Infant and Toddler

Infants

Age group 1-18 months

Infants

Most vulnerable and dependent members of society:

Through health promotion, advocacy, and education

How do nurses play a vital role in positive interaction and parenting environment?

6 months

When can solids be introduced in an infant’s diet?

2 years old

It is recommended to breast feed until what age?

Vitamin D

What supplement should be added to breast milk, that is already added in formula and carton milk?

The have smaller digestive systems

Why do infants drink small amounts through the day?

They wake up hungry. They eat little at a time because their digestive system is smaller.

Why do infants wake up during the night, making their sleep inconsistent?

Homogenized milk. It has more fatty acids and is important for development

If not breast milk, what milk should infants be drinking?

Age 2

Toddlers should drink whole milk until what age?

1. Talk to them

2. Repeat sounds

3. Read to them

4. Singing and playing music

5. Praise

6. Attention

To encourage infant’s development, the nurse should encourage the family of an infant to:

By manipulating. Feeling textures, learning how to use fingers and hands.

Key way that infants learn:

Object permanence

Realizing that people/ things exist when you cannot see them

There are fewer contacts for health promotion than infancy. Fewer checks.

Why can things (health things) get missed in toddlers sometimes?

They are busier, up and moving. Posture straightens as well

Why do toddlers shed baby fat?

by 18 months. The skull begins to thicken

When does anterior fontanelle close?

24 months

When is skull 80% of adult size?

Survival

First and most basic tasks of infants:

Many of the infant survival tasks involve the mouth (sucking, breathing, eating)

Why is the period of early infancy referred to as “oral development?”

1. Focus vision

2. Explore

3. Reach out

4. Seek things around them

5. Develop love and trust with caregivers

In the first year, infants learn to [5, but there are many]

Trust vs. Mistrust

Erikson’s stage for infancy:

Physical tasks of

1. Eating

2. breathing

3. sucking

4. eliminating

5. sleeping

Tasks included in infant survival: [5]

Important for brain development. As environment expands, brain development relies on cognitive stimulation (visual, auditory) in the home (Ex: language, books, toys, etc.)

Why is external stimuli so important for infants?

1. Trust is established when parents meet basic needs for survival

2. Prompt, sensitive, consistent response to needs establishes trust

Psychosocial considerations for infants: [2]

1. Problem solving happens with sensory systems and motor activity (Piaget)

2. Reacts to touch (ex: soothing touch or pain)

3. reflexive behaviors such as sucking and rooting to find food source

Cognitive considerations for infants: [3]

12-18 months to 3 years of age

Age window for toddlers:

At the end of infancy until the start of puberty

When is growth rate steady after infancy?

Toddler age, this is why toddlers need meals and snacks more frequently.

When does a child reach gastro-intestinal maturity?

18 months

When does passive immunity disappear and active immunity start?

All 20

How many teeth have emerged by toddlerhood?

Tummy time when awake to reduce time laying on head

How to reduce flat head in infants?

No, toddlers do not have the motor coordination yet. Adults should do it for them, but encourage a partnership.

Should toddlers brush their own teeth?

Non-fluoride toothpaste (a pea size amount), as they may swallow it

What kind of toothpaste should be used between 1 and 2 years of age? Why?

Encourage water, but 125mL per day if at all.

How much juice should a toddler be limited to daily to avoid dental caries?

Water. Juice and milk should be offered in a cup, and not before bedtime to prevent tooth decay.

If a toddler needs a bottle at night, what should be the only thing given in the bottle?

12 months

When should a child have their first dental visit?

Milk only (breastfed or formula)

Diet from birth to six months

500-720 mL, so that they are not too full for solid foods

After 12 months, milk should be limited to how much daily?

6 months

When should babies be introduced to solid foods?

Their growth rate slows from infancy

Why might toddlers have a decreased appetite?

• Finger foods

• Avoid mixed textures with many tastes

• New foods along with favorite ones

• Small portions, let the toddler ask for more

• Encourage utensils but fingers are still fine

• Parents choose what to eat, toddler decides how much

Food recommendations for toddlers: [6]

1. Mini marshmellows

2. whole grapes

3. pretzels

4. popcorn

5. hard candy

6. large chunks of meat

7. nuts and seeds

8. Hot dogs

9. large chunks of meat

10. spoons of peanut butter

11. chips

12. Raw carrots

Foods that are choking hazards for toddlers: [12]

18 months

Most children are not ready for toilet training before ____ months of age

1. Walking well

2. Being able to stoop and recover

3. Stay dry for 2 hours or more

4. Communicate sensation of needing to go

5. Communicates discomfort of wetness

Prerequisite skills for toilet training: [5]

1. Sitting on the potty first, feet touching the floor

2. Place on the potty after meals for 2-3 minutes

3. Praising good behaviour

4. Accepting delays and frustrations

Tips for toilet training: [4]

3 years old

When does daytime dryness occur?

180 minutes

How much activity is recommended between ages 1 to 2 years old?

60 minutes of energetic play

How much exercise is recommended for children aged 3-4?

Parallel play

Toddlers are interested in other children, and play alongside other children with similar toys independently.

12 hours of sleep, including 1-2 shorter naps

How many hours of sleep does a toddler need?

Quiet time, could be reading side by side, calming music, rocking in a rocking chair.

Toddler naps can be replaced with what?

Rituals give a sense of security at the end of the day

Why are bedtime rituals so important for toddlers?

3-12

Night terrors are common between what ages?

Night terrors

Bad dreams in the light REM sleep where child is partially awake. Can be triggered or random. They may call out, frightened. Normally resolves after 5-10 minutes

1. Healthy snack

2. Bathing

3. Brushing teeth

4. Story time

5. turn off light, turn on night light

6. bedtime kiss

Example of a typical bedtime ritual a nurse might recommend to parents of a toddler: [6]

Preoperational

At the beginning of toddlerhood, kids are starting to move towards which cognitive stage?

2-3 word sentences

How long are toddler sentences?

about 400 words

How vaast is the language repertoire of a toddler?

3 years old

By what age do kids master the basics of language function?

3 years old, they know something will come back. Peek-a-boo is not as funny.

When do toddlers have a solid understanding of object permanence?

Speech and language development. Quality and quantity is important for listening ability.

Hearing is critical for what?

20/40

How good is toddler’s vision?

Amblyopia (“lazy eye”)

Diminished or loss of vision in an eye that has not received adequate use. The brain favors the stronger eye.

Strabismus

Deviated line of vision. Extra-ocular muscle weakness or imbalance (cross eyed). Common cause of amblyopia.

1. Rubbing eyes

2. Shuts one eye

3. Difficulty doing close work

4. Holding books close to face

5. Blinking, squinting

6. Red, inflamed, water eyes

7. Recurring styes

Red flags to look for concerning a child’s vision [7]

Conditioned association

By toddler age, kids are learning to associate certain good and bad smells and tastes. This is called:

1. Childproof the home

2. give advance notice of change

3. Do not offer choice if there is not one

4. Set and enfrce consistent limits

5. dealing with temper tantrums

6. Praise toddler’s skills and abilities

Nursing interventions for parents of toddlers: [6 things to recommend]

They are not necessarily being bad. They may not be able to find the words, unable to communicate, are frustrated. They cannot articulate what is wrong. Linked to need for autonomy

Why might a toddler have temper tantrums?

Autonomy vs. shame and doubt. Toddlers want to do things for themselves, developing independence.

Erikson’s stage for toddlers:

Egocentric approach

In regards to personality and moral development, toddlers base relationships on themselves. Everything is about them

1. Jealousy, acting out

2. reverting to younger stages. More accidents, starting to talk like a baby

3. Not sleeping well, night terrors

4. Stemming from jealousy and change

Possible outcomes for a toddler with a new sibling:

1 in 7 experience abuse or neglect

Prevalence of child abuse in toddlers:

1. Parents delay seeking help

2. Inconsistencies in story of injury

3. Recurring, unexplained illness

4. Injury is inconsistent with story

5. Old fracturs

6. Bruises to back of body (neck, knees)

7. Perineal injuries

Potential signs of child abuse to look out for [7]

Toilet training puts a focus on the genitals. Curiosity is normal, it is important to use the correct anatomical terminology.

Why might toddlers be more curious about their body parts?

Helps toddlers develop an accurate knowledge about sexuality and communicate more effectively with others (people know what they are talking about)

Why is is important to use correct anatomical terminology with toddlers about genitals?

1. "easy child”

2. “difficult child”

3. “slow-to warm up child”

Three stereotypical temperments that shouldn’t be used to describe toddler behaviour:

Imitating parents. Toddler coping is egocentric, focusing on the need for autonomy

What is one way toddlers learn to cope?

1. new siblings

2. babysitters

3. daycare

4. toilet training

5. parental limit setting

6. tasks involving skills that are not yet developed

What are typical stressors for toddlers?

High risk, they lack judgement and experience, and are constantly curous and exploring.

Why are toddlers at a high risk of accidents?

Toddlers can drown in water deep enough to cover their nose and mouth. They should be under constant supervision when in and around water. They are at the highest risk of drowning, as most of them cannot swim, keep their head above water, or get out of the water by themselves.

Why are toddlers at high risk of drowning?

1. Accidents

2. structural hazards

3. toys

4. sports

5. drowning

6. burns

7. motor vehicles

8. contagious illnesses

9. poisoning

Concerns for toddlers (risks and dangers to consider) [8]