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
