Our Lady of Fatima University

College of Nursing Department

Mac Arthur Highway, Dela Paz Norte, City of San Fernando, Pampanga

NCMA 217 Care of Mother, Child & Adolescent

(Well Client)
2ND YEAR: GROUP ACTIVITY
Finals

Submitted By:
GROUP 2
LEADER: Ramirez, Joel Lois L.
MEMBERS:
Dela Cruz, Jan Bee H. Manabat, Aleckzie Joy
Forte, Kylone Sumang, Patricia Mae
Gomez, Christine Joy Sunga, Charlot
Mallari, Christian Andrei Verdida, Aira Kharys
Reyes, Hazel Joy M. Simbulan, Erica Mae
Depalac, Flieoyed V.

Submitted To:
Ms. Alma Reina B. Alejandro MAN, RN, RM
Mr. Marcellus Belisario LPT, MAN, RN
 Nursing Process for Promotion of Normal Growth and Development
FAMILY WITH A TODDLER
I. INTRODUCTION
Toddlers are considered to be children that range from 1 year to 3 years of age. During this stage, the
toddler's physical growth and motor development will slow, but you can expect to see some tremendous
intellectual, social, and emotional changes. This stage may be challenging for the parents because
toddlers are becoming more mobile, independent and start to explore everything they can access around
them. Also, behavioral issues can be seen most of the time at this stage. As toddlers are being eager to
be independent, they also tend to have trouble dealing with their limits which sometimes can lead to
having tantrums and misbehavior. As the parent is involved with the growth and development of their
child, they also needed to gain knowledge on how to manage this kind of situation so, seeking for a
healthcare provider to talk about the child's development can be a big help for them.

II. GENERAL OBJECTIVES

 To improve the health and well-being of the toddler, to promote proper growth development, and
reduce the risk of having health problems
 Promote strategies in assessing and diagnosing toddlers for a better outcome
 Educate family members in observing their family with a toddler and give them strategies in
handling a toddler.

III. PURPOSE AND GOAL

To be able to assess the normal growth and development of toddlers as well as the associated parental
concerns. Also, to provide the parents with enough knowledge about the proper parenting and taking
care of their toddler in order to ensure and achieve healthy development.

IV. DISCUSSION
A. ASSESSMENT
CHARLOT: In this video, we’re going to talk about a toddler, a child ages 1-3 years old. At this stage, toddlers
are aware of their environment, they want to explore and discover new things on their own, meaning they are
independent. When it comes to weight, we would expect them to gain about 4-6 lbs per year, and a toddler
should be 4 times their birth weight. The average weight for a girl is 26.5 lbs and for a boy, it’s 27.5 lbs. In
terms of height, we would expect a toddler to gain about 2-3 inches per year. That’s just brief information about
a toddler.
CHARLOT: Now, let’s proceed to our agenda, which is the assessment for toddlers. When a child with his/her
parents visits a health center for a specific health concern, we should start by taking the health history of the
child, of course, because they are still toddlers, they don’t know what’s going on with their health, so ask the
parents or guardian instead, about a toddler’s ability to carry out activities of daily living, which provides
information not only on a child’s developmental progress but also important clues about the child-parent
relationship. So, what does the child-parent relationship have to do with our topic? Well, a child-parent
relationship is one of the factors that nurture a child’s physical, emotional, and social development, it is the
foundation for a child’s personality. A positive child-parent relation will help the child to have healthy
developmental growth.
FLOYD: Also, while doing the assessment, we should carefully observe the parents because some parents may
become emotional and may not be able to describe the problem objectively, which can lead to confusion or
worst; wrong diagnosis. Asking the parents to calm down first before addressing the question is the best thing to
do. When a parent brings their child to a health center, it's not always because they're worried about their child's
physical health; sometimes it's because they're worried about their child's behavior or emotional health. So, to
know if there is something wrong with their behavior or development, assess the language development,
physical skills, personal and social relationship of a child.
FLOYD: First, language development. To assess language development, use a special spoken test to evaluate
the child. A hearing test is often included in the evaluation because a hearing problem can affect speech and
language development. Second, the physical skills. To do this, we need to ask some questions to the parents
about what the child can do. Lastly, the social skills. To do so, we need to observe the child or ask the parents
about their skills, as well as some formalized testing and checklists. This assessment will help to detect the
health concern of a child.
VIDEO PRESENTATION:
 Aware of their environment
 Want to explore
 Independent

Weight:
 Gain about 4-6 lbs per year
 4 times their birth weight

Average weight:
 Girl: 26.5 lbs
 Boy: 27.5 lbs

Height
 Gain about 2-3 inches per year

ASSESSMENT:
 health history of the child (ask the parents/guardian) about:
 Toddler’s ability to carry out activities of daily living
 Child-parent relationship.
 Observe the parents
 Assess the:
 Language development (hearing)
 Physical skills
 Personal and social relationship

B. NURSING DIAGNOSIS
Nursing diagnoses related to the normal growth and development of toddlers usually focus on the parents’
eagerness to learn more about the parameters of normal growth and development or issues of safety or care.

Through the use of nursing diagnosis, the parents can also be able to gain awareness regarding the condition of
their child and be able to know how they can manage this kind of situation or issues for the safety of their
children.
Examples are:
  Health-seeking behaviors related to normal toddler development
As a parent, it is your obligation to consider and ensure the health of your child. A parent should consider
having a health-seeking behavior to be able to gain awareness and knowledge about maintaining the overall
well-being of a child. This will allow them to prevent acquiring any illnesses or avoid any occurrence of
complications due to illness, and be able to manage the growth and development of their child. It is important
for the parents to seek help to be able to gain more knowledge about parenting or fulfilling their role as parents.

 Deficient knowledge related to best method of toilet training

As the toddlers are being more curious about their surroundings, they are having the desire to explore new
objects. As a parent, you are also the one who will introduce them to these things. Like teaching them to
practice a smaller task or activities for them to be able to learn with new skills. One of these important tasks you
must introduce to them is performing the everyday self-care skills such as doing the toilet training which is
commonly an issue for parents. Some parents find it challenging since they don't know the methods on how or
when they need to begin doing toilet training. So, it is one of the concerns that needed to give attention, because
if these are being disregarded, this can lead to complications on the health of the child, such as in terms of
urinating and bowel movement. So parents must be needed to educate first correctly regarding the appropriate
way and time for toilet training.

 Risk for injury related to impulsiveness of toddler

During this stage, toddlers are moving more around such as they are being more involved in different activities.
They run, jump, climb and explore everything most of the time around the house and because of that they are
prone to dangers as well. And anytime they can get being injured because harm can just happen quickly so as a
parent the most important thing you can do is to always keep an eye on your toddler. Toddlers are being
impulsive in their actions because they still don't know and understand how to have self-control and even
cannot judge what are the hazardous things around them. But all of these are also part of growing. As a parent,
you just always need to be there to guide and protect them from any harm.

 Interrupted family process related to need for close supervision of 2-year-old

An interrupted family process is like the inability to adjust or perform needs in the family. Family development
is very important and every member should adjust to these changes. We all know that toddlers at this age they
starting to explore new things and as a parent, your focus is on keeping your little one safe. This diagnosis will
show how parents secure their child and will show what are the needs to be fulfilled during supervision.

 Readiness for enhanced family coping related to parents’ ability to adjust to new needs of child
As I’ve said Family development is very important that’s why every member should be ready to adjust to
these changes especially for their child at this stage. Positive parenting is a very big help because the readiness
and willingness will affect the responses of the toddler and help them grow up to be better humans. So the main
point of this diagnosis is that parents should open themselves in accepting learning and adjusting for their child.
Because changes are part of the growing and development process we have to accept these changes for our
children.

 Readiness for enhanced parenting related to increased awareness for poison prevention
 This diagnosis shows parents the need in accepting learning about parenting. We all know that this age is
more on exploring and curiosity of the toddler it is when they always ask something and some situations if they
see unfamiliar things they tend to eat or drink it that’s why there is a high risk of poisoning so we need to teach
parents what to do to prevent it for the safety of their children. Safety precautions are very needed.

 Disturbed sleep pattern related to lack of bedtime routine

One of the problems of toddlers is their sleeping pattern. Disruption to children’s sleep patterns can occur
for many reasons, including behavioral disorders, respiratory and airway disorders, and neurological
disorders. This diagnosis will focus on sleep disruption and daytime sleepiness caused by behavioral factors
and disorders.

C. OUTCOME IDENTIFICATION AND PLANNING

To help parents resolve a concern during the toddler period, focus largely on family education and anticipatory
guidance. Urge them to establish realistic goals and outcomes so they can meet the rapidly changing needs of
their toddler and learn to cope with typical toddler behaviors. Otherwise, parents can expect too much of a
toddler and grow frustrated instead of enjoying being a parent of a child this age.

Here are the examples connected to our Diagnosis:

•Health-seeking behaviors related to normal toddler development
This is an awareness or prevention of childhood illness. These include access to health facilities, availability of
drugs, quality of medical care, and the right nutrition for toddlers. The purpose of this is to reduce child
mortality over the last decades, however, the magnitude of the problem is yet high globally. Because there are a
lot of children that are not receiving enough health care or right nutrition because of poverty and lack of health
teaching education for mothers/guardians. Appropriate healthcare-seeking behavior of mothers/guardians for
common childhood illnesses could prevent a significant number of child deaths and complications due to
childhood illnesses

For example:
At this time of age, your child is starting to eat solid foods, so you must give her the right food that is high in
nutrition because her body needs it especially in her growth and development.
Your child should be on an eating schedule and can join the family at the dinner table 3 times a day. You can
put her in a high chair but give them separate food. Additionally, Children take pride in new accomplishments
and want to do everything independently. So, you can teach her to start the habit of washing her hands before
meals.

•Deficient knowledge related to the best method of toilet training

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.
Erikson defines the developmental task of the toddler age as learning autonomy versus shame or doubt.
Autonomy (self-government or independence) builds on children’s new motor and mental abilities.
New accomplishments make children proud, and the desire to do everything on their own, whether it is pulling
the wrapper off a piece of candy, selecting a vitamin tablet out of the bottle, flushing the toilet, or replying,
“No!” If parents recognize toddlers need to do what they are capable of doing, at their own pace and in their
own time, then children develop a sense of being able to control their muscles and impulses during this time.

For example:
You can start teaching your child to go to the bathroom every time she wants to pee or poop or be accompanied
by them when you are using the toilet so that they will see you using it. Teaching them also requires action that
comes from you. You can also buy them their own potty training toilet and place them in the bathroom so that
every time they want to pee or poop, they will know where is their toilet. This can help them to do it on their
own also they don’t need to wear diapers anymore. In teaching them, you have to be patient until they will
learn.
When mothers/guardians are impatient and do everything for them, this enforces a sense of shame and doubt. If
children are never allowed to do things they want to do, they will eventually doubt their ability to do them; they
will stop trying and cannot do them. If children leave this stage with less autonomy than shame or doubt, they
can be disabled in their attempts to achieve independence and may lack confidence in their abilities to achieve
well into adolescence and adulthood

•Risk for injury related to impulsiveness of toddler

Self-regulation is the ability to control one’s behavior, including emotions, thoughts, actions, and attention.
Self-regulation is really the ability to control impulses— From not striking your sibling when he grabs your toy,
to waiting till you have enough money to pay your rent before buying that pricey TV, cellphone or etc.
Infants and young children are unable to regulate their emotions on their own; they require loving adults in their
life to assist them in regulating their emotions and actions instantly, as well as learning skills to do it
independently. Young children can learn skills that will help them self-regulate with practice and guidance.
Unintentional injuries rank as the number one cause of death and a leading cause of hospitalization for children
beyond 1 year of age. At this time of age, toddlers use lots of energy to learn to walk, they learn how to roll and
kick a ball, to jump on both feet, to walk up and down stairs independently, to run and etc.
They lack self-control even you told your child not to do it 10 times already. But you have to be patient because
they are still learning and exploring things. Once they get hurt by doing that action, you don’t have to scold a
toddler because it will mark on them. Instead, comfort them and repeat what you said. That is your perfect time
to teach your child because she saw what happens to her. So next time, she’ll learn to control her emotions and
actions also she’ll start to listen to you. Also, lower your expectation to them based on what they can and can’t
do.

For example:
You can play games that require impulse control. Color one side of a paper plate red and the other green, and
play some “stop and go” games. For example, when you are outside playing, your child runs toward you until
you put up the red sign. Then she runs again when the sign is green. Play “freeze dance” with music. When the
music is on, your child dances; when you stop it, she has to freeze. By playing you are also teaching your child
to do self-control. As a parent/guardian, be responsive. Be patient. Talk about emotions. Sooth and help them
self-sooth.
• Interrupted family process related to need for close supervision of 2-year-old- change in family relationships
and/or functioning
- With adequate supervision, an adult can respond immediately including when a child is distressed or is in a
hazardous situation. Close supervision helps protect your child from hazards or harm that may arise in their
daily experiences in play, interactions with others, and daily routines.

• Readiness for enhanced family coping related to parents’ ability to adjust to new needs of the child- effective
management of adaptive tasks by family member involved with client’s health challenge, who now exhibits
desire and readiness for enhanced health and growth with regard to self in relation to client
-Give your child attention and praise when she follows instructions and shows positive behavior and limit
attention for defiant behavior like tantrums. Teach your child acceptable ways to show that she’s upset.

• Readiness for enhanced parenting related to increased awareness for poison prevention- a pattern of providing
an environment for children or other dependent person/s that is sufficient to nurture growth and development
- Store medicines, chemicals, and cleaners up high in a locked cupboard, safely out of reach and out of sight of
your child. Once you’re aware of substances that are or might be dangerous, it’s easier to protect your child.

• Disturbed sleep pattern related to lack of bedtime routine- time-limited interruptions of sleep amount and
quality due to external factors
- Establishing a consistent bedtime routine is helpful for all manifestations of behavioral insomnia (bedtime
resistance, prolonged sleep onset, and night waking). The routine should last approximately 20 to 45 minutes
and include three to four soothing activities, such as taking a bath, changing into pajamas, and reading stories; it
should not include television or other electronic devices.

D. IMPLEMENTATION
Toddler
1st Paragraph - Erica
PPT INPUT
When teaching about typical toddler behavior, teach parents a good rule is to think of a toddler as a visitor from
a foreign land who wants to participate in everything the family is doing but does not know the customs or the
language. They need to help their toddler learn these the same as they would that stranger.

EXPLANATION
- Part of being a toddler is learning to handle strong emotions, sometimes they act up and throw tantrums when
they can’t get what they want or can’t say how they feel.
- Toddlers are realizing that they are separate individuals from their parents and caregivers. This means that
they are driven to assert themselves, to communicate their likes and dislikes, and to act independently (as much
as they can!). Toddlers are also developing the language skills that help them express their ideas, wants, and
needs.
- As a parent, your job is to help your young toddler navigate the tide of strong emotions they are experiencing.
Toddlers may begin to experience a feeling of pride, shame, guilt, and embarrassment for the first time.

EXAMPLES
TALK ABOUT FEELINGS AND HOW TO COPE - you can read books and notice aloud how the characters
are feeling. And share your own feelings for example I just spilled the baby’s milk. I feel really frustrated! Will
you help me wipe it up? Wow, it feels so good to have your help. - When your child can label how he is feeling,
it helps him gain control over his emotions and communicate them to others. - Once your child has named his
feelings, you can suggest what he might do to feel better or solve the problem. This helps him learn what to do
in the future when he faces a similar challenge. For example, if he is sad because his grandparents just left after
a 2-week visit, you can suggest looking at photos of them or drawing them a picture.

LET YOUR CHILD MAKE CHOICES APPROPRIATE TO HER AGE - This gives her a feeling of control
and supports her growing confidence and sense of competency (the belief that “I can do it”). - for example, you
can have an apple, a string cheese, or a bagel for a snack. What sounds good to you?

EMPATHIZE WITH YOUR CHILD - It’s okay to let her know that you understand the choices she is being
offered are not the ones she wants - for example, We have to leave now to go to Ms. Kelly’s house. I know you
want to stay home with Daddy. You miss me and I miss you during the day. But staying home is not a choice
today. Daddy has to go to work. But when we get home, we will finish the puzzle we started and have a yummy
dinner. Do you want to get into the car seat yourself or do you want me to put you in?
2nd Paragraph- Christine
PPT INPUT
Also, teach parents not only how to approach a current problem but also how to learn adequate methods for
resolving similar situations that are sure to arise in the future. If parents do not learn methods that can be
applied throughout their child’s growing years, they may win battles but lose wars. For instance, parents may
find those promising children a treat when they are in the middle of a temper tantrum will stop the tantrum, but
it will not prevent other tantrums from occurring in the future (and, in fact, may encourage them).

EXPLANATION
- Toddlers are known for tantrums and other behavioral issues. They are young children who hunger for early
independence but have trouble expressing their needs. Toddlers also have difficulty in compromising, dealing
with limits, and experiencing disappointments which causes them to throw a fit or misbehave.
- What should a parent do if her child whines, cries, or screams? The best thing to do is to keep cool when
responding to a tantrum. Parents must understand that tantrums are normal and that they are the results of their
child’s frustrations. Parents should not complicate the problem with their own anger and frustration and
remember that the goal is to help their child learn to calm down.
- Good parenting which involves learning methods that can be applied throughout the child’s growing years is
very important because it would help the child understand that there are existing limitations and rules that must
be followed. If a parent handles the “tantrum scenarios” properly, the child would be able to recognize and
control his feelings and pull himself together.
EXAMPLES
Tantrums are handled differently depending on why a child is upset.
If the child is HUNGRY or TIRED:
- Find ways to provide comfort for the child by giving him/her snacks or letting them take a nap. Other times, it
is better to ignore the outburst or distract the child with new activities.
If tantrums happen because the child wants ATTENTION:
- One of the best ways to reduce this behavior is to ignore the tantrums.
If the tantrums happen because the child is REFUSED SOMETHING:
-Parents should stay calm and do not give a lot of explanations on why he/she cannot have what she wants.
Instead, move on to another activity with the child.
If a tantrum happens because the child is told to do something she DOES NOT WANT TO DO:
-It is best to ignore the tantrum but be sure to follow through on having the child complete the task after he/she
is calm.
If tantrums can HURT the CHILD or OTHERS:
-The child should be taken to a quiet and safe place in order for them to calm down. This also applies to
tantrums happening in public places.
If a safety issue is involved and the child REPEATS THE FORBIDDEN BEHAVIOR after being told to stop:
-Parents can use a time-out or hold the child firmly for several minutes. Be consistent on this.
DO NOT REWARD the child’s tantrum by giving in. The child will think that tantrums are effective in getting
what they want and it would encourage him/her to do it more in the future.

AFTER THE TANTRUM:

-Parents should praise the child for regaining control. (“I like how you calmed down.”)
-Hug the child and provide reassurance by telling them that they are loved no matter what.
-Let your child rest by letting them take a nap (since throwing a fit somehow uses a lot of their energy).
Children with too little sleep can become hyper, disagreeable, and may exhibit extreme behavior.

3rd Paragraph- Christian

PPT INPUT
Health visits provide opportunities to help parents learn healthy coping techniques. In addition, demonstrating
good communication skills with toddlers can serve as a model for healthy communication behavior with them.
EXPLANATION
-As mentioned, toddlers are known to have tantrums, etc... as it is their way of communicating.
-Communication with toddlers is essential to their development and relationship, means of understanding them
and being aware of their simple actions help them develop their skills.
EXAMPLE
-Giving your full attention to them, listening and responding to their simple actions in a sensitive way.
- Focusing on body language can help determine their mood, for example, their facial expressions, the sounds
they make, gesture and body movements, and sound. Those simple ways are their means of communicating.
- They develop when adults respond to their efforts.

E. OUTCOME EVALUATION
Expected outcomes must be evaluated frequently during the toddler period because children change so much
and learn so many new skills during this time that their abilities and associated parental concerns can change
from day today.

These are some examples of Expected outcomes for toddler:

Nutrition:
Parents state the provision of nutritious meals and snacks
 Teaching simple mealtime manners
 Dental care

Elimination:
 The parent’s state child knows the toilet training techniques

Rest/Sleep:
 Parent’s state child maintains a consistent bedtime routine within the next 2 weeks.
Play:
 Parents state that they provide adequate space and a variety of activities

 Toys that allow “acting on” behaviors and provide motor sensory stimulation

Toddler Safety:
• Parents state they have childproofed their home by putting a lock on the kitchen cupboard by the next clinic
visit.

At this stage, the toddlers seem to be adventurous and into everything, and not only do children begin to take
their first physical steps at this stage, but they also take their initial steps toward becoming independent people.
So it is essential that the parents childproof their home by putting a lock on the kitchen etc. for the safety of the
potential hazard because the toddler is naughty and they love playing they are at risk for injuries.

 Parents state the importance of constant supervision and teaching children to obey commands
 Parents state the home environment safety measures (e.g., lock medicine cabinet)
 Also the outdoor safety measures (e.g, close supervision near water)
 And also the elimination of toxins in the environment (e.g., pesticides, herbicides, mercury, lead, arsenic
in playground materials)

All of these are important for their health risk:

Because toddlers experience significant health problems due to injuries, visual problems, dental caries, and
respiratory infections.

Injuries are the leading cause of mortality of toddlers, it is because they are curious and like to feel taste
everything. The most common causes of fatal injuries are automobile crashes, drowning, burns, poisoning, and
falls. Parents or other caregivers need to take the appropriate preventive measures to guard against these healthy
treats.

Growth and development in the toddler years provide the basis for a child’s future health and well-being. It is
essential that caregivers do an accurate and timely assessment to promote health and detect problems early, thus
allowing for early interventions. Providing health education, information about growth development, and
anticipatory guidance to parents is also an important nursing role. Assessment activities for the toddler are
similar to those for the infant in terms of measuring weight, length or height, and vital signs.

Physical Development:
 The child demonstrates physical growth (weight, height, and head circumference) within normal range
 Manifest vital signs within the normal range for age
 Exhibit vision and hearing abilities

Motor Development:
Perform gross and fine milestones within the normal range for age, for example by the 3 years of age the toddler
is able to do the following
 Walk up steps without assistance
 Balance on one foot, jump and walk on toes.
 Copy a circle
 Build a bridge from blocks
Psychosocial Development:
Perform psychosocial developmental milestones for age. For example, by 3 years of age the toddler able to do
the following
 Express likes and dislikes
 Display curiosity and ask questions
 Accept separation from a short period of time
 Begin to play and communicate with children and others outside the family
 Speak in sentences of three to four words

Developmental in activities of daily living

 Feed itself
 Eat and drink a variety of foods
 Exhibit a sleep pattern appropriate for the age
 Dress self.

V. REFERENCES
http://www1.us.elsevierhealth.com/MERLIN/Johnson/linkage/
linkagesHealth_Maintenance_Altered.html
https://www.zerotothree.org/resources/1603-toddlers-and-self-control-a-survival-guide-for-
parents