Positive Parenting Tips for Toddlers

Talking To Toddlers

Talking to Toddlers is a program that offers effective parenting tips to help shape behavior in toddlers. It is a creation of Chris Thompson, a parenting professional and certified NLP practitioner. No doubt he has all it takes to address the issue of parenting. The program helps parents understand problems often experienced by children, include the reasons behind their behaviors. In most cases, parents communicate to children in inappropriate ways without know. This may lead kids to behave contrary to parents expectations. This is among the major problems this program helps to fix. You will be able to learn about the word you often misuse and evoke bad reactions from kids. Kids are often misunderstood and this makes it difficult for them to learn. This guide has helped thousands of parents across the world and it is going to help you too. Buy it today and start learning the best strategies you can use to train your children. More here...

Talking To Toddlers Summary

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Contents: Audio Course
Author: Chris Thompson
Price: $37.00

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Highly Recommended

The writer presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this manual are precise.

When compared to other ebooks and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

Infants And Toddlers With Disabilities

No. 99-457, The Education for the Handicapped Act Amendments of 1986 (now IDEA-Part C), provides grants to states to develop and implement a statewide, comprehensive system of early intervention services for infants and toddlers with disabilities and their families. The purpose of IDEA-Part C is (a) to enhance the development of infants and toddlers with disabilities and to minimize their potential for developmental delay (b) to reduce the education costs to our society, including our nation's schools, by minimizing the need for special education and related services after infants and toddlers with disabilities reach school age (c) to minimize the likelihood of institutionalization of individuals with disabili ties and maximize the potential for their independent living in society (d) to enhance the capacity of families to meet the special needs of their infants and toddlers with disabilities and (e) to enhance the capacity of state and local agencies and service providers to...

Infants and Toddlers

Both WHO and AAP promote exclusive breastfeeding for the first 6 months of life. However safe, nutritious solid foods may be introduced between 4 and 6 months of age, when the infant is developmentally ready. The order of introduction of solid foods is generally not critical however, single-ingredient foods should be tried for 1 week at a time to observe for possible allergic reactions before introducing another food or mixtures of foods. Single-grain infant cereals such as rice (which lacks gluten) are usually well tolerated and provide a source of fortified iron. Homemade infant foods should not have added salt or sugar. Honey is associated with infant botulism and should not be given to infants younger than 1 year. Teething biscuits or finely chopped foods may be given by 8 to 10 months of age. However, foods such as popcorn, nuts, or rounded candies should not be offered to infants or toddlers because of the risks of choking, aspiration, and even death. Potentially hazardous foods...

Our daughter seems to feel no pain She sticks pins in her feet and likes to dig my fingernails into her hand Whats

In contrast to hypersensitive children, hyposensitive children don't seem to be disturbed by an overload of environmental stimuli. Many hyposensitive children seem to seek out additional stimulation. Sam is one of these children. As a toddler, she put anything that was within reach in her mouth she sucked on electrical cords and dolls' heads and chewed string. She was also prone to self-injury because she did not register pain the way typical children do. She would slide down a flight of stairs head-first or place her hand on a hot toaster oven without so much as an ouch. She also engaged in hand biting and has even drawn blood with no reaction to the pain. There are stories of children with broken bones and appendicitis who don't complain and don't even seek out their parents for comfort.

Specific Lines of Development

In looking at organizational levels, one also may consider the development of human relationships. The infant progresses from a general interest in both the inanimate and the human world, to a specific and preferred interest in primary caregivers (engagement), to a capacity to be intentional with and differentiate the primary caregivers from others, to an ability to relate to the primary caregivers with a deepening sense of pleasure as well as protest and assertion. We observe, for example, the toddler develop as part of his or her unfolding relationship capacities the ability to communicate through complex gestures desires for closeness, intimacy, and dependency and an interest in curious, independent, assertive exploration of the world. It is also possible to delineate the age-appropriate organizational levels and unique experiential patterns for affects such as anxiety and thematic communication capacities. It is important to keep in mind the distinction between the child's...

Further Developmental Considerations

Of danger when the child has developed the unfettered mobility of a toddler. The satisfactions of daydreaming may become the later basis of creative, innovative thought, but the two are not identical. Similarly, the use of intcllectualization in adolescence may give way to the intellectual capacities of adulthood.

Federal Antidiscrimination Legislation

Congress also has passed antidiscrimination or civil rights legislation that has had an impact on public school policies and practices. These statutes prohibit state and school authorities from discriminating against individuals on the basis of race, color, or national origin 3 sex 4 or handicapping condition5 in any program or activity receiving any federal funding. A state department of education may choose not to pursue monies available under federal grant statutes (e.g., funds for infants and toddlers with disabilities). School districts must comply with antidiscrimination legislation if they receive any federal funds for any purpose, however.

Attachment and Locomotion

In a baby's sixth or seventh month, she has reached prime time to solidify her attachment with a primary adult, usually mother. In another bow to ethology, Bowlby noticed that this timing coincides with the start of a baby's crawling. This suggested to him a link between independent locomotion and the completion of the baby's process of attachment which began at birth. Of course, it takes a baby a lot longer to climb out of his crib than it does for a chick to hop out of the nest. Before chicks and toddlers go wandering too far away, instinct makes sure that they know where home base can be found.

What Intensive Intervention Means

What constitutes an intensive early intervention program Intensive usually means giving a child between 25 to 40 hours of treatment services per week. This may sound like an extraordinary number of hours, especially if you have an infant or a toddler. But in fact, research suggests that it's the intensity (as well as the timing of early intervention) that has a great effect on a child's development. Intensive treatment is much more helpful than a slow and steady approach spread out over time.

Infant outcome measures

The Short Temperament Scale for Infants (STSI) and Short Temperament Scale for Toddlers (STST) are 30-item, parent-completed questionnaires eliciting information on infant temperament (Prior, Sanson, Smart, & Oberklaid, 2000). The STSI is intended for infants under 1-year-old and the STST for toddlers. They are based on factor analyses of the Revised Infant Temperament Questionnaire and the Toddler Temperament Scale, respectively (Carey & McDevitt, 1978 Fullard, McDevitt, & Carey 1984). The 30 items are averaged, generating slightly different, but overlapping, sets of subscales for the two instruments. These include approach co-operation-manageability persistence rhythmicity distractibility irritability and reactivity.

Clinical Presentation

Typically, an infant or toddler presents with routine signs and symptoms of upper respiratory infection, such as cough, sneezing, rhinitis, and low-grade fever. Dyspnea and irritability and perhaps audible wheezing soon follow. Tachypnea and nasal flaring are typical, along with signs of airway obstruction, such as a hyperexpanded chest and wheezing on auscultation, with a prolonged expiratory phase. Chest radiograph can show air trapping, peribronchial thickening, atelectasis, and patchy infiltrates. Premature infants and children with chronic disease are at special risk for respiratory failure or complications such as bacterial pneumonia, and up to 5 of patients require hospitalization for severe respiratory distress.

Appropriate Discipline

So how does a parent reason with a toddler who's repeatedly stealing his baby brother's toy They don't. Physical redirection and restraint are necessary to demonstrate that a parent's words are to be taken seriously. Using their feet and firmly restraining hands by directly intervening instead of yelling across the room is the most effective way for parents to help a toddler learn the meaning of the most important word at that age No.

The Evidence of Morality in Babies

From watching babies' eye movements and behaviors, researchers have also determined that they can detect and mimic other people's moods and expressions starting a few days after birth. If a baby sees a playmate or caregiver crying, he frowns. If another child is joyful, he responds in kind. This sort of mimicking is called an empathetic response. When Charles Darwin noticed that certain animal species acted empathetically and so did his own 6-month-old son, he concluded that empathy must be innate. Demonstrations of empathy in toddlers are the basis for the belief that altruism came about as a human adaptation to assure the survival of the species.

Heres the answer now whats the question

Preferentially turn to look at a pattern arranged like a face rather than a random pattern. At a few months old, infants expect objects to be solid and think of any whole object that moves as a single entity, regardless of its size, shape or colour (contrast this with a cat, which is programmed to detect and respond to movement, regardless of what the whole object is, and might well attack its own tail or the owner's hand), and are surprised by apparently solid objects passing through each other. Babies less than a year old can distinguish animate from inanimate objects, even when the inanimate objects are moved, and attribute the movement of animate objects to that object's unknown goals and desires. Toddlers assume that an adult making a word-like sound and pointing to an object is referring to the whole object rather than a part of it. These observations suggest that, even early in development, we have certain assumptions. Although it could be argued that reactions occurring months...

Care of Children in Family Medicine

Bins stored either out of reach or under lock and key from curious young toddlers. Guidelines for the frequency of well child or well teen visits are available from the American Academy of Pediatrics (AAP) Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents (Hagan et al., 2008).

Treatment for Child Victims

Efforts should be made to normalize and optimize the child's functioning as much as possible. Psychotherapy is indicated unless the victim is an infant or preverbal toddler. Victims of illness falsification may deny it have intense anger at the medical team, abuser, or other collusive family members have residual sick-role beliefs and behavior and or have posttraumatic stress disorder (especially in medical settings), self-esteem problems, difficulty defining family relationships, and immense grief (Ayoub 2006 Bools et al. 1993 Bursch 1999). The psychological impact of MBP victimization appears to be significant and chronic. Ongoing problems with social interaction, attention and concentration, oppositional disorders, patterns of reality distortion, poor self-esteem, and attachment difficulties with adults and peers are documented in the literature (Libow 1995). Although children can present as socially skilled and superficially well adjusted, they often struggle with the basic...

Individualized Family Service Plan

IDEA-Part C requires a written individualized family service plan (IFSP) rather than an IEP for each infant or toddler. The IFSP is developed at a meeting that includes the parents of the child other family members, as requested by the parent, if feasible to do so an advocate or person outside of the family, if the parent requests that the person participate the service coordinator a person directly involved in conducting the evaluations and assessment and, as appropriate, persons who will be providing services to the child or family. If one of these persons is unable to attend, arrangements are made for his or her involvement via telephone conference calls or other means. Agencies must provide adequate prior written notice regarding meetings, and IFSP meetings must be conducted in settings and at times that are convenient to families and in the native language of the family or other mode of communication used by the family, unless it is clearly not feasible to do so. For the child...

Early Intervention Services

Under Part C, early intervention services include both special instruction and related services an infant or toddler can receive a related service under Part C without receiving special instruction. (This differs from the requirement under Part B that children with disabilities ages 3-21 only receive related services in order to benefit from special education.) The term early intervention services means services that are (a) designed to meet the developmental needs of the child and the needs of the family related to enhancing the child's development (b) are selected in collaboration with the parents (c) are provided under public supervision by qualified personnel in conformity with an individualized family service plan and (d) are provided at no cost, unless federal or state law provides for a system of payments by families. Types of services include family training, counseling, and home visits special instruction speech-language pathology and audiology services occupational therapy...

The Center of the Universe

Piaget points out that this age is when a child's way of thinking is most different from that of an adult (at least we hope adults do not still think this way). For a child to learn at this preoperational stage, Piaget said, he must be given opportunities to explore and construct schemas that explain his world to him in terms he can understand. Think back to Erikson's point on the toddler's need for a sense of autonomy, and this makes a lot of sense. At the same time, because of his limited ability to process information and his dependency on direct experience, the pre-operational child makes many incorrect generalizations. For example, if falling down and cutting his knee hurts, he reasons that getting a haircut or clipping his toenails will cause physical pain. If a dog barks and a car drives away, he concludes the bark caused the car to leave.

Bundle of Contradictions

A child of this age often surprises with behavior that is both selfish and altruistic. By 15 months, a toddler can recognize his image in a mirror and find himself in a group photograph. Me and mine are his favorite words. Try taking a toy from a 2' 2-year-old, and you'll discover how strongly he takes this newly learned notion of ownership. Fortunately, the vast majority of these willful toddlers do not

Critical Period for Language

With their newfound identities taking hold, boys and girls of 18 months are on the threshold of becoming social beings. In order to articulate their thoughts and desires, and to fully take part in the more interactive play of which they are now capable, toddlers need advanced language skills.

How Self Talk Builds the Brain

Private speech also helps a child delay gratification, get motivated, and regulate his emotions, and these are all important for cognitive and emotional growth. In one study, psychologists tape-recorded the monologues of a girl while she was alone in her crib from the age of 21 months to 3 years. From the analysis of these tapes came the theory that such toddler monologues are not simply practice or play. Rather, they represent attempts by a child to make sense of her daily experiences.

Social Rules of Discourse

The conventions or rules used by speakers in conversation may be fairly simple, such as the taking turns rule. Other rules require more cognitive skills in order to master them. An example of a more advanced language convention is called the toddlers language pragmatics answer obviousness rule. This rule says that if the answer to a question is obvious from the context and speaker, then the listener should interpret the question as a request (perhaps a demand) rather than a question. The typical toddler plays six hours every day. If they are with another child or children their own age, 2-year-olds usually engage in parallel play, meaning each child carries on a separate activity in close proximity to the other. As you watch them, it may not be obvious, but they enjoy each other's company just not in the same ways that older children do. As they reach their third year, children have more verbal interaction with peers in their play. That's when language becomes all important. Children...

Cognitive Development 2002 17 12651282 Phonological specificity in early words

A recent study by Werker, Fennell, Corcoran, and Stager (2002) offers evidence in support of the developmental hypothesis. They tested toddlers aged 14, 17, and 20 months in a word-learning task. After learning to associate similar pseudo-words ('bih,' 'dhh') to different pictures, children were tested either with the same word-picture pairs, or with reversed pairings. In the reverse condition, children in the two older groups detected the mismatch between word and picture (as revealed by release from habituation), while children in the youngest group did not. Vocabulary size was related to children's ability to detect mismatches in the 17-month-old group but not in the 20-month-old group. Werker et al.'s results indicate that by 17 months of age, but not 14 months, children can represent newly-learned words with enough detail to distinguish slight differences in an on-line habituation task. Werker et al. suggest a developmental interpretation of their findings whereby young language...

Visual fixations to targets

In the final paper in this chapter we consider a study of factors that affect infants' ability to look at the same thing as somebody else. This study is rather different from the other infant studies considered so far because, although it involves the assessment of looking behaviour, here the looking is to objects set out across a room. The study is concerned with how adults direct the visual attention of infants and toddlers to objects both behind and in front of them.

Effects of Gesture and Target on 12 and 18Month Olds Joint Visual Attention to Objects in Front of or Behind Them

Infants' tendency to turn to follow an adult's gaze. Gaze-following is a critical component of joint visual attention, defined as looking toward the object of another person's attention because it is the object of their attention. Joint visual attention is a particularly important social event because it is thought to be the earliest manifestaion of intersubjectivity, that is, the ability to infer others' mental states (Baron-Cohen, 1995 Tomasello, 1995 Trevarthen & Hubley, 1978). It also seems to facilitate language development. Toddlers' vocabulary is predicted by the frequency of mothers' and infants' joint visual attention (Tomasello & Todd, 1983). It is also predicted by infants' responsiveness to pointing (Harris, Barlow-Brown, & Chasin, 1995 Smith, Adamson, & Bakeman, 1988). In addition, failure to respond to others' gaze predicts childhood autism, which is typified by severe language deficits (Loveland & Landry, 1986 Mundy, Sigman, & Kassari, 1990). Finally,...

Stress Burning the Candle at Both Ends

Your workload has doubled since the layoffs at your place of employment, both your toddlers are home sick from school, your town leaf pickup is in two days, and you forgot your mother's birthday. As you feel your heart pound, your blood pressure rises, muscles tense, and the pupils of your eyes open wider. Guess what You're stressed. It's the old fight-or-flight reaction Should I stay on or should I go

When my son is frustrated or upset he scratches the side of his facesometimes to the point where he bleeds What can I

Some discipline techniques that work for typical children may work for children with ASDs as well, such as sending the child to his room or giving him a time-out. These techniques work well for some children, but you must be aware of your child's specific needs to determine whether or not the techniques will be effective. Sending a child with an ASD to his room may be exactly what he wants to avoid social interaction. A time-out may encourage stimming behaviors. The best way to find out what is right for your child is to try different techniques and observe your child's resulting behavior. For example, if you notice that your child is no longer hitting his sister, or that his misbehavior has decreased, you have found the right discipline strategy. Other strategies include removing a reward or a special treat such as TV or computer privileges, dessert, or anything else that your child values. Be aware that, over time, you may have to reconsider which reward gets withheld. For instance,...

General discussion

Although there appear to be no significant differences between the deaf and hearing in the quality of attachment and mother-toddler interaction (Lederberg & Mobley, 1990), deaf children of hearing parents receive much less communication than do deaf children of deaf parents. Hearing mothers of deaf 2- and 3-year-olds direct more visual communication to their children than do hearing mothers of hearing children but they still communicate primarily through speech to which the children often do not attend (Lederberg & Everhart, 1998). In contrast, through proficiency in visual communication, deaf mothers of deaf children can match the responsiveness of hearing mothers of hearing children (Spencer & Meadow-Orlans, 1966).

Location And Tumor Histology

Age has a strong association with the likely pathologic diagnosis. In the infant, teratomas and hamartomas are the most common lesions, followed by nasal gliomas and dermoid cysts and tract. Neurofibromas are occasionally seen in infants the most common sarcoma is rhabdomyosarcoma. The metastatic lesion that is most common is orbital neuroblastoma, which is often bilateral. The primary melanomas of the retina can metastasize to the skull base. Also, in the first year of life, Langerhans histiocytosis can affect the skull base, rather than the vault, and is usually misdiagnosed on imaging studies as rhabdomyosarcoma. The major differential of a mass at this age is encephalocele. In the toddler and young child, chordomas arise and can be seen through the rest of childhood. Sinus tumors such as the rare myxoma can occur at this age, as can neurofibromas. Metastatic tumors are most commonly Ewing's sarcoma or neuroblastoma. Some of the rare sarcomas begin to occur in the child older than...

Conduct of Anaesthesia

The use of sedation, particularly in children, is controversial. More than 80 of toddlers are sedated for CT in some units.36 Techniques employed for sedation of children include ketamine, barbiturates, benzodiazepines, high-dose chloral hydrate (50-150 mg kg) and low-dose propofol infusions.37 38 Sedation can safely be employed for MRI in children provided they are accompanied by trained personnel and are adequately monitored.38 Supplementary oxygen should be given to sedated infants,39 as well as any other patients requiring sedation for MRI.

How Methodology Bleeds into Daily Life

Agendas of prenatal testing, and how are they enacted for and by different individuals and communities How are popular understandings of genetics and inheritance shaped in contemporary America What does scientific literacy mean in a culture as deeply stratified as our own I have worked on these problems as an anthropologist and as a feminist activist for more than a decade. In learning about the social impact and cultural meaning of prenatal diagnosis, I have used standard anthropological methods of participant observation. That professional umbrella is a catchall label for hands-on research that is open-ended, and locates the researcher as far into the experiences of the people whose lives are touched by the topic as she can figure out how to go. My methods have been as conventional as sitting through medical school lectures or interviewing candidates for prenatal diagnosis in English, Spanish, and sometimes French as arcane as learning to recognize and cut up laboratory photographs...

What Are The Types Of Generalized Seizures

There is rarely any difficulty in correctly diagnosing generalized tonic-clonic (GTC) seizures (formerly termed grand mal seizures). The only caution is that toddlers with breath-holding attacks and adults and children with syncope may have brief generalized tonic-clonic seizures at the end of the attack.7 Those brief seizures should not be treated with antiepileptic drugs.

Stages of language development

This is the 'one-word stage' but before children produce words they will show many signs of understanding them (usually at 7-8 months names of familiar others and self will be understood, for instance). Overall research (Fenson et al., 1990) indicates that girls understand more than boys and there is a developmental (vocabulary) spurt at about 12 months. Children produce their first word around 10 months. This work was derived from using the MacArthur Communicative Development Inventories (CDI), which are checklists examining development from 8-28 months old, using infant and toddler scales, focusing on early gestures and then word production.

Agebased Conceptualization of Death and its Behavioural Manifestations

Similarly, toddlers do not understand the concept of death. They do, however, struggle with the impact of death's irreversibility as it clashes with their developmental task of separation. Normally, separation anxiety emerges as a toddler learns that he is an entity independent from his caregiver. He is challenged each time the caregiver leaves, but is then rewarded with a reunion that reconfirms that the caregiver is a stable figure. This teaches the toddler to have expectations in his life. With a death, the reunion never occurs, his sense of consistency is threatened, and regressive or destructive behaviour can ensue (Couldrick, 1991).

Phantasy See Fantasy Phantasy

Practicing subphase (Mahler) The subphase (10-12 to 16-18 months of age) of the separation-individuation process that is initiated by the infant's mat-urational capacity to create physical distance from mother, beginning with crawling and peaking with running, and is at its height with the achievement of upright locomotion. The subphase is distinguished by elation, as the toddler experiences a love affair with the world, and excitement about exploration and his or her own growing ECO capacities and b) the toddler's capacity to reassure himself or herself by returning to mother's physical body if anxiety intrudes. Rapprochement subphasc (Mahler) The subphase of the separation-individuation process following the practicing subphase. It extends from about 16 to 25 months of age. The infant has mastered upright locomotion and now becomes more aware of physical separateness from the mother. The need to share every experience with mother is heightened as the infant's exuberance wanes with...

Determined Digestion What Goes Down Can Stay Down

Avoid cold or raw foods, which may overtax the digestive system. Toddlers quickly develop a taste for fatty, greasy foods like chips, fried foods, or peanut butter. Cutting out these items, despite the protests, will often resolve the vomiting and indigestion challenges.

Pharmacologic Therapy

Immunizations may prevent AOM in certain patients, such as those with recurrent infections. Influenza vaccine is more effective in preventing AOM in children older than 2 years of age than in younger patients possibly from impaired immune responses and immature host defense in infants and toddlers.20 Pneumococcal conjugate vaccine is protective against infection by vaccine serotypes only with a limited overall benefit for AOM.21 Antibiotic prophylaxis is no longer recommended for otitis-prone children because of increasing resistance. Avoidance or minimization of risk factors associated with otitis media, such as tobacco smoke and bottle feeding, is advised, but the effects of these interventions remain unproven.

Normal Development and Feeding

Conceptualization of feeding problems requires an understanding of normal feeding development and of how problems can arise. The complex and dynamic process of feeding involves a sequence of hierarchical steps (e.g., accepting, chewing, propelling, swallowing). Feeding difficulties can occur at any point along this continuum, and the complexity involved during the earliest stages of feeding development may serve as the root of feeding issues (Drewett and Young 1998 Patel et al. 2002). For example, the transition from milk to solid foods represents a period of rapid developmental adaptation for infants and toddlers, and feeding-related difficulties may arise around this time (Drewett and Young 1998). Although the stages involved in feeding remain fairly consistent, parenting practices and a family's cultural beliefs may result in some variations.

Distribution and Incidence

Acute diarrhea is often hyperendemic in certain populations infants and young children in developing tropical countries of Latin America, Africa, and southern Asia persons traveling from industrialized to developing regions military populations stationed in or deployed to tropical areas and toddlers who are not toilet trained and are attending daycare centers. Diarrhea rates in children less than 5 years of age in developing countries range from between three and seven episodes per child each year. The rate of diarrhea for non-toilet-trained infants in day-care centers in urban areas of the United States is comparable to the rate of illness seen in Third World countries. Travelers' diarrhea occurs in 20 to 40 percent of persons visiting high-

The Pediatric History

A good relationship with a child begins by making friends with him or her. Not wearing a white coat may alleviate some of the child's fears, but there are other ways as well. Start by admiring the child's shoes or toy his possessions are more neutral topics for the child to talk about at first than his or her own body or behavior. One of the best ways to make a child feel comfortable is through praise. When talking to a child, it is useful to say, ''Thank you for holding still. That makes the examination easier.'' The use of ''You're a good boy'' or ''You are such a sweet girl'' may produce embarrassment. Therefore, praise should be given for a child's behavior and not for his or her personality. Sharing a book with the child (e.g., as part of the ''Reach Out and Read'' program*) is another useful way to engage the toddler or preschooler. Interviewers are often amazed by how well a child can respond to questions phrased according to these rules. School-aged children can respond to...

Preface to the Sixth Edition

Another feature of this edition is the inclusion of a DVD-ROM that contains step-by-step demonstrations of the complete physical examination of the man and of the breast and pelvic examinations of the woman. The DVD-ROM, playable on your computer as well as on a DVD player, also illustrates the pediatric examinations of the newborn and of the toddler, as well as a new section on the neurologic evaluation of the toddler. Using standardized patients, the DVD-ROM shows history-taking with an adolescent and her mother, as well as interviewing techniques regarding sensitive topics with a geriatric patient. These sensitive topics include a discussion of advance directives (i.e., health care proxy determination and living wills), a mental status examination of a patient with cognitive impairment, and a scenario showing how to give bad news. In addition, this new edition also contains scenarios demonstrating the focused history and physical examination of a young man with abdominal pain,

Examination of the Infant

Heart history of murmur, cyanosis trouble feeding, sweating during feedings, squatting (in older infants and toddlers this is a symptom in children with tetralogy of Fallot, because squatting increases peripheral resistance and decreases the right-to-left shunting across the ventricular septal defect).

Hand Foot And Mouth Disease Clinical Summary

Hand, foot, and mouth disease is a seasonal (summer-fall) viral infection caused by coxsackievirus A16. Toddlers and school-age children are affected most commonly. It is characterized by a prodrome of fever, malaise, sore throat, and anorexia over 1 to 2 days, followed by the appearance of the characteristic enanthem in the posterior oropharynx and on the tonsillar pillars consisting of small, red macules evolving into small vesicles 1 to 3 mm in diameter that rapidly ulcerate. The oral manifestations

Electrical Injury Clinical Summary

Electricity may cause harm by heat generated through tissue resistance or directly by the current on cells. Skin, nerves, vessels, and muscles usually sustain the greatest damage. Many factors affect the severity of injury type of current (DC or AC), current intensity, contact duration, tissue resistance, and current pathway through the body. Those at high risk for electrical injury are toddlers, and people who work with electricity.

Lesch Nyhan Disease Hypoxanthine Guanine Phosphoribosyltransferase Deficiency

Incidence is rare, perhaps 1 in 380,000 births. The disorder occurs in many racial groups equally and is not more frequent in consanguineous populations. Patients are normal at birth, but by 6 months, developmental delay is evident. Axial hypotonia but appendicular spasticity and choreoathetoid movements appear in late infancy, and cerebral palsy is usually diagnosed at this time. The diagnosis is usually suspected in the toddler and early childhood years, when various kinds of compulsive self-mutilation, usually biting of lips, cheeks, or fingers, occur. Dysarthria makes communication difficult, and excitation may stimulate opisthotonus or torsion dystonia. Compulsive aggression can be directed toward anyone near the patient, including family members, and includes hitting as well as abusive language. Associated disorders are various hematological disorders, growth retardation, renal stones, and gouty arthritis if patients survive to adulthood.

Guidelines for Clinical Assessment

Although most children are able to crawl by 9 months of age and walk by 14.5 months, even severely delayed children follow the sequence of crawl, stand, and walk (Milani-Comparetti and Gidoni, 1967). This predictable sequence is dictated by building on previously learned skills, as well as by maturation of the central nervous system (CNS) (Springate, 1981). Before a critical stage in the maturation of the CNS, certain skills cannot be learned regardless of the intellectual potential or will of the child or parent. For example, because CNS control of the external anal sphincter is incomplete before 18 to 24 months of age, it is impossible to toilet-train even the most precocious toddler before this age. Delays in one developmental domain can impair development in another domain. For example, an 18-month-old infant with motor impairments secondary to spina bifida lacks the freedom to explore the environment to learn how two pieces of furniture are oriented in space. Likewise, delays in...

How to Use This Book

Part 5, Ages and Stages, doubles back and goes into depth on each major stage of a child's life from the womb to young adulthood. In each 2- to 6-year stage, this part focuses on the most important challenge and area of development. For a baby, it's learning to trust and becoming mobile for a toddler, it's learning language and becoming capable of self-control for a preschooler, it's developing a self-identity and becoming a social being for an elementary school child, it's learning how to think logically and becoming a worker and for an adolescent, it's building a unique self-identity and becoming a young woman or a young man.

Ascariasis

The giant intestinal roundworm, Ascaris lum-bricoides, is a common parasite with worldwide distribution. Adult worms are 15-35 cm (6-14 inches) long and reside in the lumen of the small intestine. Sometimes, however, they are passed in the feces and, if vomited into the oral cavity, may exit from the host's mouth or nostrils thus they have been known to medical observers for millennia. Female worms produce up to 200,000 fertilized eggs daily, which are passed in the feces. Eggs incubate in soil for at least 2-3 weeks to produce an infective larval stage within them. The eggs are resistant to chemicals, desiccation, and extreme temperatures but mature or em-bryonate most rapidly in warm, moist, shady conditions in clay soils. People become infected by eating embryonated eggs in contaminated food or water or, in the case of toddlers, infection occurs by direct ingestion of eggs with dirt. Poor rural sanitation and the use of human feces for fertilizer obviously favor transmission....

Management

In a study of delirium in pediatric patients in the ICU, children were treated with haloperidol paren-terally or risperidone orally (Schieveld et al. 2007). All patients made a complete recovery from the delirium, although two patients treated with haloperi-dol developed side effects of acute torticollis. Olan-zapine, risperidone, and quetiapine are effective and safe in children and adolescents, and olanza-pine and risperidone are effective and safe in infants and toddlers with delirium (Turkel et al. 2008a, 2008b).

Fathers Chemistry

At the same time, fathers interact with babies and toddlers in different ways than mothers. A father is more likely to jiggle or rock babies in a playful, rhythmic fashion, while women use firm or light touching to soothe and contain them. As children grow older, a father tends to take a more rough-and-tumble approach to their physical care, and to be more challenging and less sympathetic than a mother. Research shows that both approaches are good and necessary for developing children. When the primary attachment is made between mother and baby in her baby's first six months, research has shown that they both typically begin to form much closer relationships with fathers and siblings soon thereafter.

Epidemiology

Tetanus occurs worldwide and is considered endemic in 90 developing countries, but its incidence varies considerably among them. The most common form of the disease, neonatal (umbilical) tetanus, kills at least 500 000 infants each year simply because their mothers were not immunized. Over 70 of these deaths occur in just 10 tropical Asian and African countries. Various customs, such as using dung, dirt or local butter (ghee) to pack the umbilical stump, often are responsible for infant infection.12'13 In addition, an estimated 15 000-30 000 unimmunized women worldwide die each year from maternal tetanus, the result of post-partum, post-abortal or post-surgical wound infection with C. tetani.14 In the United States approximately 50 cases of tetanus are reported each year, mostly in persons aged 60 years or older, but cases in toddlers and neonates also occur.15

Constraints

As the baby becomes a toddler, she learns to regulate her emotional states in response to parental boundaries or constraints, especially when and how often Throughout childhood, there are many times when a parent leads a child and other times when a child leads a parent. The challenge for parents is learning how to appropriately shift back and forth between leader and follower roles with their children. For example, during infancy a child actually wields great power and leads a parent by setting the feeding-sleep cycle. Parental power is introduced later around limit setting. Many parents do not realize how important it is to set limits, even for toddlers. It is easy to give in to their demands. The more difficult but rewarding course is to help them learn the limits of their power. Parents who show empathy to their children and to others, and who set firm limits for their children especially as they reach grade school age, raise children who show high levels of self-discipline and...

Medical Overview

Have lower cognitive abilities later in life (Heffer and Kelly 1994). For example, some early studies suggested that children with severe feeding problems have cognitive delays compared with their healthy counterparts and are more likely to require special education services (Dowdney et al. 1987 Drotar and Sturm 1988). More recent studies, however, found no significant impact on cognitive outcomes of children with failure to thrive after controlling for socioeconomic status (Rudolf and Logan 2005). Moreover, in their systematic review of failure to thrive, Rudolf and Logan (2005) argued that the identified IQ differences found between children with a history of failure to thrive and their healthy counterparts (i.e., 3 points) are of questionable clinical significance. Given the heterogeneity of pe-diatric feeding difficulties, these outcomes may be dependent on the classification schemes used to categorize infants and toddlers with feeding issues.

Assessment Process

Inconsistencies Examples include reported symptoms that do not match objective findings (e.g., a caretaker reports severe anorexia and abdominal pain for 5 days in a child who appears well hydrated with no weight loss) reported medical history that does not match previous medical records (e.g., the parent reports the presence of a diagnosis of a more serious illness that was mentioned to the parent in passing as something to be ruled out, or the parent reports that test results are abnormal just because the test was done) a pattern of frequent diagnoses that do not match objective findings (e.g., a toddler with reported intestinal pseudo-obstruction eats ravenously with no resulting symptoms during lengthy hospitalizations) behavior of a parent that does not match expressed distress or reports of symptoms other false or disturbing history provided by the parent or medical record names and numbers that do not match. Collateral records and interviews with others can be helpful to...

Sleep Refusal

Toddlers often resist going to bed when their parents want them to go. Parents may have difficulty recognizing whether the resistance is related to true needs and fears or whether it is attention seeking or oppositional. The resistance often takes the form of repeated requests for a snack, a drink, or a trip to the toilet and may include fears of noises, shadows, or imaginary monsters.

Night Waking

Nightmares, on the other hand, are frightening dreams that awaken the child from REM sleep. Therefore, they tend to occur during the second half of the night, leaving the child upset or scared with a vivid recall of the dream. The child responds to comforting efforts by the parent but may be slow to go back to sleep because of fear. As with night terrors, nightmares occur most often during the toddler to preschool years and are more common during stressful times.

Statewide System

Prior to 1986, services for infants and toddlers with disabilities typically were provided by a number of different agencies in each state (social services, public health, education), often resulting in service gaps or unnecessary duplication (Gallagher, 1989). IDEA-Part C was designed to encourage states to develop and implement a statewide, comprehensive, coordinated, multidisciplinary, interagency program of early intervention services for infants and toddlers with disabilities and their families (34 C.F.R. 303.1). The law requires each state to identify a lead agency responsible for administration, supervision, coordination, and monitoring of programs and activities in the state. Different states have chosen different lead agencies, including state departments of health, education, and social welfare (Gallagher, 1989). In order to receive funds, each state must have submitted an application to Washington that outlines state policies and procedures for the delivery of services...

Eligible Children

IDEA-Part C defines infant or toddler with a disability to mean a child under 3 years who needs early intervention services because he or she (a) is experiencing developmental delays, as measured by appropriate diagnostic instruments and procedures, in one or more of the areas of cognitive, physical, communication, social or emotional, or adaptive development or (b) has a diagnosed physical or mental condition that has a high probability of resulting in developmental delay. The term also may include, at a state's discretion, at-risk infants and toddlers. The term at-risk infant or toddler means a child under 3 years who would be at risk of experiencing a substantial delay if early intervention services were not provided. The factors that put the child at risk may be biological or environmental (34 C.F.R. 303.16).

Want to Be Me

It's not that the average toddler always wants to be apart from his significant caregiver. The same child who runs and hides behind a sofa to demonstrate his autonomy will cling and cry the next time his mother leaves him in someone else's care. In the short term, says Erikson, when a child is too often and too rigidly prevented from acting independently, his frustration increases. In the long term, he internalizes the overcontrolling behavior of the authority figure. According to Erikson, this can result in the child becoming an inflexible, unyielding adult. Erikson's theory of child development was the first to make connections between how effectively this period of growth is navigated and later personality traits. When a child and his parents successfully navigate this stage the child develops a strong sense of self-control without losing his self-esteem. He is secure, proud, and confident. An unsuccessful navigation of the autonomy-independence conflict produces the opposite...

Complex Sentences

By the time a toddler reaches 24 months of age she is using, on average, 200 words, albeit one or two at a time. If a child of this age is reporting on an important event in her day she might exclaim, for example, Home dada. The same child, on or after her third birthday, is capable of adding complexity to this sentence. Describing the same event she might say My dada home now. Her ability to represent relations between people and things reflects new thinking on this child's part. It also reveals the toddler's developing sense of identity as identified by Erikson and described later in this chapter.

Fast Mapping

When this process of increasing complexity starts, it happens very quickly. The term fast mapping describes how a child determines probable meanings of words she hears based on the context or situation she's in. She doesn't always get her words exactly right, but in a short time the average monosyllabic toddler becomes a relatively sophisticated conversationalist.

Language Milestones

As discussed previously, children learn the rules of language beginning before birth and continuing in earnest throughout their toddler and preschool years. Many key skills are in place by the time they enter first grade. Here is a recap of the behaviors and essential milestones related to language during early childhood

Adding Traits

In the preschool years, the toddler's egocentrism gives way to a concern about what others think and feel. Before this point, when what is true only revolves around themselves, children have a distorted view of people and objects. Now, at 4 and 5, they're embarrassed when they attract unwanted attention. Now they feel pride for their accomplishments and envy when other children receive praise. And although a 3-year-old can readily believe she has superpowers, a 6-year-old knows her limits and puts more stock in the rules.

Experiment

The essence of the inter-modal preferential looking, which was specifically designed for experimental research on young children's language comprehension, is that an auditory stimulus (in this case a word) is presented via a loudspeaker located in the middle of two video screens, one of which shows a target item and the other a carefully matched item. At the start of each trial the toddler can see both screens and the amount of looking to each is recorded. Then, after a specified time, the target word is played through the loud speaker and looking times are recorded. The critical comparison is between looking time to each screen before the word presented and looking time to each screen after the word is presented. In theory, before they hear a word, toddlers should look at each screen for a similar amount of time, providing that the two stimuli are equally unfamiliar and equally attractive. Then, after hearing a word, infants should show more looking to the screen that matches the...

Recurrent Infections

An estimated 3 to 8 of girls and 1 to 2 of boys will have a UTI (Foxman, 2002 Hellstrom et al., 1991). Pyelonephritis is a clinical diagnosis and is the most common documented serious bacterial infection in febrile infants. Cystitis is common in school-age children and adolescents and, as a general rule, is not a condition of infants or pre-toilet-trained toddlers. Risk factors for UTI range from constipation and dysfunctional voiding to congenital uropathies. Presenting symptoms vary with age and site of infection and may be nonspecific in younger children. Pyelonephritis in infants, for example, may present with fever, irritability, vomiting, diarrhea, poor feeding, or failure to thrive. School-age children and adolescents may present with fever, vomiting and flank pain. Symptoms of cystitis are more common after age 2 years and may include dysuria, frequency, urgency, and low-grade fever (< 38.3 C).

Visual Loss

Fewer children appear to have visual loss at diagno-sis.19,48,76 The explanation for this discrepancy is unclear it may be due to the lack of awareness among children of a progressive narrowing of the peripheral fields. Toddlers, in particular, can become virtually blind before the extent of visual loss becomes apparent. All patients with craniopharyngiomas should have assessment of visual acuity and a complete visual-field examination before any treatment and then at intervals after treatment at follow-up evaluations.

PluggedIn Kids

Overly eager parents who buy educational DVDs to turn their toddlers into the next Einstein or Shakespeare should know these products don't appear to have any beneficial effect. Babies learn language best from a live human speaker, not a screen. Another tidbit from the research babies learn a word faster when they hear several people say it, not just one.

Internet Resources

NATIONAL DISSEMINATION CENTER FOR CHILDREN AND YOUTH WITH DISABILITIES (NDCCYD) A central source of information on disabilities in infants toddlers children and youth IDEA, which is the law authorizing special education No Child Left Behind (as it relates to children with disabilities) and research-based information on effective educational practices. The center provides information about disabilities to families, educators, and other professionals and also serves as a referral center. The center and its website offer services in Spanish, too. OFFICE OF SPECIAL EDUCATION PROGRAMS (OSEP) Dedicated to improving results for infants, toddlers, children, and youth with disabilities from birth through age twenty-one by providing leadership and financial support to assist states and local districts. The IDEA authorizes formula grants to states and discretionary grants to institutions of higher education and other nonprofit organizations to support research, demonstrations, technical...

Distraction

Are adapted according to the age and developmental level. Rocking, patting, a pacifier, or a toy with lights and sounds can help distract an infant. Toddlers respond well to blowing bubbles, party blowers, and interactive books. With older children and adolescents, distraction techniques include listening to music, playing video games, working on riddles, or watching movies or television shows during the procedure.

Patient Satisfaction

Response to injury, and probable response to the application and wearing of a splint. For example, splinting materials or designs for adult patients may not be appropriate for a thumb-sucking toddler whose hand is frequently moist. A complicated splint could further confuse a forgetful geriatric patient, and a shy teenager may not comply with a schedule that requires wearing a splint to school.

Vnii3 Ascariasis

The giant intestinal roundworm, Ascaris lumbri-coides, is a very common parasite with a worldwide distribution. The adult worms are 15 to 35 cm (6 to 14 inches) long and reside in the lumen of the small intestine. Sometimes, however, they are passed in the feces and, if vomited into the oral cavity, may exit from the host's mouth or nostrils thus they have been known to medical observers for millennia. Female worms produce up to 200,000 fertilized eggs daily, which are passed in the feces. Eggs incubate in the soil for at least 2 to 3 weeks to produce an infective larval stage within them. The eggs are very resistant to chemicals, desiccation, and extreme temperatures, but they mature or em-bryonate most rapidly in warm, moist, shady conditions in clay soils. People become infected by eating embryonated eggs in food or water contaminated with feces or, in the case of toddlers, infection occurs by direct ingestion of eggs with dirt. Poor rural sanitation and the use of human feces for...

Imported Diseases

Along with internecine warfare and the usual natural disasters that led to famine and water shortages, diseases in this region caused extensive loss of life before preventive or curative methods were successful. Endemic diseases regulated fertility and mortality over time epidemics of new diseases often caused severe depopulation in all age groups when first introduced. The latter were devastating not just because of their initial toll but also because the loss of mature adults reduced the group's ability to provide food, shelter, and nursing care for itself or to reproduce itself. Pneumonia, diarrheal diseases, and-if present - malaria are still major causes of severe morbidity and mortality for infants and toddlers in the region (Prior 1968 Moodie 1973 Marshall and Marshall 1980 Townsend 1985).

Immunity

Acquired immunity in malaria is species-specific and also specific to stage, that is, to the sporozoite, to the asexual forms in the blood, or to the sexual stages (Clyde 1987). In endemic areas, newborns may be protected for a few months by maternal antibodies that have crossed the placenta. After this phase of protection, however, infants and toddlers are especially vulnerable most of the severe illnesses and deaths due to malaria in endemic regions occur in these early years. Older children and adults gradually acquire immunity with repeated exposure to infection. This partial immunity (premunition) is sustained in the presence of low densities of parasites in the blood. In premune individuals the spleen may remain enlarged hence the spleen rate may be relatively high in an adult population despite a low parasite rate. With prolonged exposure and infection, however, as in a holoendemic area, eventual spleen scarring and shrinkage leads to a low adult spleen rate. Attenuated malaria...

Nutrition

For a toddler or older child, determine how many ounces of milk and juice the child drinks. Inquire about the daily consumption of vegetables, fruit, protein, and ''junk foods.'' Does the child take a vitamin supplement It is also valuable to ask about the meal pattern Does he or she eat breakfast, lunch, dinner, and snacks Where does he or she eat With whom Older children and adolescents eat many meals away from home such patients are your best source of information about their eating patterns.

Equipment

The LMA consists of a short-curved tube connected to a small mask with inflatable cuff. The shape promotes blind insertion with an endpoint detected as resistance, as the leading edge of the cuff just enters and obstructs and the esophageal inlet. The inflated cuff then seals around the laryngeal inlet. The distal mask incorporates a small grate to prevent prolapse of the epiglottis within the mask. The LMA has several configurations including a disposable model, the LMA Unique and a model that facilitates blind oral intubation, the intubating LMA, or I-LMA. LMAs are available in three adult sizes, 3 (30-50 kg), 4 (50-70 kg), and 5 (> 70 kg). They are also available in pediatric sizes from size 0 to 2.5 for infants through toddlers.

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