disorders of arousal: immaturity of nervous system; most outgrow with CNS maturation; genetic component
- late, non REM sleep
- Open, glassy eyes, look confused
- can be triggered by change in sleep patterns; fever
Somnambulism interventions
- reassure parents that is usually goes away
- reintroduce nap
- don’t wake, causes more confusion
- guide back to bed
- safety proofing; bell on bedroom door, motion detectors, gates, high locks
Health promotion in PS: Safety and injury prevention
- capitalize on dev stage: “the great imitators” “rule followers”
- stranger danger (ask what would you do if…?)
- car safety
- traffic and pedestrian safety
- bicycle safety and helmet use
- in preschool, it’s still “cool” to follow the rules
Safety issues: car safety
- May be switched to approved booster seat when: maxed out of height/weight standard for car seat
- continue w booster until reaching 4’9” and pass “5 step” test (back against the vehicle seat; knees bend at the edge of seat, lap belt on tops of thighs not belly, shoulder belt between neck and shoulder, sits properly, no slouching, no playing with seat belt, etc
- door lock mechanisms; back seat until 13 years old
Traffic/pedestrian safety
-discourage playing near street traffic, obey pedestrian rules, learn about cross walks, crossing signals
Bicycle, scooter, and skateboard safety
- helmet: low on forehead, should sit parallel to ground
- should be able to place balls of both feet on the ground
School age child growth (5-12 years of age)
- alternate “spurts” and minimal growth
- grow about 5 cm per year; gain 2 to 3 kg per year
- menstruation: age of onset related to genetics, body fat - average age 12 years
Teeth of school age
-transition from deciduous to permanent teeth: lose in same order as initially erupted; approx. 4 teeth per year
School age child motor skills dev
- maturing nervous system: brain hemisphere articulation
- lengthening long bones (risk of fractures, joint pain)
- muscle mass increase: potential for more complex fine and gross motor functions
School age social dev
- Family remains a constant source of support at this age:
- routines with family
- still learn from observation
- disruptions can be very upsetting (divorce)
School age nutrition
-factors influencing food intake: access to food: lack of nutritious food, make own snacks; mass media influence (billboards, TV); contemporary busy lifestyles (skip meals; eat out)
School age nutritional issues
- Overweight: in defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex
- obesity: defined as a BMI at or above the 95th percentile for children of the same age and sex
Obesity
- has tripled in the past 40 years
- only 29% of US children have PE daily
- Children watching TV: 1, 023 hrs/year
- Children in school: 90 hours/year
- Media use: 8-12 years old, about 6 hours per day
Obesity risk factors
- genetic
- environmental: use of food as reward, lack of physical activity, living conditions, financial constraints
- associated health issues: elevated BP; increase risk of type 2 diabetes
- social issues: peer acceptance; self-esteem
Weight/nutri nursing interventions
Child focused:
-teaching children about healthy food choices
-exercise daily, decrease screen time
-peer groups/peer support groups
Parent focused:
-incorporate discussion of healthy foods into daily life
-role modeling
-encourage activity, limiting tv, video games
-healthy food choices
Activity/play
- critical time to acquire and foster activity behaviors
- recommendation: 60 min of physical activity daily
- increase in organized sports as a mean of activity
- play is still important for school age kids: promotes social dev; promotes cog skills
Elimination: school age
- most have full bladder and bowel control
- enuresis: primary vs secondary; nocturnal most common; cause of primary is not well understood (sleep patterns, functional bladder capacity, family inheritance); can be socially isolating; management: most cases spont. resolve; voiding before bed, positive reinforcement
Sexuality patterns in school age children
- school age children understand their gender differences
- continue to learn “typical gender role”
- Increasing awareness of body
- peers tend to be the source of questions about sexual matters
- school sexual education programs (state specific)
- important for family to begin these conversations
Safety school age
- accidents: sports and recreation - increase during the school years; musculoskeletal injuries with competitive sports
- prevention: protective equipment hydration, conditioning exercises, reasonable expectations
- firearms: gun accidents; adolescent shootings
- prevention: locked guns, gun safety
backpack safety
- choose wide, padded shoulder straps and padded back
- pack light (shouldn’t weight more than 10 to 20 percent of child’s body weight)
Youth violence
- harmful behaviors that can start early and continue into young adulthood
- person can be a victim, an offender, ora witness to the violence
- violent acts - various behaviors: bullying, slapping, or hitting, can cause more emotional harm than physical; others, such as assault (with or without weapons), can lead to serious injury/death
Bullying
-form of violent behavior that can lead to serious problems: between 8-38% of children/adolescents report bullying; bullied child at risk for behavioral problems, physical health problems, and suicidal ideation; young children tend to believe that bullying is acceptable; older children believe victims are at least partially responsible for bringing on bullying
Bullying Behavior
- the AAP defines bullying as a form of aggression in which one or more children repeatedly and intentionally intimidate, harass, or physically harm a victim who *cannot defend herself or himself
- bullying behavior is purposeful and is aimed at gaining control over another child; mild to severe
Consequences of bullying
- victims can experience low self esteem, depression, and anxiety
- academic performance and progress can be impaired
- retaliation; suicide
