Mental health & crisis management 7 APRIL qui z

Jack Fowler

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Chapter 37

Toddler and the Family

Promoting Optimal
Growth and Development

Ages 12 to 36 months
Intense period of exploration
Terrible ‘2’s’

GOAL for Parents?

Biological Development

Weight gain slows to 1.8 to 2.7 kg/year.
Birth weight should be quadrupled
by 2½ years.
Height increases about 7.5 cm/year.
Growth is steplike rather than linear.

Sensory Changes

Visual acuity of 20/40 acceptable
Hearing, smell, taste, and touch increasingly well developed
Uses all senses to explore environment

Maturation of Systems

Most physiological systems relatively mature by the end of toddlerhood
Upper respiratory infections, otitis media, and tonsillitis common among toddlers
Voluntary control of elimination
Sphincter control: ages 18 to 24 months

Gross and Fine Motor
Development

Mobility

Improved coordination: between ages 2 and 3
Fine motor development
Improved manual dexterity: ages 12 to 15 months
Throw ball: by 18 months

Psychosocial Development

Erikson; developing sense of autonomy
Autonomy vs. shame and doubt
Negativism
Ritualization—sense of comfort
Id, ego, superego or conscience

Toddler response

All typically developing toddlers push for their independence.

♦ Each child has a unique timetable for this burst of “negativism”, but many parents will notice an increase in this difficult behavior around 18 months and again around 30 months.

Toddler Response

A common toddler response to frustration is a temper tantrum.

♦ Toddlers are having their own struggle, as they try to balance their need for independence with their need for dependence.

♦ Toddlers often respond with a loud “NO!” almost automatically, even when they really mean, “yes”.

♦ Toddlers often forget the rules parents set, so they make the same mistakes over and over again.

♦ The purpose of the toddler’s negativism is not to be disrespectful. He is attempting to assert him- self as an individual, separate from his parents.

♦ “Difficult” behavior during the toddler years will not last a lifetime. When parents allow their toddler to assert his independence in acceptable ways, the toddler can pass through this stage and move to the more cooperative, reasonable preschool stage.

♦ Older toddlers can be taught, with patience and understanding, the basics of appropriate social behavior.
Tips for parents…
♦ Keep your sense of humor when dealing with your toddler. It can be a joy to watch your toddler try new skills and practice his newfound independence.

♦ Don’t ask questions that will require a “yes” or “no” answer. The toddlers will undoubtedly say “NO!” For example, instead of “Would you like oatmeal for breakfast?” say, “Would you like hot or cold cereal?”

♦ Stay focused on the positive behaviors your toddler exhibits, as she explores her world and learns new skills.

♦ Continue to remind yourself that toddlers won’t learn all the “right”

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Toddler Response

Difficult” behavior during the toddler years will not last a lifetime. When parents allow their toddler to assert his independence in acceptable ways, the toddler can pass through this stage and move to the more cooperative, reasonable preschool stage.

Toddler Response

Toddlers often forget the rules parents set, so they make the same mistakes over and over again.

♦ The purpose of the toddler’s negativism is not to be disrespectful. He is attempting to assert him- self as an individual, separate from his parents.

Autonomy vs Shame & Doubt Group 2 Period 5

YouTube clip

https://www.youtube.com/watch?v=mFUWT85eDNY&list=PLDkaXQqwyu1RjuTBAHv0LuMkT0ERuosoB

Cognitive Development

Piaget; sensorimotor and preoperational phase
Awareness of causal relationships between two events
Learning of spatial relationships

Piaget's Preoperational Stage.mov

YouTube Clip

https://www.youtube.com/watch?v=M244b2aDcz8

Invention of New Means
Through Mental Combinations

Imitation of behaviours
Domestic mimicry and gender role behaviour
Concept of time still embryonic

Fig. 37-2. Domestic mimicry and gender-role behaviour are common during toddlerhood.

Preoperational Phase

Phase begins about age 2.
Transition occurs between self-satisfying behaviour and socialized relationships.
Preconceptual phase is a subdivision of the preoperational phase.
Preoperational thought implies children cannot think in terms of operations.

Spiritual Development

Spiritual routines can be comforting.
Religious teachings and moral development influence toddler behaviour.

Development of Body Image

Refer to body parts by name.
Recognize gender differences by age 2.
Avoid labels about physical appearance

Dr. Robin Berman Labels are Limits

Development of Gender Identity

Exploration of genitalia common
Gender identity formed by age 3
Gender roles understood by toddler
Evident in much of their imitative play

Girl toys vs boy toys: The experiment - BBC Stories

YouTube Clip

https://www.youtube.com/watch?v=nWu44AqF0iI

Social Development

Differentiation of self from mother and significant others
Separation
Individualization

Fig. 37-3. Transitional objects, such as a fuzzy stuffed animal, are sources of security to a toddler.

Language

Increasing level of comprehension
Increasing ability to understand
Comprehension much greater than the number of words a toddler can say
At age 1 uses one-word sentences (holophrases)
By age 2 uses multiword sentences by stringing together two or three words

Personal Social Behaviour

Toddlers develop skills of independence.
Skills for independence may result in tyrannical, strong-willed, volatile behaviours.
Skills include feeding, playing, dressing, and undressing self.

(back to autonomy vs. doubt)

Fig. 37-6. To minimize sibling rivalry, parents should include the toddler during caregiving activities.

Fig. 37-4. Young children enjoy dressing up.

Play

Magnifies physical and psychosocial development
Interaction with others becoming more important
Parallel play
Related to emerging linguistic abilities
Tactile play
Selection of appropriate toys

Coping With Concerns Related to
Normal Growth and Development

Toilet training
Sibling rivalry
Temper tantrums
Negativism
Regression

Toddlers regulate their behavior to avoid making adults angry

YouTube Clip

https://www.youtube.com/watch?v=7FC4qRD1vn8

Assessing Readiness
for Toilet Training

Can get to potty chair
Able to stay dry for several hours
Can balance while sitting on potty
Receptive language skills
Expressive language skills to communicate need to use potty

Fig. 37-5. A: Sitting in reverse fashion on a regular toilet provides additional security to a young child. B: Children may begin toilet training sitting on a small potty chair.

Promoting Optimum Health
During Toddlerhood

Nutrition
Ritualism
Nutritional counselling
Dietary guidelines; Canada's Food Guide
Sleep and activity
Dental health
Regular dental examinations
Removal of plaque
Fluoride
Low-cariogenic diet

Fig. 37-7. Young children can participate in toothbrushing, but parents need to brush all the child's teeth thoroughly.

Fig. 37-8. The most effective cleaning of the teeth is done by parents.

Fig. 37-9. Nursing caries. Note extensive carious involvement of maxillary primary incisors.

Injury Prevention

Motor vehicle injuries: car seat safety
Drowning
Burns
Poisoning
Falls
Aspiration and suffocation
Bodily damage

Fig. 37-10. A: Convertible car safety seat in forward-facing position. B: Use of locking clip.

Fig. 37-11. Lower anchors and tethers for children (LATCH). A, Flexible two-point attachment with top tether. B, Rigid 2-point attachment with top tether. C, Top tether.

Anticipatory Guidance

Understanding toddlers is fundamental to successful childrearing.
Nurses can assist parents in facilitating tasks and meeting the needs of children.
Provide opportunities for parents to express their feelings.