Toddler and Preschooler Nutrition & Development

• Nursing care for families includes infants to adolescents

Infant Growth and Development

• Physical growth includes monitoring weight, height, head circumference, body proportion, body systems, and teeth
• Motor development is tracked through gross motor skills, tracking ventral suspension position, prone position, sitting position, and standing position
• Fine motor development includes the development of thumb opposition and pincer grasp
• Language development is an important developmental milestone
• Assessing an average infant includes looking for the the following:
• At 2 months, social smile appears.
• At 3 months, infants follow past the midline.
• At 6 months, first tooth erupts.
• By the end of the first year, the heart rate slows to 100-120 bpm.
• Respiratory rate slows to 20 to 30 breaths per minute by the years end.
• The abdomen will be protuberant.
• Babies triple their weight by 1 year.
• A pincer grasp will be present at 10 months.
• The liver remains immature.
• Legs may appear short and bowed.
• Infants grow in height by 50% from 20-30 inches.

Assessing Infant Growth and Development

• Nursing care includes assessing physical health through observation and physical examination
• Immunizations are an essential part of infant health maintenance done in accordance with healthcare agency policies:
• Haemophilus influenzae type B (Hib) is administered at 2, 4, 6, and 12-month visits
• Varicella (VAR) at 12-month visit
• Inactivated Poliomyelitis (IPV) at 2,4, and 6-month visits
• Pneumococcal Disease (PCV) at 2, 4, 6, and 12-month visits
• Diphtheria, Tetanus and Pertussis (DTaP) at 2, 4, 6, and 12-15 months
• Hepatitis B (HcpB) at birth, 2-month, and 6- or 12-month visits
• Rotavirus (RV) at 2, 4, and possibly 6-month visits
• Influenza (IIV) yearly at 6 month or later visit
• Mumps, Measles and Rubella (MMR) at 12- or 15-month visit
• Varicella (VAR) at 12- or 15-month visit
• Hepatitis A (HepA) at 12- or 15-month visit
• Anticipatory guidance is provided through active listening and health teaching

Nursing Diagnoses for Infant Growth and Development

• Nursing diagnoses may include:
• Ineffective breastfeeding related to maternal fatigue
• Disturbed maternal sleep pattern related to baby's need to nurse every 2 hours
• Health-seeking behaviors related to adjusting to parenthood
• Delayed infant growth and development related to lack of stimulating environment
• Ineffective parental role performance related to new family responsibilities

Health Promotion

• Health promotion focuses on achieving developmental tasks, especially trust versus mistrust
• Encouraging mothers to breastfeed and providing necessary support can help promote nutrition in the hospital setting
• Nurses can promote trust in an ill infant by providing consistent caregivers
• Hold the infant no matter what feeding method or for a time after or between feedings
• Pacifiers provide pleasure if infant feeding is non-oral, consider medical and parental preferences
• The infant needs to be comforted after procedures and IV sites frequently checked
• Nonallergenic tape should be used for dressing changes, and pain should be reduced when removed
• Stockinette, gauze, or Kling gauze should be used, exposure during dressing changes should be kept at a minimum, restrain only the body parts necessary for safety
• Use nonthreatening tone of voice as comfort.
• The taste of oral medicine should be disguised so that it is more acceptable to the infant.
• Medicine should never be mixed with formula to prevent changes in taste.
• Parents should be encouraged to rock infants to sleep, and should also be done if no parent is present
• Always wake infants gently because it is frightening
• If bed rest is necessary, check for irritated elbows, heels, and knees and protection should be provided with long sleeves, pants, or a Kling bandage
• Hygiene includes checking the bath water temperature and changing diapers frequently
• To avoid caries, begin toothbrushing with the first tooth
• Hold and comfort the infant in pain, reduce the amount of painful procedures
• Remember that an infant is focused on a human face, give a crib mirror for visual stimulation
• If no mobile is available, create one, and when the baby is about to crawl, use a pad or sheet on the floor with reassurance
• If no contagion, bring the crib to the station to interact while doing paper work

Infant Safety Promotion

• Safety promotion includes preventing aspiration, falls, and providing car safety
• It is important to provide safety information regarding siblings, bathing, swimming and childproofing

Nutritional Health Promotion

• Nutritional health promotion includes providing information about recommended dietary allowances

• Introduction of solid foods, the loss of the extrusion reflex, and techniques for feeding solid foods

• Exclusively breastfed infants are typically ready for solid foods at 4-6 months of age

• Only introduce 1 food at a time, waiting 3-7 days between new items

• Introduce food before formula or breastfeeding when the infant is hungry.

• Give small amounts of new food, like 1-2 teaspoons

• Food preferences should be respected

• Use minimal to no salt and sugar on solid food

• It is important to remember the tongue has an extrusion reflex present for the first 4-6 months so food is pushed forward.

• Do not place food to drink with formula in bottles to prevent aspiration

• A positive attitude should be used when introducing new foods since it could be the child's favorite

• Also important are quantities and types of food, like cereal, vegetables, fruits, meats and eggs, and table food

• Further nutritional health promotion includes establishing healthy eating patterns and discussing weaning

• Offer small portions, but do not urge to finish the meal and serve meals at the same time each day

• Weaning can begin when the infant shows less interest in the breast or bottle or can drink from a cup

• New foods should be introduced with solids

• Provide a spoon and a cup for self feeding and encourage the infant to eat

• Infants can have an adequate intake with a vegetarian diet with enough calories, protein, Vitamin B12, Vitamin D, Calcium, and iron

Infants Routine Activities

• Promotion of health in daily activities such as bathing, diaper-area care, dental care, dressing, sleep, and exercise

Family Functioning Promotion

• Encouraging healthy family functioning
• Discussing parental concerns such as:
• Teething
• Thumb sucking
• Use of pacifiers
• Head banging
• Sleep concerns
• Constipation
• Loose stools
• Colic
• Spitting up
• Diaper dermatitis
• Miliaria (prickly heat)
• Baby-bottle tooth decay syndrome
• Infant obesity
• Family concerns with infants with unique needs such as cognitive or physical challenges

Common parental difficulties and suggestions for assessment.

• Parents may have trouble evaluating the health of their infant, but the parents should call their primary doctor if there is a concern.
• Improving assessment of pain involves watching immobile extremities, brushing or tugging at an ear, pulling ip legs against the abdomen
• Lack of smiling or interaction, and lying supine with legs nonflexed may suggest fatigue
• To properly report temperature parents should take an axillary or tympanic temperature
• Estimates of vomiting or diarrhea can be compared to the amount the child ate and whether diapers are soaked or stained.

Toddler Growth and Development

• Physical growth includes measurements such as weight, height, head circumference, and body mass index
• Monitoring also includes body contour, body systems, and teeth
• Milestones are measured by language and emotional development, autonomy, socialization, and play behavior
• Cognitive milestones involve imitating an action some time after it has been witnessed, preoperational thought and assimilation
• At 15 months, toddlers can put small pellets into bottles, scribble, and hold a spoon well. They can walk well, seat themselves in a chair and creep up chairs. They can speak 4-6 words. And stack two blocks
• At 18 months, they no longer rotate the spoon to bring it to their mouth, they can run and jump and walk up and down stairs holding onto something. They speak 7-20 words, can imitate chores and do parallel play
• At 24 months, they can open doors and unscrew lids, they can walk up stairs alone and same step at the same time, They speak 50 words along with two-word sentences, and do parallel play
• At 30 months, they can make simple lines for crosses with a pencil, can jump down from chairs, verbal language increases with knowing their full name and one color, and they also spend time playing home while imitating other actions

Assessing the Average Toddler

• Speaks in two-word sentences, has 20 deciduous teeth present at 2.5 years
• Typical heart rate is 90 to 110 beats/min.
• Also typical is a "pouchy" abdomen due to weak abdominal muscles
• Chest circumference becomes bigger, there is noticeable lordosis, "baby fat" begins to disappear and they have a wide gait

Diagnoses for Toddler Growth and Development

• Potential diagnoses could be deficient knowledge related to the best method of toilet training and the risk for injury related to impulsiveness. There could also be an interrupted family process related to need for close supervision, and a readiness for enhanced family coping related to parents' ability to adjust to new needs of child

Safety Promotion

• Regarding safety, important items to share with a family are the prevention of accidents, poisonings, and lead screening
• Sources of lead, testing, and effects

Unintentional Injury Prevention

Prevention measures include car seats, not allowing the child to play outside unsupervised, and supervising toddlers with pedaling toys.

• Falls can be prevented by keeping house windows closed or screened and placing gates at stairs
• Drowning and animal bites should be prevented in bathtubs or near water and with strange pets
• Poisoning happens when medication isn’t treated like candy and out away. Make sure food aren’t mixed with other substances and that dangerous numbers like the poison help line is active
• Burns happen when a toddler is able to reach the back of stove and handle them back
• Teach fire is not fun , electric wires and cords should not be out and electric outlets should have plugs.
• Be mindful that toddlers can climb onto chairs and door nobs where they should be aware , precautions should be taken during family stress
• Supervise all that they go to and what they go near

Toddler Nutritional Considerations

• Sedentary childrens aged 1-3 should consume 1,000 calories daily and active children in that age group need up to 1,400 calories daily and space out three meals a day
• Protein and carb needs should be those met and diets should be high in sugar
• Veg diets
• should have whole milk until 2 and trans fat should be minimum. Intake of phosphorus is important for bone mineralization.

Toddler Daily Activities

• Health promotion consists of dressing, sleeping, bathing and taking care of teeth

Toddler Family Functioning

• Family functioning consists concerns such as promoting toilet training and language. And if there are concerns of certain autism and nutrition
• 2 year olds are ready for training when they can walk and 2 weeks of psychological readiness.
• Training pants should be quick when using and a chair can have a footstool in front. Defecation is usually the first thing a toddler notices
• Boys have to be watched at a toilet seat while standing and aiming in them
• Do not force a child to stay in a seat to long, and do not give them the impression that it's bad to be wet when potty training. If they aren’t ready diapers for a few weeks should be fine.

Tips for Communicating with a Toddler in the Clinic

• Communicate with positive language and encourage patient involvement
• Offer focused choices that minimize "no"
• Avoid commands and attempts to bribe

Preventing Temper Tantrums

• Preventing temper tantrums begins finding the reason for tantrums when a child is sleepy or asked something. When they aren’t ready, find the problem behind being asked to change their tantrum
• Could they be having a disorder behind it? Reward them when they don’t have on e
• Avoid the situation when they show some of those signs

Daily Activities

• Dressing, sleep, exercise, bathing

Health Promotion

• Time-outs can be helpful in disciplining: implement as many minutes as the child is

Preschool Growth and Development

• Physical growth during the preschool years includes monitoring height, weight, body mass index, and head circumference
• Developmental milestones encompass language development and play
• Preschoolers typically dress themselves, stack towers, and draw crosses around age 3. They can also run, use stairs with alternating feet, and ride a big wheel
• 4 year olds can do simple buttons, they are constantly in motion, skip and know 1500 words
• At this age, they can also be tested by a standard chart or by audiometry tests for hearing.
• 5 year olds can draw a 6 part figure, thew over their shoulder and lace the shoes with understanding about 2100 words

Emotional Milestones

• Developmental tasks, intiative, imitation, fantasy and social and cognitive development.
• Concerning that kids act out in either Oedipus setting as their gender.
• Preschool age girls tend to experience urinary tract infections more frequently

Parental concerns during the preschool years

• It is importand to address parental fears, tell tales, imaginary friends,
• Address concerns such as, separation , regression, sibling rivalry,sex education and daycare language if applicable

Assessing the average preschooler

• Assessing Appearance
• Between Years preschooler have less growth and use mor e words , and should be have no new teeth
• There pulse decrease. But they can still show genu valgus and the increased coordinated allows for walking , kicking or bicycling

Promoting safety in preschoolers

• Motor vehicles, Falls, Drowning, Animal bites, Poisoning, Burns, Community safety, General
• Don’t’ talk to strangers because they’re considered harmful
• Always be aware of stress because it makes it easier t og et hurt due them be more aware, active
• Parents may be overly eager during questioning of their child wanting them to say yes
• Listen to their bodies instead which will avoid them getting hurts, frequent and regular appointments

Nutrition

• Serving toast or sandwiches in cut animal shapes or in alphabet letters
• Respect the child's food preferences because eating a non favorite food is difficult
• Allow preschoolers to measure and cut tape or draw a face on it and provide extra bandages to put on a doll
• Do not the toddler know what they’re putting the needle in their toy and use Simon Says to know treat

Covers nutrition (fat, sugar, calcium, phosphorus) for children under 5. Also explores fantasy play and independence in preschoolers, linking behavior to emotional development and nursing diagnoses.