Pedia (Toddler)

• The toddler period covers from 1 year up to 3 years
• During the toddler period, children change from largely immobile and preverbal infants to walking, talking young children with a growing sense of autonomy
• Parents must also change during the toddler period to match the growth of their children
• Learning Outcomes:

  1. Integrate knowledge and principles of toddler growth and development with application of appropriate nursing care to the child and family

  2. Assess the toddler for normal growth and developmental milestones

  3. Formulate nursing diagnoses related to growth and development of a toddler and parental concerns

  4. Implement safe and quality nursing interventions related to normal growth and development of a toddler

  5. Evaluate with the mother and family the health outcomes of the nurse-client relationship
• Definition of Terms:

  • Animism: the belief that inanimate objects have human feelings and intentions
  • Assimilation: using toys in the wrong way
  • Centration: focusing on only one aspect of a situation at a time
  • Deferred imitation: remembering an action and imitating it later
  • Discipline: setting rules and expectations for children
  • Egocentrism: inability to see a situation from another's point of view
  • Lordosis: forward curve of the spine at the sacral area seen in toddlers
  • Parallel play: playing beside other children, not with them
  • Punishment: consequence resulting from a breakdown in discipline
  • Separation Anxiety: fear when away from home or separated from a loved one
  • Sibling Rivalry: jealousy of a toddler when a new baby enters their domain
  • Symbolic Representation: making one thing stand for something other than itself
• Physiologic Development:

  • Weight and Height: toddlers gain about 5 to 6 lb and 5 in. a year, transitioning from a plump baby to a leaner, more muscular child
  • Head Circumference: increases about 2 cm during the second year
  • Body Proportion: toddlers tend to have a prominent abdomen and lordosis
  • Body Systems: continue to mature, with changes in respiration, heart rate, blood pressure, brain development, respiratory system, stomach secretions, and control of sphincters
  • Dentition: eruption of new teeth during the second year
• Motor Development:

  • Developmental milestones of the toddler years are less numerous but dramatic
  • Influenced by social contact, opportunities for exploration, and individual readiness for new skills
  • Milestones include fine motor skills like putting small pellets into bottles and scribbling, and gross motor skills like walking alone well and creeping upstairs
• Freud’s Theory of Psychosexual Development - Anal Stage:

  • Activities: toilet training
  • Major Conflict: Bowel Training
  • Child's interest in the anal region is part of self-discovery and exerting independence
  • Pleasure in retention of feces and defecation
  • Toilet training usually completed by 3 years old
• The process of toilet training is regarded as the resolution of the autonomy vs. shame and doubt conflict
• Toilet training is considered a part of a child's discovery of self and a way of exerting independence
• Toilet training is usually completed by 3 years of age
• Developmental tasks during toilet training include learning autonomy vs. shame and doubt, self-government, and independence
• Ways to develop autonomy in toddlers:

  • Offer choices for decision-making
  • Encourage the child to make decisions rather than judge
  • Toddlers begin to develop their sense of autonomy by asserting themselves with the frequent use of the word "no"
• Behaviors to observe in toddlers:

  • Shows a sense of self ("me")
  • Negativism
  • Ritualistic and stereotyped behavior
  • Temper tantrums
• Emotional Development:

  • Toddlers change in their ability to understand the world and how they relate to people
  • Trust in themselves and others is crucial for emotional development
• Socialization:

  • Toddlers resist sitting in laps and being cuddled once they are walking well
  • At 15 months, they are enthusiastic about interacting with people
  • At 18 months, they imitate things they see
  • By 2 years, they become aware of gender differences
• Language Development:

  • Toddlerhood is a critical time for language development
  • Children need practice time to master language
  • Language develops quickest if parents respect what toddlers have to say
• Piaget's Theory of Cognitive Development - Stage 5 (12-18 months):

  • Described as "Little scientists" due to interest in discovering new ways to handle objects
  • Achieves object permanence
  • Uses "magical" thinking and experiments by trial and error
  • Develops dependency on transitional objects
  • Shows insatiable curiosity about the environment
• Toddlers in the 18 to 24 months stage can try out various actions mentally rather than physically performing them
• This stage marks the beginning of problem-solving or symbolic thought
• Pre-logical reasoning in toddlers may lead to wrong conclusions and faulty judgment
• Deferred imitation is when a toddler can remember an action and imitate it later
• Object permanence becomes complete in toddlers at this stage
• At the end of the toddler period, pre-operational thought begins, and toddlers may use assimilation, like using toys in the wrong way
• During the preoperational thought period (2 to 3 years), children become more symbolic and egocentric
• Children in the preoperational stage may display static thinking and draw conclusions from obvious facts they see
• Key features of the preoperational stage include centration, egocentrism, symbolic representation, and animism
• In the pre-conventional stage of Kohlberg's moral development, children obey rules to avoid punishment and see morality as external to themselves
• Nutrition for toddlers includes providing a variety of foods, allowing self-feeding, and avoiding excessive sugar intake to prevent obesity
• Toilet training readiness markers include the ability to stand, squat, walk alone, communicate toilet needs, and stay dry for intervals
• Ritualistic behavior in toddlers can be a way to establish predictability and order in their world
• Negativism in toddlers is a way for them to assert themselves and make decisions on their own
• Discipline involves setting rules and road signs for children to know what is expected of them
• Timeout is a technique to help children learn that actions have consequences, with the length typically being 1 minute per year of age
• Separation anxiety in children begins around six months of age and can persist throughout the preschool period
• Separation Anxiety in Children:

  • Fearful and nervous when away from home or separated from a loved one
  • Stages: Protest, Despair, Detachment
  • Management: Educate child and family, reinforce independence, say goodbye firmly
• Temper Tantrums in Toddlers:

  • Causes: Tiredness, unrealistic requests, frequent NOs, difficulty making choices
  • Management: Give choices, institute countdowns, avoid reasoning, remain calm and consistent
• Overtiredness and Tantrums:

  • Watch for sleep cues to avoid overtiredness
  • An exhausted toddler is more likely to throw tantrums
• Sibling Rivalry in Toddlers:

  • Tough for toddlers to welcome a new baby
  • Management: Tell about the new baby, involve in preparations, spend time, avoid comparisons
• Assessment of a Toddler:

  • Begins with a careful health history
  • Parents are the best source of information on a child's behavior
  • Careful observation is crucial in nursing assessment