PEDIA QUIZ 4 | 101216

CARE OF THE TODDLER

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Growth slows, average of gain 4-6 lbs/year

Adult height twice the height at 2 years old
Pouchy belly pot-bellied, bow-legged
Visual acuity 20/40, full binocular vision
Other senses increasingly well-developed, uses them to explore environment
Brain growth 75% completely by 2
Complete myelination of spinal cord at 2 years old
Internal ear and throat short and straight, large tonsils and adenoids, prone
to otilitis media, tonsillitis and still abdominal breathers
Increasing gastric capacity, voluntary control of elimination
Bladder capacity increases, can retain urine for 2 hours or longer
Functional eccrine gland, minimum amount of sweat glands
Passive Immunity from mother gone but can produce own antibody

GROSS MOTOR DEVELOPMENT (p. 499)

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Finds pleasure in controlling his eliminatory function

Feeling of INDEPENDENCE develops
EGO develops as child is able to delay gratification
Rudimentary beginning of SUPEREGO
Negativism NO stage set limits/offer acceptable choices
Ritualistic or stereotype behavior
Temper tantrums Ignore tantrums

CONCERNS RELATED TO GROWTH AND DEVELOPMENT

TOILET TRAINING
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Voluntary control by 22 and 30 months currently advised to start at 20-21

months
Most important factor in success (guidelines p. 501) READINESS
Bladder, bowel, cognitive motor, psychological, physiologic
Bowel training is started first at 18 monts old, then daytime bladder, last is
night time bladder training
Generally covers 1 to 2 years, completed by 4 or 5 years old

SIBLING RIVALRY
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Jealously and rejection because a dethronement by the new baby

Needs adequate preparation for the birth of new sibling
Give realistic idea about what the newborn will be like
Involve them in the care of the baby

TEMPER TANTRUMS
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Non verbal expression of frustration because toddlers are not able to express
themselves

NEGATIVISM

NO (AYAW! HINDI!) stage

Due to toddlers need to develop autonomy or independence

RITUALISM OR STEREOTYPE BEHAVIOR

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Doing the same way/manner at the time

REGRESSION
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Retreating to past level of behavior

PROMOTING OPTIMUM HEALTH

NUTRITION: Feeding milestones (TABLE 12-3)
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Slow growth: less caloric needs

Physiologic anorexia: picky, fussy eaters, food jags at 18 months
Imitates adult response to food, eats adult foods at 12 months
Limit milk intake to 24-28 oz./day
DO NOT use food as a means of reward and punishment
Make mealtimes enjoyable
Serve food attractively, allow rituals

SLEEP
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Average: 11-12 hours of sleep a day with nap

Sleep problems are common like going to bed
Bedtime rituals and transitional object

DENTAL CARE
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Oral health exam by 6 months of age

Regular dental visit by 12 months
Brushing and Rossing in remove plaque
Fluoride supplement
Low cariogenic diet = low in sweets
Prevent nursing caries or baby bottle mouth syndrome: eliminate

SAFETY MEASURES/ INJURY PREVENTION

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Motor vehicle injury: car seats and car restraints

Drowning
Poisoning: cabinet
Falls
Aspiration and suffocation
Bodily damage

CARE OF THE PRE-SCHOOL CHILD

BIOLOGIC DEVELOPMENT
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Average weight gain 2-3 kg/year

Slender but slurdy, graceful, posturally erect

Increased strength, refined skills

Mostly toilet trained

MILESTONES (p. 529)

ERIKSONS INITIATIVE VS. GUILT
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Stage of energetic learning

Attempts to imitate adults
Imaginative and creative
Pretends he can participate in the adult world
Development of the SUPEREGO/CONSCIENCE

FREUDS PHALLIC STAGE

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Forms a strong attachment to the opposite sex parents

o Oedipal/Electra period
Sexual exploration may be more pronounced manipulates their genitals
o Book ignore
o Practice divert
Asks questions about sex (Gender differences and Sexual reproduction)
Sex Education

PIAGETS PRE-OPERATIONAL (2-7 years old)

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Shifts from total egocentric thought to social awareness and ability to

consider other viewpoints
Magical thinking believes that their thinking is so powerful, they can make
things happen
Believes in the power of words and accepts the meaning literally
Animism

DEVELOPMENT OF SEXUALITY
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Strong attachment to parent of the opposite sex

Sex typing by imitation
Sexual exploration and genital manipulation

CONCERNS RELATED TO GROWTH AND DEVELOPMENT

SCHOOL EXPERIENCE
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Pre-school or day care centers learns group cooperation and adjustment to

differences
Beneficial especially for an only child
Proper preparation of the child

SEX EDUCATION
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Answers questions about sex honestly and matter-of-factly

Avoid giving an unasked for answer
Be honest
Know the difference between sexes at 3 years old

AGGRESSION
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Behavior that attempts to hurt or destroy

Influenced by biologic, socio-cultural and familial variables
Common among males, interaction in the family, frustration, parental
disapproval, humiliation, insults
Modeling or imitating the behaviors
Should not be made to feel guilty, help them find control

SPEECH PROBLEM
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Developmental stattering and stammering

Refrain from correcting and criticizing the4 child
Do not complete the sentence for him; take time to listen
Determine the possible causes: Deafness, developmental delay, autism, lack
of stimulation

STRESS
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May be innate (fears) or imposed (beginning school) (TABLE 13-2)

Best management is prevention: Monitor amount of stress so that levels do
not exceed ability to cope

FEARS
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Variety of real and imagined fear: fear of the dark, of being left alone, of
animals, of ghosts, of pain, sexual matters (castration), body mutilation

Ms: Desensititzation, night light, reassurance but not co-sleeping, positive selftalk, thought stopping, tokens for bravery
PROMOTING OPTIMUM HEALTH
NUTRITION
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Emphasize importance of quality not quantity of food eaten

Serve food and pretty dishes, comfortable chairs, child-size proportions
Parents should serve good role models

SLEEP ACTIVITY/PROBLEMS
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Nightmares, sleep terrors

FEAR OF THE DARK/NIGHTMARES

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Caused by vivid imagination and over stimulation before bed time

Offer comfort, assurance, sense of protection
Set a consistent bedtime ritual, night light, security object

INJURY PREVENTION
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Safe environment especially in nursery schools

Parents should serve as good example by practicing what the preach