Nursing Care of A Family With A Toddler

NURSING CARE OF A
FAMILY WITH A TODDLER

By Araceli F.Surat,MAN
Growth and Development of a Toddler
PHYSICAL GROWTH
1. Weight
- Gains 5-6lbs (2.5kg)
2.Height
-5inches * 12 cm) a year
**subcutaneous fats begins to disappear towards the
end of 2nd yr
**from a plump baby to leaner
**appetite decreases
3.Head circumference
nd
- Increases only about 2 cm during the 2 yr
- Equals chest circumference at 6 months to1year
- By 2 yrs = chest cicumference has grown greater of
the head
4. Body contour
- Prominent abdomen ( abdominal muscles are
notyet strong enough to support abdominal

contents)
- Lordosis
- Walk with awide stance

5.Body systems
- Respiratory system
- Respirations slow slightly but continue to be abdominal
- Lumens of vessels enlarge progressively
- Cardiovascular system
- Heart rate slows from 110 to90 bpm
- BP increases about 99/64 mmHg
- Neuomuscular system
- Brain develops about 90% ofthe adultsize
- Gastrointestinal system
- Stomach secretions become more acid( gastrointestinalinfection becomes less common)
◻ Stomach capacity increases= can eat 3 meals/day
Urinary system
◻ Control of the urinary and analsphincter becomes
possible with complete myelination of the spinal
cord—toilet training is possible
Immune system
◻ IgG and IgM production becomes mature at 2 yrs old
◻ The passive antibody received intrauterinely is no longer
operative
6. Teeth
st
- 8 new teeth ( canine and 1 molar) erupts during
2nd yr
- All deciduous teeth are generally present by 2.5
to3 yrs of age
- brush teeth 2x a day
- Dont give bottle when lying/sleeping

Developmental Milestones
Language
- A child who is 2 yrs old and does not talk in two-word,noun-verb
simple sentences needs a carefulassessment to dtermine the cause.
- NO is the usual word used by toddlers which means they are
refusing a task, donot understand or maybe practicing a sound
- To learn other words =must be expose to conversations
- Encouge language development by naming objects as they play

with their child or when they give something
- Some toddlers do not develop language readily because they are
not called on to use it
- Active children use fewer words than those less active
- Children learn language by imitating and what they
hear
- Pronouns are difficult for children....it’sonly when
they 3 ½ or 4 that they can separate uses of” I, me,
him and her”
EMOTIONAL DEVELOPMENT
1.Autonomy
- Autonomy vs shame or doubt
- To develop autonomy is to develop sense of

independence
- They recognize themselves as separte individual
- Realized that they donot always do what others

want them todo
- - NEGATIVISTIC
2. Socializaton
- 15months= stil enthusiastic abt interacting with
people
- 18 months = imitate the things they see
- 2 yrs ormore = becomeaware of their gender

differences and identify them as “boy, or girl”
3.Play behavior
- Parallel play ( play beside children)
**remind parents to provide duplicate toys

- Toys toddlers enjoy most are those they can play
with by themselves and that require action
- TOYS: Trucks they can make go, equecky frogs that
they can squeeze; waddling ducks they can pull,
rocking horses they can ride, pegs they can pound,
blocks they can stack,toy telephone they can talk
into
◻ At 15 months= still in put-in, take-out stage so they
continue to enjoy stacks of boxes or balls to fit iside
each other.
◻ Enjoy throwing toys out of playpen or froma high
chair
◻ At 18months = walking securely enough to enjoy
pull toys
◻ At 2 years= they began to use fewer toys than
before
◻ Spend time imitating adult actions in their play
COGNITIVE DEVELOPMENT
12 and 18months = tertiary circular reaction
- Little scientist ( because of the child’s interest in in
trying to discover new ways to handle objectsor new
results that different actions can achieve)
- Trial and error
- At 15 months=able to follow different path ( walk
in back of the chair)

◻ Between 18 and 24 months = able to try out various
actions mentally rathen than having to actually perform
them----beginning of problem solving or symbolic
thought
◻ Able to remember an action and imitate it later (
deferred imitation)
◻ Preoperational thought- dealwith symbols
◻ Assimilation –learn to change the situation to fit their
thoughts.
◻ This causes toddlers touse toys in the wrong way
PSYCHOSEXUAL DEVELOPMENT:
Anal stage- focus is on the anal region as they begin
toilet training
- Find pleasure in retention of feces and defecation
◻ MORAL DEVELOPMENT
- Preconventional (level1)- punishment/obedience
orientation
- Child does the right because parents tells them
toand avoid punishment
Nursing implications:
- Child need help to determine what are right actions.
- Give clear instructions to avoid confusion

HEALTH PROMOTION FOR A
TODDLERAND FAMILY
1.Promoting Toddler safety
- Urge parents to childroof their home by putting all poisonous
products,drugs and smallobjects out of reach
- Motor vehicle accidents,burns, falls, drowning and playground
injuries
- Occur because toddlers motor ability jumps ahead of their
judgeent.
- A toddlermust be supervised at alltimes
- Should be placed at the back rear of the car until 2 yrs
- Need to wear a helmet as soon as they begin riding a tricycle
- 15 month= can climb over the side rails ( place them on abed with
side rails tokeepthem from falling)
- enjoy exploring the house early in the morning before anyone else
is awake
◻ Safety gate on the door of the room to keep a toddler
contained and safe
◻ As the child reaches 2 years of age and begin to
imitate houework or repairing a car.....parents must be
sure that the child does not use real cleaning compunfs
or sharptools
◻ LEAD Screening
◻ * all children ages 6 months and 6yrs who live in a
community with buildings built should be tested
periodically for the presence of lead poisoing
◻ SUPERVISE TODDLER AT ALL TIMES
2. Promoting Nutritional Health of a Toddler
- Allow self feedng
- Do not like foods that are mixed up
- Prefer food that donot touch one another
- They eat all of one item before going on to another
- Prefer brightly colored foods to bland colors

Toddler nutrition
-Sedentary 1-3 yrs old = should consume 1000kcal
-Active 1-3 years old = 1400 kcal
- Avoid giving foods high in sugar
- Fats should not be restricted for children under 2 years or over 2

years
- fats-= 30%
- Calories= 35%
- Trans fatty acids should be kept in minimum
- Calcium and phosphoros is important for bone mineralization
- Milk should be wholemilk under 2 years
- 3 meals, 2 snacks/day
3.Promoting Adequate intake with a vegetarian diet
- Adequate for toddlers
- Shouldbe prepared as finger foods
- Fortified soy milk-prevents fluid,protein B12 and
calcium deficiencies.
- Tofu should be part of every meal to supply protein
4. Promoing Toddler development in daily activities
a.Dressing
- When they dress themselves, shoes are placed on
the wrong feet and skirt and pants on backward
*** encourage parents to give up their perfection
forthe benefit ofthe chils’sdevelopment
***if parents want to change the clothes , they should
begin with a positive stateent such as”you did good
job “ before making the switch
b.Sleeping
-napping 2x a day
-Sleep 12hours each night and end it with one nap a
day and only sleep 8hours at night
***need of sleep declines
- If a child has a problem falling tosleep – omit or
shorten afternoon nap
- If a child isso short-tempered at dinertime- the child
needs 2 naps/day
c. Bathing
-enjoy bath time – provide toy such as rubber duck,boat or plastic fish
d. Care of teeth
- Encourage parents to offer fruits ( banana, pieces of apple, orange slices)
or protein food ( cheese or pieces of chicken) rather than high CHO
- Calcium
- Continue to drink flouridated water
- For tooth care= need to toothbrush with supervision until 8 yrs)
- Brush thoroughly once a day preferably at bedtime
- After brushing = can use dentalfloss toclean between the child’s teeth and
remove plaque
- Urge parents to schedule a first visit to a dentist at about 12 months= can
prepare them by reading storis of visiting a dentist
e. Promoting healthy family functioning
- Help parents to understand their responses to these
attempts at independece are crucial to the helthy
development of their child
- A child must be begin some room to make
indpendent decisions in areas that the parents
feelthey donot need to control
- If parents punish children, children will not fight them
but they will feel guilty for wanting to do things
independently
f.Promoting concerns associated with the toddler period
1. Toilet training
- Before childrn can begin toilet training, they must have the impt
devtal level:
a. Must have control of rectal and urethral sphincter--Usually
achieved at the time they wlak well
b. Must have cognitive understanding ofwhat it means to hold urine
and stools until they can release them at a certain place and
time
c. Have a desire to delay immediate gratification for a more
socially accepted action
***some may pay their feces = because they become aware of body
excretions but have no adult values toward them
****it can be prevented by provding play substances of similartexture
and by changing diapers immediately after defecation.
2. Ritualistic behavior
- They will use only their spoon at mealtime and only
washcloth at bath time.

3. Negativism
- They do not want to do what parents wants them to
do
- Reply is NO
4.Discipline
- Setting rules orroad signs so children know what is expected
of them.
- Punishment – is a consequence that results from a breakdown
in discipline from the child’s disregard of the rules thatere
lerned
***prents should begin to instill some sense of discipline early in
life because part of it involves setting safety limits and
protecting others or property
- Time out- technique to help children learn that actions have
consequences
- Shouldbe1 minute per year of age
◻ 5. separation anviety
◻ Have difficulty in accepting being separted from their
primary caregiver
◻ Tend to cry
6. Temper tantrums
- Normal consequence of toddler’s development---occur
because toddlers are independent enough to know what
they want but they do not have that vocabulary or the
wisdom to express their feelings in a more socially
acceptable way
Concerns of the family with a physically
challenged or chronically ill toddler
Nutrition and the physically challenged
or Chronically ill Toddler
- Toddlers need experience feedings themselves if all
possible
- Help parents accept the accidents that occur with
self feeding particularly if the child has difficulty
with coordination, suggest finger foods if possible
- If on special diet, children may not be allowed to
eat finger fooods
- If they are tube fed, they receive no experinece
with finger foods at all

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NURSING CARE OF A

FAMILY WITH A TODDLER

- By 2 yrs = chest cicumference has grown greater of

notyet strong enough to support abdominal

- Walk with awide stance

◻ The passive antibody received intrauterinely is no longer

- Dont give bottle when lying/sleeping

- Encouge language development by naming objects as they play

- To develop autonomy is to develop sense of

- Realized that they donot always do what others

- 2 yrs ormore = becomeaware of their gender

**remind parents to provide duplicate toys

- At 15 months=able to follow different path ( walk

in back of the chair)

- Give clear instructions to avoid confusion

- Should be placed at the back rear of the car until 2 yrs

- Need to wear a helmet as soon as they begin riding a tricycle

- Prefer food that donot touch one another

- They eat all of one item before going on to another

- Prefer brightly colored foods to bland colors

- Fats should not be restricted for children under 2 years or over 2

- Trans fatty acids should be kept in minimum

- Calcium and phosphoros is important for bone mineralization

- Milk should be wholemilk under 2 years

- Shouldbe prepared as finger foods

- Fortified soy milk-prevents fluid,protein B12 and

washcloth at bath time.

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