Quiz #1 Flashcards Preview

Pediatrics > Quiz #1 > Flashcards

Flashcards in Quiz #1 Deck (65)
Loading flashcards...

Authoritarian parents

try to control their children's behavior and attitudes unquestioned mandates.

They establish rules and regulations for standards of conduct that they expect to be followed rigidly and unquestioningly.

The message is do it because I say so.

Punishment need not be corporal but maybe Stern withdraw of love and approval.

The children are more likely to be courteous, loyal, honest, dependable, but docile.


Permissive parents

exert little or no control over their children's actions.

They avoid imposing their own standards of conduct and allow their children to regulate their own activities as much as possible.

These parents consider themselves to be resources for the children rather than role models.

The parents consult the children in the decision-making processes.

These parents rarely punished their children.


Authoritative parents

combined practices from both authoritarian and permissive parenting styles.

They direct their children's behavior and attitudes by emphasizing the reason for the rules and negatively reinforcing deviations.

Parental control is firm and consistent but tempered with encouragement, understanding, and security.

Control is focused on the issue, not on withdrawal of load of work. Punishment.

These children will have high self-esteem who are self-reliance, assertive, inquisitive, content, and highly interactive with other children.



means to teach or refers to a set of rules governing conduct.

In a narrow sense it refers to the action taken to reinforce the rules after noncompliance.


Limit setting refers to

the establishing of the rules for guidelines for behavior.

For example, parents can place time limits on the amount of time their children spend watching the television or chatting online.


Minimizing misbehavior –

the best approach is to structure interactions with children to prevent or minimize unacceptable behavior.


Family centered care minimizing this behavior –

– set realistic goals for acceptable behavior and expected achievements.

– structure opportunities for small successes to lessen feelings of inadequacy.

– praise children for desirable behavior with attention and verbal approval.

– structure the environment to prevent unnecessary difficulties, such as place fragile objects in an inaccessible area.

– set clear and reasonable rules, expect the same behavior regardless of the circumstances, if exceptions are made, clarify that the change is for one time only.

– teach desirable behavior through own example, such as using a quiet calm voice rather than screaming.

– review expected behavior before special or unusual events, such as visiting a relative or having dinner at a restaurant.

– phrase request for appropriate behavior positively, such as put the book down, rather than don't touch the book.

– call attention to unacceptable behavior as soon as it begins, use distraction to change the behavior for offer alternatives to annoying actions, such as exchanging a quiet toy for one that is too noisy.

– Give advance notice work friendly reminders such as when the TV program is over, it is time for dinner. Or I'll give you to the count of three and then we have to go.

– Be attentive to situations that increase the likelihood of misbehaving, such as over excitement were fatigue, or decreased personal tolerance to minor infractions

– offers sympathetic explanations for not granting a request, such as I'm sorry I can't read to you the story now, but I have to finish dinner. Then we can spend
time together.

– Keep any promises made to children

– avoid outright conflicts, timber discussions with statements such as let's talk about it and see what we can decide together for I have to think about it first

– provide children with opportunities for power and control


Nursing alert –

– when reprimanding children, focused only on the misbehavior, not only child.

Use of “I” messages rather than “you” messages express personal feelings without accusation or ridiculed.

For example, an “I” message attacks the behavior – “I am upset when Johnny is punched, I don't like to see him hurt”-

not the child.


Reasoning –

involves explaining why it's wrong and it is usually appropriate for older children, especially when moral issues are involved.

However young children cannot be expected to see the other side because of their egocentrism.

Unfortunately, reasoning is also combined with scolding, which sometimes takes the form of shame or criticism.

For example, the parent may state you are a bad boy preventing your brother, children actually take such remarks seriously and personally believing that they are bad.


Family centered care – implementing discipline:

consistency – implement disciplinary action exactly as agreed on and for each infraction.

Timing – initiate discipline as soon as the child misbehaves: if the laser necessary, such as to avoid embarrassment, verbally disapprove of the behavior and statement disciplinary will action will be implemented.

Commitment – follow through with details of the discipline, such as timing of minutes, avoid distractions that may interfere with the plan such as telephone calls.

Unity – make certain that all caregivers agree on the plan and are familiar with the details to prevent confusion and alliances between child and one parent.

Flexibility – choose disciplinary strategies that are appropriate to the child ge age and temperament and the severity of the misbehavior.

Planning – plan disciplinary strategies in advance and prepare child if feasible such as explained the use of the timeout, for unexpected misbehavior try to discipline when you are calm.

Behavior orientation – always disapprove of the behavior, not the child, with statements such as that was the wrong thing to do, I am in happy when I see behavior like that.

Privacy – administer discipline in private, especially with older children, who may feel ashamed in front of others.

Termination – after the discipline is administered consider the child as having a clean slate and avoid bringing up the incident or lecturing.


Positive and negative reinforcement is the basis of behavior modification theory –

behavior that is rewarded will be repeated: behavior that is not rewarded will be extinguished.


Using rewards is a positive approach.

With young children, using paper stars is an effective method.

For older children, the token system is appropriate, especially if a certain number of stars or tokens yield special rewards, such as a trip to the movies or a new book.


Consistently ignoring behavior will eventually extinguished or minimize the act.

although this approach sounds simple, it is difficult to implement consistently.

Parents will frequently give in and resort to previous patterns of discipline.


Timeout is an excellent disciplinary strategy for young children.

Time out is a refinement of the common practice of sending a child to his or her room and is a type of unrelated consequence.

It is based on the premise of removing the reinforcer such as the satisfaction or attention the child is receiving from the activity.


Natural consequence –

those that occur without any intervention, such as being late and having to clean up the dinner table.


Logical consequence –

hose that are directly related to the role, such as not being allowed to play with another toy until the used ones are put away.


Corporal or physical punishment –

most often takes the form of a spanking.


family centered care – using time out:

– selected area for timeout that is safe, convenient, and stimulating, but where the child can be monitored, such as in the bathroom, hallway, or laundry room.

– determine what behaviors warrant a time out.

– Make certain children understand the roles and how they are expected to behave.

– explain to the children the process of the timeout:

when they misbehave, they will be given one warning. If they do not obey, they will be sent to a place designated for time out.

They are to sit there for a specified period. If they cry, refuse, or display any disruptive behavior, the timeout period will begin after the quiet down.

When they are quiet for the duration of the time, they can leave the room.

– a role for the length of time out is one minutes per year of age, use a kitchen timer with an audible bell to record the time rather than a watch.


Sensory motor:

tertiary circular reactions 13 to 18 months

– cognitive development:

active experimentation to achieve previously unattainable goals.

Increases concept of object permanence.

Differentiation of oneself from objects.

Early traces of memory. Beginning awareness of spatial, casual, temporal relationships.

Able to enter into an action at any point without reproducing entire sequence.


Sensory motor:

tertiary circular reactions 13 to 18 months


insatiable curiosity about the environment.

Uses all sensory cues for exploration.

Pictures away from parents for longer periods.

Uses physical skills to achieve particular goal.

Can find similar hidden objects but only in first location.

Able to insert round objects into whole.

But smaller objects into each other nesting.

Gestures up and down.

Puts objects into a container and takes them out.

Realizes that out of sight is not out of reach, opens doors and drawers to find objects.

gains comfort from parents voice even if parent is not visible.


Sensory motor:

invention of new means through mental combinations

19 to 24 –

cognitive development:

awareness of object permanence regardless of number of invisible displacements.

Can infer a cause only while experiencing the effect.

Imitation increasingly symbolic period beginning sense of time in terms of anticipation, memory, and ability to wait.

Egocentrism in thought and behavior.

Global organization of thought.


Sensory motor:

invention of new means through mental combinations

19 to 24 –


searches for an object through several hiding places.

Will infer caused by getting two or more experiences such as candy missing and sister is smiling.

Imitates words and sounds of animals.

Imitate adult behavior domestic mimicry.

Follows directions and understands requests.

Uses words up, down, come, go with meaning.

May sit and wait for meals at the table for a short period.

Has some sense of time, waits in response to just a minute, may use the word now.

Refers to self by name. Engages in parallel play.

Demonstrates awareness of ownership.

Concerned with ritualistic routine schedule.


2 to 4 years – cognitive development:

increased use of language as mental symbolization.

Egocentrism still present in thoughts, play, and behavior.

Increased sense of time, space, casuality.


2 to 4 years – Behavior:

uses two or three word phrases. Increased vocabulary, refers to self by pronoun.

Possessive of the own toys and uses word mine.

Begins to use past tense verbs.

Uses phrases going to, in a minute, today, all done.

Uses many future oriented words such as tomorrow, next day, afternoon, has poor concept of the passage of time.

Follows directions using prepositions such as, behind, under, in back of.


Domestic mimicry is common during toddlerhood.



Characteristics of preoperational thought:

egocentrism –

inability to envision situations from perspectives other then one's own.

Example, if a person is positioned between the toddler and another child , the toddler, who is facing the person, will explain that both children can see the middle persons face. The child is unable to realize at the other child views the middle person from a different perspective, the back.


Characteristics of preoperational thought:

transductive –

reasoning from the particular to the particular. Example child refuses to eat food because something previously did not taste good.


Characteristics of preoperational thought:

Global organization –

beliefs that changes any one part of the whole changes the entire whole.

Example child refuses to sleep in the room because location of that has changed.


Characteristics of preoperational thought:


focusing on one aspect rather than considering all of the possible alternatives.

Example child refuses to eat food because of its color, even though it's taste and smell are acceptable.


Characteristics of preoperational thought:


Attributing lifelike qualities to inanimate objects.

Example, the child's scolds the stairs because the stairs made the child fall.


Characteristics of preoperational thought:

Irreversibility –

inability to undo or reverse the actions initiated physically,

example when told to stop doing something, such as talking, child is unable to think of the opposite activity.


Characteristics of preoperational thought:

Magical –

believing that thoughts are all powerful and can cause events.

Example – child wishes someone dead been if the person dies the child feels at fault because of the bad thought that made the deaths happen.


Characteristics of preoperational thought:

Inability to conserve –

inability to understand the idea that mass can be changed in size, shape, volume, or leave without losing or adding to the original mass instead children just what they see the immediate perceptual cues given to them.

Example if two lines are of equal lengths are presented to a child where one line looks longer than the other,the child will say that it is longer even though they measured it and it is the same.


age 15 months-

gross motor:

walks without help.

Goes slowly upstairs.

kneels without support.

Cannot walk around corners for stop fast without losing balance.

Assume standing position without support.

Cannot throw a ball without falling.


age 15 months-

Fine motor:

constantly casting objects to floor.

Builds tower of two cubes.

Holds two cubes in one hand.

Releases pellet into a narrow neck bottle.

Scribble spontaneously.

Uses cup well but often rotates spoon.


Age 18 months –

gross motor:

runs clumsily, falls often.

Walks upstairs with one hand held.

Pulls and pushes toys.

Jumps in place with both feet.

Seats self in a chair.

Throws a ball over and without falling.


Age 18 months –

Fine motor:

builds a tower of three or four Cubes.

Release, prevention, and reach well developed.

Turns 2 to 3 pages in a book at a time.

In drawing, makes strokes imatively.

Manages spoon without rotation.


Age 18 months –

Anterior fontanelle closed.

Physiologically able to control sphincters.


Age 24 months-

gross motor:

goes up and down stairs alone with 2 feet on each step.

Runs fairly well, with wide stance.

Picks up object without falling.

Kicks ball forward without over balancing.


Age 24 months-

build a tower of 6 to 7 cubes.

aligns cubes to make a train.

Turn pages of a book one at a time.

In drawing, imitates vertical and circular strokes.

Turns doorknob, unscrew the lid.


Age 24 months-

16 teeth.

hAs vocabulary of approximately 300 words.

Uses two or three word raises


Age 30 months –

gross motor:

jumps with both feet.

Jumps from chair to step. Stands on 1 foot momentarily.

Makes a few steps on tiptoes.


Age 30 months –

Fine motor:

build a tower of eight cubes.

As a chimney to the train of Cubes.

Good hand finger coordination.

It holds a crayon with two fingers rather than face.

In drawing, imitates vertical and horizontal strokes.

Makes two or more strokes for cross.

Draw circles.


Age 30 months –

Birth weight quadrupled.

20 teeth.

May have daytime bowel and bladder control.

Gives first and last name.

Refers to self by appropriate pronoun.

Uses plurals.

Names one color.

Notices gender.


Assessing toilet training readiness –

physiological readiness – voluntary control of angle and urethral sphincter's, and usually by age 22 to 30 months. Ability to stay dry for two hours, decreased number of wet diapers, waiting drive from a nap. Regular bowel movements. Gross motor skills of sitting, walking, and sporting. Fine motor skills to remove clothing.

Mental readiness – recognition of urge to defecate or urinate. Verbal or nonverbal communication skills to indicate when wet or urge to defecate or urinate. Cognitive skills to imitate appropriate behavior and follow directions.

Physiologic readiness – expressing willingness to please parents. Ability to sit on the toilet for 5 to 8 minutes without fussing or getting off. Curiosity about the adults were older siblings toileting habits. In patients with soiled or wet diapers. Desire to be changed immediately.

Parental readiness- recognition of child's level of readiness. Willingness to invest the time required for toilet training. Absence of family stress, such as divorce, moving, new sibling, or vacation.


Cultural competence for toilet training –

cultural practices influence the timing, method, and significance of toilet training. For many families in China, the timing is liberal, the method is distinct, and the significance is low. Children are diapered during infancy. Once they are walking, they wear loose pants with long slit between the legs. And they eliminate onto the ground. This practice may continue until the child is five years of age. In cold weather, a piece of cloth, like a curtain, may be inserted. However, the Chinese have a concept that the buttocks are not susceptible to the cold, so this is not a common practice.


Children may begin toilet training sitting on a small toilet or sitting in a reverse fashion on the regular toilet provides additional security to a young child.



To minimize sibling rivalry, parents should include the toddler during caregiving activities..



Unintentional childhood injuries was the leading cause of death among children ages 1 to 19 years old in 2009, accounting for 37% of all deaths in this age group.

motor vehicle injuries caused more accidental deaths and all pediatric group ages after page 1 year than any other type of injury or disease and are responsible for significant number of all accidental deaths among children ages 1 to 4 years old.


Unrestrained children riding in the vehicle's front seat are at the highest risk for injury.



Nurses are responsible for educating parents regarding the importance of car restraints and the proper use.



Children up to the age of two years old ride in a rear facing safety seat until the child has outgrown the manufactures-weight recommendations.

many are facing child safety seats accommodate children weighing up to a maximum of 35 pounds.

It is also safer for the child safety seat to be in the middle of the back seat versus by the door.


Booster seats are used for children who are less than 145 cm or 4 feet 9 inches tall.

In general school age children should write in a belt positioning seat booster until approximately 7 to 8 years of age.


Using car safety seats –

read manufacturer's directions and follow them exactly.

make sure safety seat securely to car seat and apply harness snugly to the child.

Do not start the car until everyone is properly restrained.

Always use the car seat restraint, even for short trips.

If the child begins to climb out for undo the harness, firmly say no it may not be necessary to stop the car to reinforce the expected behavior.

Use rewards such as stars or stickers to encourage cooperative behavior.

Allow the child to hold a favorite toy, or blanket, or stuffed animal in the car seat.

Encourage child to help attach the vocals, straps, and shields.

Decreased boredom on long trips.

bring special toys in the car for quiet play. Talk to the child. Point out objects and teach the child about them. Stop periodically. If child wishes to sleep, and make certain the child's stays in the restraints of the seat. Insist that others who are transporting children also follow the safety rules.



the highest rate of drowning in the years 2000 2006 was in children 0 to 4 years of age, children ages 12 to 36 months are at highest risk for drowning during the same period of time.

Drowning deaths in infants occur most commonly in the bathtub and large buckets.

Close adult supervision of children when near any source of water is essential, many drownings in this age group occur when a supervising adult becomes distracted.

Teaching swimming and water safety can be helpful but cannot be regarded as sufficient protection.


Burns – children pulling parts of hot liquids, especially oil and grease, on top of themselves are a major source of Burns.

As a precaution, turn pot handles towards the back of the stove, and electric pots including the cords, should be placed out of reach.

Other sources of heat such as radiators, fireplaces, accessible furnaces, kerosene heaters, or wood-burning stoves should have guards placed in front of them. Flame burns represent one of the most fatal types of burns and are commonly occurring when children play with matches or lighters and accidentally set themselves and the home on fire.

Electrical burns represent an immediate danger to children. Electrical outlet should have protective guards went into them when not in use to make them inaccessible to the child.

Scalding burns are the most common type of thermal injury in children, especially one and two years of age.

Scalding often occurs because the child is reaching towards the stove or other surface and pulling hot water onto themselves.

It is recommended that passive prevention of scalding Burns is to set the water heater to limit house of water temperatures to less than 49°C 120°F.


Accidental poisoning- toddlers are at the highest risk for accidental poisoning because of their unique curiosity and ability to open childproof containers.

Mouthing activity continues to be prevalent after one year of age, and exploring objects by tasting them as part of the children's curious investigation.

The major reason for poisoning is improper storage.

For toddlers, only a locked cabinet is safe.

Ingestion of acetaminophen is also a common cause of morbidity because it is found in many combinations of over-the-counter products.

Caregivers may unknowingly administer a dose of Tylenol in addition to another over-the-counter drug containing the same Tylenol without knowing the danger.

Children are most likely to ingest substances that are on their level, such as cleaning agents stored under sinks, rat poison, plants, or diaper deodorants.


falls- children can fall from highchairs, shopping carts, carriages, and car seats if not properly restraining or if balance changes when the place they were going or sitting is weighed down by the object.

Therefore proper restraint adequate supervision is essential.

Falls in the hospitalized children have received little attention with the scientific literature until recently but are known to occur.

Research is currently in progress to identify fall risk factors to specific author's children.


Aspiration and suffocation –

suffocation death rates among infants less than one years of age have dramatically increased in the last decade.

Suffocation deaths usually occur in this age group by wedging between a wall and a mattress or crib side and collapsible play yard wall.

Usually by one year of age children chew their food well, that they may have difficulty with large pieces of food such as meat or whole hot dogs, and with hard foods such as nuts or dried beans.


The typical play activity in which toddlers engage is called parallel play.



One indication that the toddler is ready to begin toilet training is

the child recognizes first to let go and to hold on and is able to communicate the sensation to the parent.


A letter brings her three-year-old daughter into the well clinic and expresses concern that the child's behavior is worrisome and possibly requires therapy or medication minimum. The mother further explains that the child consistently responds to the mother simple request with the no answer and even though the activity has been a favorite in the recent past. Furthermore the child as a need for an increase in the number of temper tantrums at bedtime and refuses to go to bed. The mother is afraid her daughter will hurt herself during the temper tantrum because she holds her breath until the mother picks her up and gives her when she requested. The nurse's best response to the mother is

that the child's behavior is normal for a toddler and may represent further frustration with control of her emotions.

Further exploration of events surrounding the temper tantrums and possible intervention should be explored.


Toddlers are often known to be finicky eaters and may exhibit abnormal eating patterns and may concern their parents. Which of the following actions for feeding toddlers should be suggested so adequate amounts of nutrients for growth and development are consumed?

Avoid placing large portions on the toddlers plate.

Allow the child to graze on nutrients during the day. Allow the child to make certain food choices within reasonable limits for example would you like a half of the peanut butter sandwich for half of the ham sandwich.

Provide meals at the same time of the day as much as possible so the toddler has a sense of consistency.


A common cause of accidental death in children ages 1 to 19 years old involves motor vehicle crashes. Evidence from test crashes indicate that the safest action to prevent accidental deaths in toddlers includes

placing the child in a rear facing weight appropriate car seats until age 24 months.


What are the primary reasons for monitoring the toddler's activities and intervening to prevent accidental injury is

that toddlers do not understand the concept of cause and effect, so explaining that certain actions will result in serious injury is useless.