Lecture #2 Toddler o Toddler Development: 1-3 years old EriksonAutonomy vs.

. shame and doubt PiagetSensorimotor and preoperational Developmental Approach Strong attachment to mom/dad Ritualistic Egocentric Time for toilet training Play Parallel play o Be in the same space, different toys, and not share anything Time of huge language development o A Stanger can understand a 2 years old- 50%, 3 years old-75% and 4 years old 100% Temperament! o Normal for this age o Ignore the bad behavior, not feed into it o Toilet training Achieved late in toddler period usually around 30-40 months. Girl is earlier than boy Readiness factors- MUST exhibit the following Physical (sphincter control, stay dry for 2 hours, regular bms, gross motor--sitting, walking, squatting, and fine motor Mental (recognition of urge, communicate, follow directions) Psychologic (to please, sit for 5 min., curiosity, desire to be dry) Parental (recognize child is ready, willingness, absence of a stresses) Toddlers and How Hospitalization Affects Them Fear of abandonment Leave something for the child as insurance that parent will come back Do not leave while the child is sleeping Fear of loss of control Negativism and temper tantrums Poor understanding of body boundaries Play used for understanding and coping. Include the child-like experts!! Developmental Approach with Toddlers Firm, positive approach Give choice only when possible Do you want blue or green bandage? Do not expect cooperation Do not argue Never say you are a BIG BOY get over it. Concrete Poor concept of time

Procedures Use distraction Non invasive procedures Explain just prior to event.

Toddler Diet Continue to wean if not complete Milk 2-3 cups per day How many ounces? About 800 ounces Finger foods Watch chokables! What is the # 1 chokable food in America? HOT DOG!! Limit sugar, fat, and salt Ritualistic Small, frequent meals Mini meals

Question-- The mother of a 30-month old child arranges a play date with a mother of another child of similar age. During the play date, the mothers should expect that the children will: A. share and trade their toys while playing. B. play with one another with little or no conflict. C. play alongside one another but not actively with one another. D. play with 1 or 2 items, ignoring the rest of the toys. Preschool Preschool Play o Associative play Similar activity but no rigid organization o Motor activity! Love to be on the go and moving o Dramatic play Dress up, imitation o Games Rules are absolute and rigid in games PreschoolerGender Role Identity!! o Becomes aware of their similarity to parent of the same sex Usually like to be like the same sex parent Reinforced by the parent Girlscooking with mom; Boysworking with dad in the shop o Sexual identity Modesty Sexual exploration o Not absolutemany identify with both parents Preschoolers: Pain perception o Assessment tools Can use multiple tools

Ask parents Verbal ability and Fears Better verbal ability, but fear the consequences. The pain reliever may be worse than the pain Fear healthcare workers May cry and cling May become passive

Question. Before cleaning an abrasion on a 3 year old, what could the nurse use to help decrease the childs anxiety? Choose all that apply-never one or never all of them A. Give the child pain medication as prescribed. B. Tell the child what to expect 2 hours before the intervention C. Allow the child to pick out a sticker. D. Have the child clean the owie on her doll. The school age childThey love SCHOOL!! Think regarding to this matter when answer the questions School Age Development: 6-12 years old o EriksonIndustry vs. Inferiority o PiagetConcrete operational o Developmental Approach Better understanding of cause and effect Likes to be with same gender Likes competition Likes to learn Appreciates tangible rewards Limit screen time o Video, TV, cell phone, computer. o Direct link to obesity School Age and Play o Cooperative Play Teams, organized clubs o Rules Likes competition o Construction Enjoys building and constructing things o Computer games Watch amount of TV or screen time It is recommend not to have Computer in the bedrooms until college School AgeSocial Development o Concrete Thinking Conservation of matter Able to have mental representations Concept of time and body parts o Likes to learn Interested in learning new skills and information o Interested in friends and school Clubs and sports

School Age and Hospitalization o Fears Concern for physical harm Separation from friends and school Loss of control o Procedures Explain more fully. Use diagrams and books o Coping Reports pain Will be open to learning distraction techniques Question Which of the following nursing interventions is the most appropriate when working with a school age child who has a terminal illness? A. Give factual explanations of the disease, medications, and procedures B. Perform all care for the child C. Tell the child that everything will be okay D. Assure the child that being in the hospital is not a punishment for any thoughts or actions. Adolescent Adolescent Development: 12-18 years old o EriksonIdentity vs. Role Confusion o Piaget Formal operations o Developmental approach Likes independence and autonomy Capable of abstract thinking Peer relationships are VERY important Crises can be ANYTHING that threatens their identity or body image Adolescents and Social Activity o FRIENDS o Sports o School Activities o Dances, Movies, Dating o Music o Computer, Texting Their way to communicate o Development of Views o What are the safety concerns of adolescents? Target teaching and education toward sex, drugs and alcohol, gun safety, suicide, risky behaviors, driving, Internet safety, etc. Adolescence and Hospitalization o Procedures Give full explanations More concerned with the present than the future o Respect and Confidentiality Resent authority figure or nurses trying to be their peers Like nurses to be friendly o Restrictions Impose few restrictions, but do set limits May sleep or get on the phone to avoid discussions.

Confidentiality Issues o Minors in all 50 states have the right to consent to STI treatment and testing o Most states allow HIV testing of minors and a few states require parental consent for HIV treatment o Adolescents who want 100% assurance of confidential testing should be referred to health departments or federally funded family planning centers At private clinics, EOBs from the insurance company may go directly to the parents. When is it NOT Confidential? o Youth in danger of harming themselves or others. o Certain types of addiction treatments may not be considered confidential Adolescents and Pain o Verbal skills Excellent ability to verbalize Can use adult pain assessment tools Adult level response to pain o Fears Fears loss of control. Give information and provide privacy o Coping Will appreciate and participate in coping methods

School Age and Teen Diet o Decreased parental control o High fat, sugar and salt diets Vending machines o Decreased activity o Obesity epidemic o Eating Disorders Anorexia, Bulimia Question. A 13-year-old boy is hospitalized for a femur fracture because he was hit by a car while racing bikes with his friends. The parents are concerned about his judgment. What should the nurse understand? A. This behavior is typical of young teens. B. The behavior is related to hormonal surges. C. This was an isolated incident and likely to not happen again. D. This behavior is related to teen rebellion. Matching KNOW!!! o Infant .D o Toddler (up to 3 yo) C. o Preschooler E o School Age B o Adolescent A A. Identity vs. Role confusion B. Industry vs. inferiority C. Autonomy vs. shame and doubt D. Trust vs. mistrust E. Initiative vs. guilt.

Family Working with FamiliesIn general o Supportive and Understanding Many uncomfortable feelings Dont be defensive o Feelings of loss of control New place, new diagnosis Feeling of inability to care for their own child o Encourage involvement Also encourage breaks as well o Siblings Other family needs o Non-judgmental Many different coping styles and reactions Children with chronic illness or special needs Chronic illness o Condition Congenital disability o Disability from birth Developmental delay o Maturational lag Developmental disability o Mental or physical disability Children with disabilities Spend 3x as many days ill and absent from school as other children. Substantial effects on family functioning Assess functioning of ALL family members Parents stretched to limits Parents are an ESSENTIAL part of the team Medical Home model used Well coordinated plan of care One health care provider coordinates! Accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care Nursing Implications for Children with Disability o Recognize that children with special needs may have unique risk factors o Developmental approach rather than a chronological one. o Collaboration is a MUST o Open communication o There is often a gap in transitioning from pediatric care to adult care for this population Coping with chronic disability or illness o Shock Some denial is normal o Adjustment Grief, chronic sorrow, overprotection, rejection, denial

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Gradual Acceptance May never have full acceptance Re-integration of the family New forms of functioning and new roles.

Management Ongoing management o Realistic future goals Very difficult adjustment o Meeting the childs normal developmental needs o Marriage difficulties Research shown it brings family together o Financial o Siblings Often feel that they are responsible for disabilities o Extended family members Support system o Social supports Nurses role with families of children with disabilities o Assessment Strengths and focus on abilities (not disabilities) o Support Accept reactions and encourage expression of feelings o Identification of resources o Discuss realistic Goal Setting o Child First language. A child with Autism, not an Autistic child o Health education Question. You are the nurse caring for a 5-year-old child with Autism. What would be the best approach for the nurse to take when first assessing this child? A. Ask the childs family to step out of the room. B. Ask the childs mother what approach would work best. C. Ask the child what he/she would like you to do. D. Ask the childs grandmother to interpret the childs behaviors.