developmental approach to toddlers (age 1-3)
- strong attachment to mom/dad
- ritualistic
- egocentric
- time for toilet training
- play: parallel play–>2 kids playing next to each other w/ separate toys, no interaction b/w them
- time of huge language development
- temperament
when a child is 2 yo, how much of their speech should a stranger be able to understand?
50% (if 3 yo, then 75%; if 4 yo, then 100%)
toilet training in toddlers: when and readiness factors
- achieved late in toddler period b/w 30-40 mos
- readiness factors:
- physical: sphincter control, stay dry for 2 hours, regular BM’s, gross motor–sitting/walking/squatting, 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 stresses
how does hospitalization affect toddlers?
- fear of abandonment
- fear of loss of control
- negativism and temper tantrums
- poor understanding of body boundaries
- play used for understanding and coping
how to approach toddlers in the hospital at their developmental level
- firm, positive approach: give a choice only when possible
- do not expect cooperation: do not argue
- concrete: poor concept of time
- the younger the pt is, the closer to the event happening are you going to explain it, b/c it can cause lots of anxiety
- procedures:
- use distraction
- non invasive procedures
- explain just prior to event
toddler diet
- continue to wean if not complete
- milk: 2-3 cups/16-24 oz per day
- finger foods, but need to watch for chokables
- limit sugar, fat, and salt
- ritualistic
- small, frequent meals
preschool play
- associative play: similar activity but no rigid organization
- motor activity: on the go
- dramatic play: imitation, dress up
- games: rules are absolute and rigid in games
gender role identity in preschoolers
- becomes aware of their similarity to parent of the same sex
- usually like to be like the same sex parent
- reinforced by the parent
- girls–cook w/ mom; boys–work with dad
- sexual identity:
- modesty
- sexual exploration: children may masturbate
- not absolute–may identify w/ both parents
pain perception in preschoolers
- FACES assessment tool is most helpful
- can also ask parents
- verbal ability is better but they fear the consequences
- the pain reliever may be worse than the pain
- they also fear healthcare providers
- may cry and cling
- may become passive
developmental approach to school age child (6-12 yo)
- better understanding of cause and effect
- likes to be w/ same gender
- likes competition
- likes to learn
- appreciates tangible rewards
- limits “screen time”
- direct link to obesity
school age child and play
- cooperative play: teams, organized clubs
- rules: like competition
- construction: enjoys building and constructing things
- computer games: need to be wary of amount of screen time
school age child and social development
- concrete thinking:
- conservation of matter
- able to have mental representations
- concept of time and body parts
- likes to learn
- interested in friends and school
how does hospitalization affect the school age child?
- fears:
- concern for physical harm
- separation from friends and school
- loss of control
- procedures: explain more fully
- use books, pictures
- coping:
- reports pain
- will be open to learning distraction techniques
developmental approach to adolescents (12-18 yo)
- likes independence and autonomy
- capable of abstract thinking
- peer relationships are very important
- crises can be anything that threatens identity or body image
adolescents and social activity
- friends
- sports
- school activities
- dances, movies, dating
- music
- texting, computer: their communication
- development of “views”–they want their views to be heard and respected
safety concerns for adolescents
- sex
- drugs and alcohol
- guns
- suicide risk behaviors
- driving
- internet
how does hospitalization affect adolescents?
- procedures:
- give full explanations
- mmore concerned w/ present than future
- respect and confidentiality
- resent authority figures/nurses trying to be their peers
- like nurses ot be friendly
- restrictions:
- impose few restrictions, but do set limits
- may “sleep” or get on phone to avoid discussions
when are you able to breach confidentiality w/ patients?
- youth in danger of harming themselves or others
- certain types of addiction tx may not be considered confidential
adolescents and pain
- verbal skills:
- excellent ability to verbalize
- can use adult pain assessment tools
- adult level response to pain
- fears:
- fear loss of control
- give info and provide privacy
- fear loss of control
- coping: will appreciate and participate in coping methods
school age and teen diet
- dec parental control
- high fat, sugar, and salt diets
- dec activity
- obesity epidemic
- eating disorders: have to fix the root of the problem
Erikson stage of infants
trust vs. mistrust
Erikson stage of toddlers (up to 3 yo)
autonomy vs. shame and doubt
Erikson stage of preschoolers
initiative vs. guilt
Erikson stage of school age children
industry vs. inferiority
