SAM:

INTRO: Good afternoon everyone, We are Group 2 and we will be discussing our
topic, The Nursing Care of a Family with a Toddler.

❖ Toddler Period
- The age span from 1 to 3 years

A. GROWTH AND DEVELOPMENT

1. Physical Growth
❖ Weight, Height, and Head Circumference

● A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year during the
toddler period, much less than the rate of infant growth. As subcutaneous tissue,
or baby fat, begins to disappear toward the end of the second year, the child
changes from a plump baby into a leaner, more muscular little girl or boy. A
toddler’s appetite decreases accordingly, yet adequate intake of all nutrients is
still essential to meet energy needs (Rolfes, Pinna, & Whitney, 2009).
● Head circumference increases only about 2 cm during the second year
compared to about 12 cm during the first year. Head circumference equals chest
circumference at 6 months to 1 year of age. By 2 years, the chest circumference
has grown greater than the head.
● Body Contour
- Toddlers tend to have a prominent abdomen because although they are walking
well, their abdominal muscles are not yet strong enough to support abdominal
contents as well as they will later.
- They also have a forward curve of the spine at the sacral area (lordosis). As they
become more experienced at walking, this will correct itself naturally.
- Many toddlers, in addition, waddle or walk with a wide stance (see Fig. 30.1B).

JUDE:
● Body Systems
➔ Body systems continue to mature during this time:
➔ Respirations slow slightly but continue to be mainly abdominal.
➔ The heart rate slows from 110 to 90 beats per minute; blood pressure increases
to about 99/64 mm Hg.
➔ The brain develops to about 90% of its adult size.
➔ In the respiratory system, the lumens of vessels enlarge progressively so the
threat of lower respiratory infection becomes less.
 ➔ Stomach secretions become more acidic; therefore, gastrointestinal infections
also become less common.
➔ Stomach capacity increases to the point a child can eat three meals a day.
➔ Control of the urinary and anal sphincters becomes possible with complete
myelination of the spinal cord so toilet training is possible.
➔ IgG and IgM antibody production becomes mature at 2 years of age. The passive
immunity obtained during intrauterine life is no longer operative.
● Teeth
- Eight new teeth (the canines and the first molars) erupt during the second year.
All 20 deciduous teeth are generally present by 2.5 to 3 years of age (Gonsalves,
2008).

VLASTA:
2. Motor Development
● At 15 Months
Fine
- Put small pellets into small bottles. Scribbles voluntarily with a pencil or crayon.
Hold a spoon well but may still turn it upside down on the way to the mouth.
Gross
- Walks alone well; can seat self in chair; can creep upstairs

● 18 Months
Fine
- No longer rotates a spoon to bring it to mouth
Gross
- Can run and jump in place. Can walk up and down stairs holding onto a person’s
hand or railing. Typically places both feet on one step before advancing.

● 24 Months
Fine
- Can Open doors by turning door knobs, unscrew lids
Gross
- Walks up stairs alone still using both feet on same step at same time

● 30 Months
Fine
- Makes simple lines or strokes for crosses with a pencil
Gross
- Can jump down from chairs
KARLY:
B. Developmental Milestone

❖ The developmental milestones of the toddler years are less numerous but no
less dramatic than those of the infant year, because this is a period of slow and
steady, not sudden, growth. Toddler development is influenced to some extent by
the amount of social contact and the number of opportunities children have to
explore and experience new degrees of independence.

1. Language development
● Although even this varies from kid to child, toddlerhood is a crucial stage for
language development since children need practice time to become proficient in
a language. When a child is 2 years old and still unable to speak in two-word,
noun-verb simple phrases, the root problem must be carefully investigated. This
goes past the bounds of typical development. Parents frequently worry that their
child's lack of language indicates autism (Johnson, 2008). However, a language
delay may just be a short-term developmental setback.
● A word that is used frequently by toddlers and that is a manifestation of their
developing autonomy is “no.” Toddlers may use the word to mean they are
refusing a task, or they do not understand it, or they may only be practicing a
sound that they have noticed has potent effects on those around them.
● To learn other words, children need exposure to conversation and need to be
read to often.
● Children learn language from imitating what they hear, they will speak like those
around them. If they are spoken to in baby talk, their enunciation of words can be
poor; if they hear examples of bad grammar, they will not use good grammar.

JEZZA:
2. Play
● Children play beside children next to them, not with them. This side-by-side play
(called parallel play) is not unfriendly but is a normal developmental sequence
that occurs during the toddler period.
● The toys toddlers enjoy most are those they can play with by themselves and
that requires action. Trucks they can make go, squeaky frogs they can squeeze,
waddling ducks they can pull, rocking horses they can ride, pegs they can pound,
blocks they can stack, and a toy telephone they can talk into are all favorites.
These are all toys children can control, giving them a sense of power in
manipulation, an expression of autonomy.
- Another toy for the other toddler (parallel play)
 3. Emotional development
● Learning what feelings and emotions are, how and why they occur, recognizing
your own feelings and those of others, and developing appropriate coping
mechanisms are all examples of emotional development. At the age of 2-3 years,
there is a lot going on in the development of a child. Expect strong sentiments,
tantrums, basic phrases, pretend play, independence, new cognitive skills, and
much more at this age. Talking and listening, reading, working on everyday skills,
and cooking together are all terrific development activities.

RAUL:
4. Cognitve development
● During their cognitive development, toddlers learn to process and organize
information more effectively, laying the groundwork for a solid understanding of
the world around them. However, between the ages of two and three years,
language acquisition and logical thought frequently lag behind a child's curiosity
and drive for self-expression.
● Static thinking
● Egocentric
● Preoperational stage

5. Moral and spiritual development

● Toddlers begin to formulate a sense of right and wrong, but their reason for doing
right is centered most strongly in "mother or father says so" rather than in any
spiritual or societal motivation. Kohlberg referred to this as a "punishment
obedience orientation" (a child is good because a parent says a child must be
good, not because it is "right" to be good).
● Toddlers may not obey requests from people other than their parents because
they do not view their authority as being at the same level as their parents'
authority. This means that while providing nursing care, it might be necessary to
ask a parent to reinforce instructions to be certain a toddler will follow them.

6. Psychosexual development
● Freud described the toddler period as an “anal phase” because during this time,
children’s interests focus on the anal region as they begin toilet training.
Elimination takes on new importance for them. Children find pleasure in both the
retention of feces and defecation. This anal interest is part of toddlers’
self-discovery, a way of exerting independence, and probably accounts for some
of the difficulties parents may experience in toilet-training children of this age.
 ● Developmental task is to form a sense of autonomy versus shame. Child learns
to be independent and make decisions for self. - explore a lot, manipulate things
- toddlers are learning (let them decide what dress to wear, allow them to wear
their shoes kahit baliktad, allow them to choose what food to eat, allow to feed
himself/herself, allow child to take a bath on his own (may close supervision) -
because toddlers are risk for injury.
● Correcting immediately - can cause a double feeling and feeling shame
● Show appreciation
●

● Anal retention - punctual in everything that he/she does

● Likes something in order - doesn't like messy

SHERRY:
C. HEALTH PROMOTION
1. Safety
- Accidents are the major cause of death in children of all ages. Accidental
ingestions (poisoning) are the type of accident that occurs most frequently in
toddlers. Although poisoning can involve medicine such as acetaminophen, it
most often occurs from ingestion of cleaning products. Aspiration or ingestion of
small objects such as pencil erasers, or crayons is also a major danger for
children of this age. Urge parents to childproof their home by putting all
poisonous products, drugs, and small objects out of reach by the time their infant
is crawling, and certainly by the time their infant is walking.

- Other accidents that occur frequently in toddlers include motor vehicle accidents,
burns, falls, drowning, and playground injuries. These occur because toddlers’
motor ability jumps ahead of their judgment. To prevent serious injury, a toddler
must be supervised at all times. Toddlers can walk surely and swiftly enough so
that if they are left outside to play, they can very quickly travel a block away.
Because they have no judgment concerning moving cars, they walk across
streets with no regard for oncoming cars. Because they cannot swim well,
parents need to check whether backyard pools are securely fenced.

CHARMY:
2. Nutritional health
- Growth slows abruptly after the first year of life, a toddler’s appetite is smaller
than an infant’s. Children who ate hungrily 2 months earlier now sit and play with
their food. If feeding problems begin at this time, it is often because parents are
 unaware their toddler’s appetite has decreased so food consumption will be less.
Because the actual amount of food eaten daily varies from one child to another,
teach parents to place a small amount of food on a plate and allow their child to
eat it and ask for more rather than serve a large portion the child cannot finish.
One tablespoonful of each food served is a good start. Also, cleaning a plate
gives a child a feeling of independent functioning, whereas leaving food uneaten
may suggest that parents expected something more.

- Allowing self-feeding is a major way to strengthen independence in a toddler.

Offering finger foods and allowing a choice between two types of food helps
promote independence while exposing children to varied foods. Nutritious finger
foods that toddlers enjoy include pieces of chicken, slices of banana, pieces of
cheese, and crackers. Most toddlers insist on feeding themselves and generally
will resist eating if a parent insists on feeding them. An individual child may react
to repeated attempts at being fed by refusing to eat at all. Many toddlers prefer to
eat the same type of food over and over because of the sense of security this
offers. Toddlers usually do not like food that is “mixed up” such as casseroles
(except maybe spaghetti); they often prefer that different foods do not touch one
another on their plate. Frequently they eat all of one item before going on to
another. They often prefer brightly colored foods to bland colors.

- Prefer food that are bright colors

- Prefer finger foods
- Consume one at a time
.
PRINCESS:
3. Development in daily activities
- There are certain activities that a toddler could learn to develop a new
independence and developing abilities in self-care, such as dressing,
eating, and to a limited extent, hygiene, present special challenges for
parents.
These following activities are:
1. Dressing - Most kids can put on their own underwear, underpants, and
socks. Some people could also be able to put on basic skirts, slacks, or
pullover shirts (a toddler frequently gets confused by a shirt's sleeves).
Given that it is frequently simpler and faster to put on a toddler's clothes
for them, and given that a toddler who is dressed by parents will (typically)
be wearing garments in the right way, parents may be reluctant to
encourage toddlers to dress themselves. Toddlers who dress themselves
almost always put their shoes on the wrong feet and their shirts and pants
 in the incorrect way. Encourage parents to let go of perfection in favor of
the child's growing feeling of independence. If kids wear their underwear
or shirts backward, in most instances it does not make that much
difference, and toddlers are not likely to feel indepen- dent and confident if
their attempts at dressing are criticized.

2. Sleep - The amount of sleep children need gradually decreases as they

grow older. They may begin the toddler period napping twice a day and
sleeping 12 hours each night, and end it with one nap a day and only 8
hours’ sleep at night. A toddler enjoys a bedtime routine as much as any
other activity during this time: a bath, pajamas, a story, brushing teeth,
being tucked into bed, drinking water, selecting a toy to sleep with, and
turning out the lights. However, parents must be careful not to allow a
youngster to talk them into a lengthy treatment that pushes sleep well past
the time originally planned. While toddlers require independence, they
also require a sense of protection. Toddlers, especially when they are
sleepy, like to see parents as firm, consistent individuals who can be relied
upon to be dependable time and time again, much as adults like to know
there are guardrails along high mountain routes.
● Decrease sleep (toddlers)

SAM:
3. Bathing - Toddler bath time should be determined by the schedule and
preferences of both the child and the parents. Some parents like to bathe
their toddlers before dinner because it has a calming effect and helps
them get ready to eat, while others prefer to bathe them before night
because it helps them fall asleep. However, the attempt to create a feeling
of routine and an order to life is more significant than the actual time. Bath
time is usually so enjoyable for toddlers that parents can use it as a
recreational activity or something to do on a rainy day when they can find
nothing else to interest their child. Toddlers usually enjoy bath time, and
parents should make an effort to make it fun by providing a toy, such as a
rubber duck, boat, or plastic fish.

4. Care of Teeth - Frequently, toddlers require between-meal snacks.

Encourage parents to serve protein-rich snacks like cheese or pieces of
chicken instead of high-carbohydrate foods like cookies, not only for the
added nutrition, but also because protein snacks help prevent caries more
effectively than sugary snacks by limiting the exposure of the child's teeth
 to carbohydrates. Calcium is particularly crucial for the development of
strong teeth and is present in considerable quantities in milk, cheese, and
yogurt. Additionally, if fluoridated water is available, children should
continue to consume it to ensure that all future teeth develop
cavity-resistant. Toddlers should have a toothbrush that they identify as
being theirs for oral hygiene. When the toddler stage is over, they can start
brushing themselves with supervision (almost all children need some
supervision until about age 8). Remind parents that it is preferable for a
child to brush well just one time per day, perhaps before bed, rather than
doing so ineffectively frequently. Parents can use dental floss to remove
plaque from between the child's teeth after brushing.
- 12 months or 1 year (Dental visit)

JUDE:
4. Promoting health family functioning
- Learning self-reliance is the primary goal of a child dur- ing the toddler
period, some parents who enjoyed caring for their child as an infant may
find it difficult to have their authority challenged by a toddler. Help parents
to understand their responses to these attempts at independence are
crucial to the healthy development of their child. Although the child still
needs firm limits to feel secure, a child must be given some room to make
independent decisions in areas that the parents feel they do not need to
control. An outside person, such as a nurse, can provide an important
perspective on this issue.

D. Parental concerns associated with the toddler period

- Toddler is the stage wanting what they want when they want it, that’s why i am to
discuss..
○ Toilet training
￫ Learning how to use the toilet is one of the most challenging goals that a
toddler strives to accomplish and it is possible that comprehending the
process may become one of the most difficult duties for parents at this
time. The majority of first-time parents have questions regarding when
training should begin and when it should be finished. The response to that
is toilet training is something that must be done on an individual basis with
each child. Meaning, the task at hand should start and be finished in
accordance with the child's level of ability. (yung iba saka lang nattrain if
kaya nilang umupo or maglakad na on their own)
 ￫ But, before toddlers may begin toilet training, they need to have
accomplished having control of their urethral and rectal sphincters, (in a
way na kaya nilang pigilan umhi or tumae hanggang sa mailabas nila yun
at a particular time and location)
￫ Some excellent indicators for parents that their child's development has
reached this stage is to wait until the toddler is able to walk properly and
unassisted on their own, also if they can hold their urine or feces. Another
sign is when they begin to experience discomfort while wearing wet
diapers.

VLASTA:
○ Ritualistic behavior
￫ Toddlers like following routines and routine activities, despite the fact that
they spend a significant amount of time each day discovering new
methods to complete familiar tasks and undertaking activities they have
never completed before. In this case, they will only use "their" spoon for
meals, "their" washcloth for baths, and they will not leave the house until
their parents find their favorite cap. The child who looks to require an
excessive number of objects to cling to or an excessive number of
routines, however, may be trying to say, “I need more guidelines, more
rules. Don’t let me be quite so independent.”

○ Negativism
￫ Toddlers typically go through a period of extreme negativism. Anything a
parent asks them to do, they refuse to do. Toddlers always respond with a
solid "no" to any questions or demands. At some point, parents may
require reassurance that this is a healthy and natural part of their child's
growth rather than a cause for concern. This development shows that
toddlers are beginning to understand that they are unique people with
specific requirements.
￫ Some long-term parent–child interaction problems begin during this period
because parents insist on being obeyed totally. A toddler’s “no” can best
be eliminated by limiting the number of questions asked of the child.

KARLY:
￫ For example, a mother asks, “Will you come take a bath now?” She
means, “It’s time for your bath.” (kung tutuusin, hindi lang ito for toddlers
eh. Pwede rin siyang ma-apply satin eh… If ‘di pa convinced, a parent can
say, “Do you want to take your duck or your toy boat into the tub with
you?”)
 ￫ Making a statement instead of asking a question can avoid a great many
negative responses and with this, parents usually find it helpful in
smoothing out the tension caused by the negativism of the toddler stage

○ Discipline
￫ Some parents wonder if and when they should begin disciplining their
child. It's necessary to remind parents that "discipline" and "punishment"
are not interchangeable terms. Discipline means setting rules or road
signs in order for children to understand what is expected of them. In
contrast, punishment is a consequence that results from a breakdown in
discipline, from the child’s disregard of the rules that were learned.
Parents should begin to instill some sense of discipline early in life
because part of it involves setting safety limits and protecting others or
property
￫ Two general rules to follow are (a) parents need to be consistent and (b)
rules are learned best if correct behavior is praised rather than wrong
behavior punished. We have a thing called “Timeout”. It is a technique to
help children learn that actions have consequences. Parents should give
one warning.

JEZZA:
○ Separation anxiety
￫ Separation anxiety is the universal fear of this age group. This makes it
hard for toddlers to adjust to spending the day away from their primary
caretaker at a day care. Parents may assist their kids adjust to their
absence by saying goodbye firmly and explaining that they will be there for
them when they wake up in the morning. Prolonged goodbyes only lead to
more crying. While sneaking out to prevent crying and ease parental guilt
may seem like a good idea, but it can actually increase the child's fear of
abandonment and so should be avoided.

RAUL:
E. Concerns of the family with a physically challenged or chronically ill

It may be difficult for children with handicaps or disabilities to achieve a sense of

autonomy or independence because they may never be totally independent. It is
important for these children to develop as strong a sense of autonomy as possible,
though, so they see themselves as independent and can work to become increasingly
self-sufficient as they grow older. It takes courage for an adult to do such things as
move a wheelchair through a busy airport or a concert crowd. Most important are
 actions that allow toddlers to do as much for themselves as possible. If toddlers have
physical limitations, for example, they may be unable to explore freely or may not have
the physical ability to pound and manipulate toys as the average toddler does. They do
have the ability to work at a project while they sit in a chair at a table.

A toddler with a long-term illness or who is physically challenged can be

expected to exhibit normal toddler behaviors, such as temper tantrums, and to have
normal outlooks, such as negativism. Parents whose child is uncoordinated or has a
neurologic disease may mistake temper tantrums for seizure activity. Investigate such
activity carefully, and explain to parents the difference between the two. Parents may
also mistake particular toddlers’ insistence on having their own way as a manifestation
of illness. Remind these parents the behavior is more often an indication of age and
development rather than of illness so they can respond appropriately.

SHERRY:
Toilet training is difficult for a child who is hospitalized at periodic intervals, as
success usually requires a consistent caregiver; in addition, hospitalization can result in
regressive behaviors. If a chronically ill child has difficulty with ambulation, soiling
accidents may occur beyond the usual age because of inability to reach a bathroom
easily.
Children who survive a long-term illness are sometimes referred to as medically
fragile or vulnerable children (Green & Solnit, 1964). Some parents tend to protect and
shelter such a child, and you may have to remind them even though chronically ill, a
toddler will demand independence and has the right to explore. A child who uses a
lower-extremity prosthesis, for example, might prefer to crawl somewhere rather than
wait for help to put the prosthesis in place. Although this degree of independence is
good, parents may have to limit how it is expressed so the child will learn how to use the
prosthesis (for example, they could make a rule the child must use the prosthesis to
walk but can choose whether to use a spoon when eating).

CHARMY: NUTRITION TO REST

PRINCESS: HYGIENE TO ELIMINATION
Nursing Interventions to Help a Physically Challenged or Chronically Ill Child
Develop a Sense of Autonomy

Area Nursing Action

Nutrition A special diet may limit typical finger foods. Use imagination to offer other foods not usually
eaten this way as finger foods. Allow the child to help pour liquid diet for a tube feeding.
 Toddlers are frightened by vomiting because they have no control over it. Check for the
possibility of nausea; toddlers have no way to express this other than by not eating.

Dressing A child can hold pieces of tape or put tape in place to maintain a sense of control. The
changes child can remove an old bandage if it is not contaminated. Allow children to view their
incisions and watch dressing changes; explaining each step of a procedure as you perform
it helps a child maintain control. Restrain only those body parts necessary during a
procedure to allow a child a sense of control. Remove all supplies after a procedure, or the
child may “redo” the dressing.

Medication Allow children no choice regarding whether a medicine will be taken. Do allow a child to
choose a “chaser,” such as milk or juice, after oral medicine. Do not ask a toddler to
indicate a choice of site for an injection or intravenous insertion; this is too advanced a
decision for a toddler to handle.

Rest Locate or create a ritual for bedtime (put child into bed, tuck him in, say, “Goodnight,
Bobby.” Tuck in bear. Say, “Goodnight, Bear”). Allow a choice of toy or cover but not a
choice of bedtime or naptime hour

Hygiene Allow a child a choice of bathtub toy or clothing. Allow a child to wash their face and hands
to gain control of the situation. Allow the child to put toothpaste on a brush, but you should
brush or “touch up” teeth afterward to ensure that all plaque has been removed

Pain Encourage a child to express pain (“Say ‘ouch’ when I pull off the tape”). Help channel a
child’s self-expression to what is acceptable (e.g., the child may shout but may not kick).

Stimulation Provide a toddler with a toy that can be manipulated, such as boxes that fit inside one
another and can be taken out again, trucks that can be pushed, and pegs that can be
pounded. In a health care setting, items can usually be found that fit together (boxes from
central supply or plastic vials from the pharmacy). Another action toy: buy a non-latex
balloon and tie it to the crib side to be used as a punching bag; another one tied to the foot
of the crib can serve as a leg exerciser

Elimination A child who is toilet trained needs to be encouraged to use a potty chair or toilet during an
illness. Help children with ureter or bowel stomas to help with changing bags so they are as
independent in bowel function as possible.

SAM:
F. Nutrition and the physically ill challenged or chronically ill
Toddlers need experience feeding themselves if at all possible. Help parents accept the
accidents that occur with self-feeding, particularly if the child has difficulty with
coordination; suggest finger foods if possible.

If on a special diet, children may not be allowed to eat finger foods; if they are tube fed,
they receive no experience with finger foods at all. For these toddlers, parents should
try to provide other, comparable experiences in independence, such as letting them
choose what toy to take to bed.

OUTRO: That ends our presentation. Enjoy the rest of the day. Thank you for
listening!

References:
https://nursekey.com/nursing-care-of-toddlers/