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NSG 309 peds
Ch 17 - Toddler care
| Question | Answer |
|---|---|
| Health assessment of toddlers | - Use play to gather information and distract (singing, toys, pictures, etc) - children may touch safe medical equipment - do not ask PERMISSION - positive reinforcement/praise - invasive procedures last - Explain procedures in simple/concrete/positive terms |
| Physical head variations in toddlers | - All 20 baby teeth present by age 3 - Complete brain myelination by age 2 |
| Cardiac/Pulmonary Variations in toddlers | - Diaphragmatic breathing - PMI at 4th intercostal space (adults at 5th) - Increase BP and decrease HR with age |
| Abdominal/GI variation in toddlers | - Decreased stool frequency (~1 BM/daily) - Protruding abdomen (potbelly appearance) |
| Toddler age range | Toddlers = 12-36 months age |
| MSK variations in toddlers | - Hand preference at age 2-3 - Wide gait w/ flat feet - Lordosis w/ bowed legs |
| Physical variations in toddlers | - immature adaptive immunity - normal Hgb ratio @ 12 months |
| Pain assessment in toddlers | FLACC scale (0-10) - Face, Legs, Activity, Cry, Consolability - toddlers react same way to painful procedures and painless procedures - Encourage toddler to use words for pain |
| Physical growth in toddlers | Height: 5 in from 12-24 months, 2-3 in from 2-3 years Weight: 5 lbs/year Head circumference: 2 cm from 12-18 months - Standing height starting age 2 - Sitting weight until 3 years |
| Kohlberg developmental theory (toddler) | "Preconventional" stage (moral) learning obedience |
| Freud developmental theory (toddler) | "anal" stage (psychosexual) toddler learning when to shit, stool holding common during potty training |
| Piaget developmental theory (toddler) | - "Sensorimotor" stage (up to 2yrs) - "Preoperational" stage (begin at 2yrs) toddlers manipulate objects to learn and imitate others |
| Erikson developmental theory (toddler) | "autonomy vs shame and doubt" - the toddler learns to do things on their own and make choices (develop independence) |
| Psychosocial developmental theory | - Erikson - Development of independence |
| Cognitive developmental theory | - Symbolic thinking develops at age 2 Animism: belief inanimate objects have consciousness and lifelike properties |
| Animinism | belief inanimate objects have consciousness and lifelike properties |
| Moral developmental theory | - avoidance of punishment as motivation for obedience, at a preconventional level - not focused on rights or wrongs |
| Toddler motor development | 15 months: Takes few steps and feeds self with fingers 18 months: Walks independently, drinks from lidless cups, use spoons, climb couch/chair independently 24-30 months: Runs, kicks balls, walk up/down stairs, fine motor skills (use spoon, takes clothes off, turns page, unscrew lids) 36 months: use fork, string items together, puts clothes, 1 foot on each step |
| Cognitive milestones in toddlers | 15 mo: use objects for intended purpose, stacks 2 small objects 18 mo: copies adult chores and play with toys purposefully 24-30 mo: holds something with 1 hand while using other, use knobs/switches, plays with multiple toys at a time, toys to pretend, simple problem solving skills, follow 2 step instruction, knows at least 1 color 36 mo: avoid touching hot objects when warned, copies a circle |
| Speech/Communication in toddlers | - understands directions before giving direction - echolalia - telegraphic speech |
| Receptive language | ability to understand, process, and comprehend spoken or written language think input |
| Expressive language | ability to use words, gestures, or writing to communicate thoughts, needs, and feelings think output |
| echolalia | repetition of words and phrases w/o understanding meaning |
| telegraphic speech | 2-3 word sentences, only enough words to get point across |
| Language/communication milestones in toddlers | 15 mo: 1 other word besides mama/dada, looks at named objects, use jargon, points to ask for something, follows directions 18 mo: says 3 words in addition to mama/dada, follows 1 step direction 24-30 mo: uses 2 word sentences, points to 2 body parts when asked, points to pictures after named, uses gestures, 50+ words, names things in picture books, uses 2+ words with 1 action word, I/Me/We use 36 mo: carries short conversations, asks who/what/when, identifies actions in pics, |
| Social/Emotional Development in toddler | Egocentric: believe the world revolves around them, focused on self - understands consequences - may throw temper tantrums - parents to offer choices to foster independence - possible separation anxiety Risk factors for behavioral issues - poverty, maternal depression, exposure to toxic substances |
| Burn safety considerations for toddlers | keep hot objects out of reach and use back burners lower hot water heater to 120 F |
| Fall safety considerations for toddlers | avoid climbing furniture supervise on stairs/playground equipment use gates on top/bottom of stairs |
| Motor vehicle safety for toddlers | - forward facing in backseat w/ 5 point harness from 2-4 y.o - rear facing in backseat for under 2 y.o |
| play considerations for toddlers | parallel play - short attention spans w/o concept of sharing - use toy to develop gross/fine motor skill, social skills - musical instruments/active play popular |
| parallel play | playing alongside another but not together |
| sleep considerations for toddlers | - growth/development/cognitive functioning - negative consequences of lack of sleep -> mood disturbance and irritability, poor behavior and hyperactivity - 11-13 hours of sleep in 24 hour - 9 hours nightly + 2 naps (<18 months) - 9 hours nightly + 1 longer nap (18+ months) |
| discipline for toddlers | - cannot fully understand rules -> use teaching not punishment - positive encouragement - developmentally appropriate/consistent method - nonphysical methods |
| Nutrition for toddlers | - switch to cow's milk at 12 months (nonflavored whole milk until 2 y.o) - Switch from bottle to cup (no bottles at naptime/bedtime) - food jags (picky eatings) - physiological anorexia from decrease caloric needs - no more than 24 oz milk to prevent anemia (not iron rich food) |
| Food jags | toddler's propensity to eat only certain foods and refuse to eat those foods anymore |
| Toilet training for toddlers | Begins at ~2 y.o when able to: - be dry for up to 2 hours - words for urine/stool - brings clean diaper to be changed - discontent with soiled diapers - positive reinforcement/avoid punishment |
| Temper Tantrums in toddlers | - receptive language development vs expressive language development - may begin at 12 mo (typically from 2-3 y.o) - reward good behavior and ignore unwanted - disruption in routine and inconsistent expectations increase temper tantrums |
| Atopic Dermatitis (Toddlers) | AKA Eczema - most common skin condition in children, more likely for allergies/asthma S/S: severely dry skin, erythematous patches, extreme pruritis, lichenification (skin thickening) |
| Lichenification | thickening of skin, seen in eczema/atopic dermatitis |
| Acute Otitis Media (AOM) in toddlers | - inflammation of middle ear w/ middle ear effusion - risk for speech delay if AOM is recurrent/untreated Risk Factors: 2nd hand smoke exposure, exposure to other kids, congenital anomalies Protective factors: breastfeeding, PCV vaccine Tx: antibiotics + comfort; myringotomy for recurrent AOM |
| Myringotomy | surgical tx for recurrent AOM I&D of eardrum |
Created by:
sleepingbear