Positive Parenting Tips for Toddlers
Hearing loss in a young child is ignored. The toddler seldom offers complaints, only the mother or another family member. The subtle findings of chronic middle ear fluid may be missed. Moreover, there may be a sensorineural hearing loss and no middle ear problem. A careful history, examination, tympanometry, and hearing evaluation will pick up most of these problems. See pages 65-67 and 97-99.
Benign paroxysmal vertigo is reflected by the recurrence of events of brief dysequilibrium in young children. When the attacks occur, the child appears frightened and off balance, often reaching out to steady himself. The events may be associated with nystagmus, diaphoresis, nausea, and vomiting. These attacks occur in toddlers and young children but typically resolve by age 5 years. Neurologic examination, development, and EEG are normal. A later association with migraine has been reported (21).
Puerto Rican families often emphasize the child's behavior both at home and in public. They underline the necessity of children to be obedient, to follow rules, and to conform in classroom settings (Zayas and Solari 1994). Re-latedness and proper demeanor are highly valued, and parents prefer the child to be educado (well brought up), amable (polite and gentle), and tranquilo, obediente, and respetuoso (calm, obedient, and respectful). In contrast to Anglo-American mothers' concern with instilling in their toddlers an optimal balance of autonomy and relatedness, mainland Puerto Rican mothers focus on contextually appropriate levels of relatedness (R.L. Harwood et al. 1995). Puerto Rican parents also believe in social control based on strong family attachments and direct parental control based on discipline and coercion (Hagan 1989 Hirschi 1969 Paterson 1982).
There is a dramatic shift in cognitive functioning from the here and now concrete operational thinking of latency to the future oriented formal operational thinking of early adolescence. As a result, early adolescents, even more so brilliant ones, are confronted with a developmental milestone in cognitive functioning that is very similar to the toddler. They must grapple with the excitement of being exposed to a rapidly expanding world of information and ideas, while also struggling with the terror of becoming insignificant and lost in the sudden and massive expansion of their universe.
While early adolescence can be an exceptionally fascinating and creative time, it is also a very difficult time. This is particularly true for gifted teenagers. The more brilliant they are as toddlers, the earlier they begin to judge their world. Hence, the more primitive their judgments are. This intense primitiveness creates an inner world that is very black and white, all or nothing, perfectionistic, rigid, cruel, unrelenting, and unforgiving. Trying to make sense of the bewildering world around them, infants also take responsibility for every
PCA is a computerized, self-administered delivery system first used in adults. Children as young as 5 years old can appropriately use the apparatus. This technique allows for single loading doses and continuous background infusions to be administered in addition to the PCA bolus dose (104). The use of continuous nighttime infusions added to PCA have shown improved sleep and analgesia (105). However, the use of around-the-clock, continuous background infusions have been associated with higher PCA intake (106). PCA has been adapted for use by parents and caretakers for toddlers and older children who are not cognitively or physically capable of executing the self-activated PCA demand button. PCA by proxy has been administered as nurse-controlled or parent-controlled analgesia yet has been associated with a higher incidence of side effects, with oversedation the main adverse event.
Encourage increased oral fluid intake in proportion to losses provide a varied selection of beverages (specify) if the fluid volume deficit is caused by diarrhea, allow child to request oral fluid preferences or provide ORT solutions start with rapid replacement for 4 to 6 hours and continue over 2 4 hours for maintenance therapy as tolerated Infant 150 ml kg day Toddler 120 ml kg day Preschool 100 ml kg day School-age 75 ml kg day
In airplanes, advanced seat selection can help minimize some of the stress of traveling with children. On intercontinental flights, infants can use fold-out cots attached to walls in front of the bulkhead (front row) seats. Without impeding parental leg room, children can thus stretch out for restful sleep. Families with toddlers should have aisle access for 'walks' around the cabin during long trips. Older children can select air seats with care to obtain a good view of the video screen.
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