Transcript Fertilization

Chapter 17
The Toddler
GENERAL CHARACTERISITCS
• Toddler- 1-3 years
• VS- 70-110, 25, 90/56
• No longer completely dependent on others
• Rapid growth and development during infancy
slows down
2
3
General Characteristics (cont.)
• Major parental responsibility
– Maintaining safety for the toddler while allowing
the opportunity for social and physical
independence
– Maintain positive self-image and body image in
child
• Negativism can be countered by offering
limited choices and the use of distraction in
handling toddlers whose favorite word is “no”
4
General Characteristics (cont.)
• Developing self-control and socially
acceptable outlets for aggression and
anger are important in the formation of
personality and behavior
• Rituals increase the toddler’s sense of
security by making compulsive routines of
simple tasks
5
Erickson’s Developmental Tasks
• Autonomy vs Shame and Doubt
– Trying out own powers of speech
– Beginning acceptance of reality vs pleasure
principle
6
Physical Development
• Birthweight quadruples by 2.5 years of age
• Rate of brain growth slows
• Musculoskeletal system grows and bones begin to
ossify
7
Physical Development (cont.)
• Respirations still mainly abdominal but shift to
thoracic as child reaches school-age
• Eruption of deciduous teeth complete by 2.5
years
• Defense mechanisms of the skin and blood are
more effective
• Digestive processes and stomach capacity
increase to allow three-meal-a-day schedule
8
Sensorimotor and Cognitive
Development
• Sensory and motor abilities do not function
independently
• Memory strengthens
• Is able to assimilate information through
trial, error, and repetition
9
Sensorimotor and Cognitive
Development (cont.)
• Able to tolerate longer periods of
separation from parents to explore
environment
• Aware of cause and effect
• Copies words and roles of the models
seen in the home
10
Sensorimotor and Cognitive
Development (cont.)
• May confuse essential with nonessential
body parts/functions
• Expelling feces and urine and then
flushing it down the toilet may be upsetting
as the toddler may see it as flushing a part
of themselves away
• Nurse should teach parents skills that will
enable the toddler to feel loved even if
behavior is not acceptable
11
Fine Motor - Toddler
• 1 year old: transfer objects from hand to hand
• 2 year old: can hold a crayon and color vertical
strokes
• Turn the page of a book
• Build a tower of six blocks
• 3 year old: copy a circle and a cross – build
using small blocks
12
Speech Development
• Parallels cognitive growth
• Expressive and receptive language
continue to develop
• Respond to tone of voice and facial
expressions of those around them
13
Gross - Motor of Toddler
At 15 months, the toddler can:
• Walk alone.
• Creep upstairs.
• Assume standing position without falling.
• Hold a cup with all fingers grasped around it.
At 18 months:
• Hold cup with both hands.
• Transfer objects hand-to hand at will.
14
At 30 months: the toddler can:
• Jump with both feet.
• Jump from chair or step.
• Walk up and downstairs, one foot
on a step.
• Drink without assistance.
15
Issues in Parenting – Toddler
(Emotional Development)
• Stranger anxiety – should dissipate by age 2 ½
to 3 years
• Temper tantrums: occur weekly in 50 to 80%
of children – peak incidence 18 months – most
disappear by age 3
• Sibling rivalry: aggressive behavior towards
new infant: peak between 1 to 2 years but
may be prolonged indefinitely
• Thumb sucking
• Toilet Training
16
Cognitive Development:
• Up to 2 years, the toddler uses his senses
and motor development to different self
from objects.
• The toddler from 2 to 3 years will be in
the pre-conceptual phase of
cognitive development (2-4 years),
where he is still egocentric and can not
take the point of view of other people.
17
Social Development:
• The toddler is very social being but still
egocentric.
• He imitates parents.
• Notice sex differences and know own sex.
• According to Erikson,
• The development of autonomy during this
period is centered around toddlers increasing
abilities to control their bodies, themselves
and their environment i.e., "I can do it
myself".
18
Screening for Signs of Autism
• Preliminary symptoms may include
– No pointing, gesturing (e.g., bye-bye) by 12 months
– No single words by 16 months
– No spontaneous two-word phrases by 24 months
– Loss of achieved language or social skills
19
Guidance and Discipline
• Goal is to teach, not punish
• Parent responses to temper tantrums can
either reinforce the desirability of or the
risks involved in such behavior
• Expectations must be in line with the
child’s physical and cognitive abilities
– Limit-setting
– Time-outs
20
Daily Care
• Adults should be at eye level when talking
to toddler
– Seems less overwhelming
• Flexible schedule organized around needs
of entire household is best
• Clothing should be easily put on and
removed
21
Daily Care (cont.)
• Shoes should fit shape of foot and be ½
inch longer and ¼ inch wider than the foot
• Important for toddler to wear their regular
shoes to the clinic as it shows the health
care provider how the body is being used
22
Toilet Independence
• Much depends on
temperament of the
toddler and the
person guiding toilet
training
• Voluntary control of
anal and urethral
sphincters begins
around 18 to 24
months of age
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
23
Toilet Independence (cont.)
• Use potty chair or place the child on the toilet
facing the tank
• Bowel training usually attempted first
• Do not leave toddler on toilet for more than a few
minutes at a time
• Bladder training can begin when toddler stays
dry for about 2 hours
• If toddler has special words for defecation or
urination, be sure to tell other health care
providers and document in care plan for toddler
24
Nutrition Counseling
• Caloric needs decline to about 100
calories/kg/day
• Limit milk intake to no more than 24
ounces (720 mL) per day
• Food is chopped into fine pieces
• Various foods are offered
• A 2-year-old likes finger foods
• Calm child down before eating
25
Day Care
• Must meet families’
– Personal preferences
– Cultural perspectives
– Financial and special needs
• Should be state-approved
26
Day Care (cont.)
• Differs for toddlers because
– Shorter attention span
– Tendency to engage in parallel play rather
than group play
– Need closer supervision to maintain safety
27
Injury Prevention
• Best prevention is knowledge of ageappropriate risk and anticipatory
guidelines
• Parents need to understand their child’s
activities at certain ages in order to
prevent injuries by taking appropriate
precautions
• Toddlers are curious and mobile
28
Injury Prevention (cont.)
29
Toys and Play
• Parents must be
• Through play they
taught to inspect
learn how to
toys and to buy toys
– Manipulate and
suitable to the age,
understand their
skills, and abilities of
environment
their child
– Socialize
• Play is the work of
– Explore their world
toddlers
30