Question

Chapter 26: Growth and Development of the Toddler

 1. Bill and Ted are a domestic couple that have brought in their 30-month-old daughter, Victoria, complaining of a runny nose, cough, and low-grade fever. Bill and Ted adopted Victoria at birth. The biological mother was a teenager who chose to give her child up for adoption and Bill and Ted provided financial support to ensure that she received the appropriate prenatal care. Her pregnancy and delivery were unremarkable. She has had no contact with Victoria or her fathers since the birth. The nurse practitioner determined that the symptoms are attributed to an upper respiratory tract infection (URI) or common cold and recommended that it be treated symptomatically. While in the office, Bill and Ted have some questions regarding Victoria’s behavior. They explain that she has become more defiant, repeatedly responding to their questions or commands with “no” or temper tantrums. Neither Bill nor Ted has been a parent before adopting Victoria and they are concerned that they are to blame for her behavior. (Learning Objectives 1, 5, and 12)

 a. What can the nurse teach Bill and Ted about the psychosocial or cognitive development of a toddler that would help them understand Victoria’s behavior?

 b. What can the nurse teach Bill and Ted regarding promoting appropriate discipline for Victoria?

 c. What is “temperament” and how would it influence Victoria’s behavior?

 2. Tenzin and Dechen have brought in their 24-month-old son, Kim, for his wellness examination and immunizations. Kim is the first child for Tenzin and Dechen, but Dechen is 6 months pregnant with their second child. Tenzin and Dechen are Tibetan refugees who have moved to the United States from India. Kim was born in the United States. Tenzin and Dechen are very focused on Kim’s physical abilities (i.e., motor skills, communication, and sensory skills). They express their desire for Kim to do well in school and be successful in business. (Learning Objectives 3, 4, 7, 11, and 13)

 a. What could the nurse share with Kim’s parents regarding the normal motor, communication, and sensory development of a 24-month-old?

 b. What can the nurse teach Tenzin and Dechen regarding promoting healthy growth and development in Kim?

 c. Kim’s parents are curious about toilet training. How can the nurse teach Kim’s parents about toilet training with a toddler?

Answer 1

1. A) COGNITIVE DEVELOPMENT OF A TODDLER: This is the time when a child learn about the world by touching, looking, manipulating and listening. Moreover, the learning process of a 2 year old child will become more thoughful and begins to form mental images for things, actions and concepts. To understand the concept of behavior of Victoria, the nurse should teach her parents ( Bill and Ted) about keys to overcome her behaviors. a) One of the simplest and most effective method is observation. Though she is adopted, Bill and Ted should show interest in what she is doing or saying. Her actions, observations and temperament have to be watched when they eat or sleep or play. Moreover, comparing with other child should be completely avoided because it makes the child to feel inferior. b) Spending quality time with the child allows her parents to understand their psychological behavior. It is mandatory to make a good rapport between parents and child. c) Pay undivided attention because it helps Victoria to feel safe and validated. This makes the child to open up to them more d) The nurse should teach her parents to show attention to child's environment. e) The nurse should ask the parents to have an open minded questions by asking right questions which makes the child to share in details and finally f) the nurse should teach them to encourage her daughter to engage in different activities like painting, singing and dancing. All these effective steps can further helps to maintain a quality relationship between them.

B) To promote appropriate discipline in Victoria, the nurse should teach her parents about some positive behavioral strategies to make life easier for the whole family. They are a) the parents should keep an eye contact and get toddler's attention before they speak. b) use of a gentle touch while making conversations c) avoid stressful situations d) keep conversations clear, simple and direct. e) use positive communications and f) be calm and patient.

C) Temperament are predictable calm or difficult behavior not able to manage their emotional experiences and expression with ease. It is an innate quality of a child. In this case, Victoria have temper tantrums and she is occasionally explosive, stubborn and intense and adapts poorly to new situations. Moreover, her illnesses is also responsible for temperament, beacuse these causes behavioral difficulties in Victoria.

2. A) Speech begins with one or two syllable at this age with words and extends to two letter words, understands 10 times more words than what he speaks and tries to say atleast 50 words. In sensory and motor skills, he gains control and coordination and become steady walkers soon followed by climbing, running and jumping while motor function includes development of muscles and nerves.

B) PHYSICAL GROWTH: The expected qrowth of a child between 24 months old is about 7 to 12 cm in height and gain weighs about 3 to 5 ib. COGNITIVE DEVELOPMENT: At this stage, the child start to think, learn and remember things and also events, actions, symbols, imitate others, imagine and pretend. EMOTIONAL AND SOCIAL DEVELOPMENT: the child want to do things by their own or according to their own wishes. This stage is the development of conflict, confusion and occasional breakdowns. LANGUAGE DEVELOPMENT: At this stage, the child develops to speak and talk about 10 times more words than 15 t0 18 months. SENSORY AND MOTOR DEVELOPMENT: TOoddlers gain control and coordination and become steady walkers. In motor development, the child's muscles and nerves work together ath these ages.

C) Most children begin their toilet training between 22 qnd 30 months. Showing an interest in the potty, being aware of peeing and pooping and expressing the need to go are signs of that a child is ready for toilet training. The nurse should teach his parents about his bladder and bowel control before beginning potty training. Encourage the child to use a potty seat or potty chair on his own and give awareness on how to do toilet training.