Coping with Concerns Related to Normal Growth and development of Toddler By: Dr. Omayyah Nassar

1. Coping with Concerns Related to Normal Growth and development of Toddler By: Dr. OmayyahNassar

2. Objectives • By the end of this topic, the students will be able to: • Identify major concerns during toddlerhood • Explain readiness of toddler for toilet training • Recognize parents readiness to begin toilet training • Teach parents guidelines for toilet training • Discuss concepts of sibling rivalry, temper tantrum, regression, and negativism • Explain anticipatory guidance for preparation of children for the birth of a sibling • Outline anticipatory guidance for temper tantrum, regression, and negativism

3. Major Concerns during Toddlerhood

4. Toilet training Anticipatory guidance for families about toilet training should begin prior to the child's developmental readiness to toilet train. Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking, probably between ages 18 and 24 months. complex psychophysiologic factors are required for readiness.

5. For toilet training, toddler must be able to • Recognize the urge to let go and hold on • Communicate this sensation to the parent.

6. Cultural beliefs may affect the age at which toddler demonstrate readiness • (Feigelman,2016)

7. Toilet training • Nighttime bladder control normally takes several months to years after daytime training begins (sleep cycle needs to mature). • https://www.google.jo/search?q=toilet+training+for+toddlers&source=lnms&tbm=isch&sa=X&ved=0ahUKEwijsur61sXXAhXLI1AKHW4HDLcQ_AUICigB&biw=1366&bih=613#imgrc=9TJ0N1FD6YY4wM:

8. Toilet training • Trends of toilet training changed due to the availability of disposable diaper. • Currently, it initiated around 21 months old • Half of children are toilet trained by 36 age (Rogers, 2017)

9. Signs of a child readiness

10. Toilet training • Physiologic and psychologic readiness is not complete until 24-30 to 24 months of age (Rogers, 2013). • Parents should begin preparing toddler for toilet training earlier than 30 months old • By this time the child: • Has mastered the majority of essential gross motor skills • Can communicate clearly • Is less in conflict with self-assertion and negativism • Is aware of the ability to control the body and please the parent

11. Toilet training • There is not a universal right age to begin toilet training or an absolute deadline to complete training • The role of the nurse Helping parents to identify readiness signs in toddler • Girls are developmentally ready to begin toilet training than boys (Elder, 2016).

12. Assessing toilet training readiness • Physical readiness • Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking (between 24to 30months). • Ability to stay dry for 2 hours; decreased number of wet diapers; waking dry from nap.

13. Physical readiness • Regular bowel movements. • Gross motor skills of sitting, walking are developed • Fine motor skills to remove clothing.

14. Assessing toilet training readiness • Mental readiness: • Recognizing urge to defecate or urinate. • Verbal or nonverbal communicative skills to indicate when wet or has urge to defecate or urinate. • Cognitive skills to imitate appropriate behavior and follow directions

15. Assessing toilet training readiness • Psychological readiness: • Expresses willingness to please parent. • Able to sit on toilet for 5 to 10 minutes without fussing or getting off. • Interest about adult's or older sibling's toilet habits. • Impatience with soiled or wet diapers; desire to be changed immediately.

16. Assessing toilet training readiness • Parental readiness: • Recognizes child's level of readiness. • Willing to invest the time required for toilet training. • Absence of family stress or change , such as a divorce, moving , new sibling, or awaiting vacation.

17. Assessing toilet training readiness • Nighttime bladder control takes several months to years after daytime training begins Why????? • Sleep cycle needs to mature to enable the child to awake to urinate

18. EBP • Bed wetting is normal in girls up to (Younger) than 4 years and in boys younger than 5 years Bed wetting after 6 years require intervention (Feigelman, 2016).

19. Anticipatory Guidance for toilet training • Bowel training is usually accomplished before bladder training because of its greater regularity and predictability. • The sensation for defecation is stronger than for urination, and the sensation of defecation can be brought to the child's attention. • A well-balanced diet that includes dietary fiber helps keep stool soft and supports the development and maintenance of regular bowel movements.

20. Anticipatory Guidance for Toilet Training • A number of techniques can be helpful when initiating training: • One is the selection of a potty chair or use of the toilet. • Practice sessions should be limited to 5 or 10 minutes • a parent should stay with the child • sanitary habits should be employed after every session.

21. Anticipatory Guidance for Toilet Training • Allow the child time to become familiar with the potty chair. • Let the child sit on it first fully clothed before removing the clothing. • Dressing children in easily removed clothing; using training pants, "pull-on" diapers, or panties; and encouraging imitation by watching others are other helpful suggestions

22. Anticipatory Guidance for Toilet Training • Young children become so engrossed in play activity that if they are not reminded, they will wait until it is too late to reach the bathroom. Therefore, frequent reminders and trips to the toilet are necessary.

23. Anticipatory Guidance for Toilet Training • As the child develops each step of toileting (discussion, undressing, going, wiping, dressing, flushing, and hand-washing), he or she gains a sense of accomplishment that should be reinforced by parents

24. Sibling rivalry • Sibling rivalry: is the natural jealousy and resentmentالاستياء of children toward a new child in the family, when a parent turns his or her attention from the toddler and interact with a new baby.

25. Sibling rivalry • Sibling rivalry tends to be most pronounced in the firstborn, who experiences dethronement (loss of sole parental attention). • It is most difficult for young children, particularly in terms of mother-child interaction.

26. Anticipatory Guidance Preparation of children for the birth of a sibling • 1. A good time to start talking about the baby is when toddlers become aware of the pregnancy • 2. Telling them that a new playmate will come home soon sets up unrealistic expectations. https://www.google.jo/search?q=sibling+rivalry&hl=en&tbm=isch&tbs=rimg:Cf-T2HnFFcNoIjjnQbmI2KA1kl1loYkHVBckqvBqqNn67kzoOQk4Xc5TZVkQ0jwW6EMf8NMjW-XGixXT6HuuVJnhLCoSCedBuYjYoDWSETKxIvoCcS1PKhIJXWWhiQdUFyQRZBJxcHnSjeIqEgmq8Gqo2fruTBEU8-Pf94VQZCoSCeg5CThdzlNlEc3yJnClTgKxKhIJWRDSPBboQx8RffMImfIK2WkqEgnw0yNb5caLFRFM4XZPtuMQ6ioSCdPoe65UmeEsEVubTg_1MEAWt&tbo=u&sa=X&ved=0ahUKEwji2ofJo8bXAhWLalAKHZG9CGgQ9C8IHw&biw=1366&bih=662&dpr=1#imgrc=VN6WiZCDModhUM:

27. Anticipatory GuidancePreparation of children for the birth of a sibling 3. Parents should emphasize which routines will stay the same, such as reading-stories. • 4. Providing a doll on which toddlers can imitate parental behaviors.

28. Anticipatory GuidancePreparation of children for the birth of a sibling 5. A new sibling in the home is stressful, so any additional stresses for the toddler should be avoided or minimized 6. Pregnancy is an abstraction for toddler, so seeing simple pictures of the uterus and fetus and feeling the fetus move help the child feel involved the experience.

29. Anticipatory GuidancePreparation of children for the birth of a sibling • 7. Parents can alerting visitors to the toddler's needs, having small presents on hand for the toddler, and including the child in the visit as much as possible. • 8.The toddler can also help with the care of the newborn by getting diapers and doing other small tasks

30. What are the signs of jealousy??? Toddler may exhibit the following signs: • Some will overtly hit the infant. • Push the child off the mother's lap. • Pull the bottle or breast from the infant's mouth. • Subtle and covert the baby. • Toddlers may verbally express a wish that the infant “go back inside mommy”.

31. They revert to more infantile forms of behavior as demanding a bottle, using baby talk. • That act aggressively toward others. • For this reason, infant must be protected by parental supervision of the interaction between the siblings.

32. Temper Tantrum • Toddlers may assert their independence by violently objecting to discipline. eg: • They may lie down on the floor. • Kick their feet. • Scream at the top of their lungs. • Some have learned the effectiveness of holding their breath until the parent relents.

33. Anticipatory Guidance Temper Tantrum • The best approach toward tapering temper tantrums requires consistency and developmentally appropriate expectationsandrewards. • Parents can reinforce consistency and expectations by stating :after this story it is bed time”. https://www.google.jo/search?hl=en&tbm=isch&source=hp&biw=1366&bih=662&ei=yCAPWrWLL4v5wQLtgJKoBQ&q=toddler+temper+tantrum&oq=toddler+temper+tantrum&gs_l=img.1.0.0l3j0i8i30k1j0i24k1l6.1750.13230.0.15747.25.24.1.0.0.0.224.2814.0j22j1.23.0....0...1.1.64.img..1.24.2811.0..35i39k1.0.MZGFqcgr_ng#imgrc=jBSPklWvfFMreM:

34. Anticipatory Guidance Temper Tantrum • Starting at 18 months, time-outs work well for managing temper tantrums. • During period of no tantrums, provide developmentally appropriate positive reinforcement.

35. Negativism • One of the more difficult aspect of rearing children in this age-group is their persistent “no” response to every request. Which Is necessary assertion of self-control • Negativism begins to subside as most children prepare to enter kindergarten. • .

36. Anticipatory Guidance Negativism • One method of dealing with the negativism is to reduce the opportunities for a “no” answer. • In their attempt to exert control, children like to make choices. • If their response is negative , parents should make the choice for the child

37. Regression • Regression: is the retreat from one's present pattern of functioning to past levels of behavior . • It usually occurs in instances of discomfort or stress . • Regression is common in toddlers.

38. Regression • Forms of regression : • A- Any threat to their autonomy, such as illness, hospitalization, separation, • B- An adjustments to a sibling, represents a need up revert to earlier forms of behavior, such as increased dependency, refusal to use the potty chair

39. Anticipatory GuidanceRegression • The best approach is to ignore it while praising existing patterns of appropriate behavior. • Regression is a child's way of saying," I can't cope with this present stress and perfect this skill as well, but I will if given patience and understanding

40. Anticipatory GuidanceRegression • it is advisable not to attempt new areas of learning when an additional crisis is present or expected such as beginning toilet training shortly before a sibling is born.

41. References Hockenberry, M. J.,Wilson, D. & Rodgers, C., (2017). Wong's Essentials of Pediatric Nursing (10th ed.). St. Louis, MO: Elsevier Mosby