By: Lauren Acree BSN, RN, CPN TODDLERS (1 to 3 years) By: Lauren Acree BSN, RN, CPN

Future Nurse ?

Autonomy vs. Shame & Doubt Erikson’s Theory Autonomy vs. Shame & Doubt Child is increasingly independent in many spheres of life Shown by controlling body excretions, saying “no” when asked to do something, and directing motor activity

Erikson’s Theory Autonomy vs. Shame & Doubt Nursing Implications Child who is consistently criticized for expression of autonomy or lack of control (such as during toilet training) will develop a sense of shame in themselves and doubt in their abilities . Support autonomy during hospitalization.

Erikson’s Theory Autonomy vs. Shame & Doubt Nursing Implications Allow self feeding activities Independence in brushing teeth Independence in removing and putting on clothes

Freud’s Theory Anal Stage Child derives gratification from control over bodily excretions The young child’s pleasure is centered in the anal area

Freud- Anal Stage Nursing Implications Admission History: Ask about toilet training and the toddler’s ritual and words for elimination Intervention: Continue toddler’s normal patterns of elimination

Nursing Implications cont. Freud- Anal Stage Nursing Implications cont. Accept possible regression in potty training during hospitalization Do not begin toilet training during illness or hospitalization Potty seats should be available in hospital

Physical Growth & Development Slow period of growth Weight gain of 4-9 lbs (2-4 kg) over 2 years 1 year old: birth weight triples

Physical Growth & Development 2 years old: child is roughly half of their adult height Pot-bellied appearance and stands with feed apart to provide a wide base of support

Motor Ability Development 1-2 years Fine Motor Ability Builds a tower of 4 blocks Scribbles on paper Can undress self Throws a ball Gross Motor Ability Walks by 15 months Climb stairs by 21 months Runs by 2 years

Motor Ability Development 2-3 years Fine Motor Ability Draws a circle Learns to pour Can dress self Gross Motor Ability Jumps Kicks ball Throw ball overhead

Diet & Nutrition Decreased appetite Encourage 3 nutritious meals & 2 healthy snacks per day At 12 months switch from formula or breast milk to whole milk

Diet & Nutrition Avoid foods small in size due to choking hazard Allow toddlers to feed themselves to promote autonomy. Ex: finger foods

Diet & Nutrition What is an appropriate food item for a toddler? Peanuts Grapes Hot dog Thinly sliced fruit

Diet & Nutrition Answer: Thinly sliced fruit Healthy snack Not a choking hazard Choking hazardous food items: Hot dogs, peanuts, grapes, nuts, dried beans, and candy

Cognitive Development Child moves from sensorimotor to preoperational stage of development through interactions with the environment Understands object permanence By age 2, toddlers use two- to three-word phases and comprehends many more words

Cognitive Development Exhibits magical thinking The belief that events occur because of one’s thoughts or actions Example: Three-year-old Sally, who is hospitalized for treatment of a brain tumor, tells her nurse that she got sick because she was a bad girl.

Psychosocial Development Toddler is egocentric Separation anxiety continues to be present from late infancy The parent who is leaving should say so and should promise to return

Psychosocial Development Sleep issues are common problems due to separation anxiety and fear of dark Nursing Intervention: Provide transitional objects (special blanket or stuffed animal)

Play Toddlers have better motor skills and begin to find other children fun to be around. During toddlerhood, it is all about “ME” so concepts like sharing have not yet developed. A toddler’s favorite words are usually “no” and “mine.”

Play Parallel play Most toddlers play in tandem or side by side. Enjoy playing near other children, but not engaging in social interaction with each other

Parallel Play

Appropriate Toys Wooden puzzles Blocks Cloth books Imitation activities: kitchen set; using a toy telephone; push and pull vacuum Tricycle Ball

Toddler- Vital signs Heart Rate (beats/min): 75-130 Respiratory Rate (breaths/min): 25-35 Blood Pressure: Systolic (mmHG): 95-105 Diastolic (mmHG): 56-68

Procedure Preparations Nursing Interventions: Use their own words Explain procedure immediately before it happens Be honest Realize that you may not get their cooperation (restraint will be needed). Reward after procedure.

Nursing Care for Toddlers To promote autonomy, let the toddler perform developmentally appropriate tasks independently and praise success Provide choices when possible Avoid separation from parents; keep parents in child’s line of vision Slow to warm up so allow time to get acquainted and talk in a friendly voice

Nursing Care for Toddlers Walking, climbing, and running are motor skills developed so remember crib safety Keep crib rails up at all times to prevent falls

References Ball, J. W., & Bindler, R. C. (2006). Child health nursing: Partnering with children & families (1st ed.). Upper Saddle River, NJ: Prentice Hall. Selekman, J. & Jakubik, L. (2007). Pediatric Nursing: Certification Review. Pensacola, FL: Society of Pediatric Nurses.