Toddler Ch. 18 (previous owner)

Toddler:

18 months to 3 years

Growth-

2-4 inches per year
4-6 lbs per year
-shed baby fat
-posture straightens
-big belly

lumbar lordosis

A curving inward of the lower back that puts pressure on the entire back.

Toddlers height at 2 years of age is

50% of final adult height

anterior fontanel

closes by 18 months
-continue to measure head circumference

Birthweight quadruples by

2 and 1/2 years old

Bladder-

-urinate less freq than in infancy, still control issues
-child has to be able to walk and stoop to be able to learn potty training

Bowel control

-potty training usually successful w/bowel first, then urine
-More control over bowel

Toilet training

18-24 months

Daytime dryness is

more under control

Diapers at night

not moving around more likely to go potty in bed.

Respiratory rate at age 1

30

Respiratory rate age 3

25

Diameter of the respiratory track is

small and may lead to mouth breathing if the nose is clogged with mucous

Heart rate

80-120 bpm

BP

90/56

AHA reccommends BP screening to begin at

3 years old, then annually

First round of immunizations ends at 18 months...

next one age 4-6 years old

increased exposure to

communicable diseases so they may get sick often

Gain resistanse to organisms as they are exposed to

more

Tonsils and Adenoids remain

large

continued risk for

otitis media- due to the anatomy of the ear

Tonsils and adenoids are pretty much the same size as when they're

adults

Ear/ throat

More horizontal= more prone to ear infections

Passive immunity acquired via mom has

disappeared

20 primary teeth erupt by the end of

toddlerhood

prevent fental carries by

water only in bedtime bottle

Iron supplements with

orange juice (vit C)

Too much milk can

affect their appetite

moderate amount of milk

impacts Fe

Juice overconsumption can lead to

obesity

juice

only given one serving a day.
-100 pure pasteurized juice shoudl be given

Avoid putting the kids in front of the tv while

eating

Never use food as a

reward or punishment

Choking hazard foods

grapes, blueberries, popcorn, hot dogs, carrots

Food allergy signs

itching or hives

High allergy foods:

eggs, milk, nuts, gluten, seafood, soy.

Vision

20/40

EMOs

Not strong

Strabismus

diagnosed between 1 and 4. Eye movements aren't yoked together.
-eye exercises, surgery, glasses

Amblyopia

irreversible. Major health concern for this age group 2-4% of children. Can result from untreated strabismus.
-brain favors the normal eye.
-Management focused on making child use eye with reduced vision (lazy eye)

Taste and smell

begin to associate taste with smell. Develop food aversions

can

scribble, copy a circle, hold utensils, kick

Becoming autonomous- (Erikson)

Wanting to try things on their own. If they don't get to do things for themselves they will feel less confident in themselves.
-dressing themselves. Less dependent on parents, kid has to try by themselves.

"NO", temper tantrums

common
- ignore it, wait until they burn themselves out.
-have temper tantrums because they cannot communicate what they want.
-trick them into thinking they're in control. Do you want to take a bath before dinner or after dinner?

Always busy and exploring;

most waking hours spent at play

Parallel play

playing on their own but not interacting with one another.

Impact of TV

-early screen time related to childhood obesity and language barriers.
-Recommend no screen time because of lack of language development

Major role of nurse at this stage-

Provide guidance to parents about environmental hazards, dealing with tantrums, assisting with toilet training

Sleep

Need 12 hours a day, one to two naps
-schedules are helpful to avoid over fatigue
-night terrors can develop

Language

hearing loss assessed at birth, can be tested during toddler preschool years

Otitis Media:

leading cause of hearing loss in toddlers

Toddlers use

gestures until the words are formed

400 words

NO being the most used

By age 3 children have mastered basics of

language

Well child visits

Often fearful of nurses, doctors. Need to have some type of control

Strategies- hold equipment, blow out otoscope light, let them listen to their
heart w/stethoscope, distraction, jokes

Child abuse-

more likely to occur with a major change or turmoil in the family.
Toddlerhood is a trying time for even patient parents.

Nursing Role: child abuse

be alert to family changes and stress; be aware of potential
s/s abuse and report when suspected A major nursing role is to provide
anticipatory guidance; provide info about support groups.

Warning signs for child abuse

parental delay in seeking help and reluctance to provide
info, bare spots and broken hair, inconsistencies in story, old fractures,
pattern injuries, well demarcated burn marks, bruises (especially on
back of body)

Accidental injuries

Toddlers are at high risk for accidental injury because they lack judgment, and have limited physical coordination and a heightened level of curiosity. Toddlers love to explore and climb objects. Injuries to toddlers occur most often when they fall from furniture, stairs, or windows.

Drowning

Highest risk ages 1 to 3
Ø Can drown in water if covers nose/mouth
ØDanger: pools, tubs, toilets, pails of water

Burns

Ø Hot liquids, electrical cords, fireplaces
ØLower water heater to 120° to 125° F

Poisoning

Greatest risk ages 1 to 2
Ø Use mouths as way to explore environment
Ø Medications, household products, plants, cigarettes, alcohol, cosmetics
ØSuspected poisoning—contact Poison Control Center

Structural hazards

Ø "Baby-proof" environment
Ø Inspect for hazards in unfamiliar environments
ØAppropriate supervision

Toys

Ø Inspect toys
Ø Risk of small removable parts, batteries, toxic paint, sharp edges

autism boys

1 in 37
-four times more likely than girls

autism girls

1 in 151

Most children with autism were still being diagnosed after the age 4

though autism can be reliably diagnosed as early as age 2

There is no medical detection for

autism

behavioral

inapproperiate social interaction, poor eye contact, compulsive behavior, impulsivity, repetitive movements, self harm, or persistant repetition of words or actions

Developmental

learning disability or speech delay in a child

cognitive

intense interest in a limited number of things or problem paying attention

Phychological

unaware of others emotions or depression

motor veichle accidents are the

leading causes of death 1 to 4 years old (both passanger and pedestrian)

rear seat position is

preferred. Supports the head, neck, and spine during a crash

forward facing seat until

40-65 lbs

CT Law, infants must remain rear facing until they are a minimum of both

2 years old and 30 lbs

CT Law, toddlers must be in a forward facing car seat with

5 point harness . Stay in seat with 5 point harness until as long as possible according to manufacturers guidelines for height and weight.

CT Law, children should ride in a booster until they reach

8-12 years old and 4'9". children who ride in a booster seat must use a lap and shoulder belt.

CT Law: Children, tweens, and teens must

be in a seat belt whenever they ride in a veichle

Children should ride in the back seat until they are

13 years old. all people and objects should be properly restrained whenever they are in a vehicle.