Nursing Care of a Family with a Toddler PDF

# Nursing Care of a Family with a Toddler ## Group 2 Members - Jhaide S. Cobo - Mary Mae C. Galang - Nicole P. Dinopol - Jessah Mae F. Dela Peña - Juveniel A. Escosía - Michael Felix T. Guste - Martin Dwight Li King C. Go III - King Arman L. Fernandez - Mir L. Gerones - Mark Glench Von G. Gonzales...

# Nursing Care of a Family with a Toddler ## Group 2 Members - Jhaide S. Cobo - Mary Mae C. Galang - Nicole P. Dinopol - Jessah Mae F. Dela Peña - Juveniel A. Escosía - Michael Felix T. Guste - Martin Dwight Li King C. Go III - King Arman L. Fernandez - Mir L. Gerones - Mark Glench Von G. Gonzales ## Reporter Mir L. Gerones # Objectives ## General Objectives After an hour of varied lecture discussion, the BSN 2K students will be able to: - enhance their positive attitude - recognize key developmental milestones in toddlers - gain foundational knowledge for promoting healthy growth and well-being in this age group. ## Specific Objectives The students will be able to: 1. Define the key developmental milestones of toddlers using Freud, Piaget, Erikson, and Kohlberg's theories 2. Describe the physical, motional, and cognitive characteristics of toddlers 3. Differentiate between fine and gross motor skills, providing at least three examples of each 4. Summarize the key skills learned by toddlers and their impact on overall development 5. Appreciate the significance of understanding toddler development in promoting holistic care. # Toddler A toddler, typically defined as a child aged 1 to 3 years, undergoes significant growth and development. During this stage, children transition from dependent infants to walking and talking young ones who begin to assert their independence. This evolution involves achieving various developmental milestones that reshape both the child and family dynamics. Parents may need to adjust their approaches; some might miss the nurturing tasks of infancy, while others embrace the energy of engaging with a more active child. Understanding what a toddler is means recognizing these crucial developmental changes and their impact on family life. ## Reporters - King Arman L. Fernandez - Michael Felix T. Guste # Developmental Theories: Toddler ## 1. Freud Freud's Anal Stage (1-3 years) focuses on toddlers gaining control over bowel and bladder functions. Nurses should support toilet training positively, avoiding punishment to prevent shame or anxiety related to bodily functions. ## 2. Piaget Piaget's Sensorimotor Stage transitions to the Preoperational Stage (2-7 years), where toddlers develop symbolic thinking but lack logical reasoning. Nurses should encourage play and exploration to promote cognitive growth and introduce simple concepts for better understanding. ## 3. Erikson Erikson's Autonomy vs. Shame and Doubt stage emphasizes independence. Nurses can support parents in fostering autonomy by allowing safe choices and encouraging self-help skills, like feeding and dressing. ## 4. Kohlberg In Kohlberg's Preconventional Stage, toddlers base moral decisions on avoiding punishment or gaining rewards. Nurses can teach parents to use positive reinforcement and model appropriate behavior to shape their moral development. ## Reporter Mark Glench Von G. Gonzales # Nursing Assessment of a Toddler ## Nursing Assessment of a Toddler to Developmental Milestones This nursing assessment systematically evaluates a toddler's developmental progress across physical, cognitive, social-emotional, and linguistic domains to facilitate early detection of any delays and enable timely intervention. # Physical Growth - Weight: 5 to 6 lb (2.5 kg) - Height: 5 in (12 cm) - Head Circumference: Increases only about 2 cm during the second year compared to about 12 cm during the first year. ## Body Max Index | Weight Status | BMI Percentile Rang | |------------------|--------------------| | Underweight | <5th percentile | | Healthy weight | 5th - <85th percentile | | Overweight | 85th - <95th percentile | | Obese | ≥95th percentile | *Pediatric Weight Status Classification by BMI Percentiles* ## Body Contour Toddlers tend to have a prominent abdomen because, although they are walking well, their abdominal muscles are not yet strong. They have a forward curve of the spine at the sacral area (lordosis) that will correct itself naturally. Many toddlers waddle or walk with a wide stance. ## Teeth Eight new teeth (the canines and the first molars) erupt during the second year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age. ## Appearance of the Average Toddler - Speaks in two-word sentences - 20 deciduous teeth present at 2.5 years - Heart rate: 90 to 110 beats/min - "Pouchy" abdomen from weak abdominal muscles - Chest circumference becomes bigger than head circumference at 2 years - Noticeable lordosis - "Baby fat" begins to disappear - Wide-based gait ## Body Systems Body systems continue to mature during this time: - Respirations slow slightly but continue to be mainly abdominal. - Heart rate slows from 110 to 90 beats per minute. - Blood pressure increases to about 99/64 mm Hg. - The brain develops to about 90% of its adult size. - In the respiratory system, the lumens of vessels enlarge progressively, so the incidence of lower respiratory infection decreases. - Stomach secretions become more acidic. - Stomach capacity increases to the point that a child can eat three meals a day. - Control of the urinary and anal sphincters becomes possible with complete myelination of the spinal cord, so toilet training is possible. - Immunoglobulin (lg)G and IgM antibody production becomes mature at 2 years of age. Passive immunity obtained during intrauterine life is no longer operative. ## Reporter Martin Dwight Li King C. Go III # Developmental Milestones The developmental milestones of the toddler years are less numerous but no less dramatic than those of the infant year because this is a period of slow and steady, *not sudden*, growth. Toddler development is influenced to some extent by the amount of social contact and the number of opportunities children have to explore and experience new degrees of independence. It is strongly influenced by individual readiness for a new skill. ## Age: 15 months ### Fine Motor Skills - Puts small pellets into small bottles - Scribbles voluntarily with a pencil or crayon - Holds a spoon well but may still turn it upside down on the way to mouth ### Gross Motor Skills - Walks alone well - Can seat self in chair - Can creep up stairs ### Language - 4-6 words ### Play - Can stack two blocks - Enjoys being read to - Drops toys for adult to recover (exploring sense of permanence) ## Age: 18 months ### Fine Motor Skills - No longer rotates a spoon to bring it to mouth ### Gross Motor Skills - Can run and jump in place - Can walk up and down stairs holding onto a person's hand or railing - Typically places both feet on one step before advancing ### Language - 7-20 words - Uses jargoning - Names one body part ### Play - Imitates household chores such as dusting - Begins parallel play (playing beside, not with, another child) ## Age: 24 months ### Fine Motor Skills - Can open doors by turning doorknobs - Unscrew lids ### Gross Motor Skills - Walks up stairs alone, still using both feet on same step at same time. ### Language - 50 words - Two-word sentences (noun or pronoun and verb), such as "Daddy go," "Dog talks" ### Play - Parallel play evident ## Age: 30 months ### Fine Motor Skills - Makes simple lines or strokes for crosses with a pencil ### Gross Motor Skills - Can jump down from chairs ### Language - Verbal language increasing steadily - Knows full name - Can name one color - Holds up fingers to show age. ### Play - Spends time playing house, imitating parents' actions - Play is "rough-housing" or active # Language Development Toddlerhood is key for language development. Assess any 2-year-old not using two-word phrases. Things to note during this stage: - *"No"* is a common expression of emerging autonomy. Can indicate refusal, misunderstanding, or sound exploration. - Children need to be exposed through conversations. - Limit screen time (AAP or the American Academy of Pediatrics recommends no screen time before 18 months). - Passive screen time provides minimal language input. ## Encourage language development by: - Naming objects during play and daily routines. - Encouraging children to ask for items; avoid forcing them to label before providing. - Reinforce requests by repeating and voicing them (e.g., "You want the ball?"). - Reading aloud is also another effective way to increase vocabulary. Focus on describing pictures, not just reading the text. - Active children may have larger *receptive (understanding)* than *expressive (spoken)* vocabularies. - Children learn by imitation. - Pronouns *(I, me, him, her)* can be challenging; mastery may not occur until 3.5-4 years old. # Emotional Development During these years, children change a great deal in their ability to understand the world and how they relate to people. ## Autonomy According to Erikson, the developmental task of the toddler years is the development of Autonomy vs. Shame/Doubt. Toddlers strive for independence (autonomy). Caregivers should provide consistent rules to support healthy autonomy. ## Socialization - **Independence vs. Clinging.** Toddlers may resist constant holding, reflecting their growing independence, not a lack of desire for socialization. - **At 15 months,** they are still enthusiastic in interacting with people as long as those people will follow where they want to go. - **By 18 months,** toddlers imitate caregiver actions (using phones, wiping surfaces). - **By 2 or 4 years of age,** they become aware of gender and point at other kids and identify them as "boy" or "girl”, if this is what they heard from their parents. ## Play Behavior - **Parallel Play.** Toddlers typically play *beside* other children, not *with* them (parallel play), which is developmentally normal. - **Independent Play.** They enjoy toys they can manipulate independently (trucks, squeaky toys, rocking horses, pegs, toy phones). These offer control and autonomy. - 15 months: Enjoy throwing toys (if someone retrieves them). - 18 months: Enjoy pull toys. - Toddlers explore toys differently than infants. - **Imitative Play.** By 2 years, toddlers begin imitating adult actions in play (e.g., caring for a doll, "driving" a car). This is a significant part of their active play. # Cognitive Development Toddlers are still in the final stages of Piaget's sensorimotor stage. - They are described as “little scientists" because of their interest in discovering new results that different actions can achieve. ## Sixth Stage (18-24 Months) - Begin problem-solving and symbolic thought. - May struggle to differentiate similar objects. - Exhibit prelogical reasoning (faulty conclusions). - Demonstrate deferred imitation (imitating actions later). - Object permanence is fully developed. ## Transition to Preoperational Thought - At the end of the toddler period, they transition to the preoperational stage. - Difficulty adapting thoughts to situations; instead, they adapt the situation to their thoughts (e.g., shaking a hammer instead of pounding). # Types of Tantrums and Time-Out Methods ## What are Tantrums? A tantrum is a sudden outburst of anger and frustration in a child, often uncontrollable and challenging to manage. While it may seem irrational, tantrums usually have underlying reasons. They may be a way for children to express their needs, assert demands, or seek attention and recognition. These episodes often involve crying, yelling, kicking, or even throwing objects, and can sometimes become violent. Understanding the cause of a tantrum is key to handling it effectively. ## Attention-Seeking Tantrums Tantrums designed to get the caregiver's attention (crying, whining, or exaggerated behaviors). Parents should spend quality time with their child and listen to them. ### Time-Out Method: - Ignore the tantrum calmly, without giving eye contact or reacting. - Acknowledge positive behavior when the child calms down to reinforce attention for good conduct. ## Frustration or Fatigue-Related Tantrums Happen when the child is tired, hungry, or struggling to achieve a task. Just as adults need understanding when frustrated, so do children. ### Time-Out Method: - Offer a quiet space to calm down without framing it as punishment. - Address basic needs (food, rest) or help with the frustrating task when they are calmer. ## Refusal Tantrums Occur when the child doesn't want to follow instructions or comply (e.g., refusing to leave the park). Children, like adults, don't like being forced. Refusal tantrums often happen when they feel powerless. ### Time-Out Method: - Be firm and consistent. Remove the child from the situation and place them in a timeout space. - After the timeout, calmly restate the rule without negotiating. ## Destructive Tantrums Tantrums involving throwing, breaking things, or harming others. ### Time-Out Method: - Immediately remove the child from the environment to a safe and quiet place. - Calmly explain that destructive behavior is unacceptable. - Allow time to settle before discussing proper behavior. ## Self-Damaging or Rage Tantrums Extreme tantrums where the child hits themselves, bangs their head, or loses control. ### Time-Out Method: - Ensure the child's safety by gently holding or moving them away from dangerous situations. - Speak in a calm voice, offering comfort when they're ready. - Afterward, discuss emotions and ways to handle anger safely. # References ## Book: - Maternal and Child Health Nursing (Care of the Childbearing and Childrearing Family) 9th edition # Thank you!