Nursing Care of Toddlers

Today's Goal

• Review the following topics for competent nursing care:

  • Health Assessment of Toddlers

  • Growth and Development of Toddlers

  • Psychosocial Needs affecting nursing care

  • Importance of Discipline, Nutrition, and Sleep; cultural considerations

  • Common medical conditions in toddlers

Health Assessment of Toddlers

• Assessments recommended at ages: 15 months, 18 months, 2 years, 2.5 years, 3 years.

• Key practices:

  • Be flexible; use play for information gathering.

  • Incorporate distractions (e.g., singing, toys).

  • Allow touching of safe medical equipment.

  • Avoid asking for permission.

  • Use positive reinforcement.

  • Invasive procedures should be performed last.

• Ear inspection: pull pinna back and down.

• Use simple, concrete language to explain procedures.

Physical Variants in Toddlers

• Age range: 12 to 36 months.

• Teeth: All 20 baby teeth should emerge by 3 years.

• Brain Development: Myelination completed by 24 months.

• Physical characteristics:

  • Hand preference by age 2-3 years.

  • Diaphragmatic breathing patterns.

  • Point of maximal impulse: Located at the 4th intercostal space, midclavicular line.

  • Blood pressure increases; heart rate decreases as child ages.

  • Stool frequency typically reduces to once daily.

  • Common physical appearance: protruding abdomen, wide gait, flat feet.

  • Immature adaptive immunity until later toddler years.

Pain Assessment of Toddlers

• Use valid and reliable scales; incorporate caregiver input.

• FLACC scale:

  • Measures Face, Legs, Activity, Cry, Consolability, each scoring 0 to 2.

  • Total score ranges from 0 to 10, higher indicates greater pain.

• Toddlers may react similarly to painless vs. painful stimuli; encourage verbal expression of pain.

Physical Growth of Toddlers

• Height:

  • Increase of 5 inches (12.7 cm) from 12 months to 2 years.

  • Increase of 2 to 3 inches (5-7.6 cm) from 2 to 3 years.

  • Measure standing height at 3 years.

• Weight:

  • Measure weight in sitting position until age 3.

  • Gain approximately 5 pounds (2.3 kg) each year.

• Head Circumference:

  • Increases by 2 cm from 12 to 24 months.

• Document all physical growth metrics on growth charts for trend analysis.

Developmental Theories

Developmental Stages Overview

• Erikson: Autonomy vs. Shame and Doubt

  • Toddlers learn independence; explore choices and autonomy.

• Piaget:

  • Sensorimotor stage (up to 2 years)

  • Preoperational stage (begins 2 years).

• Freud: Anal phase; focus on toilet training and control.

• Kohlberg: Preconventional moral stage focusing on obedience to avoid punishment.

Motor Development of Toddlers

Gross Motor Milestones

Fine Motor Milestones

Communication and Speech of Toddlers

• Receptive Language: Develops faster than expressive.

• Echolalia: Repetition of words/phrases without understanding.

• Telegraphic Speech: 2-3 word sentences for concise communication.

• Caregivers encouraged to read to children.

Language Development Milestones

Social and Emotional Development

• Egocentrism: World revolves around them, focus on self.

• Begin understanding actions affect others at 3 years.

• Imitative behavior and potential for temper tantrums.

• Encourage caregivers to offer choices for independence.

• Risk Factors: Poverty, maternal depression, exposure to toxins can affect emotional and behavioral health.

Social Milestones

Safety Considerations for Toddlers

• Higher risk for various injuries:

  • Burns: Keep hot objects away; set water heater to 120°F.

  • Falls: Supervise playground and stairs; avoid climbing furniture.

  • Motor Vehicle Safety: Use a five-point harness in back seat from 2 to 4 years; rear-facing before age 2.

Play Considerations for Toddlers

• Parallel Play: Playing adjacent but not together.

• Short attention spans: Toddlers don't grasp sharing.

• Recommended toys: promote gross/fine motor skills and social interactions, including musical instruments.

Sleep Considerations for Toddlers

• Sleep: 11 to 13 hours required in 24-hour cycles.

  • Age 0-18 months: 9 hours at night + 2 naps.

  • Age >18 months: 9 hours at night + 1 longer nap.

• Establish bedtime routines to promote quality sleep.

Discipline for Toddlers

• Approach discipline as teaching rather than punishment.

• Focus on positive behavior reinforcement and ignoring unwanted behavior.

• Consistency is key; clarify negative behaviors without labeling the child.

Nutrition for Toddlers

• Transition from formula or breastmilk to whole cow's milk at 12 months.

• Limit milk intake to <24 oz/day to prevent anemia.

• Avoid bottles at naptime/bedtime.

• Address picky eating by offering varied healthy foods without pressure.

Common Medical Conditions

Atopic Dermatitis

• Most common chronic skin condition; linked to allergies/asthma.

• Symptoms include dry skin, erythematous patches, severe itching.

• Treatment focuses on avoiding triggers; topical corticosteroids if necessary.

Acute Otitis Media (AOM)

• Characterized by middle ear inflammation; frequent cases risk speech delay.

• Risk Factors: tobacco smoke, exposure to peers, congenital conditions.

• Protective Factors: breastfeeding, pneumococcal vaccination.

• Treatment includes antibiotics/symptom management; myringotomy for recurrent cases.

Failure to Thrive

• Causes: either organic (chronic disorders affecting nutrition) or non-organic (environmental neglect).

Toilet Training

• Signs of readiness typically emerge around 2 years.

• Encouragement via positive reinforcement, such as stickers.

• Avoid punishment for accidents.