Download Highlights of Chapter 17

Highlights of Chapter 17
Toddlers
Developmental highlights of
Toddlers
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Autonomy vs. shame and doubt
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Negativism
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Ritualism
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Anal
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Preoperational
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Magical thinking
Play is parallel
Physical development
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Gains 4-6 pounds per year
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Grows 4 inches per year
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Bowel and bladder control achieved by 2 1/2-3
years (based on myelination of the spinal cord)
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Primary dentition (deciduous teeth) complete by
2 1/2 years
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Page 399 new 405 old book
Piaget, Erikson and Freud
Preoperational stage
Autonomy vs Shame and Doubt
Anal
Piaget; preoperational
characteristics
Egocentric
Reality based on perceptions; magical
thinking
Early language, symbolic: words represent
something.
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
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.
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……”
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.
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.
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
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
Twenty Four Months
Jumps
Kicks ball
Walks down stairs
with rail
Throws overhand
6 cube tower
Vertical Stroke
Points to Six Pictures
More Pictures of Toddlers
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
Language Milestones
Receptive
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
Guidance and discipline
Goal is to teach toddler self-control with positive selfesteem
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
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…….
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.
Iron Deficiency Anemia
Risk factors
Excess amounts of whole cow’s milk
 Poor dietary intake of iron
 Impaired absorption
 Infection
 Sickle cell, thalassemia
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Iron deficiency anemia
Nursing management
Dietary management
Iron preparations
Foods high in vitamin C
Liquid Fe via straw
Lead Poisoning
Lead absorbed through GI tract & pulmonary system.
Assessment findings:
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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
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