Health Promotion of the Infant and Toddler Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Learning Objectives  Define the term attachment and describe infant attachment behaviors.  Discuss the influence of the infant's temperament and parents' perception of the child.  Discuss how body systems mature between the first and third years of life.  Apply parent education and measures to prevent injury in the infant. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.2

Learning Objectives (cont.)  Explain the toddler's understanding of his or her own body.  Describe resources available for parents and health care providers for assessing and teaching about nutritional needs of toddlers. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.3

A 12-month-old infant is being seen for a well- child exam. The family asks if the child’s weight is appropriate for age. The nurse explains that: A. infants double their birth weight in the first year. B. infants triple their birth weight in the first year. C. infants slowly gain weight throughout the first year. D. infant weight gain is predicted by the parents’ weight. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.4

Infant Attachment Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.5

Understanding the Bond  What is attachment?  What are infant attachment behaviors? Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.6

Temperment Does a parent’s perception impact the behavior or growth of their child? Yes No Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.7

Scenario Elizabeth is a 6-month-old girl delivered at 40 weeks of gestation weighing 3.4 kg (7 lb, 8 oz). She now weighs 6.8 kg (15 lb). The nurse is discussing infant growth and development with Elizabeth's mother.  Do you have concerns about Elizabeth’s growth? Why? Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.8

Elizabeth's mother is aware of the importance of play for children. What games and interactions should the nurse recommend? A. Encourage the infant to play with push-pull toys. B. Hang mobiles with black and white designs above the crib. C. Place an unbreakable mirror where the infant can see herself. D. Point to body parts and name each one. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.9

The Toddler Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2.The nurse is discussing with a parent group the importance of fluoride for healthy teeth. Which of the following should the nurse recommend? A.A. Use fluoridated mouth rinses in children older than 1 year. B.B. Brush teeth with fluoridated toothpaste unless fluoride content of the water supply is adequate. C.C. Give fluoride supplements to breast-fed infants beginning at age 1 month. D.D. Determine whether the water supply is fluoridated. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.11

Maturity between first and third year of life Ages 12 to 36 months Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.12

Biologic Development  Weight gain slows to 4 to 6 pounds per year  Birth weight should be quadrupled by 2½ years of age  Height increases about 3 inches per year  Growth is “steplike” rather than “linear” Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.13

Promoting Optimal Growth and Development Why is it called the “The terrible 2s”?  Intense period of exploration  Temper tantrums, obstinacy occur frequently  Clear guidance (limit setting) from adults assist the toddler with successful transition Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.14

Maturation of Systems  Most physiologic systems relatively mature by the end of toddlerhood  Upper respiratory infections, otitis media, and tonsillitis are common among toddlers  Voluntary control of elimination  Sphincter control age 18 to 24 months Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.15

 A mother apologizes because her 2 year old fights when the doctor attempts to examine the child’s ear. She asks you why the toddler behaved this way. Which answer is incorrect: A. The examination is intrusive B. The doctor was forceful C. The child was protesting D. This is normal development Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.16

NUTRITIONAL NEEDS Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.17

Promoting Optimal Nutrition During Toddlerhood  Nutrition  Phenomenon of “physiologic anorexia”  Ritualism is common  Dietary guidelines to prevent obesity and prevent iron-deficiency anemia Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.18

Toddler Scenario  Matt is a healthy 2½-year-old boy whose mother asks the nurse for advice about toilet training. Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training a child. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.19

The nurse should do which of the following first? A. Ask Matt if he wants to learn to use the toilet. B. Discuss signs that indicate Matt is ready to begin toilet training. C. Encourage the mother to initiate toilet training after the birth of the new baby. D. Assess the mother to determine why she has waited so long to begin toilet training. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.20

Matt’s Follow-up  Matt is brought to the clinic 4½ months later because he has an ear infection. The nurse asks about toilet training. His mother says, "He has done real well except, since the baby came, he has wanted to wear diapers instead of underpants. I have been letting him wear diapers. He takes them on and off to use the toilet. I hope that is OK." Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.21

The most appropriate action by the nurse is to A. assess why the mother decided to let Matt wear diapers. B. recommend that the mother put Matt back into underpants immediately. C. reassure the mother that regression such as this is common in toddlers after the birth of a sibling. D. explain to mother that negativism such as this is common in toddlers who are toilet trained before they are ready. Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.22