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Synops Final
 

Synops Final

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behavioral problems of toddlers

behavioral problems of toddlers

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    Synops Final Synops Final Document Transcript

    • RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1 NAME OF THE CANDIDATE Mr. VISHWAS JOG. K AND ADDRESS I Year M.Sc Nursing, Padmashree Institute of Nursing Nagarbhavi Bengaluru-72. 2 NAME OF THE INSTITUTE Padmashree Institute of Nursing Bangalore 3 COURSE OF THE STUDY AND I Year M.Sc Nursing SUBJECT Child Health Nursing. June 2007 4 DATE OF ADMISSION Assessment of effectiveness of 5 TITLE OF THE STUDY structured teaching programme on knowledge regarding behavioral problems of toddlers among mothers at selected community of Bengaluru. . 1
    • 6. BRIEF RESUME OF THE INTENDED WORK 6.1 INTRODUCTION quot;Whatever they grow up to be, they are still our children, and the one most important of all the things we can give to them is unconditional love. Not a love that depends on anything at all except that they are our childrenquot;1 Toddlers are learning to think. They have opinions and ideas. They want to do things their own way. They have learned how to say no, and they can physically resist what they do not want. However, they are still too young to understand how their actions affect others, to see danger, and to think before they act. It is important for children to become independent. We want them to grow up to follow their own ideas. However, we must keep children safe. We also must teach them to .consider the needs of others, to mind parents about important things, and to say no in acceptable ways. 2 Behavior problems in toddlers are common, and they most commonly result from the child's need for autonomy and exploration behavior problems, toddlers, hitting, biting, temper tantrums. These needs arise from the child's newly acquired mobility and communication skills. 3 2
    • Behavior problems of toddlers are many most commonly seen problems are temper tantrum, aggression, bed-wetting, thumb-sucking, biting and hitting, sleep problems, specific eating problems etc. 3 One can notice behavior like this beginning around child's first birthday. It may happen more and more before the second birthday. At this age, most children do not yet have good language skills. They often misunderstand what parents want them t do, and they cannot speak many words to express their feelings and needs. 7 Most children gradually become more cooperative between 3 and 5 years old. They can think and remember better. They learn more about using and listening to words. They get better at controlling their emotions and their behavior. Moreover, they learn what adults expect of them. 4 Mothers will play an important role in early identifications of toddlers' behavioral problems while they are spending time with the child. Many of the mothers have fear of their children's behavior in negative way. Amy. M. Smith (2004) states that over reactive mothers are also cause behavioral abnormalities among toddlers. 6 The diagnosis of behavioral problems of toddlers like temper tantrum, thumb sucking, bed-wetting, biting and hitting, aggression are made only by parental reporting or if child hospitalized can be observed by the health team members mainly by nurses. 5 Teaching toddlers is only measure can take to treat behavioral problems. First, parents need to model these examples themselves. The old saying quot;Do what 3
    • I say, not what I doquot; is poppycock. Kids pay attention to their parent's actions. Having examples from us will help toddler understand the concept much easier. More than any other member of the health team, nurse have the most frequent and direct contact with families; therefore, they can provide parents with education regarding behavioral problems of toddlers. 6.2 NEED FOR THE STUDY Behavioral problems are most frequent in toddler age group of children. It almost all children have some other kind of behavioral problems. Most children can adjust to their natural and social environments within normal range. Mothers are having more opportunity to observe the behavioral problems of their toddlers. 5 Most commonly, a toddler exhibits behavioral problems such as temper tantrum, aggression, thumb-sucking, biting and hitting, sleep problems, specific eating problems are certain unwanted behaviors that need immediate attention as well as analysis of situation4 A study was done on influence of maternal smoking on behavioral problems of toddlers, the findings suggest that maternal smoking during pregnancy has an adverse effect on the child's behavioral problem, and that a decrease in maternal smoking during pregnancy might expected to lead to a decrease in the child's behavioral problem. The relationship of maternal smoking during pregnancy and early childhood negativity to other problem behaviors remains to explore. 8 A study was done on persistence of parent-reported social-emotional and behavioral problems in infants and toddlers. Findings indicate that infant-toddler 4
    • social-emotional/behavioral problems are not transient and highlight the need for early identification, multidomain and family assessment, and effective early intervention.8 A study was done on testing a maternal attachment model of behavior problems in early childhood. The study concluded that, there are meaningful associations between attachment insecurity and behavior problems as assessed not only by mothers but also by caregivers. 10 Another study was done on effect of television watching on aggressive behavior of toddler shows that, toddlers who watched too much television become aggressive and suffered from poor attention span. It also found that the number of children who were spending more time in front of television is also raised. 11 In terms of time spent with the child, mother has more opportunities than father does to influence her offspring's psycho-social growth and behavior, since child rearing in our culture is generally recognized as primarily the mother's privilege and responsibility. The toddler's age group said to be the most active period in child development. He is at his creative best. This rapid pace of development is also accompanied by behavioral change in the child. Mothers have to be made aware about their child’s developmental stages, what problems can expect? And how to manage them? 6 In light of above facts with the personal experience of the investigator working as staff in caring toddlers have encountered many parents specially mothers with the complaints of various unwelcome behaviors of their toddler children. So this has created interest in investigator to provide a structured 5
    • teaching programme on behavioral problems of toddlers to mothers of the toddlers. 63 STATEMENT OF THE PROBLEM A study to assess the effectiveness structured teaching programme on knowledge regarding behavioral problems of toddlers among mothers at selected community of Bengaluru. 6.4 OBJECTIVES 1 .To assess the pretest knowledge regarding behavioral problems of toddlers among mothers. 2. To assess the post test knowledge regarding behavioral problems of toddlers among mothers. 3. To evaluate the effectiveness of structured teaching programme on knowledge regarding behavioral problems of toddlers among mothers 4. To associate posttest knowledge regarding behavioral problems of toddlers among mothers with their selected demographic variables. 6.5 OPERATIONAL DEFINITIONS 1. Knowledge: It refers to level of understanding regarding behavioral problems of toddlers among mothers 2. Effectiveness: It refers to the improvement in knowledge of mothers regarding behavioral problems of toddlers 6
    • 3. Structured teaching programme: It refers to systematically organized teaching strategy for duration of 45 mins to one hour for mothers on behavioral problems of toddlers by verbal interaction with the use of flash cards. 4. Behavioral problems: In this study behavioral problem refers to certain selected problems like temper tantrum, thumb sucking, aggression, negativism, sibling rivalry. 5. Toddlers: Toddlers are children of age group between one to three years. 6. Mother: A mother is a biological and/or social female parent of a toddler. 6.6 ASSUMPTIONS 1. Mothers may have inadequate knowledge regarding behavioral problems of toddlers. 2. Structured teaching programme will improve the knowledge regarding behavioral problems of toddlers. 3. Mother's knowledge may vary with selected demographic variables. 7
    • 6.7 RESEARCH HYPOTHESES H1: There is a significant difference between mean pre test and post test knowledge regarding care behavioral problems of toddlers among mothers. H2: There is a significant association between the knowledge of the mothers with their selected demographic variable. 6.8 REVIEW OF LITERATURE A study done on Phonological Behavior in Toddlers with slow expressive language development Toddlers, were compared to normally speaking age-mates on three global measures of phonological behavior: the average level of complexity of their syllable structures, the number of different consonant phonemes produced, and the percentage of consonants correctly produced in intelligible utterances. The groups were found to differ significantly on all three variables. Detailed analyses of the range of phonemes and syllable structures produced, as well as the appearance of phoneme classes within syllable structures and positions, revealed that late talkers showed a delayed rather than a deviant pattern of phonological development. The implications of these findings for identifying and monitoring expressive delay in toddlers are discussed. A study done on temper tantrum in children, analyzed 335 children of aged 18 to 16 months Modal tantrum durations were 0.5 to 1 minute; 75% of the tantrums lasted 5 minutes or less. If the child stamped or dropped to the floor in the first 30 seconds, the tantrum was likely to be shorter and the likelihood of parental intervention less. A novel analysis of behavior probabilities that permitted grouping of tantrums of different durations converged with our previous statistically independent results to yield a model of tantrums as the expression of 8
    • two independent but partially overlapping emotional and behavioral processes: Anger and Distress. Anger rises quickly, has its peak at or near the beginning of the tantrum, and declines thereafter. 13 A study done on sucking habits of toddler and effects on primary dentition This study determined the prevalence of non-nutritive sucking habits and the effects on the developing dentition within a longitudinal observational cohort. The Children in Focus Longitudinal Study of Pregnancy and Childhood was studied. Questionnaire data on non-nutritive sucking habits were collected on the children at 15 months, 24 months, and 36 months of age. Dental examinations were performed on the same children at 31 months, 43months, and 61 months of age.14 A study was done on how toddler eating problem relate their eating behavior .Eating problems are a common cause of concern for the parents of toddlers, but few studies have examined the correlates, of eating problems or the growth patterns associated with them in a large population-based sample. Goal of study was to examine the distribution of eating behaviors in a large representative sample of toddlers and their mothers' approach to feeding. In addition, describe the prevalence of parentally perceived eating problems and how they relate to specific behaviors, food preferences, and growth in the child.15 A study was done on mothers over reacting discipline and toddlers externalizing behavior examine over 500 mothers who are over reactive in terms of their toddlers discipline on behaviors. The study concluded that there is an association between mothers over reactive discipline and toddler's externalizing behaviors in the form of temper tantrum and many other psychological problems. 16 9
    • A study was done on Parenting of temper tantrum toddler in this study 108 temper tantrum toddlers were studied and mothers were assessed for their method of parenting toddlers during there visit to the care center by there interaction with their toddlers. Study concluded that behaviors of mother have significant effects on toddlers temper tantrum. And the management of these kinds of problems can be achieved only by changing mother's behaviors. 17 A study was done on Prevalence of social and behavioral problems of infants and toddlers. The studies done on children of age group 1 to 2 years and of 1280 of samples were included for this study. Social and behavioral problems of toddler parent questioner were used. The study concluded that 80% of selected samples are affected with some form of clinical and sub clinical symptoms of social and behavioral problems. A significant need for early identification of social and behavioral problems in very young children is highlighted.18 A study was done on effect of prenatal stress on behavioral problems of toddlers; the study was conducted on 200 prenatal mothers and assessed for there stress levels by examining level of cortisone in saliva. Children assessed by direct observation while their mother's interview to the hospital. The study concluded that there is an increase chance of behavioral problems of toddlers with prenatal stress and increased levels of maternal prenatal stress appear to be associated with temperamental and behavioral problems in toddlers. 19 A study was done on toddler aggressiveness associated with parenting and maternal relations. This study examined the relation among parenting factors, marital relations, and toddler aggression. A structured questionnaire was administered to both parents of 254 2-year-olds. Results showed that the maternal child-rearing and parental aggression domains had a direct effect on toddler aggression. 20 10
    • A study was done on behavioral problems of toddlers associated with alcoholic parents. This study examined the relationship between paternal alcoholism and toddler behavior problems from 18 to 36 months of age, as well as the potential moderating effects of 12-month infant-mother attachment security on this relationship. Children with alcoholic fathers had higher levels of internalizing and externalizing behavior than children of nonalcoholic fathers. 21 7. MATERIALS AND METHODS 7.1 SOURCE OF DATA The data will be collected, from the mothers of toddlers in selected community, Bengaluru. 7.2 METHODS OF COLLECTION OF DATA i. Research design Quasi-Experimental - one group pretest posttest design ii. Research variables Dependent variables: Level of knowledge of mothers on behavioral problems of toddlers. Independent variables: Structured teaching programme on knowledge regarding behavioral problems of toddlers. 11
    • iii. Setting The study will be conducted in selected community at Kengeri Upanagara, Bengaluru. iv. Population All the mothers having children of age group between one to three years in selected community. v. Sample Mothers who fulfill inclusive criteria and sample size are 60. vi. Criteria for sample selection Inclusive criteria: The study includes: 1. Mothers of children age group between one to three years. 2. Mothers who are available at the time of data collection. Exclusive criteria: The study will exclude: 1. Mothers, who cannot understand Kannada/English language. 2. Mothers who are not willing to participate vii. Sampling technique Non- probability convenient sampling technique. 12
    • viii. Tool for data collection The tool consists of two sections: Section A: Demographic variable such as age, education, family income, religion, occupation, number of children, age of marriage. Section B: Structured questionnaire is used to assess the knowledge of mothers on behavioral problems of toddlers. ix. Method of data collection. After obtaining the permission from the concerned authorities and informed consent from the samples the investigator will collect the data in following three phases. Phases-One - Pre test will be given to assess the existing knowledge of mothers on behavioral problems with the help of structured questionnaire. Phases-Two - On the same day structured teaching programme will be given to mothers on behavioral problems by using flash card for 45mt -1 hr duration. Phases-Three - Same questionnaire will be administered on behavioral problems of toddlers to mothers after 7 days. Duration of the data collection is 4 to 6 weeks. 13
    • x. Plan for data analysis The data collected will be analyzed by means of descriptive statistics and inferential statistics. Descriptive statistics: Frequency and percentage distribution of demographic variables will be analyzed. Mean, and standard deviation will be used to assess the level of knowledge of mothers regarding behavioral problems of toddlers. Inferential statistics: Paired-'t' test will be used to compare the pretest and posttest knowledge regarding behavioral problems of toddlers among mothers; chi-square test will be used to associate posttest knowledge on behavioral problems of toddlers with selected demographic variable. xi. Projected outcome Structured teaching will improve the knowledge of mothers regarding behavioral problems of toddlers. This will enable the mothers to improve their self-help skills in their activities of daily living. 7.3 Does the study require any investigation or interventions to be conduct on patients or other human or animals? Yes, structured teaching programme will be administered for mothers on behavioral problems of toddlers in selected community at Bengaluru. 7.4 Has ethical clearance been obtained from your institution? 14
    • Yes, permission will be obtained from concerned authority and informed consent will be obtained from samples. List of references: 1. Rosaline Dickson quotes Available from: URL: .http//www.thinkexist.com 2. Rekha Anup Kumar. Child Health Action. 2006 July; volume 19 (issue no.7): 30-31. 3. Dorothy R Marlow, Barbara A Redding. Text book of pediatric nursing; behavioral characteristics of toddlers. Philadelphia: Elsevier, 2005.733-34 4. Hockberry, Wilson, winkelsteina, kelin, Wong's. Nursing Care of New bom and Children: health promotion of toddlers, Philadelphia: Elsevier, 2005. 601, 05, 07, & 09a 5. O.P.Ghai, Piyush Gupta, U.K. Paul. Essentials of Pediatrics: Developmental Problems, Delhi: O.P.Ghai, 2005. 55-56 6. Rekha Anup Kumar. Know Your Child Better. Health Action. 2006 September; volume 19 (issue no.9): 23-24 7. L. Warren, available from: URL http://www.associatedcontent.com 8. Judith S. Brook, David W. Brook, MD; Martin Whiteman, the Influence of Maternal Smoking During Pregnancy on the Toddlers Arch Pediatr Adolsec med Apr-2000 vol 154, P.No. 381- 385. Available from: URL: archpedi.ama-assn.org 15
    • 9. Briggs gowan, Margaret J. carter, Alices S. Bosson heenan John BA et.al. Social emotional problems infants and toddlers, July 2006 Volume 849-858. 10. Me Cartney K, Owen M T Booth C L Clarke- Stewart, A. Vandell D L Testing maternal attachment model of behavior problems in early childhood. Journal of Child Psychology and Psychiatry. May- 2004 .Volume.45.(issue no.4).765-778. 11. S. Harring K, Gray J Taffe, D Sweeny S. Einfeld, Effect of Television Watching on Toddler's Aggressiveness. University of New south wells; 2006.Volumel8. 1365-2788. 12. Gail S. Ross Language delay and Behavioral problems in toddlers. Weill- Comell University Medical College. August.2007.Vol.50. 1063- 1078. 13. Potegal M, Kosork MR, Davidson RJ. Temper Tantrum in children. Department of Psychology, University of Wiscosin. December.2001 .Volume.43:651-61. 14. Dukan K, McNamara. C, Ireland AJ, Sandy JR. Sucking, sucking habits of toddler and effects on primary dentition. School Of Dental Care Professionals, University of Bristol, May.2008.Volume.l8(issue no.3):178-88. 15. Wright CM, Parkinson KN, Shiptona D Drewett RF, how toddler eating problem relate to their eating behavior. Glasgow University, Glasgow.2007.october.(issue no. 4).1069-75. 16
    • 16. Springer Netherlands Mothers over reacting discipline and toddlers externalizing behavior. Journal of abnormal child psychology.2001.november.5:331-341 17. Kenneth H Rubin, Kirn B Burgees & Poul D. Hastings. Parenting of temper tantrum toddler. University of Maryland. 2002.volume.24(issueno.3): 140-47 18. Sarah McCue Horwith, Prevalence of social and behavioral problems of infants and toddlers. Journal of the American Academy of Child & Adolescents. 2001. July .Volume-40.(issue no.7):811-19 19. Gutteling BM, de Werth. C. Prenatal Stress on Behavioral Problems of Toddlers, Eru Child Psychiatry. Feb.2005.Volumel4(issue no.l).41-51 20. Brook JS, Zehag L,Whiteman M, Brook DW. Toddler aggressiveness associated with parenting and maternal relations. Mount Sinai School of Medicine.2001.Feb.Volume-162(issueno.2):228-41 21. Edwards EP, Eiden RD Leonard KE. Behavioral problems of toddlers associated with alcoholic parents. Research Institute. 2006.Vomme.l8(issue2):395-407 17