CLIENT NEEDS

Module 1: Developmental Stages and Transitions

Lesson 1: Infant, Child, and Adolescent

Lesson 1 reviews the developmental stages of the infant, child, and adolescent. Physical characteristics, vital signs, nutritional requirements, skills, play, and
safety for each developmental stage are presented.

Theories of Personality Development

• Erik Erikson: psychosocial development

• Sigmund Freud: psychosexual development
• Jean Piaget: cognitive development
• Lawrence Kohlberg: moral development

Age Range Erikson Freud Piaget Kohlberg

Infancy: birth to 1 year Trust vs mistrust Oral gratification Sensorimotor (birth to 2 Infant has no awareness of
years) right or wrong

Toddler: 1 to 3 years Autonomy vs shame and Anal stage: gains a sense Preoperational (2 to 7 years) Punishment and obedience
doubt of control over orientation
instinctive drives

Preschool: 3 to 6 years Initiative vs guilt Phallic stage: becomes Preoperational (2 to 7 years) Preconventional: conforms
aware of self as sexual to rules to avoid
being punishment

School-age: 6 to 12 years Industry vs inferiority Latency stage: focuses Concrete operational (7 to 11 Conventional: conforms to
on developing peer years) rules to please others
relationships

Adolescent: 12 to 20 Identity vs role confusion Genital stage: develops Formal operations (11 years Postconventional: focuses
years relationships with to adulthood) on individual rights and
members of the principles of conscience
opposite sex, plans life
goals, and gains strong
sense of personal
identity

A pediatric nurse is developing nursing care plans on the basis of Erik Erikson's stages of psychosocial
development. Using Erikson's stages of psychosocial development, number the psychosocial crises in order of
occurrence on the basis of developmental stage, from birth (1) to 20 years of age (5).

a. Identity versus role confusion -5

B. Industry versus inferiority -4
c. Initiative versus guilt -3
D. Autonomy versus shame and doubt -2
e. Trust versus mistrust -1

The Infant

Physical Characteristics

• Weight has doubled at 5 to 6 months and tripled by 12 months.

• By 1 to 2 years of age, head circumference and chest circumference are equal.
• Anterior fontanel (soft and flat in a normal infant) closes between 12 and 18 months.
• Posterior fontanel (soft and flat in a normal infant) closes after 2 to 3 months.
• Lower central incisors erupt after 6 to 8 months.
• The infant sleeps most of the time.

Vital signs

Newborn

• Axillary temperature: 97.7° F to 99.5° F (36.5 to 37.5° C)

• Apical rate: 120 to 160 beats per minute (100 sleeping, 180 crying)
• Respirations: 30 to 60 (average 40) breaths per minute
• Blood pressure: averages 73/55 mm Hg
• temp 36.5 to 37.5 C

1-Year-Old

• Axillary temperature: 96.8° F to 99° F (36 to 37.2° C)

• Apical rate: 90 to 130 beats per minute
 • Respirations: 20 to 40 breaths per minute
• Blood pressure: averages 90/56 mm Hg
• temp 36 to 37.2 C

Nutrition

• The infant may breastfeed or bottle-feed, depending on the mother's choice.

• Human milk is the best food for infants younger than 6 months.
• Whole milk should not be introduced to an infant until after 1 year of age.
• Skim and low-fat milk should not be given, because the essential fatty acids are inadequate and the solute concentration of protein and
electrolytes is too high.
• Fluoride supplementation may be needed starting around 6 months of age.
• Solid foods are introduced at 5 to 6 months of age. New foods are introduced one at a time, usually at intervals of 4 to 7 days, as a means of
identifying food allergies.
• Sequence of introduction of solid foods: rice cereal; fruits and vegetables, first yellow and then green; meats; egg yolks, avoiding egg whites
(introduce egg white toward the end of the first year); cheese may be used as a substitute for meat and as a finger food.
• Avoid solid foods, such as nuts, foods with seeds, raisins, popcorn, grapes, and pieces of hot dog, that put the infant at risk for choking.
• Avoid microwaving baby bottles and baby food.
• Never mix food or medications with formula.
• To help prevent botulism, never add honey or corn syrup to formula, water, or other fluid.
• Offer fruit juice from a cup. rather than a bottle, to prevent bottle-mouth caries.

Skills

2 to 3 Months

• Smiles
• Turns head from side to side
• Cries
• Follows objects
• Holds head in midline

4 to 5 Months

• Grasps objects
• Switches objects from hand to hand
• Rolls over for first time
• Enjoys social interaction
• Begins to show memory
• Aware of unfamiliar surroundings

6 to 7 Months

• Creeps
• Sits with support
• Imitates
• Exhibits fear of strangers
• Holds arms out
• Frequent mood swings
• Waves bye-bye

8 to 9 Months

• Sits steadily when unsupported

• Crawls
• May stand while holding on to support
• Begins to stand without help

10 to 11 Months

• Can move from prone to sitting position

• Walks while holding on to furniture
• Stands securely
• Entertains self for periods

12 to 13 Months

• Walks with one hand held

• Can take a few steps without falling

14 to 15 Months

• Walks alone
• Can crawl up stairs
• Shows emotions such as anger and affection
• Explores away from parent in familiar surroundings

Play

• Solitary
 • Enjoys soft stuffed animals, crib mobiles with contrasting colors, squeeze toys, rattles, musical toys, water toys in the bath, large picture books, and,
after beginning to walk, push toys

Safety

• The home should be baby-proofed.

• Car safety seats are not placed in the front seats of cars; the infant could be seriously injured if the passenger air bag is released, because safety
seats extend closer to the dashboard.
• Guard infant on bed or changing table.
• Use gates to protect infant from stairs.
• Never vigorously shake an infant.
• Be sure that bathwater is not hot; do not leave child unattended in bath.
• Do not hold infant while drinking or working near hot liquids.
• Cool vaporizers should be used instead of steam to help prevent burn injuries.
• To help prevent choking, avoid offering food that is round and similar in diameter to the airway.
• Be sure that toys have no small pieces.
• To help prevent strangulation, hang mobiles and other toys over the crib well out of reach of the infant.
• Avoid placing large toys in the crib; an older infant may use them as steps to climb.
• Cribs should be positioned away from curtains and blind cords.
• Cover electrical outlets.
• Remove hazardous objects from low, reachable places.
• Remove chemicals, medications, poisons, and plants from the infant's reach.
• Keep the poison-control hotline number available.

A nurse is providing information to the parents of a 5-month-old infant about introducing solid foods to the infant. Which of the following instructions
should the nurse give to the parents?

1. Cheese should not be used a substitute for meat.

2. Introduce one new food at a time at intervals of 4 to 7 days.

3. Mix soft solid food with formula if the infant refuses to eat.

4. Start with fruits and vegetables; if these are tolerated, add cereal to the diet.

RATIONALE

Solids may be added to feedings when the infant is 5 to 6 months old. Rice cereal is introduced first because of its low allergenic potential. The
recommended sequence after the introduction of rice is weekly introduction of fruits, followed by vegetables and then meat. Cheese may be used as a
substitute for meat or as a finger food. Parents are instructed to introduce one food at a time, usually at intervals of 4 to 7 days, as a means of identifying
food allergies. Foods are never mixed with formula in the bottle.

The Toddler
Physical Characteristics

• Height and weight increase in steplike fashion, reflecting growth spurts and lags. (Weight gain is slower during this phase than in infancy.)
• The toddler should see a dentist soon after the first teeth erupt, usually around 1 year of age; a fluoride supplement may be necessary.
• A toddler should never be allowed to fall asleep with a bottle containing milk, juice, soda pop, or sweetened water because o f the risk of bottle-
mouth caries.
• The toddler typically sleeps through the night and takes one daytime nap; nap is discontinued around age 3.
• A consistent bedtime ritual helps prepare the toddler for sleep.
• Security objects may also help the toddler get to sleep.

Vital Signs

• Axillary temperature: 97.5° F to 98.6° F; 36.4°C to 37 °C

• Apical rate: 80 to 120 beats per minute
• Respirations: 20 to 30 breaths per minute
• Blood pressure: averages 92/55 mm Hg

Nutrition

• The toddler generally does best eating several small, nutritious meals each day rather than three large meals.
• The MyPlate for Kids food plan provides dietary guidelines for children as young as 2 years of age.
• Offer a limited number of foods at any one time; avoid concentrated sweets and empty calories.
• Seat the toddler in a high chair at the family table for meals.
• Allow toddler sufficient time to eat but remove food when he or she begins playing with it.
• The toddler drinks well from a cup held with both hands.
• Toddlers are at risk for aspiration of small foods that are not easily chewed (e.g., nuts, foods with seeds, raisins, popcorn, grapes, pieces of hot dog).

Skills

• The toddler begins to walk with one hand held by age 12 to 13 months, runs by 2 years, and walks backward and hops on one foot by 3 years.
• Children of this age usually cannot alternate feet when climbing stairs.
• Toddlers are beginning to master fine motor skills for building, undressing, and drawing lines.
• The young toddler often uses "no," even when he or she means "yes," to assert independence.
• The toddler is beginning to use short sentences and has a vocabulary of about 300 words by age 2; tends to ask many "why" questions.

Bowel and Bladder Control

• The toddler is beginning to exhibit signs of readiness for toilet training.

• Bowel control develops before bladder control.
• By age 3, the toddler has generally achieved fairly good bowel and bladder control.

Play
 • The major socializing mechanism is parallel play; therapeutic play may be started at this age.
• A short attention span causes the toddler to change toys often.
• The toddler explores body parts of self and others.
• Typical toys include push/pull toys, blocks, sand, finger paints, bubbles, large balls, crayons, trucks, dolls, containers, Play-Doh, toy telephones,
cloth books, and wooden puzzles.

Safety

• Toddlers are eager to explore the world around them.

• The toddler should be supervised at play.
• Refer to the American Academy of Pediatrics for information on car safety.
• Lock all car doors.
• Use back burners on the stove to prepare meals; turn handles inward and toward the middle of the stove to keep pots from being pulled off the
stove.
• Keep dangling cords from small appliances away from the toddler.
• Place inaccessible locks on windows and doors, and keep furniture away from windows.
• Secure screens on all windows.
• Place gates at stairways.
• Do not allow the toddler to sleep or play in an upper bunk.
• Never leave a toddler alone near a bathtub, pail, swimming pool, or any other body of water.
• Keep toilet lids closed.
• Store all medicines, poisons, and other toxic products high and locked out of reach; keep household plants out of reach as well.

A nurse in a daycare center is planning play activities for a group of toddlers. Which choice are the most appropriate play materials for these children?

1.Videos, compact disc player, board games

2.Rattles, stuffed animals, squeaky dolls, soft mobiles

3.Cards, Monopoly game, sewing kits, paint-by-number kits

4.Blocks, rocking horse, finger paints, wooden puzzles, thick crayons, paper

RATIONALE

The toddler engages in parallel play. Appropriate toys promote increased locomotive skills, meet the need for tactile play, and are safe. Blocks, a rocking
horse, finger paints, wooden puzzles, thick crayons, and paper are all appropriate toys for a toddler. Videos, a compact disc player, board games, sewing kits,
and paint-by-number kits are more appropriate for a school-age child. Rattles, stuffed animals, squeaky dolls, and soft mobiles are more appropriate for an
infant.

The Preschooler
Physical Characteristics

• Average height and weight at age 5 are 43 inches (102 cm); 32 lbs (14.5 kg), respectively.
• The preschooler requires about 12 hours of sleep each day.
• A security object and a night light will help the preschooler get to sleep.
• At the beginning of the preschool period, the eruption of the deciduous (primary) teeth is complete.
• Regular dental care is essential, and the preschooler requires assistance with brushing and flossing of teeth; a fluoride supplement may be
necessary.

Vital Signs

• Axillary temperature: 97.5° F to 98.6° F; 36.4°C to 37° C

• Apical rate: 70 to 110 beats per minute
• Respirations: 16 to 22 breaths per minute
• Blood pressure: average, 95/57 mmHg

Nutrition

• The preschooler exhibits food fads and has strong food and taste preferences.
• By 5 years, the preschooler tends to focus on social aspects of eating, table conversation, manners, and willingness to try new foods.

Skills

• The preschooler has good posture.

• Fine motor coordination and athletic abilities begin to develop.
• Increasing skill is demonstrated in activities that require balance.
• The preschooler usually talks in three- or four-word sentences by age 3, five- or six-word sentences by age 4, and longer sentences that contain all
parts of speech by age 5.
• Speech is easily understood by others, and the preschooler can clearly understand what others are saying.

Play

• Cooperative
• Imaginary playmates
• Likes to build and create things
• Simple, imaginative play
• Understands sharing and is able to interact with peers
• Enjoys a large space for running and jumping
• Likes dress-up clothes, paints, paper, and crayons for creative expression
• Activities such as swimming and sports for growth development
• Activities such as puzzles and toys for fine motor development

Safety

• Preschoolers are active and inquisitive (magical thinking).

• Children of this age can learn simple safety practices because they can follow simple and verbal directions and their attention span is longer.
• Refer to the American Academy of Pediatrics for information on car safety.
• Teach the preschooler basic safety rules to ensure safety when playing in a playground near swings and ladders.
• Never allow the preschooler to play with matches or lighters.
 • The preschooler should be taught what to do in the event of a fire or if clothes catch fire; fire drills should be conducted.
• Guns should be stored unloaded and secured under lock and key; the preschooler should be taught to leave an area immediately if a gun is seen
and to tell an adult.
• The preschooler should be taught never to point a toy gun at another person.
• Teach the preschooler that if another person touches his or her body in an inappropriate way, he or she should tell an adult.
• Teach the preschooler to avoid speaking to strangers and to never accept a ride, toys, or gifts from a stranger.
• Teach the preschooler his or her full name, address, parents' names, and telephone number.
• Teach the preschooler how to dial 911 in an emergency situation.
• Keep the poison-control hotline number available.

Which instruction should the nurse provide to the mother?

1.Place the child in the back seat of the car in a booster seat

2.Place the child in the back seat in a forward-facing convertible seat with a harness

3.Restrain the child in the passenger side of the front seat as long as an air bag is in place

4.Place the child in the back seat of the car in a forward-facing position using the car seat belts

RATIONALE

The convertible restraint is used for toddlers and preschoolers. It is best that the child ride in a rear-facing position for as long as possible, to the highest
height and weight allowed by the manufacturer of their convertible seat. Once a child has outgrown the rear-facing seat, a forward-facing seat with a full
harness should be used for as long as the child fits. Booster seats are for older children who have outgrown their forward-facing car safety seats. Air bags can
be harmful or even lethal to small children.

The School-Age Child

Physical Characteristics

• Average height and weight at age 12 are 59 inches (30.5 cm to 150 cm) and 88 lb (40 kg)
• The first permanent (secondary) teeth erupt around age 6, and deciduous teeth are gradually lost
• Regular dentist visits are necessary, and the school-age child must be supervised while brushing and flossing teeth; fluoride supplements may be
necessary
• Sleep requirements range from 10 to 12 hours a night

Vital Signs

• Oral temperature: 97.5° F to 98.6° F; 36.4°C to 37°C

• Apical rate: 60 to 100 beats per minute
• Respirations: 16 to 20 breaths per minute
• Blood pressure: averages 107/64 mmHg

Nutrition

• Increased growth needs

• Feed a balanced diet chosen from foods in the MyPlate food plan.

Skills

• Refinement of fine motor skills

• Continued development of gross motor skills
• Increased strength and endurance

Play

• Play is more competitive.

• Rules and rituals are important aspects of play and games.
• The school-age child enjoys drawing, collecting items, dolls, pets, guessing games, board games, listening to the radio, TV, reading, and videos and
computer games.
• Many children of this age participate in team sports.
• School-age children also enjoy secret clubs, gang activities, and scouting organizations.

Safety

• The school-age child experiences less fear in play activities and frequently imitates real life by using tools and household items.
• Refer to the American Academy of Pediatrics for information on car safety; (Canadian site).
• Major causes of injuries include bicycles, skateboards, and team sports as the child's motor abilities and independence increase.
• Children should always wear a helmet when riding a bike or using inline skates, skateboards, or other items that could result in falls.
• Teach the school-age child water safety rules.
• Instruct the school-age child to avoid teasing or playing roughly with animals.
• Teach the school-age child traffic safety rules.
• See the safety guidelines for the preschooler for additional principles.

A nurse, assigned to care for a hospitalized child who is 8 years old, plans care, taking into account Erik Erikson's theory of psychosocial development.
According to this theory, which choice represents the primary developmental task of the child?

1.To master useful skills and tools

2.To gain independence from parents

3.To develop a sense of trust in the world

4.To develop a sense of control over self and body functions

RATIONALE

According to Erikson's theory of psychosocial development, the school-age child's task is to master useful skills and tools of the culture (industry versus
inferiority). Gaining independence from parents is the psychosocial task of the adolescent. Development of a sense of trust in the world is the psychosocial
task of an infant. Development of a sense of control over self and body functions is the psychosocial task of the toddler.

The Adolescent
Physical Characteristics

• Puberty is the maturational, hormonal, and growth process that occurs when the reproductive organs begin to function and secondary sex
characteristics develop.
• Body mass increases to adult size.
• Menstrual periods begin about 2½ years after the onset of puberty.
• Oral care, including careful brushing, is important; many adolescents need to wear braces.
• Adolescents tend to stay up late and, in an attempt to catch up on missed sleep, sleep late whenever possible; an average of 8 hours per night is
recommended.

Vital Signs

• Oral temperature: 97.5° F to 98.6° F; 36.4°C to 37°C

• Apical rate: 55 to 90 beats per minute
• Respirations: 12 to 20 breaths per minute
• Blood pressure: averages 121/70 mmHg

Nutrition

• Teaching about the MyPlate food plan is important.

• Calcium, zinc, iron, folic acid, and protein are especially important nutritional needs.
• Body image is very important to children in this age group.
• Eating disorders are a concern in this age group.

Skills

• Gross and fine motor skills are well developed.

• Strength and endurance increase.

Play

• Games and athletics are the most common forms of play.

• Competition and strict rules are important.
• Adolescents enjoy such activities as sports, videos, movies, reading, parties, dancing, hobbies, computer and other electronic games or activities,
music, and experimenting with makeup and hairstyles.
• Friends are important, and adolescents like to gather in small groups.

Safety

• Adolescents are risk-takers.

• Instruct adolescents in the dangers of cigarette smoking, caffeine ingestion, drugs, and alcohol.
• Help adolescents recognize that they have choices when difficult or potentially dangerous situations arise.
• Advocate the use of seat belts; discuss the causes of motor vehicle accidents, including the use of cell phones and other electronic devices while
driving.
• Discuss water safety.
• Warn adolescents about the dangers of guns, violence, and gangs.
• Instruct adolescents in the complications associated with body piercing, tattooing, and tanning.
• Discuss such issues as bullying, date rape, sexual relationships, and sexually transmitted infections, and the dangers of the Internet in regard to
communicating and setting up meetings (dates) with unknown persons.

A nurse has provided information to a 16-year-old girl about adequate nutritional intake. Which statement by the girl indicates a need for additional
information?

1.It is all right to eat pizza for breakfast once in a while.

2.It is important to eat at least two servings of fruit per day.

3.It is acceptable to eat an occasional hamburger and fries at a fast-food restaurant.

4.It is acceptable to replace the daily milk requirement with a protein food such as a cheeseburger.

RATIONALE

According to the MyPlate food plan, three servings per day should be consumed from the dairy group. Protein foods are not acceptable substitutes for this
food group. The other statements are accurate.

Priority Points to Remember!

• Human milk is the best food for infants younger than 6 months.
• Skim and low-fat milk should not be used for infants because the essential fatty acids are inadequate and the solute concentration of protein and
electrolytes is too high.
• Fluoride supplementation may be needed starting around 6 months of age, depending on the infant's intake of fluoridated tap water.
• Introduce solid foods one at a time, usually at intervals of 4 to 7 days, to identify food allergens.
• Avoid giving solid foods that place the child at risk for choking, such as nuts, foods with seeds, raisins, popcorn, grapes, and pieces of hot dog.
• Baby-proof the home; hazardous items must be stored out of reach.
• Toddlers are eager to explore the world around them.
• Preschoolers are active and inquisitive; because of their magical thinking, they may believe that the daring feats seen in cartoons are possible and
may attempt them.
• Children should always wear a helmet when riding a bike, using inline skates or skateboards, or participating in other activities that may result in
falls.
• Teach children to avoid speaking to strangers and to never accept a ride, toys, or gifts from a stranger.
• Teach children how to dial 911 in an emergency situation.
• Teach parents to keep the poison-control hotline number available.
• Adolescents are risk-takers.
• Discuss such issues as bullying, date rape, sexual relationships, and sexually transmitted infections and the dangers of the Internet with regard to
communicating and setting up meetings (dates) with unknown persons.

Testlet

Joanna Burns has brought her 2-year-old son, Joel, to the well-baby clinic for a scheduled visit. She expresses concern to the nurse about her son's behavior,
telling the nurse that she has a great deal of difficulty getting Joel to bed at night. Joel throws temper tantrums to postpone the event, she reports. Joanna
also tells the nurse that because of this behavior she is worried about being able to toilet-train Joel. Joanna asks the nurse about strategies to deal with Joel's
behavior.

Joanna asks the nurse how to deal with Joel's bedtime temper tantrums. Which strategy should the nurse recommend to Joanna?

1.Safely isolating Joel and ignoring the temper tantrum

2.Giving in to Joel's demand and allowing him to stay up a little longer

3.Telling Joel that he will be punished if the temper tantrum continues

4.Telling Joel that a favorite toy will be taken away if the temper tantrum doesn't stop

RATIONALE

Temper tantrums, a common toddler response to anger and frustration, are often a result of thwarted attempts at exerting mastery and autonomy. Generally
the most effective method of handling a tantrum is to safely isolate and ignore the child. The child should learn that nothing, not even attention, is gained
from a tantrum. Giving in to the child's demands or scolding and punishing the child will only worsen the behavior. Toddlers stop using tantrums when they
do not achieve their goals and as their verbal skills increase.

What should the nurse tell Joanna?

1.Avoid letting Joel take any daytime naps

2.Provide a quiet activity for 30 minutes before bedtime

3.Provide a high-carbohydrate snack before bedtime to promote sleep

4.Allow the stalling tactics for 30 minutes, then tell Joel that he must go to bed

RATIONALE

Toddlers often resist going to bed by stalling or even throwing temper tantrums to postpone the event. Firm, consistent limits are needed when toddlers try
stalling tactics. Warning the child a few minutes before it is time for bed may reduce bedtime protests. Winding down with a quiet activity for 30 minutes
before bedtime also helps the toddler prepare for sleep. Bedtime rituals are important and should be followed consistently. Daytime naps do not need to be
avoided; a balance of activity, rest, and sleep is important. Avoiding high-carbohydrate snacks and excitement before bedtime promotes relaxation.

Joanna asks the nurse about toilet-training Joel. She is not sure whether he is ready and anticipates that he will throw temper tantrums if she begins to toilet-
train him. The nurse tells Joanna to watch for certain signs of readiness to toilet-train. What are they? Select all that apply.

1.Ability to remove clothing

2.Refusal to sit on the toilet

3.Impatience with a wet or soiled diaper.

4.An increased number of wet diapers during the day

5.A dry diaper when the child wakes from a nap

RATIONALE

Signs of readiness for toilet training include the ability to stay dry for 2 hours; waking dry from a nap; the ability to sit, squat, and walk; the ability to remove
clothing; the ability to recognize the urge to defecate or urinate; the ability to sit on the toilet for 5 to 10 minutes without fussing or getting off; impatience
with a wet or soiled diaper; and willingness to please the parent.

During the office visit, the nurse assesses Joel's developmental level, documents the findings, and reviews the data (click "Chart" below). Which statement
correctly describes the nurse's assessment of these findings?

1.All findings are appropriate for a 2-year-old child.

2.The physical findings are not appropriate for a 2-year-old child.

3.The language findings are not appropriate for a 2-year-old child.

4.The socialization findings are not appropriate for a 2-year-old child.

Physical Development

• Chest circumference exceeding head circumference

• Lateral diameter of chest exceeding anteroposterior diameter
• Has 16 primary teeth

Language Development

• Uses pronouns "I," "me," and "you"

• Refers to self by name
• Talks incessantly
• Understands directional commands.

Socialization Development

• Does not tolerate separation from parent

• Fears strangers
• Brief attention span
• Willing to share toys

RATIONALE
By the age of 2 years, children should have a sustained attention span, exhibit increased independence from their parents, be less likely to fear strangers, and
have an awareness of ownership, as expressed by phrases such as "my toy." The findings listed under the "Physical Development" and "Language
Development" tabs are appropriate for Joel's age.

Which statements by Joanna reflect a need for further information?

1."He's too young to get cavities."

2."I will use the car seat every time we drive somewhere."

3."He will probably swallow gum instead of just chewing it."

4."He can eat most foods as long as I cut them into round pieces."

5."I will apply sunscreen if we are outside for more than an hour."

6."We need to make sure that our cleaning supplies are in a locked cabinet."

RATIONALE

Cavities can occur in teeth of a person of any age, and parents of toddlers should be taught how to care for a toddler's teeth, and be provided with
information about foods that are highly likely to cause cavities. Toddlers are at a very high risk for poisoning, and a major cause is improper storage of
harmful items. Therefore, locking cleaning supplies and other toxic items is essential, along with constant vigilance in supervising the toddler. Toddlers can
chew, but may have problems with large pieces of food. Food should be cut into small pieces; round pieces may be easily aspirated and are choking hazards.
It takes practice for a toddler to learn how to chew gum, but not to swallow it. Sunscreen should be applied before any exposure to sunlight. Parents
should always use a care safety seat, even if the trip is short.