Study Notes on Toddler and Preschooler Growth, Development and Health Promotion

Toddler and Preschooler Growth, Development, & Health Promotion

Morgan Chojnacki, DNP, APRN, CPNP-PC - University of Kentucky College of Nursing NUR 204 IN class lecture

Pre-Class Module Questions

  • Introduction: Formative assessment through clicker questions.

Behavior Management for Toddlers

  • Scenario: Mother of a 14-month-old distressed by the child's behavior.
    • Key Instructions for Discipline:
    • Set limits: Essential for ensuring safety.
    • Redirect negative behavior: Suggest engaging the child in a preferred positive action.
    • Disciplinary methods discussed:
      • Spanking permissible if it does not leave a mark.
      • Time-out: Recommended duration of 5 minutes.

Developmental Evaluation for Toddlers

  • Evaluation of a 2-year-old child: Common behaviors expected
    • Uses a fork: Demonstrates developing motor skills.
    • Uses a cup: Independently drinking from a cup.
    • Uses a knife for cutting food: Not typically expected at this age.
    • Pours own milk into a cup: Skill not yet developed by age 2.

Understanding Parallel Play among Toddlers

  • Definition of Parallel Play:
    • Described as sharing crayons to color separate pictures.
  • Comparison with other activities:
    • Playing a board game with a nurse does not qualify.
    • Sitting near each other while playing indicates parallel play.
    • Sharing dolls does not fit the definition of parallel play.

Managing Tantrums in Preschoolers

  • Situation: A mother of a 3-year-old expresses concerns about frequent tantrums.
    • Best nursing advice:
    • Instead of punishing each instance of saying “no,” it’s important to allow the behavior as it is normal for this age.
    • Setting limits on behavior remains critical, but ignoring the behavior isn't the suggested approach.

Appropriate Toys for Toddlers

  • Selection for an 18-month-old child:
    • Multiple piece puzzle: Inappropriate.
    • Miniature cars: Not suitable.
    • Non-toxic finger paints: Acceptable choice.
    • Comic book: Generally not recommended for this age.

Language Development at 12 Months

  • Normal speech capabilities for a 12-month-old:
    • Expected to say 3-5 words besides “momma” and “dada”.
    • Typically does not fully verbalize until about 15 months of age.
    • Ability to say 10 words including two-word phrases (like “Momma go”) is above typical expectation.
    • Use of “momma” and “dada” exclusively is a developmental delay concern.

Communicating with Children in Medical Settings

  • Scenario: Kindergarten child questioning about mother's arrival.
    • Best nursing reply:
    • “Your mommy should get here in about a half hour” provides a clear timeframe.
    • Alternatives such as measuring time by clock hands or meal times are less effective.
    • Ambiguous reassurance like “soon” lacks specificity.

Managing Anxiety in Young Patients

  • Scenario: 3-year-old exhibiting anxiety during a medical procedure.
    • Best initial action:
    • Guide her to breathe in through her nose, and out through her mouth until calm.
    • Alternatives like calling the doctor or applying a band-aid may not address immediate anxiety.
    • Offering a story may not sufficiently distract from the anxiety she feels.

Feedback on Potty Training

  • Concern raised by a father about his 15-month-old regarding potty training.
    • Nurse's response:
    • Delay training until roughly 3 years of age, as control of bladder and bowel functions is expected around 18 months.
    • Encouraging through reward systems is a positive approach, though best outcomes from patience and timing.

Appropriate Snacks for Toddlers

  • Snack Options Evaluated:
    • Grapes: Suitable but must ensure they are cut.
    • Popcorn: Generally inappropriate due to choking hazard.
    • Banana: Highly suitable as a snack choice.
    • Peanuts: Not suitable due to choking risk.

Administering Liquid Oral Medication to Toddlers

  • Correct procedure for administering liquid antibiotics to a 2-year-old:
    • Utilize a syringe placed in the inner cheek to dispense the medication safely.
    • Avoiding sleep dosing or mixing with food is advised due to efficacy concerns.

Transitioning to Cognitive and Psychosocial Development

  • Moving on to the next topic:
    • Cognitive and psychosocial learning phases during toddler and preschool years.

Psychosocial Development in Toddlers (Erikson)

  • Developmental Stage: Autonomy vs. Shame and Doubt
    • Key Concepts:
    • Toddlers begin to relinquish dependence on caregivers.
    • They strive to do tasks independently which fosters a sense of accomplishment.
    • Providing choices throughout the day reduces behavior problems and cultivates a sense of control.
    • Avoiding negativity: Limit use of the word 'NO' in instructions and questions.
    • Encouragement of ritualism brings comfort; maintaining routines during hospitalization is beneficial.
    • Differentiation from caregivers results in a complete separation anxiety resolved by 18 months.

Consequences of Overdependence in Toddlers

  • Issue: If parents maintain dependence where capability exists.
    • Resulting feeling in toddler: Shame.
    • Impact on autonomy and trust-building.

Cognitive Development in Toddlers and Preschoolers (Piaget)

  • Stage: Preoperational Thinking
    • Initial understanding of causality begins development.
    • Limited understanding of the concept of time.
    • Animism: attributing lifelike qualities to inanimate objects (e.g., toys).
    • Irreversibility: inability to reverse actions taken physically.
    • Egocentrism: inability to appreciate perspectives outside one's own.
    • Conservation Understanding: Child's inability to grasp that mass remains unchanged despite alterations in size, shape, or volume.

Observational Evidence for Cognitive Development

  • Reference to a video illustrating children's understanding of conservation at the PreK/Toddler level.

Parental Guidance on Autonomy and Rebellion in Toddlers

  • Concern expressed by parents of a 2-year-old seeking independence.
    • Nursing advice emphasizes this independence is a normal part of maturity.

Psychosocial Development in Preschoolers (Erikson)

  • Developmental Stage: Initiative vs. Guilt
    • Emotional consequences of guilt and anxiety addressed.
    • Need for parents and nurses to foster impulse control while encouraging creativity.
    • Setting age-appropriate developmental tasks to prevent feelings of inadequacy.
    • Communication Strategy: Encourage imaginative play and creativity while holding realistic expectations.
    • Importance of monitoring behavior and establishing rules before new challenges.

Stress Implications for Preschoolers

  • Acknowledgement of minimal stress being beneficial.
    • Parents should recognize signs of stress such as regression and somatic complaints.
    • Maintaining an adequate schedule for rest and preparing children for upcoming changes is essential.

Role of Imaginary Friends in Preschoolers

  • Concept of imaginary playmates:
    • Aiding children in coping with changes or new skills.
    • Parents encouraged to listen and engage in conversations about these friends.
    • Importance of healthy creative outlets without letting children utilize imaginary friends as scapegoats.

Common Fears in Preschoolers

  • Typical fears include:
    • The dark, being alone, animals, ghosts, castration/mutilation.
    • Recommended techniques: emotional involvement and systematic desensitization for overcoming these fears.

Emergency Responses to Children's Anxiety

  • Scenario involving a 4-year-old patient fearful of a nebulizer.
    • Optimal nursing response:
    • Use a comforting and playful approach, possibly incorporating a toy to demonstrate the process.
    • Avoid dismissive language that decreases the child’s feelings of distress.

Supporting Toddler Psychosocial Development During Procedures

  • Scenario with a toddler refusing vital signs.
    • Most supportive nursing intervention:
    • Offer choices such as timing (now or later for temperature).
    • Engaging in playful activities (like bubbles) to ease procedural anxiety.

Addressing Midday Challenges with Toddlers

  • Observational notes on a 24-month-old displaying increased difficulty during midday tasks.
    • Recommendation:
    • Inquire about the child's home sleep schedule to understand behavior patterns better.
    • Praise during tasks could boost morale, while avoiding midday tasks may be useful.