Toddlerhood is a stage between infancy and childhood during which the child learns how to walk, talk, solve problems and relate with other people. Toddlers desire to be independent hence they often explore and assert their independence by saying “no” often. Toddlers are often low on skill and high on self will. For this reason, the stage of toddlerhood is often referred to as “ the terrible twos.” The stage lasts between the ages of one and three with each stage marked by physical, social and emotional development. Theories have been developed by various scholars on the developmental changes that toddlers undergo.
1.1 Personality development
Erik Erickson came up with a theory that explained the development of personality in children. According to him, during toddlerhood, the toddler experiences conflict between autonomy and shame and doubt; this conflict can be resolved through provision of reasonable choices by the parent. The autonomy of the toddler is evidenced by the fact that the toddler often wants to do things by himself but the toddler also experiences fear given the unfamiliarity of the territory hence the need for affirmation and reassurance from the parent. The fears that the child experiences are different at various stages; for instance at 15 months, the child has fear of being left alone and the darkness but asserts independence by trying to feed himself. At 36 months, the child has better self esteem due to increased ability to feed, dress and do basic stuff for himself and the fear of separation decreases. These personality developmental milestones have an implication on the kind of care accorded to the toddler: the nurse needs to set reasonable limits gently but firmly, use play in order to gain information instead of coercing the child in addition to using play to gain the trust and confidence of the child so as to enable the toddler to receive care from the nurse.
1.2 Cognitive development
Jean Piaget described the stages of cognitive development in children. he states that children develop mental models or schema which are modified through assimilation and accommodation as the child learns. The preoperational stage of development according to Piaget is the stage of cognition that toddlers fall under. At this stage, the cognitive abilities of the child are characterized by three main features: irreversibility which refers to the inability to reverse a mental image, centration which refers to the focus on one aspect at a time and egocentrism which is the inability to take up another person’s point of view. For most toddlers, their ability to understand words exceeds their ability to converse. The toddler can understand directional commands, speak in short sentences and pronouns. This has the following implications for nurses: the nurse needs to recognise that the attention span of the child is limited at this time hence time and scheduled events such as play time ought to be related when communicating with the toddler. The toddler ought to be addresses using a familiar name and addressed using short, precise statements.
1.3 Physical development of a toddler
There are various physical changes that a toddler undergoes; these changes involve various body systems: the capacity of the bladder increases hence the toddler can empty their bladder after every 2-4 hours. At 16-24 months, the operational capacity of the kidneys develops to that of adults. The toddler also has better ability to control the sphincter muscles hence allowing the guardian/ parent or caregiver to toilet train. The air pathways of the toddler are small and prone to infections, the blood volume that is circulating is less than that of an adult, the vessels are easily obliterated making it difficult to get the pulse and the tongue is larger than the mouth. The growth of the milk teeth is normally complete by 30months and the toddler can gain 1.8-2.5 kgs per year and exhibits increased and enhanced eye movements.
1.4 Play with me (toys and activities)
The activities and the toys for toddlers ought to be geared towards enhancing the development of social and intellectual skills. Tools such as building blocks, colour charts, dolls and cars enhance exploration and stir up interest in how things work. Some of the activities that a toddler can be involved in include: the preparation of meals, clearing the table, lets pretend sessions, dancing, acting and singing.
1.5 Safety issues at home and in the hospital
Given that toddlers are often mobile and inquisitive, they are prone to a number of injuries. They are prone to falls, obstruction of the airways, burns and scalds, drowning and poisoning. Drowning is listed as the second most common cause of death among toddlers aged between the ages of 1 and 4 by the Centre for Disease Control. The caregivers at home ought to childproof the home in order to prevent accidents: for instance, electric plugs ought to be covered with child proof casings, firearms, buckets of water and sharp objects ought to be kept out of the reach. This also applies for nurses.
1.6 Health problems
Female toddlers are prone to urinary tract infections as a result of the introduction of the use of toilets. Toddlers are also prone to dental cavities, gingivitis, tooth loss and systemic infections as a result of the inability to adequately brush the teeth. They are also prone to respiratory tract infections due to the fact that their immunity to infections is still weak.
1.7 Health promotion
Nurses who attend to toddlers play an important role in advocating for their rights, promoting better nutrition and safety in the home and sensitizing the parents of common health problems. There has been an alarming increase in the incidences of child obesity in the USA hence the nurses need to provide information on the benefits of healthy snacking, low fat proteins, the dangers of refined sugars and the importance of a balanced diet.
2.0 Paediatric profile of preschool children aged between the ages of 3 and 6 years old
At this age, the children have increased dexterity and have less baby fat. They talk in endless sentences and listen keenly whenever there is an interesting conversation going on. The attention span of the children at this age is not long. Although the children at this age are fast developing insight, logic and comprehension skills, they cannot accomplish certain tasks for themselves. They still require help to tie knots, their shoelaces and open doors.
2.1 Personality development
According to Piaget, the beliefs of children are borne out of the restrictions that are placed upon them by the adults that are around them. At mid childhood, the children interact with their peers; an action that is marked by the challenging of the beliefs that were passed onto them by the adults. The children therefore take up beliefs that are more acceptable to their peers. Pre-schoolers are well known for their lack of self control hence when hit, they will strike back. Pre-schoolers who exercise restraint when hit exhibit the acquisition of self control. For each child, the development of personality is as a result of the environmental circumstances and to some extent the genetic predisposition. The feedback that the child receives from the social environment contributes to the development of the concept of self. For nurses, this has the following implications; the nurse needs to interact with the child in familiar situations that the child can identify with. The nurse also needs to explain the need for procedures to be carried out to the child in a simple language that the child can understand.
2.2 Cognitive development
The thoughts of pre-schoolers are prone to being disjointed since they have difficulty in making connections between their own thoughts. At this age, the child can only hold one thought at a time according to Piaget. At the age of 4, the child advance to more advanced and complex thoughts giving rise to logical thinking that takes into account different views. From the age of the 2 years and onwards, the language abilities of the child increase rapidly. They gradually acquire the ability to string words together into simple sentences according to Piaget. Because toddlers are egocentric, they do not understand indirect requests hence two children from different cultures can play together for long without understanding their language differences. Nurses therefore ought to take this into account when speaking with pre-schoolers hence they ought to speak in short sentences that can be understood by the child.
2.3 Physical development
Between the ages of 4 and 6 years, the child rapidly increases in height and gains 5 to 7 pounds on average. More calories are devoted towards the development of the nerves and the bones. Between the ages of 2 and 3 years, the toddlers gain about 4 pound and grow in height by about 3.5 inches. By the age of 2 years, the brain of child has grown to about 55% of the adult size while at the age of 6 years, the brain of the child has grown to about 90% of the adult size.
2.4 Play with me (toys/activities)
At this stage, the pre-schooler is curious and seeks to explore the world around them. They seek to develop autonomy and develop relationships with their peers. The activities should therefore be geared towards promoting the social interactions such as group reading sessions, group dancing/ singing sessions and group acting sessions. The toys should encourage the development of cognitive abilities of the child and can include toys such as cars, dolls, puzzles and building blocks.
2.5 Preparation for a procedure
Preparation of a pre-schooler by a paediatric nurse should entail interactive sessions during which the nurse makes eye contact with the child while speaking to them. Concepts should be explained in a manner that the child can understand. The sentences should short and simple.
2.6 Safety issues at home and at the hospital
The pre-schoolers are prone to injuries such as burns, falls, poisoning and drowning both at home and in the hospital. The pre-schoolers should be allowed to express their autonomy through play but the area should be child proofed. An adult should always be close by to check up on the pre-schooler. The health problems that the pre-schoolers experience are quite similar to those experienced by toddlers hence the health promotional activities for this age group would be similar to those of toddlers aged one to three years.
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Potts, N. L., & Mandleco, B. (2009). Pediatric Nursing: Caring for Children and Their Families. New York .