Highlights of Chapter 17

1. Highlights of Chapter 17 Toddlers

2. Developmental highlights ofToddlers • Autonomy vs. shame and doubt • Negativism • Ritualism • Anal • Preoperational • Magical thinking • Play is parallel

3. Physical development • Gains 4-6 pounds per year • Grows 4 inches per year • Bowel and bladder control achieved by 2 1/2-3 years (based on myelination of the spinal cord) • Primary dentition (deciduous teeth) complete by 2 1/2 years • Page 399 new 405 old book

4. Piaget, Erikson and Freud • Preoperational stage • Autonomy vs Shame and Doubt • Anal

5. Piaget; preoperational characteristics • Egocentric • Reality based on perceptions; magical thinking • Early language, symbolic: words represent something.

6. Autonomy Vs Shame and Doubt • Child recognizes his willfulness • “I will do it myself” • “No” (negativism) • Has own food choices • Curiosity to explore and “get into everything” • Ritualistic behavior

7. Autonomy Vs Shame and Doubt • increased independence =confidence and security in their own ability to survive in the world. • overly controlled, or not given the opportunity to assert themselves = inadequate in their ability to survive, and may then become overly dependent upon others, lack self-esteem, and feel a sense of shame or doubt in their own abilities.

8. Val’s Keys to Coping. • Stay a step ahead of the situation. • Think like a toddler! • Offer acceptable choices. • Utilize rituals for bedtime, meals, etc. • Choose battles carefully. • Keep household simple and safe. • “Thank you for……”

9. Freud’s Anal Stage of Development • Age one to three • Focus around learning the complex emotional, cognitive and motor task of toilet training. • Fixation can develop in either “explosive” or “retentive” form.

10. Parent and nursing implications • Understanding the complex task of toilet training from a physical, cognitive and emotional perspective is imperative • Understanding that when toddlers are under stress they will regress. That is if they have had the ability to be toileted they might temporarily loose that ability until the stress has subsided.

11. Twelve to Sixteen Months • Walking well • Creeping up stairs, running, climbing on furniture • Tower of two to three cubes • Imitating scribbles • Dumping pellet in and out with demonstration • Go to table 17-1

12. Eighteen Months • Can walk backwards • Pushes and pulls large objects • 4 cube tower • Spontaneous scribble • Points to 3 body parts • Names one picture on command

13. Twenty Four Months • Jumps • Kicks ball • Walks down stairs with rail • Throws overhand • 6 cube tower • Vertical Stroke • Points to Six Pictures

14. More Pictures of Toddlers

15. Language Milestones; Expressive • Dada/Mama nonspecific at 8 months and specific at 10 months • First word at 11 months • Second word at 12 months • Jargon at 15 months; three to five words • 5 to 10 words by 16 months • Two word sentences at 24 months; 50 words • Can use “I” “you” “me” at 24 months • Pronouns at 36 months (he, she, it, that) • Pleural at 36 months (toys, books, animals) • Table 17-2

16. Language MilestonesReceptive • Understands “no” at nine months • Understands “bye bye” at nine months • Follows one step command by 16 months • Knows one body part by 18 months • Points to one picture in book by 18 months • Follows two step command by 24 months • Points to six pictures by 24 months • Follows prepositional commands by 36 months

17. Guidance and discipline • Goal is to teach toddler self-control with positive self-esteem • Use a positive approach “thank you for…..” • Offer choices within limits • Avoid the word “no” • Time-out: 1 minute per year of age • Favorite possessions and rituals important self consoling behaviors. • Focus on the behavior not that child when disciplining • Eye level communication • Consistent routine

18. Toilet Training • Myelinization of spinal cord complete by 2 years: voluntary control of sphincters • Look for signs of readiness • Stays dry approximately 2 hours • Able to communicate that he or she is wet or needs to urinate/defecate • Willing to sit for at least 5-10 minutes • Other signs…….

19. Nutrition • Fluctuating appetite with strong food preferences • Begin whole milk at 12 months of age, wean from bottle • Limit milk to 24 ounces per day • Serving size: 1 tbsp of food per year of age • Likes finger foods: consider safety • Ritualism at mealtime • Calorie needs 100 Calories/kg.

20. Iron Deficiency Anemia • Risk factors • Excess amounts of whole cow’s milk • Poor dietary intake of iron • Impaired absorption • Infection • Sickle cell, thalassemia

21. Iron deficiency anemiaNursing management • Dietary management • Iron preparations • Foods high in vitamin C • Liquid Fe via straw

22. Lead Poisoning • Lead absorbed through GI tract & pulmonary system. • Assessment findings: • Colicky pain, • constipation, • anorexia, • vomiting, weight loss • Pallor, listlessness, fatigue • Clumsiness, loss of coordination, ataxia, • irritability • seizures • Encephalopathy • Treatment begins at lead levels of 45µg/dL • Surf the articles at this site: http://www.nsc.org/issues/lead/