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Developmental Phases and Care of

Toddlers

Early Childhood 1 to 6 years


Toddler = 1 to 3 years

Characterized by:
Physical and personality development Language and social relationships Learn roles Gain self-control Increasing awareness of dependence and independence Develop? self concept

Physical Development

Changes in body size and muscle-fat makeup period of many milestones (learning to walk, talk, solve problems, relate to others) changing states of arousal development of gross- and fine-motor skills speech development

contd

May eat less, but more frequently throughout the day Feel discomfort with wet/soiled diaper interest in toilet training

generally more active than at any other point in their lives

Theories of Personality Development for Toddlers


Psychosexual (Freud)
Anal-urethral

Psychosocial (Erikson)
Autonomy vs Shame and

right/wrong) Punishment and obedience orientation

Spiritual (Fowler)
Intuitive-projective Imitate behaviour Follow parents beliefs

Doubt

Cognitive (Piaget)
Preoperational thought

(concrete) Preconceptual phase

Moral Judgment (Kohlberg)


preconventional level (eg.

good/bad labels,

Psychosocial Development

Temper tantrums difficulty sharing, may be possessive desire to do things independently cannot remember rules show increasing fears Rapid mood shifts

contd

view themselves as the centre of their world begin to express new emotions (jealousy, affection, pride, shame) like to imitate behavior of others begin to play simple pretend games Do the opposite of what is asked

Start to be more sure of themselves


Become frustrated easily

Development of Self-Concept

Developed through their exploration of limits and their capacities and their impact on others

Body Image

Able to identify parts of their body

Cognitive Development
12-24 months: Final 2 stages of sensorimotor phase 13-18 months: Active experimentation

Beginning rational judgment and intellectual reasoning Increase independence from parents Tolerate longer periods of separation Awareness of causal relationship between 2 events No transfer to other new situations Classify objects into categories Eg. garbage bin vs laundry binw Aware of space and relationship related to their body

contd

19-24 months:
Object permanence: look for hidden objects
Imitation: more meaning and understanding Play house Gender role behaviour Sense of time Exaggerated Limited attention spans

Preoperational Phase: 2-4 yrs

Do not think in terms of operations ie. The ability to manipulate objects in relation to each other in a logical way
Their perception of an event

Increase use of language symbolically


why and how of things Eg. needle = something that hurts

Vulnerable
Fears develop Important to prepare children for procedures

and equipment

Communication

Communication focus = themselves


Egocentric

Communicate with signals and gestures Assign human attributes to inaminate objects

Communication Techniques
I messages vs You (judgemental) Third-person technique Storytelling Bibliotherapy Sentence completion Drawing Magic play

Development of Gender Identity

Exploration of body
Pleasure
Masturbation Stimulation Posturing against objects Rocking, swinging, hugging, kissing

Learning vocabulary: anatomy, elimination, reproductionAffect future sexual attitudes


Eg. refer to genitalia as dirty Concept related to elimination transferred to sexual

Sense of maleness/femaleness
Imitative play

Observation of adult intimate behaviours


Quality of relationship between parents is important to childs

capacity for sexual and emotional relationships later

Socialization

15 months:
Tolerates some separation

from parents Less likely to fear strangers Imitate parents Kiss and hug parents

Decrease tantrums Dress self in simple clothing Verbal self-reference

30 months:
Separates more easily from

18 months:
Express emotions - temper

tantrums Imitates Awareness of ownership Develop dependence on objects

parents Help put things away Notice sex diffferences knows own sex Less help with toilet Emotions expand:
Pride, shame, guilt,

embarassment

24 months:
Parallel play Increase attention span

TOILET TRAINING!!!

Voluntary control of anal and urethral sphincters


After child starts walking (18-24mths)

Recognizes need of parent that they need to hold on Parents recommended to start training earlier than 30 months

Gross motor skills mastered Able to communicate

Nurse helps identify signs of readiness Girls ready 2-3 months before boys

Readiness

Physical Readiness:
Voluntary control of anal and

Express willingness to

urethral sphincters Able to stay dry for 2 hrs Regular bowel movements Gross motor skills: sitting, walking, squatting Fine motor skills to remove Parental readiness: clothing Recognize the childs level Mental readiness: of readiness Recognizing urge to go Willingness to invest time to Verbal/nonverbal toilet train communication to indicate Absence of family stress or when wet or need to go change Cognitive skills to do the action and follow directions

please parentf Ability to sit on toilet for 5-10 minutes straight Curious about other peoples toilet habits Impatience with soiled/wet diapers

Psychologic readiness:

Temper Tantrums

Assertion of independence and inability to control emotions Manifestations:


Lying on the floor Kicking Screaming Holding their breath

Approach:
Consistency and developmentally appropriate expectations and

rewards Prioritize important rules Develop reasonable consequences Ignoring behaviour during tantrums Be present to show control and security Practice appropriate positive reinforcement during periods of no tantrum Offer options vs all or none

Negativism

Persistent no response
Assertion of self-control

Approach:
Reduce opportunities for a no response Eg. Its time to go to sleep vs do you want

to sleep now? Give an option to choose between 2 things


Or make choice for the child

Regression

Occurs when discomfort/stress


Revert to behaviours that were successful

before Stress caused by threat to autonomy, unsuccessful attempts to master tasks I cant cope with this and perfect this skill, but I will if given with patience and understanding

Approach:
Ignore regressive behaviour and praise existing

behaviour Dont add stress by setting expectations or new stressors

Preparing for Physical Assessment

Position:
Sitting or standing on or by parent Prone or supine in parents lap

Preparation

Parent removes clothing Underwear removed Allow child to handle equipment Perform quickly if uncooperative Praise cooperative behaviour

Nursing Interventions

Growth Measurements
Length
Height Head circumference

Physiologic Measurements:
Temperature: 1-2 yrs: axillary, rectal 2-3 yrs: axillary, tympanic, oral, rectal Know normal values for BP, HR, RR

Approach to Assessment

examine on parents lap if uncomfortable use play therapy distract with stories

Let toddler play with equipment


Call them by name Praise frequently Quickly do exam

contd

Let them explore in an environment thats safe routines are very important they will start to ask about their care/illness parents are most important people to them

Stressors of Hospitalizations and Toddlers Reactions

Separation anxiety aka anaclitic depression


3 phases: Protest: crying, screaming, clinging, avoiding/rejecting contact with strangers, verbally/physically attacking strangers, attempt to escape, attempt to force parent to stay Despair: inactivity, withdrawal, depression, lack of interest, regressive behaviour, uncommunicative, refusal to eat, drink or move Detachment: increased interest in environment, interact with strangers, form new relationships, appearing happy

Hospitalization and Loss of Control

Result from:
restrictions or limitations (movement,

isolation, illness) Altered routines and rituals


May regress

Enforced dependency Sick role


Severe in chronic, long-term illnesses

Separation from parents Result in negativism

Reference:

Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D., Wong, D. (2010) Maternal Child Nursing Care. Maryland Heights, Missouri. Pgs 888,1019-1022, 1028-1029, 1161-1162, 1248-1249