7.1: DE VEYRA

Nursing Process Overview

• Erik Erikson's Theory: Toddler stage is characterized by autonomy vs. shame and doubt.

  • Autonomy: Toddlers begin to establish their identity apart from caregivers.

  • Allow toddlers to engage in play that promotes experimentation and independence, such as building and problem-solving activities.

• Assessment Importance:

  • Evaluate child's ability in daily activities (self-dressing, ball-throwing) to gauge developmental progress.

  • Insight into the parent-child relationship can be derived from child’s capabilities.

• Implementation Responsibilities:

  • Educate parents about common behavioral issues (e.g., temper tantrums) and strategies for managing them.

  • Recognize the recurring nature of toddler challenges, implying that strategies must be adaptable over time.

  • Create an awareness in parents that their treatment of children can have long-term repercussions on their development and emotional health.

Nursing Assessment of a Toddler’s Growth and Development

Physical Growth

• Physical growth slows compared to infancy.

  • Weight gain: 5-6 lbs (2.5 kg) per year.

  • Height increase: approximately 5 inches annually.

  • Loss of baby fat occurs by the end of the second year, leading to leaner body composition.

  • Toddler appetite decreases—provide nutritious, easily consumable finger foods (e.g., fruits and vegetables).

Measurement Criteria

• Regularly chart growth metrics (weight, height) to identify potential developmental delays.

  • Use lying down measurements for non-walking toddlers.

  • Head circumference generally increases only by 2 cm in the second year (significant decrease from the infant growth period).

Body Systems Development

• Respiratory and Cardiovascular Changes:

  • Respiration becomes slightly slower; abdominal breathing predominates.

  • Heart rate declines from 110 to 90 beats/min; BP increases to about 99/64 mmHg.

  • Brain development reaches 90% of adult size by age two, highlighting maternal nutrition's critical importance during early childhood.

Nutritional Needs and Health Promotion

Importance of Nutrition

• Proper nutrition crucial during the first 1,000 days for cognitive development and overall health.

  • Nutritional deficiencies can impair brain function and cognitive skills.

• Encourage engaging activities (e.g., reading) and exposure to stimulating environments for language and cognitive development during this period.

Daily Nutritional Requirements

• Active toddlers require up to 1,400 kcal/day; sedentary toddlers need about 1,000 kcal.

• Emphasize balanced diets with adequate protein, carbs, and fats (no sugar overload).

• Introduce vegetarian diets if caregivers are informed about nutrient balance.

Developmental Milestones

Language Development

• Rapid language acquisition; validate attempts and engage actively by naming objects to reinforce vocabulary.

  • Imitation plays a key role; language exposure affects children’s verbal skills.

Cognitive Development

• Transitioning from sensorimotor to pre-operational stages.

  • Encourages exploration through trial and error; children may display faulty logic.

Emotional Development

• Autonomy: Encourage decision-making within safe boundaries; promote independence while ensuring safety (e.g., allow choices in food).

• Temper Tantrums: Normalize episodic outbursts due to frustrations from limited communication skills.

Safety Considerations

Common Injuries in Toddlers

• Unintentional injuries are prevalent; include measures against poisoning, falls, and vehicle accidents.

  • Emphasize the importance of childproofing homes and proper supervision during activities.

Discipline and Behavioral Management

Guidance for Parents

• Distinguish between discipline (setting expectations) and punishment (consequences for rule-breaking).

• Time-outs: Use as a teaching tool for understanding social behaviors and family expectations.

  • Firm yet loving responses will promote better behavioral outcomes.

Addressing Separation Anxiety

• Recognize separation anxiety in toddlers; provide consistent routines when leaving children in care outside the home.

Conclusion

• Understanding the developmental phase of toddlers is essential for adequate nursing care.

• Promote health, nutrition, safety, and emotional well-being effectively through education and support services for families.