Chapter 017 lo

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  • Discuss Erikson’s stage of autonomy versus shame and doubt as based on a continuum of trust established during infancy. Ask students to give examples of autonomy, shame, and doubt in the toddler. Ask students how lack of trust can likely affect the toddler’s growth and development.
  • Discuss a situation or method in which a parent can provide the opportunity for socialization while providing a safe environment. What situations and choices might a parent offer to distract the toddler?
  • Have students offer examples of how a parent can assist the toddler in expressing anger. What rituals could instill a sense of security in the toddler? Audience Response Question #1 The first thing a toddler does when visiting his grandmother is to ask for a drink in his favorite cup. The nurse tells the parents he does this because: 1. it increases his sense of security. 2. it is a form of obsessive compulsive disorder. 3. he is thirsty. 4. toddlers require increased fluids.
  • Discuss why a toddler might not be ready for toilet training based upon age and development. Audience Response Question #2 A parent should be concerned if his or her child is not bowel and bladder trained by age 3. 1. True 2. False
  • Describe abdominal respirations versus thoracic respirations. Discuss the eruption of teeth and proper oral hygiene.
  • Discuss how sensory and motor functions are synchronized. Review Table 17-1 on page 407 with the class. Give an example of how a toddler learns from trial and error. What are examples of Piaget’s sensorimotor and preconceptual phases of development?
  • Discuss how the toddler has progressed to manage longer periods of time away from his or her parents. What is an example of cause and effect? Give examples of how toddlers model behavior.
  • What are essential and nonessential body parts? Give an example of a situation in which a parent might provide love when a toddler has exhibited improper behavior.
  • Give an example of parallel cognitive growth. What is receptive language? Make facial expressions and ask students to identify the emotions behind them.
  • Discuss the nurse’s role when assessing a toddler who might have autism. How can the nurse communicate with a toddler who has autism? Discuss the term pervasive developmental disorder (PDD).
  • Give an example of how parents’ reactions to the toddler’s temper tantrum can affect the toddler’s behavior in the future. What is an example of a limit and time-out for a toddler?
  • Give examples of positive reactions to a toddler’s behavior by the parents. Discuss how the parents’ reaction to a toddler’s behavior affects the toddler’s self-confidence. How can physical aggression and fear tactics affect the toddler negatively?
  • Give an example of a fear-evoking event. What self-consoling behavior might a toddler implement when dealing with fear and separation?
  • Give an example of a household item which needs to be adjusted to meet the needs of the entire household. Describe how flexibility with a household schedule assists the family (household) during the day. Which clothing could interfere with toilet training? What methods can be used to protect the toddler from sunburn?
  • What are examples of proper and improper footwear for the toddler?
  • Discuss methods that assist the toddler in toilet training. What methods are detrimental to toilet training? Give an example of a situation in which a parent is trying to force the toddler toward toilet independence.
  • Discuss why it is necessary to place the toddler on the toilet for just a few minutes. What words might a toddler use to indicate defecation and/or urination?
  • Why is it important to limit milk intake? Give an example of various foods to offer during a meal. What are examples of finger-foods? If well-nourished, the toddler shows steady and proportional gain in height and weight.
  • Give an example of a personal preference a family might have and how it affects their choice of day care. Which cultural issue could affect a toddler in the day care setting? Discuss special needs a toddler might have and how this could affect the care provided in the day care setting.
  • Give an example of a toddler’s attention span. What is parallel play?
  • Give an example of how parents might have to release their inhibitions and allow others to influence their toddler. Discuss the facility’s responsibility to provide an environment which does not influence the toddler negatively.
  • Give an example of age-appropriate risks for the toddler. Provide an age-appropriate initiative by a parent to enhance safety in the home. What is a curious activity a toddler might engage in within the home? Audience Response Question #2 When a toddler is leaving the hospital, it is the nurse’s responsibility to ensure the child is appropriately buckled in his or her car seat. 1. True 2. False
  • Discuss proper guidelines for car seats.
  • Give an example of a toy parents might decide not to purchase for their toddler because of safety issues. How is play toddler’s work?
  • Discuss egocentric thinking. Discuss other vectors within your community from which the toddler must be protected. What methods would you use to childproof a home? Discuss childproofing the grandparent’s and/or sitter’s home.
  • Protest Despair Detachment
  • Chapter 017 lo

    1. 1. Chapter 17Chapter 17The ToddlerThe Toddler
    2. 2. ObjectivesObjectives• Describe the physical, psychosocial, andcognitive development of children from 1 to 3years of age, listing age-specific events andguidance when appropriate.• Discuss speech development in the toddler.• Describe the task to be mastered by thetoddler according to Erikson’s stages ofgrowth and development.2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    3. 3. ObjectivesObjectives (cont.)(cont.)• List two developmental tasks of the toddlerperiod.• Discuss the principles of guidance anddiscipline for a toddler.• Discuss how adults can assist small childrenin combating their fears.• Identify the principles of toilet training (boweland bladder) that will assist in guiding parents’effort to provide toilet independence.3Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    4. 4. ObjectivesObjectives (cont.)(cont.)• Describe the nutritional needs and self-feeding abilities of a toddler.• List two methods of preventing the following;automobile accidents, burns, falls, suffocationand choking, poisoning, drowning, electricshock, and animal bites.• Describe the characteristic play andappropriate toys for a toddler.4Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    5. 5. General CharacteristicsGeneral Characteristics• A toddler is between 1 to 3 years of age• No longer completely dependent on others• Rapid growth and development duringinfancy slows down• Erikson’s stage of autonomy versus shameand doubt5Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    6. 6. General CharacteristicsGeneral Characteristics (cont.)(cont.)• Major parental responsibility– Maintaining safety for the toddler whileallowing the opportunity for social and physicalindependence– Maintain positive self-image and body imagein child• Negativism can be countered by offeringlimited choices and the use of distraction inhandling toddlers whose favorite word is “no”6Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    7. 7. General CharacteristicsGeneral Characteristics (cont.)(cont.)• Developing self-control and sociallyacceptable outlets for aggression and angerare important in the formation of personalityand behavior• Rituals increase the toddler’s sense ofsecurity by making compulsive routines ofsimple tasks7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    8. 8. Physical DevelopmentPhysical Development• Birthweight quadruples by 2.5 years of age• Rate of brain growth slows• Body proportions change– Head and trunk grow more slowly• Musculoskeletal system grows and bones begin toossify• Protuberant abdomen flattens when muscle fibersincrease in size and strength• Myelination of spinal cord nearly complete by 2years• Bowel and bladder control usually complete by 2.5to 3 years of age8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    9. 9. Physical DevelopmentPhysical Development (cont.)(cont.)• Respirations still mainly abdominal but shift tothoracic as child reaches school-age• Capable of maintaining stable body temperature• Eruption of deciduous teeth complete by 2.5years• Defense mechanisms of the skin and blood aremore effective• Digestive processes and stomach capacityincrease to allow three-meal-a-day schedule9Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    10. 10. Sensorimotor and CognitiveSensorimotor and CognitiveDevelopmentDevelopment• Sensory and motor abilities do not functionindependently• Memory strengthens• Is able to assimilate information through trial,error, and repetition• Piaget’s sensorimotor and preconceptualphase of development emerges rapidly in thisage group10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    11. 11. Sensorimotor and CognitiveSensorimotor and CognitiveDevelopmentDevelopment (cont.)(cont.)• Able to tolerate longer periods of separationfrom parents to explore environment• Aware of cause and effect• Concept of spatial relationships develops• Begins to internalize standards of behavior• Copies words and roles of the models seen inthe home11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    12. 12. Sensorimotor and CognitiveSensorimotor and CognitiveDevelopmentDevelopment (cont.)(cont.)• May confuse essential with nonessentialbody parts/functions• Expelling feces and urine and then flushing itdown the toilet may be upsetting as thetoddler may see it as flushing a part ofthemselves away• Nurse should teach parents skills that willenable the toddler to feel loved even ifbehavior is not acceptable12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    13. 13. Speech DevelopmentSpeech Development• Parallels cognitive growth• Expressive and receptive language continueto develop• Respond to tone of voice and facialexpressions of those around them• Showing empathy toward the toddler who istrying to communicate verbally will helpminimize frustrations13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    14. 14. Screening for Signs of AutismScreening for Signs of Autism• Preliminary symptoms may include– No pointing, gesturing (e.g., bye-bye) by 12 months– No single words by 16 months– No spontaneous two-word phrases by 24 months– Loss of achieved language or social skills• Important to rule out lead poisoning, hearingdeficit, neurological disorders,musculoskeletal diseases and inborn errorsof metabolism.14Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    15. 15. Guidance and DisciplineGuidance and Discipline• Goal is to teach, not punish• Discipline involves guidance• Parent responses to temper tantrums caneither reinforce the desirability of or the risksinvolved in such behavior• Expectations must be in line with the child’sphysical and cognitive abilities– Limit-setting– Time-outs15Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    16. 16. Guidance and DisciplineGuidance and Discipline (cont.)(cont.)• Child seeks approval– Use positive approach whenever possible– Approval increases self-confidence• Use of fear or physical aggression with atoddler does not foster self-control– Can lead to physical and emotional abuse16Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    17. 17. Guidance and DisciplineGuidance and Discipline (cont.)(cont.)• Fear-provoking event affects extent oftoddler’s reaction– If alone, fear may be greater– Once fear has been learned, it is more difficultto eliminate• Stress increases fear of separation– Self-consoling behaviors include favoritepossession or repetitive rituals17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    18. 18. Daily CareDaily Care• Adults should be at eye level when talking totoddler– Seems less overwhelming• Flexible schedule organized around needs ofentire household is best• Clothing should be easily put on andremoved• Sunburn protection18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    19. 19. Daily CareDaily Care (cont.)(cont.)• Shoes should fit shape of foot and be ½ inchlonger and ¼ inch wider than the foot• Important for toddler to wear their regularshoes to the clinic as it shows the health careprovider how the body is being used• Posture is greatly influenced by that of otherfamily members19Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    20. 20. Toilet IndependenceToilet Independence• Much depends ontemperament of thetoddler and theperson guiding toilettraining• Voluntary control ofanal and urethralsphincters beginsaround 18 to 24months of age20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    21. 21. Toilet IndependenceToilet Independence (cont.)(cont.)• Use potty chair or place the child on the toiletfacing the tank• Bowel training usually attempted first• Do not leave toddler on toilet for more than a fewminutes at a time• Bladder training can begin when toddler staysdry for about 2 hours• If toddler has special words for defecation orurination, be sure to tell other health careproviders and document in care plan for toddler21Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    22. 22. Nutrition CounselingNutrition Counseling• Caloric needs decline to about 100calories/kg/day• Limit milk intake to no more than 24 ounces(720 mL) per day• Serving size is 1 tablespoon of solid food peryear of age• Food is chopped into fine pieces• Various foods are offered• A 2-year-old likes finger foodsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22
    23. 23. Day CareDay Care• Must meet families’– Personal preferences– Cultural perspectives– Financial and special needs• Should be state-approved23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    24. 24. Day CareDay Care (cont.)(cont.)• Differs for toddlers because– Shorter attention span– Tendency to engage in parallel play ratherthan group play– Need closer supervision to maintain safety24Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    25. 25. Nursing TipNursing Tip• A major task for parents is to “let go” andallow the toddler to interact with influencesoutside the family in day care centers orpreschools25Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    26. 26. Injury PreventionInjury Prevention• Best prevention is knowledge of age-appropriate risk and anticipatory guidelines• Parents need to understand their child’sactivities at certain ages in order to preventinjuries by taking appropriate precautions• Toddlers are curious and mobileElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26
    27. 27. Injury PreventionInjury Prevention (cont.)(cont.)27Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    28. 28. Toys and PlayToys and Play• Parents must betaught to inspecttoys and to buy toyssuitable to the age,skills, and abilities oftheir child• Play is the work oftoddlers• Through play theylearn how to– Manipulate andunderstand theirenvironment– Socialize– Explore their world28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    29. 29. Toys and PlayToys and Play (cont.)(cont.)• Social development takes form• Egocentric thinking• Parallel play gradually leads to cooperativeplay• Protect the child from sunburn, mosquitoes,and other vectors• Childproofing the home is also important29Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    30. 30. Question for ReviewQuestion for Review• What are the three stages of separationanxiety?30Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    31. 31. ReviewReview• Objectives• Key Terms• Key Points• Online Resources• Critical Thinking Question• Review Question31Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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