behavioral problems of toddlers

1. 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.
.
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2. 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
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3. 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
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4. 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
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5. 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
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6. 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
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7. 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.
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8. 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
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9. 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
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10. 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
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11. 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.
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12. 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.
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13. 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.
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14. 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?
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15. Yes, permission will be obtained from concerned authority and informed consent
will be obtained from samples.
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