MCN Finals Oral Quiz

GENERAL OBJECTIVE:
 AT THE END OF 6 HOURS OF PARTICIPATIVE

LECTURE DISCUSSION, THE LEVEL 2 STUDENTS
WOULD BE ABLE TO ACQUIRE POSITIVE
ATTITUDE, ADEQUATE KNOWLEDGE AND SKILLS
IN THE CARE OF AN INFANT.
SPECIFIC OBJECTIVES:
 SPECIFICALLY, THE LEVEL 2 STUDENTS CAN:
1. DESCRIBE THE NORMAL INFANT GROWTH &
DEVELOPMENT.
a) Physical growth
b) Motor development
c) Language development
d) Development of senses
e) Emotional development
f) Cognitive development
SPECIFIC OBJECTIVES:
 SPECIFICALLY, THE LEVEL 2 STUDENTS CAN:
2. DISCUSS THE HEALTH PROMOTION
STRATEGIES OF AN INFANT AND FAMILY.
b) Promoting achievement of TRUST VS. MISTRUST
c) Promoting infant safety
d) Promoting nutritional health of an infant
e) Promoting infant development in daily activities
f) Promoting healthy family functioning
3. ENUMERATE COMMON PARENTAL
CONCERNS & PROBLEMS R/T NORMAL
INFANT DEVELOPMENT & INTERVENTIONS.
Physical Growth
 Weight  x2 by 6 mos. Of age
 X3 by 1 yr.
 Height  Increase by 50% during the

1st yr.
 1st 6 mos apparent in trunk
 Next 6 mos more apparent
in legs
 Head
circumference  2/3 of its adult size by the
end of 1st yr.
Physical Growth
 Body
proportion
Chest  < 2cm than head at birth

circumference  Head & chest circum.
even at 6 – 12 mos.
Abdomen  Protuberant
Physical Growth
 Body Systems
HR  100-120 b/min. by end of 1st
yr
Bp  From 80/40 to 100/60 mmHg
Prone to  RBC at birth is
develop disintegrating but new cells
anemia @ 2-3 are not produced
mos. old adequately
 Life of RBC is 4 mos.
Physical Growth
 Body Systems
5-6 mos. Old
 Hemoglobin converted to adult hemoglobin
 Infant hemoglobin (Hemoglobin F)
 40-70% is fetal hemoglobin
 Composed of 2 alpha & 2 gamma polypeptide
chains.
 Shorter life span
 High level of Hgb F depress erythropoietin
released by the kidney that stimulates RBC prod.
 Adult hemoglobin (hemoglobin A)
 Composed of 2 alpha & 2 beta chains
Physical Growth
 Body Systems
6-9 mos. Old  Infant experience serum

iron levels as last iron stores
established in utero are used.
RR  20-30 b/min. by end of 1st yr.

Physical Growth
Body Systems
 URTI occur readily  Lumen of respiratory
tract remains small
 Mucus production still
inefficient
 Inability to digest  Amylase is deficient
food until 3rd month of life
 Lipase is decreased in
amount during the
entire 1st yr. of life.
Physical Growth
Body Systems
 Liver still immature  Causing inadequate
conjugation of drugs
 Inefficient formation
of carbohydrate,
protein & vitamins for
storage.
 Extrusion reflex
 Prevents infants from
present until 3 – 4 eating effectively
mos. old
Physical Growth
Body Systems
 Functional by at least 2
 Immune system mos. of age.
 Can actively produce
both IgG & IgM
antibodies by 1 yr.
 Can adjust to cold  Infant can shiver in
by 6 mos. response to cold.
 Has developed
additional adipose
tissue.
 Brown fat decreases
during the 1st yr.
• IgM
 Effective in agglutinating antigen as
well as lysing cell walls.
• IgG
 Has major responsibility for neutralizing
bacterial toxins and destruction of
bacteria.
Physical Growth
Body Systems
 Fluid in body  Extracellular fluid is
compartments 35% of an infant’s
BW, 40% intracellular
fluid by end of 1st yr.
 Increases infant’s
susceptibility to
dehydration.
Teeth
 Central incisor
usually erupts at 6
mos. Old.
 Some may be born

with neonatal teeth.
MOTOR DEVELOPMENT
 Gross Motor Development
1. Ventral suspension position
 Infant’s appearance when infant is held in
mid-air on horizontal plane.
 1 month old
 Lifts head momentarily , then drops it
again.
 2 mos. Old
 Hold head in the same plane as the rest of
their body
 3 mos. Old
 Lifts & maintain head well above the plane.
MOTOR DEVELOPMENT
 3 mos. Old
 Landau Reflex develops
 When held in ventral suspension, infant’s

head, legs & spine extend.
 Continues to be present during the 2nd 6
mos. of life.
 Parachute Reflex
 Demonstrated at 6 – 9 mos. old.

MOTOR DEVELOPMENT
2. Prone Position
 1 month old
 Can lift their head and turn them to side.
 2 mos. Old
 Can raise their head and maintain the
position.
 3 mos. Old
 Can lift head & shoulders off the table
and looks around when prone.
 Can turn from prone to side lying.
MOTOR DEVELOPMENT
2. Prone Position
 4 mos. old
 Can lift their chest off the bed and look
around actively, turning head from side
to side.
 Can turn from front to back.
 5 mos. Old
 Rest weight on forearms when prone
 Can turn to front to back, and back to

front.
MOTOR DEVELOPMENT
2. Prone Position
 6 mos. Old
 Rest weight on their hands
with extended arms.
 Can raise chest and upper abdomen off
the table.
 9 mos. Old
 Can creep from prone position
MOTOR DEVELOPMENT
3. Sitting Position
 1 month Old
 Has gross head lag when pulled to a sitting
position.
 2 mos. Old
 Can hold head fairly
steady when sitting up.
 Still has head lag when
pulled to sit.
 3 mos. Old
 slight head lag when pulled to sit.
MOTOR DEVELOPMENT
3. Sitting Position
 4 mos. Old
 No more head lag when pulled to a sitting
position.
 5 mos. Old
 Straighten back when held in sitting position
 6 mos. Old
 sits momentarily without support.
 Sits with their legs spread with arms

stiffened between them.
MOTOR DEVELOPMENT
3. Sitting Position
 7 mos. Old
 Sits alone but only when hands are held
forward for balance.
 8 mos. Old
 Sits securely without support.
 9 mos. Old
 Sits steadily.
 Can lean forward and maintain their

balance.
MOTOR DEVELOPMENT
4. Standing Position
 1 month Old
 Stepping reflex still demonstrated.
 2 mos. Old
 When held in standing, they hold their head
up.
 3 mos. Old
 Infants begin to try to support part of their
weight.
MOTOR DEVELOPMENT
 4 mos. Old
 Begin to be able to support their weight on
their legs.
 Stepping reflex has faded.
 5 mos. Old
 Ability to sustain a portion of his weight.
 Moro reflex is fading.
 6 mos. Old
 Support nearly their full weight.
MOTOR DEVELOPMENT
 7 mos. Old
 Bounces with enjoyment when held in
standing position.
 9 mos. Old
 Can stand holding on to a coffee table.
 Can pull up to that position.
 10 mos. Old
 Can pull themselves to standing position by
holding on to the side of a playpen, but
cannot let themselves down again.
MOTOR DEVELOPMENT
 11 mos. Old
 Learns to “cruise” by holding onto objects.
 12 mos. Old
 Can stand alone at least momentarily.
 A child has until 22 months of age to walk and

still within the normal limit.
MOTOR DEVELOPMENT
 FINE MOTOR DEVELOPMENT
 1 month
 Strong grasp reflex
 Hold hands in fists
 2 mos. old
 Grasp reflex begins to fade
 Will hold an object for a few minutes before
dropping it.
 Hands are held open
MOTOR DEVELOPMENT
 3 mos. old
 Reach for attractive objects in front of them
but usually miss them.
 4 mos. old
 Brings their hands together and pull their
clothes.
 Shake a rattle placed in their hand for a long
time.
 Thumb opposition is beginning but the motion
is a scooping or raking one, not picking-up
one; not very accurate.
 Palmar & Plantar grasp reflexes have
disappeared.
MOTOR DEVELOPMENT
 5 mos. old
 Can accept objects handed to them with
their whole hand.
 Often play with their toes as objects.
 Fisting beyond 5 months
 delayed motor development
 6 mos. old
 Can hold objects in both hands.
 Will drop 1 toy when a 2nd one is offered for
the same hand.
MOTOR DEVELOPMENT
 6 mos. old
 Can hold a spoon and start to feed
themselves with much spilling.
 Moro, Palmar grasp & Tonic neck reflex
have completely faded.
 Moro reflex that persists beyond this point
 Neurologic disease.
MOTOR DEVELOPMENT
 7 mos. old
 Can transfer toy from one hand to the other.
 8 mos. old
 Advanced hand – eye coordination.
 10 mos. old
 Pincer grasp
 Able to pick up small objects.
 Uses 1 finger to point to objects.
 Offers toy to people but cannot release them.
MOTOR DEVELOPMENT
 12 mos. old
 Can draw a semi-straight line with a crayon.
 Enjoy putting objects (e.g. small blocks) in
containers and taking them out again.
 Can hold cup & spoon to feed themselves
fairly well.
 Can take off socks; push their hands into
sleeves
 Can offer toys & release them.
 LANGUAGE DEVELOPMENT
 1 month
 Cooing sounds
 2 mos. old
 Differentiates cry
 3 mos. old
 Squeal with pleasure in response to
smiling face, nodding or friendly tone of
voice.
 4 mos. old
 Very “talkative”, cooing, babbling,
gurgling when spoken to.
 5 mos. old
 Laughs out loud.
 Say “goo – goo” and “gah – gah”
 6 mos. old
 Learns to imitate
 May imitate parent’s cough
 7 mos. old
 Can imitate vowel sounds
 9 mos. old
 Speaks a 1st word “da-da”
 10 mos. old
 Masters another word as “bye-bye” or
“no”.
 12 mos. old
 Can say 2 words besides “ma-ma” and
“da-da”.
 PLAY
 1 month
 Interested in watching and listening to a
musical mobile over their playpen.
 Color should be Black & White or bright
colored toys.
 Spend a great deal watching their parents’
face.
 PLAY
 2 mos. old
 Will hold light, small rattles for a short
period of time & then drop them
 3 mos. old
 Can handle small blocks or small rattles.
 4 mos. old
 Rolling over
 5 mos. old
 Plastic rings, blocks, squeeze toys
 PLAY
 6 mos. Old
 Can sit steadily enough to be
ready for bathtub toys.
 Start to teethe, infants enjoy a
teething ring to chew.
 7 mos. Old
 Can transfer toys.
 Interested in blocks, rattles, plastic keys.
 More interested in brightly-colored toys.
 PLAY
 8 mos. Old
 Sensitive to differences in texture.
 Enjoy toys that are rough, smooth, fur,
fuzzy, velvet.
 9 mos. Old
 Needs the experience of creeping.
 Begins to enjoy toys that go inside one
another.
 Likes pots & pans
 PLAY
 10 mos. Old
 Ready for peek a boo
 Can clap
 Ready to patty cake
 11 mos. Old
 Learned to cruise or walk along low tables
by holding on.
 12 mos. Old
 Enjoy putting things in and taking things
out of containers.
 VISION
 1 month old
 Infants regard an object in the midline of
their vision at 18 inches away.
 They follow it a short distance, but not
across the midline.
 2 mos. Old
 focus well and follows objects with the
eyes still not past the midline (binocular
vision)
 VISION
 3 mos. Old
 Can follow objects across their midline.
 Typically hold their hands in front of their
face and study their fingers for long
periods of time (hand regard).
 4 mos. Old
 Recognize familiar objects
 E.g. frequently seen bottle, rattle, or toy
animal.
 They follow their parents’ movements.
 VISION
 6 mos. Old
 Increases the accuracy of their reach for
objects as they begin to perceive distance
accurately.
 7 mos. Old
 Pat their image in a mirror.
 Depth perception has matured
 Can transfer toys from hand to hand.
 VISION
 10 mos. Old
 Beginning of object permanence.
 Infants look under a towel, or around a
corner for a concealed object.
 HEARING
 1 month
 Quiets momentarily at a distinctive sound
such as a bell or a squeaky rubber toy.
 HEARING
 2 mos. Old
 Stop an activity at the sound of spoken words.
 3 mos. Old
 Turn their heads to locate a sound.
 4 mos. Old
 When infant hear a distinctive sound, they turn
& look in that direction.
 5 mos. Old
 Can locate sound downwards and to the side.
 HEARING
 6 mos. Old
 Able to locate sounds made above them.
 10 mos. Old
 Can recognize their name and listens when
spoken to.
 12 mos. Old
 Can easily locate sound in any direction
and turn toward it.
Tape recording a maternal heart sound is
very soothing to very young infants.
 TOUCH
 Infants need to be touched to experience skin-
to-skin contact.
 A way of promoting close physical contact.
 TASTE
 Urge parents to make mealtime a time for
fostering trust, supplying nutrition by
being certain feedings are done at infant’s
pace.
 SMELL
 Can smell within 1 – 2 hrs. after birth.
 Keep irritating odors out of the child’s
environment.
 1 MONTH OLD
 Can differentiate between faces and
other objects by staring at them longer.
 6 WEEKS OLD
 When person smiles at them, the infant
smiles in return (social smile).
 3 MOS. OLD
 Laughs out loud at the site of a funny
face.
 Increased social awareness by readily
smiling at the sight of a parent.
 4 MOS. OLD
 When a person who has been entertaining
an infant leaves, the infant is likely to cry
 Recognize their primary caregiver.
 5 MOS. OLD
 Shows displeasure when an object is taken
from them.
 6 MOS. OLD
 Aware of the difference between people
who regularly care for them and strangers.
 7 MOS. OLD
 Begin to show fear of strangers
 8 MOS. OLD
 Fear of strangers reaches its height (8th
month anxiety) or stranger anxiety.
 9 MOS. OLD
 Very aware on changes in tone of voice.
 Cry when scolded because they can
sense their parent’s displeasure.
 12 MOS. OLD
 Have overcome their fear of strangers.
 Like being at the table for meals and
joining family activities.
 Like to play interactive nursery rhymes
and rhythm games.
 1st Month
 Uses simple reflex activity
 3rd Month
 Primary Circular Reaction
 Explores objects by grasping them with the
hands or by mouthing them.
 Unaware of what actions they can cause
 6th Month
 Secondary Circular Reaction
 Realize that their actions can initiate
pleasurable sensations.
 Unaware of object permanence
 10th Month
 Coordination of Secondary Schema
 Aware that an object out of sight still
exist.
 Ready for peek-a-boo
 1 yr. old
 Capable of reproducing interesting
events.
 They deliberately hit a mobile object
once; it moves! They would hit it again.
 They drop objects from a highchair and
watch where they fall or roll.
NURSING ROLE IN
HEALTH PROMOTION
1. Promoting achievement of
Developmental Task: TRUST vs
MISTRUST
 Synonym for trust is LOVE.
 If infants cannot trust, they cannot enjoy
satisfying interactions with others.
 May have difficulty establishing close
relationships as adults.
NURSING ROLE IN
HEALTH PROMOTION
 How to encourage a sense of trust:
1) Establish some schedule
 E.g. bath, breakfast, play time, etc.
 This gives infants a sense of being able to
predict what will happen next.
 Important to infant is the rhythm of care, and
the care given by one person.
2) If working, mother should try to arrange for
1 person to care for their child.
NURSING ROLE IN
HEALTH PROMOTION
2. Promoting Infant Safety
 Accidents are the leading cause of
death in children from 1 month through
24 mos. of age.
1) Aspiration Prevention:
 Potential threat throughout the 1st yr.
 Round, cylindrical objects are more
dangerous
 Can totally obstruct the airway
NURSING ROLE IN
HEALTH PROMOTION
1) Aspiration Prevention:
 Potentially dangerous:
 Carrot or hotdog
 Deflated balloon
 Leaving children with feeding bottle
propped up
 Teddy bears with small button eyes
 Clothing with decorative buttons
 Toys & rattles with small parts
 Pop corn and peanuts
NURSING ROLE IN
HEALTH PROMOTION
2) Fall Prevention:
 2nd major cause of infant accidents
 Never leave an infant unattended.
 Never leave an infant on an unprotected
surface such as bed or couch.
 Place a gate at the top and bottom of
stairways.
 Do not allow the infant to walk with a
sharp object in hand or mouth.
NURSING ROLE IN
HEALTH PROMOTION
2) Fall Prevention:
 Raise crib rails and make sure they are
locked before walking away from the crib.
3) Car safety
 Never transport unless an infant is buckled
into an infant car seat in the back seat of
the car.
 Do not be distracted by an infant while
driving.
 Do not leave an infant unattended in a
parked car.
NURSING ROLE IN
HEALTH PROMOTION
4) Safety with Siblings:
 Remind parents that children below 5 y.o.
as a group are not responsible enough
about infant care and safety.
5) Suffocation
 No plastic bags within the infant’s reach.
 Do not use pillows in a crib
 Store unused appliances such ref or
stoves with doors removed.
NURSING ROLE IN
HEALTH PROMOTION
5) Suffocation
 Spacing of crib rails is not over 6 cm apart.
 Remove constricting clothing such as bib
from neck at bedtime.
6) Bathing & Swimming Safety
 Do not leave infant alone in a bathtub or
near water.
7) Poisoning
 Never present medication as a candy.
NURSING ROLE IN
HEALTH PROMOTION
7) Poisoning
 Never present medication as a candy.
 Buy medications in container with safety
caps.
 Never take medications in front of infants.
 Place all medications and poisons in
locked cabinets
 Never leave medication in pockets or
handbag
 Use no lead-based paint
NURSING ROLE IN
HEALTH PROMOTION
7) Animal bites
 Do not allow an infant to approach a
strange dog.
 Supervise play with family pets.
8) Burns
 Test warmth of formula and food before
feeding.
 Do not smoke or drink hot liquids while
caring for infants.
 Use a sunscreen on a child over 6 months
when out in direct & indirect sunlight.
NURSING ROLE IN
HEALTH PROMOTION
8) Burns
 Limit child’s sun exposure to 30 min. at a time.
 Turn handles of pans toward back of stove.
 Keep a screen in front of a fireplace or heater.
 Monitor infants carefully near candles.
 Do not leave infants unsupervised near hot-
water faucet.
 Keep electric wires and cords out of reach .
 Cover electrical outlets with safety plugs.
NURSING ROLE IN
HEALTH PROMOTION
3. Promoting Nutritional Health
1) Introduction of solid food
 Chewing movements begin at 7- 9 mos. of age
 Introduce 1 food at a time, waiting 5 – 7 days
between new items.
 Introduce food before formula or BF
 Introduce small amount of new food at a time
(1 – 2 tsp.)
 Respect infant food preferences
 Use only minimal to no salt and sugar to
minimize additives
NURSING ROLE IN
HEALTH PROMOTION
 To prevent aspiration, do not place food in
bottles with formula.
 Introduce foods with a positive, “you’ll like
this” attitude.
NURSING ROLE IN
HEALTH PROMOTION
Age (month) Food to introduce Rationale

5–6 Iron-fortified infant Prevents iron-
cereal mixed with deficiency anemia,
breast milk, orange least allergenic, easily
juice or formula digested
7 Vegetables Good source of vit. A,
adds new texture &
flavor to diet
NURSING ROLE IN
HEALTH PROMOTION
Age (month) Food to introduce Rationale
8 Fruit Best source of vit. C,
good source of vit. A,
adds new texture &
flavors to diet
9 Meat Good source of
protein, iron & B vit.
10 Egg yolk Good source of iron
NURSING ROLE IN
HEALTH PROMOTION
2) Weaning
 Can drink effectively from a cup.
 Sucking reflex begins to diminish in intensity
between 6 – 9 months.
 To wean:
a) Mother choose 1 feeding a day then begins
offering fluid by the new method at that
feeding.
b) After 3 days – 1 wk., the mother change a 2nd
feeding.
1. Bathing
 Some infants need their head & scalp
washed everyday to prevent seborrhea
(cradle cap).
2. Diaper-area Care
 Change diaper frequently (every 2 – 4
hrs.)
2. Diaper-area Care
 Change diaper frequently (every 2 – 4
hrs.)
 Wash skin with clear water or alcohol-free
wipes.
 Pat or allow to air dry.
 Apply ointment such as Desitin or A & D
ointment to keep urine and feces away
from infant’s skin.
3. Care of teeth
 6 months – 12 yrs. of age
 Most important time for children to receive
fluoride to promote healthy tooth formation.
 Begin brushing the gums using soft wash
cloth.
 Eliminate plaque & reduce bacteria creating
clean environment for the arrival of the first
teeth.
 Toothpaste not necessary.
3. Care of teeth
 6 months – 12 yrs. of age
 Water level of 0.6 ppm fluoride
recommended to protect tooth enamel.
 Oral supplement may be given starting 6
mos. of 0.25 ppm.
 Fluoride toothpaste or rinses after
eruption.
3. Care of teeth
 Initial dental check-up should be made
by 2 – 2 ½ yrs. old.
 Check-up should continue at 6-month
interval throughout adulthood.
4. Dressing
 When they begin to creep
 Long pants to protect their knees
 When they begin to walk
• Soft-soled shoes
5. Sleep
 10 – 12 hrs. of sleep at night
 1 or several naps during the day.
 Always place infant on his/her back to sleep
 to reduce incidence of SIDS.
6. Exercise
 Expose the child to sun for 3 – 5 min. the 1st
day
 Best time is early morning (before 10 am)
and late afternoon.
 May use walkers but with close supervision.
Parental Concerns
1. Teething
 Cold teething rings can provide
soothing coolness against the tender
gums.
 Check with their health care provider
before giving any over the counter
drugs.
2. Thumb sucking
 Assure parents that this is normal.
 Ignore it.
Parental Concerns
3. Use of Pacifiers
 A child whose sucking needs are met
in infancy will not crave as much oral
stimulation later in life.
 An infant who completes a feeding and
still restless may need a pacifier.
 Parents should attempt to wean a
child from a pacifier anytime after 3
mos. of age and during the time
sucking reflex is fading.
Parental Concerns
4. Head banging
 Some children use this to relax and fall
asleep; considered normal.
 Investigate stress factors at home
 Parent’s overestimation of the child’s
development
 Marital discord
 Illness in another family member
 Advise parents to pad the rails of the crib
 Head banging past the preschool age
needs further evaluation.
Parental Concerns
5. Sleep Problems
 Breastfed babies tend to wake more
often than the formula-fed because
breast milk is more easily digested so
infants become hungry sooner.
 Suggestions for coping with night
waking:
1) Delay bedtime by 1 hr.
2) Shorten an afternoon sleep period
3) Do not respond to infant immediately at
night so they can have time to fall back to
sleep on their own.
Parental Concerns
5. Sleep Problems
 Suggestions for coping with night
waking:
4) Provide soft toys or music to allow infants
to play quietly alone this wakeful time.
6. Constipation
 Breast-fed are rarely constipated
because their stools tend to be loose.
 May occur in formula-fed infants if
their diet is deficient in fluid.
Parental Concerns
5. Constipation
 All infants with history of constipation
for more than 1 wk. should be
examined for:
1) anal fissure
2) tight anal sphincter
3) Hirschprung’s disease (aganglionic
megacolon)
4) Hypothyroidism
Parental Concerns
6. Loose stools
 Ask about:
1) the duration of loose stools
2) No. of stools/day
3) Color
4) Consistency
5) Presence of mucus or blood
6) Associated fever, cramping or vomiting
7) If infant continue to eat well, appear well
8) If infant seem to be thriving
9) If infant wetting at least 6 diapers daily
Parental Concerns
7. Colic
Paroxysmal abdominal pain
 Infant cries loudly
 Pulls legs up against the abdomen
 Infant’s face becomes flushed
 Fist clenched
 Abdomen is tensed
 Formula-fed babies are more likely to

have colic.
Parental Concerns
7. Colic
 Ask parents about:
1) Duration of the problem
2) Frequency (usually lasts up to 3 hrs./day;
occurs at least 3 days/wk.
3) What happened before the attack
8. Spitting up
 If infants spitting up forcefully, may be
due to pyloric stenosis and needs
surgery.
Parental Concerns
9. Diaper dermatitis
10. Miliaria
 Prickly heat
 Occurs frequently in warm weather.
11.Infant carries (baby-bottle syndrome)
 Putting infant to bed with a bottle of formula
can lead to tooth decay.
12.Obesity
 Weight greater than 90th – 95th percentile on
a standardized height/weight chart.
 Due to over-feeding
 Difficult to reverse.
IMMUNIZATION SCHEDULE
Your baby's age Immunization offered
At birth or within the first month 1st dose Hepatitis B vaccine (HepB)
after birth (or within the first 12
months after birth for catch up)
At birth (or within the first 2 mos) Single dose Bacille Calmette-Guérin vaccine (BCG)
Around 1 to 2 months old (or at least 2nd dose Hepatitis B vaccine (HepB)
four weeks after the first dose)
Around 6 weeks to 2 months old 1st dose Pneumococcal Conjugate Vaccine (PCV-7)
2 months old 1st dose Diphtheria, tetanus, and whole-cell/acellular

pertussis (whooping cough) vaccine (DTwP / DTaP)
1st dose Oral/Inactivated polio vaccine (OPV / IPV)
1st dose Haemophilus influenzae type B vaccine (HiB)
1st dose Rotavirus vaccine

4 months old 2nd dose Pneumococcal Conjugate Vaccine
(PCV-7)
2nd dose Diphtheria, tetanus, and whole-

cell/acellular pertussis (whooping cough) vaccine
(DTwP / DTaP)
2nd dose Oral/Inactivated polio vaccine

(OPV / IPV)
2nd dose Haemophilus influenzae type B vaccine

(HiB)
6 months old 3rd dose Pneumococcal Conjugate Vaccine
(PCV-7)
3rd dose Diphtheria, tetanus, and whole-cell/acellular

pertussis (whooping cough) vaccine
(DTwP / DTaP)
3rd dose Haemophilus influenzae type B vaccine
(HiB)
2 doses at 4 wks. apart Influenza vaccine
Around 6 to 8 months old 3rd dose Oral/Inactivated polio vaccine

(OPV / IPV)
Around 6 to 18 months old 3rd dose Hepatitis B vaccine

(HepB)
Around 9 to 12 months old Measles, mumps and rubella (German measles)
vaccine
(MMR)
12 months old Hepatitis A vaccine

(HepA)
Around 12 to 15 mos. old Pneumococcal Conjugate Vaccine

(PCV-7)
Around 12 to 18 mos. old Varicella (chickenpox) vaccine

Nursing Care of a Family With a
Toddler
Learning Objectives
•After mastering the contents of this chapter,
you should be able to:
1. Describe normal growth and development of
a toddler as well as common parental
concerns.
2. Assess a toddler for normal growth and
development milestones.
Toddler
Learning Objectives
3. Formulate nursing diagnoses related to
toddler growth and development or parental
concerns regarding growth and
development.
4. Identify expected outcomes for nursing care
of a toddler.
5. Plan nursing care to meet a toddler’s growth
and development needs.
Toddler
Learning Objectives
6. Implement nursing care to promote normal
growth and development of a toddler, such
as discussing toddler developmental
milestones with parents.
7. Evaluate expected outcomes for
achievement and effectiveness of care.
Body growth and development
• do not grow as quickly as the first
year
• grow at different rates

(height and weight)
-heredity
-environment
Years 1 to 3
• Babies triple their birth weight during

the first year
• Toddlers gain only 5 – 6 lbs. of BW/yr
• Gains 5 in. in height/ yr.
• Most girls reach 53% of their adult
height by age 2
• Most boys reach 50% of their adult
height by age 2
THEREFORE…
It is usually true that a tall two-year-old
will be a tall adult.
Christopher is 24 months old.

He is currently 34 ½ in. tall.
How tall will he be?
34.5 ÷ 50% = 69 in. (5’9)
If Paula is 32 in. tall at 2 y.o.,

how tall will she be when she
becomes an adult?
32 ÷ 53% = 60 in. (5 ft)
 Body contour
 Prominent abdomen (pouchy belly or
pot-bellied)
– Abdominal muscles not yet strong enough
to support abdominal contents
 bow leggedness
 Lordotic posture
 Vision - 20/50 (by 3 years)
 Body systems:
 RR slows slightly; continue to be
abdominal
 HR slows from 110 to 90 bpm
 BP increases 99/64 mmHg
 Lumen in resp. system enlarged.
 Stomach secretions become more
acidic
 Body systems:
 Stomach capacity increases
 Urinary & Anal sphincter control possible with
complete myelination of the spinal cord.
 IgG and IgM antibody production becomes
mature @ 2 yrs. of age.
– Teeth:
 8 new teeth erupt (canines & 1st molars) during
2nd yr.
 All 20 desiduous teeth are generally present by
2.5 to 3 yrs. of age.
Developmental Milestones
 Language Development
– “NO” , a manifestation of their developing
autonomy.
 How to encourage Language Dev.:
1. Urge parents to name objects as they play
with their child.
2. Answering child’s questions
 Should be simple & brief bec. They have short
attention span
3. Reading aloud.
 Language Development
– 12 – 18 mos.
 Starts to combine 2 words
 18 – 22 word vocabulary
– 18 mos. To 2 yrs.
 Articulation lags behind
 270 – 300 word vocabulary
– 2 – 3 yrs.
 Uses consonants & pronouns
 900 – word vocabulary
 Emotional Development
– Autonomy vs. Shame & Doubt (by Erikson)
– Autonomy sense of independence
– They are negativistic,
 Bec. they realize they are separate individuals,
they don’t have to do what others want them
to do.
– 15 mos.
 Fears being alone, being abandoned,
strangers, objects, and places
 Expresses independence by trying to
feed and undress self.
– 18 mos.
 Negativism predominates
 Fears water
– 18 mos.
 Tempertantrums
 Awareness of own gender begins
– 24 mos.
 May resist bedtime & naps
 Fears the dark and animals
 Temper tantrums, negativism, and
dawdling continue
– 24 mos.
 Bedtime rituals important
 Explores genitalia
 Shows readiness for bowel and bladder
control.
– 36 mos.
 Temper tantrums, negativism, and
dawdling behavior subsides.
– 36 mos.
 Self esteem increases due to increased
independence in eating, elimination &
dressing.
 Explores many emotions in pretend
play.
 Separation anxiety subsides may
develop fear of monsters.
 Elimination
– Ready to toilet train between 18 – 24
mos.
– Bladder control more difficult to
control than bowel control
– Signs of readiness for toilet training:
1) Awareness of wet diaper
2) Able to follow directions
3) Able to communicate elimination needs
 Elimination
– Signs of readiness for toilet training:
4) Able to remain dry for longer period
5) Able to independently dress & undress
6) Able to sit, squat, walk well.
 Socialization
– Become resistant to sitting in laps
– 15 mos. old
 Enthusiastic
interacting with other people
provided those people are willing to follow
them where they want to go.
– 18 mos. old
 Imitate the things they see
– 2 or more yrs.
 Childrenbecome aware of gender
differences.
– Identifies other children as girl/boy.
 Play Behavior
– Parallel play
– Types of toys:
 Toys that require action
 Trucks they can make go
 Rocking horses they can ride
 Blocks they can stack
 Toy telephone
 Puzzles
 Cognitive Development
 12 – 18 mos. Old
– Stage 5 Tertiary Circular Reaction
 Toddler is called “little scientist”
 Child experiments by trial & error
 Many children at 15 mos. Are able to follow a rolling
object in different path.
 18 – 24 mos. Old
– Stage 6 invention of new means through mental
combination
– Able to remember action & imitate them later
(deferred imitation).
 18 – 24 mos. Old
combination
 Transitional phase to the preoperational thought
period.
 Uses memory and imitation to act (deferred
imitation).
 Object permanence become complete.
 Able to think through actions or mentally project the
solution to a problem
 18 – 24 mos. Old
combination
 Able to think through actions or mentally project the
solution to a problem
 E.g. If given a box, a toddler will investigate how the
top of the box can be removed.
 E.g. If given a 2nd box, with different shape, the
child can foresee how the top can be removed.
 2 – 7 yrs. old
– Preoperational Thought
 Children deal more constructively with symbols.
 They begin to use a process termed “assimilation”.
– They learned to change the situation (or how
they perceived it) to fit their thoughts.
– Toddlers use toys in the “wrong” way.
– E.g. Given a toy hammer, instead of pounding
with it, they might shake it to see if it rattles.
Health Promotion for Toddlers
• Promoting Toddler Safety
– Accidents
• Major cause of death in children of all ages.
1)Accidental ingestion (poisoning)
– Occurs most frequently in toddlers
2)Aspiration or ingestion of small objects
3)MVA
4)Burns
5)Falls
6)Drowning
7)Playground injuries
8)Lead poisoning
Promoting Nutritional Health
• Calories
– 1,300 kcal/day ÷ 3 meals a day
– Avoid high sugars in the diet
– Appetite becomes smaller
• Allow self-feeding to strengthen independence
• Offer nutritious finger food
– E.g. chicken, slices of banana, cheese & crackers
Promoting Toddler
Development
 Dressing
– Consider self-dressing features to help them
get dressed by themselves.
– Consider safety, comfortable fabric and
construction, growth features, durability,
attractive style, and easy care.
– Always praise the child after doing activities.
Promoting Toddler Development
 Bathing
– Bath every other day unless
needed more frequently.
 Sleeping
– Gradually decreases
– Napping 2x/day; sleeping 12 hrs./night
– Nightmares are common
– Needs bedtime rituals
 Care of the Teeth

– Encourage children to offer fruits (bananas,
pieces of apple, orange slices) or protein
foods rather than high carbohydrate items
for snacks such as cookies.
– Calcium is especially important to the
development of strong teeth.
– Should continue to drink fluoridated water.
– Children below 8 y.o. need some supervision
in brushing their teeth.
 Care of the Teeth

– Schedule a first visit to a pediatric dentist
by 2 ½ yrs. of age for assessment of
dentition.
Walking (18 mos.)
 most begin within two to three months

after first birthday
 learn to walk at different ages
 Beginning
 stand with feet wide apart
 turn feet outward and flex knees
 tiptoes
 arms out
Climbing (18 mos.)
• Toddlers climb onto furniture and
other objects
• Walk up and down stairs with help
• Put both feet on each stair
• Climbing relates to accessibility and
courage
Running (2 yrs.)
 True running begins around 2 years

 Not skilled
 Cannot start or stop quickly
Jumping (2 ½ yrs.)
 Not much before 2 years

 At 2 ½ years- jump off low objects with
both feet
 Move arms backwards
 Rides tricycle by 3 yrs.
Parental Concerns
 Toilet Training
– Children must have reached 3 important
developmental levels; 1 physiologic, 2
Cognitive:
1) Must have control of rectal & urethral
sphincters, usually achieved at the time they
walk well.
Parental Concerns
 Toilet Training
– Children must have reached 3 important
developmental levels; 1 physiologic, 2
Cognitive:
2) Must have understanding of what it means to
hold urine and stools until they can release
them at a certain place & time.
3) Must have a desire to delay immediate
gratification for a more socially accepted
action.
Parental Concerns
 Infants live by a pleasure principle:
– “They want what they want when they want
it.”
– Before they can complete toilet training,
they must be able to give up an immediate
pleasure;
 Relieving themselves whenever they have an urge.
Parental Concerns
 Ritualistic Behavior
– They will use only “their” spoon at
mealtime;
– They will use only “their” washcloth” at
bath time.
– They will not go outside unless mother or
father locates their favorite cap.
Parental Concerns
 Negativism
– Is NOT an expression of being stubborn
but a necessary assertion of self control.
– One method to deal with negativism is to
reduce the opportunities for a “NO”
answer.
Parental Concerns
 Discipline
– Means setting rules or road signs so
children know what is expected of them.
 “punishment” is a consequence that results
from child’s disregard of the rules that were
learned.
– It involves setting safety limits and
protecting others or property.
Parental Concerns
 Discipline
– Example:
 “stayaway from the fireplace”.
 “must not go into the street”.
– 2 General Rules to follow:

1) Parents need to be consistent
2) Rules are learned best if correct behavior is
praised, rather than wrong behavior punished.
Parental Concerns
 Discipline
– “Timeout”
A technique to help children learn that actions
have consequences.
– To use “timeout” effectively:
1) Parents must be certain their child
understands the rule they are trying to
enforce.
2) Parents should give one warning.
Parental Concerns
 Discipline
– To use “timeout” effectively:
3) If the child repeats the behavior, parents
select an area that is non-stimulating, such as
a corner of a room, or a hallway.
4) The child is directed to go immediately to the
“timeout” space and sit there for a specified
period of time.
 1 min./yr. of age
Parental Concerns
 Separation Anxiety
– Begins at about 6 mos. of age and persist
throughout the preschool period.
– Give them fair warning that they will have
a babysitter.
– It helps if parents say goodbye firmly and
briefly.
– Sneaking out strengthen fear of
abandonment.
Parental Concerns
 Temper Tantrums
– Toddlers do not have the wisdom to
express their feelings in a more socially
acceptable way.
– May be a response to an unrealistic request
by a parent.
– May occur if parents are saying “NO” too
frequently.
Parental Concerns
 Temper Tantrums
– Best approach:
 Parents to tell a child simply that they
disapprove of the tantrum and ignore it.

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GENERAL OBJECTIVE:

 AT THE END OF 6 HOURS OF PARTICIPATIVE

 Height  Increase by 50% during the

Chest  < 2cm than head at birth

6-9 mos. Old  Infant experience serum

RR  20-30 b/min. by end of 1st yr.

 Some may be born

 When held in ventral suspension, infant’s

 Demonstrated at 6 – 9 mos. old.

 Can turn to front to back, and back to

 Sits with their legs spread with arms

 Can lean forward and maintain their

 Moro reflex is fading.

 Can pull up to that position.

 A child has until 22 months of age to walk and

Age (month) Food to introduce Rationale

 Pulls legs up against the abdomen

 Infant’s face becomes flushed

 Formula-fed babies are more likely to

2 months old 1st dose Diphtheria, tetanus, and whole-cell/acellular

1st dose Oral/Inactivated polio vaccine (OPV / IPV)

1st dose Haemophilus influenzae type B vaccine (HiB)

1st dose Rotavirus vaccine

2nd dose Diphtheria, tetanus, and whole-

2nd dose Oral/Inactivated polio vaccine

2nd dose Haemophilus influenzae type B vaccine

3rd dose Diphtheria, tetanus, and whole-cell/acellular

2 doses at 4 wks. apart Influenza vaccine

Around 6 to 8 months old 3rd dose Oral/Inactivated polio vaccine

Around 6 to 18 months old 3rd dose Hepatitis B vaccine

12 months old Hepatitis A vaccine

Around 12 to 15 mos. old Pneumococcal Conjugate Vaccine

Around 12 to 18 mos. old Varicella (chickenpox) vaccine

• grow at different rates

• Babies triple their birth weight during

Christopher is 24 months old.

If Paula is 32 in. tall at 2 y.o.,

 Care of the Teeth

 Care of the Teeth

 most begin within two to three months

 True running begins around 2 years

 Not much before 2 years

– 2 General Rules to follow:

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