Summary
Highlights
Toddlerhood is characterized by significant physical and mental changes, notably the development of autonomy. Toddlers become explorative, learn to run, climb, throw/kick balls, scribble, build blocks, and develop language skills (hundreds of words, three-word sentences). Physical changes include weight gain (four times birth weight by two years) and height increase (half adult height by two years).
This section delves into key toddler concepts using the mnemonic 'TODDLER'. T for Temper Tantrums (normal, how to manage, prevention). O for On the Move (safety risks like drowning, automobile accidents, falls, burns, poisoning, firearms, choking, using the acronym DANGERS). D for Diaper to Potty Transition (readiness for toilet training, bowel before bladder control).
This section introduces infant developmental milestones, emphasizing body changes like fontanel closure (anterior at 18 months, posterior at 2 months) and weight/length progression (weight doubles by 6 months, triples by 12 months). It also covers milestone achievements month by month, including head movement, tracking, cooing, smiling, rolling over (4 months), sitting with/without support (6-9 months), pincer grasp (8-9 months), object permanence, and beginning to walk (10-12 months). Separation anxiety also starts at this age.
Key safety topics for infants, such as SIDS prevention (back sleeping, no smoking, clear crib, avoid overheating, separate sleeping spaces), the dangers of shaken baby syndrome, choking hazards (breast milk/mucus, small foods), car seat safety (rear-facing in the back seat), burn prevention, and the importance of vigilance once infants start rolling over (stopping swaddling when rolling starts).
This part focuses on nursing interventions for hospitalized infants, aligning with Erikson's 'trust vs. mistrust' stage. It highlights the importance of promptly responding to infant cries, soothing techniques for younger infants (rocking, swaddling, holding, sucking), addressing stranger and separation anxiety in older infants (keeping caregivers present, consistent staff, age-appropriate play).
Details on infant nutrition, with breastfeeding as the gold standard for the first six months, followed by gradual introduction of solids while continuing breastfeeding. It advises vitamin D supplementation for exclusively breastfed infants and avoiding cow's milk and honey before 12 months. Social stimulation covers independent play, observing faces and high-contrast items, responding to voices, and interacting with toys like rattles and blocks as they get older.
Continues with 'TODDLER' mnemonic: D for Developmental Stage Theory, covering Piaget's pre-operational stage (egocentric, symbolic thinking, parallel play) and Erikson's autonomy vs. shame stage (fostering independence, choices, positive feedback). It also revisits separation anxiety and offers interventions, and L for Loves to say 'no' (negativism, how to give choices).
Completes the 'TODDLER' mnemonic: E for Eating Plan (grazers, small nutritious snacks, preventing dental decay, picky eating, choking hazards). R for three R's: Ritualism (comfort in predictable routines), Rivalry (sibling adjustment, inclusion, maintaining routines), and Regression (reverting to infantile behaviors due to stress, avoid punishment, provide support).
Introduces the preschooler age group (3-5 years) and the 'PRE-SCHOOL' mnemonic. P for Physical Changes, including losing baby chubbiness, elongating limbs, weight/height gain (slower than infant/toddler), developing gross motor skills (tricycle, throwing, hopping), and fine motor skills (writing name, zipping, cutting, copying shapes).
This part covers R for Reduced Separation Anxiety (less intense than toddlers). E for Erickson and Piaget's Theories, focusing on Erikson's initiative vs. guilt (sense of purpose, encouraging independence, play, choices) and Piaget's pre-operational stage (egocentric, magical thinkers, imaginary playmates, literal thinkers, animism). S for Scared of Things (real fears due to inability to distinguish fact from fiction, fear of mutilation/procedures, loss of control, regression, hospitalization interventions like honesty, medical play, choices, parental presence). C for Child Safety (gun safety, swimming lessons, protective gear for activities, stranger danger).
A for Healthy eating (less picky, enjoyment of meals, all baby teeth in by 3, losing teeth by 5-6, dental visits, choking prevention). O for Others are important for play (transition from parallel to associative play at 3 years, cooperative play at 4-5 years, which fosters social skills and sharing). U for Outline Behavior Expectations for the parent (loss of control, fears/anxieties, aggression, decreasing negativism/ritualism, managing nightmares).
L for Language Explosion (speaking around 2400 words, five-word sentences, common stammering/stuttering which is normal, patience and support from parents).
Introduction to the school-aged child (6-12 years), emphasizing the influence of school and peers. The mnemonic SCHOOL is introduced. S for Skills learned, covering fine motor skills (writing, drawing with detail, typing, cooking/cleaning) and gross motor skills (biking, skating, swimming, competitive sports). Cognitive skills include increased attention, memory, reading, math problems, conservation, and classification. Language skills advance to adult-like speech, creative writing, and grammar. Social skills shift from egocentricity to forming relationships, special friendships (same-gender), and various play styles (cooperative, competitive, physical, constructive).
C for Changes (physical), including height and weight gain (average 45 inches/45 lbs at 6 years, 59 inches/90 lbs at 12 years). Teeth changes involve shedding central incisors around 5-6 years and most permanent teeth by 12-13 years, emphasizing dental care education. Puberty onset is discussed (girls 8-13, boys 9-14), and education on body changes. H for Harmful Risks (safety issues): protective gear for activities, swimming/diving safety, stranger danger, fire and gun safety, car seat/traffic safety (booster seats, back seat).
O for Obstacles: self-concept (who am I, how do I fit in, positive reinforcement, goal setting), bullying (physical/emotional, signs, interventions), and weight/nutrition (childhood obesity, risk factors like high-calorie diet, lack of exercise, accessibility of unhealthy foods, stress eating, genetics; family-effort interventions). Exposure to drugs, violence, and sexual content via media (open communication, monitoring). Behavior issues like cheating, lying, stealing are also discussed. O for Outcome of Hospitalization: fears of pain/injury, death, loss of independence/control (interrupted routines, separation from friends), modesty concerns. Nursing role (Seven T's): take time to address fears, be truthful, teach with visuals, be tactful with privacy, allow time for activities, encourage communication with friends.
L for Learn Developmental Theories: Erikson's industry vs. inferiority (achieving competency, fostering confidence, coping with challenges). Piaget's concrete operational stage (7-12 years), demonstrating concrete thinking, understanding conservation and classification. Kohlberg's moral development, moving from reward/punishment orientation to 'good boy/nice girl' and 'law and order' orientations.
Introduction to adolescence (13-19 years), a challenging time of physical, emotional, and cognitive changes. The mnemonic TEEN is used. T for The Big Changes: Puberty (reproductive organs become active), girls (breast development, hair growth, weight/fat distribution, height increase, menstruation, increased sebaceous/apocrine gland activity, emotional changes), boys (penis/testes enlargement, hair growth, voice changes, height/muscle mass increase, gland activity, emotional challenges).
Teeth changes (second molars by 13, wisdom teeth by 17-21, orthodontic care). Social changes (peer influence, text/social media, jobs, movies, close friendships, competitive sports, parental separation/challenging authority). Body image (how you view your body, link to self-esteem, depression, eating disorders, media influence, social media feedback). E for Eating Disorder Signs (anorexia, bulimia, screening for symptoms).
E for Education (safety): Driving safety (leading cause of accidental death, driver's ed, seatbelts, no texting/DUI). Self-harm/suicide (second leading cause of death, risk factors, immediate help). Substance abuse (peer pressure, rebellion, discussion of substances and handling situations). Other safety includes swimming, sports (protective gear), gangs, firearms. Health education: Sleep (8-10 hours, consistent schedule, limiting devices). Exercise (1 hour moderate-vigorous daily). Sex education. Nutritional education (demand for calcium, iron, protein, folic acid, zinc, Vit. D, reasons for poor nutrition, BMI chart).
E for Erickson's, Piaget's, and Kohlberg's Theories: Erikson's identity vs. role confusion (forming identity, commitment/faithfulness, avoiding drift). Piaget's formal operational stage (abstract thinking, future planning, cause/effect, problem-solving). Kohlberg's moral development (social contract orientation, understanding varied moral values, laws vs. personal values). N for Nurse's Role with Hospitalized Teen (fears of separation from peers, loss of control/independence, privacy invasion, death/deformity). Interventions: honesty, anticipate questions, give control, encourage social activities, maintain privacy, creative teaching methods.