PARENTING A TODDLER

ELECTIVE 1

ASSESSMENT OF GROWTH AND DEVELOPMENT AMONG TODDLERSA. Physical Development

They tend to have a prominent abdomen; abdominal muscles are not strong enough to support abdominal contents. Toddlers waddle when they walk; they also have a wide distance when walking. Heart rate is approximately 90bpm; blood pressure increases to about 99/64mmHg The child is able to eat 3 meals every day due to increase in stomach capacity. Gastric secretions become more acidic. Urinary and anal sphincter control becomes possible with complete myelination of the spinal cord. All 20 deciduous teeth are present by 2 ½ to 3 years of age.

B. Emotional Development The developmental task during this period is to learn a sense of autonomy. An optimum level of autonomy is achieved when parents are able to encourage independence while still maintaining sound rules to promote safety. Toddlers are able to differentiate themselves at separate individuals. When the child reaches 18 months, toddlers begin to imitate what they see. By 2 years of age, they become aware of gender differences and are able to identify themselves as a boy or girl. Common behaviors manifested by toddlers include:

Does not separate easily from parents Negativism Prefers rituals and routine activities Active physical explorer of environment

Begins attempts at self-assertion Easily frustrated by limits Temper tantrums May have favorite “security object” Uses “mine” for everything; does not understand concept sharing

C. Cognitive Development The toddler enters the fifth stage of sensorimotor though or tertiary circular reaction stage (between 12 and 18 months). This behavior can be simply described as extreme curiosity or interest in trying to discover new ways to handle objects or new results. By stage 6 (18 – 24 months), problem solving or symbolic thought emerges. Children at this stage are also able to remember an action and imitate it later (deferred imitation). At the end of toddler period, children begin to use a process known as assimilation. They are not able to change their thoughts to fit a situation; therefore, they have to change the situation to fit their thoughts

PLANNING AND IMPLEMENTATION FOR HEALTH PROMOTION AMONG TODDLERSA. Safety POTENTIAL ACCIDENTS PREVENTIVE MEASURES

Motor Vehicles Maintain child in car seat: do not be distracted from safe driving by a child in a car.

Do not allow child to play outside unsupervised. Do not allow child to operate electronic garage doors.

Supervise toddler who is too young to be left alone on a tricycle

POTENTIAL ACCIDENTS PREVENTIVE MEASURES Teach safely with pedalling toys (look before crossing driveways: do not cross streets) but do not expect that toddler will obey these rules at all times (in other words, stay close by).

Falls Keep house windows closed or keep secure screens in place.

Place gates at top and bottom of stairs. Supervise at playgrounds.

Do not allow child to walk with sharp object in hand or mouth.

Raise crib rails and check to make sure they are locked before walking from crib.

Aspiration Examine toys for small parts that could be aspirated; remove toys that appear dangerous.

Do not feed toddler with popcorn, peanuts, etc.; urge children not to eat while running. Do not leave toddler alone with a balloon.

Drowning Do not leave toddler alone in a bathtub or near water (including buckets of cleaning water and washing machine)

Animal Bites Do not allow toddler to approach strange dogs. Supervise child’s play with pets.

Burns Buy flame-retardant clothing. Cook on the back burners of stove if possible and turn handles of pots toward back of stove to prevent toddler from reaching up and pulling them down.

Use cool-mist vaporizer rather than steam vaporizer or remain in room when vaporizer is operating so child is not tempted to play with it.

Keep screen in front of fireplace or heater. Monitor toddlers carefully when they are near lit candles. Do not leave toddlers unsupervised near two- water faucets. Check temperature setting for hot-water heater ad turn down thermostat it is over 125ᵒF. Do not allow toddlers to blow out matches (teach that fire is not fun); store matches out of reach. Keep electric wires and cords out of toddlers reach; cover electrical outlets with safety plugs.

General Know whereabouts of toddlers at all times. Toddlers are able to climb on chairs and stools and could turn door knobs and go outside. Be aware that the frequency of accidents increases when the family is under stress and therefore less attentive to children. Special precautions must be taken at these times.

Be aware some children are more active, curious, and impulsive and therefore more vulnerable to accidents than others.

B. Nutrition Place a small amount of food on a plate and allow the child to eat. Cleaning a plate gives the child a feeling of independent functioning. Offer finger foods and allow the child to choose between two types of food to promote independence. Avoid giving food that is high in sugar and carbohydrates. Adequate calcium and phosphorous intake is important for bone mineralization.

C. Daily Activities Dressing

By the end of the toddler period, most toddlers are able to put on their own socks, underpants and shirt. Encourage parents to allow their children to dress themselves to develop a sense of autonomy. Sneakers are ideal for toddlers because the soles are hard enough for rough surfaces and arch support is limited.

Sleep If the child finds it hard to sleep at night, shorten or omit his/her afternoon nap. Parents must be sure that older siblings do not point out the toddler all the exciting things he/she missed while napping. Include naptime as part of a routine, not as separate activity. Make a bedtime routine such as a warm bath, tooth brushing, bedtime story, or choosing a toy to sleep with. If the toddler is no longer comfortable sleeping in a crib, move him/her in a grown-up bed. Children need to understand that sleeping in a regular bed does not give them the right to get in and out of bed as they choose because they cannot roam unsupervised

Bathing The time for a toddler’s bath depends on the parents and the child’s wishes and schedule. Advice parents not to leave their child unsupervised in the bath tub. Make bath time enjoyable by providing a toy such as rubber duck, toy boat or plastic fish.

Oral Care Offer fruits (pieces of apple, banana and orange) as snack. Avoid giving high-carbohydrate food because this can cause dental decay. Encourage the child to drink fluoridated water and eat food high in calcium (e.g. Cheese, milk, and yogurt) Toddlers can begin brushing their teeth on their own under the supervision of their parents. After brushing, parents should use dental floss to clean between the child’s teeth and remove plaque. Instruct parents to make an appointment to the dentist when the child reaches 2 ½ years of age.

COMMON BEHAVIOR PROBLEMSA. Bed Wetting and Toilet Training

Involuntary urination while asleep after the age at which bladder control would normally be anticipated. The medical term for this condition is “nocturnal enuresis” Studies show that parents become frustrated because they want their children to be toilet trained at an early age. Most girls can stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Toilet training is an individualize task. It should begin depending on the child’s readiness and ability to accomplish it. Before children can begin toilet training, they must reach the following developmental levels.

Control of rectal and urethral sphincters. Cognitive understanding of what it means to hold urine and stool until they can release them at a certain place and time. Desire to delay immediate gratification.

B. Thumb Sucking It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any piece of skin within reach (such as the big toe) ad is considered to be soothing and therapeutic for the person. At birth, babies will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. As a child develops the habit, it will usually develop a “favorite” finger to suck on, in much the same way it develops a favorite hand to write with. It is not known if the preference for a hand to suck on affects handedness in any way, or vice versa. Gradually stop the toddler from sucking his/her thumb. This behavior usually stops by pre school years. If behavior persists, evaluate need for attention, peer play.

C. Temper Tantrums Occur as a natural consequence of toddler’s development. Toddlers are independent enough to know what they want; they do not have the vocabulary or wisdom to express their feelings in a more socially acceptable way. The child may kick, scream, stamp feet, shout, “No, no, no.”, lie on the floor, flail arms and legs, and bang the head against the floor. Children may even hold their breath until they become cyanotic and slump to the floor. Tantrums are often the result of kids frustration with the world – they can’t get something (for example, an object or a parent to do what they want. Toddlers want a sense of independence and control over the environment – more than they may be capable of handling. This creates the perfect condition for power struggles as a child thinks “I can do it myself” or “I want it, give it to me”. When kids discover that they can’t and can’t have everything they want, the stage is set for a tantrum.

Parents can manage temper tantrum by doing the following: Avoid abrupt end to play or making excessive demands. Offer only allowable choices. Once a decision is verbalized, avoid sudden changes of mind. Provide diversion to achieve cooperation. Ignore the outburst.

D. Discipline Discipline and punishment are not interchangeable terms. Discipline means setting the rules so children will know what is expected of them. Punishment is a result or consequence of disregard for the rules. Parents need to be consistent when setting the rules. Rules are learned best if the child’s right behavior is praised rather than punishment of wrong behavior. Time-out is a technique for discipline. To use it effectively, parents must be certain that children are aware of the rule that they are trying to enforce. If they repeat undesired behavior, parent should select an area that is non- stimulating such as a corner of a room or hallway. This is also called the “time-out” space. The child must not return from that space until he/she learns to be calm and quiet.

E. Separation Anxiety Fear of separation from parents; begins at 6 months and persists throughout the preschool period. Most toddlers react best to separation if a regular babysitter is employed or a day care center has consistent caregivers. When leaving a child, parents must say goodbye firmly, repeat the explanation that they will be there the next morning.

ROLE OF THE NURSE IN THE CARE OF A FAMILY WITH A HEALTHY/ILL TODDLER AREA NURSING ACTIONSNutrition A special diet may limit typical finger foods. Use imagination to offer other foods not usually eaten this way as finger foods. Allow child to help pour liquid diet for a tube feeding. Toddlers are frightened by vomiting because they have no control over it. Check for possibility of nausea; toddlers have no way to express this other than by not eating.

AREA NURSING ACTIONSDressing Changes A child can hold pieces of tape or put tape in place to maintain sense of control. The child can remove an old bandage if it is not contaminated. Allow the child to view his/her incision and watch dressing changes; explaining each step of a procedure as you perform, it helps the child maintain control. Restrain only those body parts necessary during a procedure to allow a child sense of control. Remove all supplies after a procedure, or the child may “redo” the dressing.

AREA NURSING ACTIONSMedication Do not give the children an option not to take the medication. Do not allow a child to choose a “chaser”, such as milk or juice after oral medicine. Do not ask a toddler to indicate a choice of site for an injection or intravenous insertion; this is too advanced a decision for a toddler to handle.

Rest Locate or create a ritual for bedtime (put child into bed, tuck him in, say “Goodnight”. Tuck in bear, say “Goodnight, bear”). Allow a choice of toy or cover but not a choice of bedtime or naptime hour.

AREA NURSING ACTIONSHygiene Let the child choose a toy that he/she can play with during bath time. Allow a child to wash face and hands to gain control of the situation. Allow the child to put toothpaste on a brush, but you should brush or “touch up” teeth afterward to ensure that all plaque has been removed.

Pain Encourage a child to express pain (say, “Ouch” when I pull off the tape). Help channel a child’s self expression to what is acceptable (e.g. The child may shout but may not kick).

AREA NURSING ACTIONSStimulation Provide a toddler with a toy that can be manipulated, such as boxes that fit inside one another and can be taken out again, tucks that can be pushed, and pegs that can be pounded.

In a health care setting, items can usually be found that fit together (boxes from central supply or plastic vials from the pharmacy). Another action toy: buy a non-latex balloon and tie it to the crib side to be used as a punching bag; another one to tie to the foot of the crib cab serve as a leg exerciser.

AREA NURSING ACTIONSElimination A child who is toilet trained needs to be encouraged to use a potty chair or toilet during an illness. Help children with ureter or bowel stomas to help in changing bags so they are as independent on bowel function as possible.

End of second week...