Toilet Training and Discipline Lecture Powerpoint

Question 1

___ is the time to lay down foundations with a child about toilet training terms (poop, messy, dry, wet, clean, potty). Average age for toilet training is ___, but this can vary by culture, and doesn’t exclude nocturnal enuresis. What age is time to refer to behavioral specialist?

Answer 1

18 months, 35-39 months, 48 months (4 years)

Question 2

Developmental readiness for toilet training in children

Answer 2

• understanding of signals (sometimes thru physical testing)
• physiologically must have control of sphincter, completed by 12-15 months typically
• behavioral might see power struggle with parents
• must have ability to ambulate to toilet and pull clothes

Question 3

4 main stages of potty training

Answer 3

• Prepotty (have supplies such as chair and rewards and music)
• make the potty chair one of the childs favorite possessions
• Practice (practice runs, routine)
• rewards (hugs, encouragement)

Question 4

Diaper dermatitis definition and 3 contributing factors

Answer 4

Generic rash - a contact dermatitis with erythematous shiny patches over convex surfaces of the diaper with redness of the skin folds around the diaper area, may resolve spontaneously but may be treated with barrier cream

-warm dark moist environment, friction, urine and feces

Question 5

Candida diaper dermatitis often has ____ lesions

Answer 5

Satellite

Question 6

Miliaria rubra

Answer 6

Prickly heat rash manifesting as tiny red papules and papulovesicles, caused by eccrine sweat duct occlusion and often self limiting

Question 7

Signs that a rash is NOT a generic dermatitis (6)

Answer 7

• acute onset
• toxic substance exposure
• fever
• systemic symptoms
• pain on palpation or with voiding
• deep ulceration (abuse or neglect?)

Question 8

ABCDE treatment for diaper dermatitis

Answer 8

Airing, barrier, cleansing, diaper selection (gel absorbant lining), education

Question 9

Barriers used for diaper dermatitis (4)

Answer 9

• Zinc oxide
• petroleum
• nystatin cream if candidiasis
• hydrocortisone 1%

Question 10

Talcum powder use for infants

Answer 10

No longer recommended due to risk of inhalation

Question 11

Enuresis

Answer 11

Involuntary loss of urine beyond age of anticipated control

Question 12

Primary enuresis vs secondary

Answer 12

Primary is child has never had a 6 month dry period but secondary is a return to wetting after 6 month dry period

Question 13

Enuresis 2 common comorbidities

Answer 13

• UTI

- constipation

Question 14

Enuresis studies (3)

Answer 14

• UA and culture
• renal and bladder US
• abnormalities indicate need for voiding cystourethrogram

Question 15

Uncomplicated vs complicated enuresis

Answer 15

Uncomplicated is nocturnal only, neg history of uti, normal PE, neg UA and culture, complicated requires further workup

Question 16

Therapies for enuresis (5)

Answer 16

-protect mattress
-daytime practice
-bed wetting alarm
-imipramine (tofranil)
-desmopressin (DDAVP)
(drug therpies can be used PRN during sleepovers)

Question 17

Imipramine ADR’s (4)

Answer 17

• anxiety
• irritability
• insomnia
• CNS toxicity

Question 18

Why is discipline important (3)

Answer 18

• teach children to live with others
• teach children to control their impulses
• need external controls after 6 months, start developing internal self control at 3-4 years

Question 19

Child abuse laws

Answer 19

-vary state by state, in PA cannot hit with an object and cannot leave a mark

Question 20

Discipline rule guidelines (7)

Answer 20

• stop physical punishment
• don’t go in public till controlled at home
• positive feedback
• ignore unimportant or irrelevant behavior
• apply rules consistently
• physically move or escort child
• use time out