THE TODDLER
This is Erikson’s stage of developing autonomy. However, the need to explore the world and be independent is in conflict with the basic dependency on the parent. This often results in frustration and negativism. The toddler may be difficult to examine; do not take this personally. Since he or she is acutely aware of the new environment, the toddler may be frightened and cling to the parent. Also, the toddler has fear of invasive procedures an dislikes being restrained.
Position
• The toddler should be sitting up on the parent’s lap for all of the examination. When the toddler must be supine (as I the abdominal examination), move chairs to sit knee-to-knee with parent. Have the toddler lie in the parent’s lap with the toddler’s legs in your lap.
• Enlist the aid of a cooperative parent to help position the toddler during invasive procedures. The child’s legs can be captured between the parent’s. an arm of the parent can encircle the child’s head, holding it against the chest and the other arm can hold the child’s arms.
Preparation
• Children of 1 to 2 years of age can understand symbols, so a security objet, such as special blanket or teddy ear, is helpful.
• Begin by greeting the child and the accompanying parent by name, but with a child to 6 years old, focus more on the parent. By essentially “ignoring” the child at first, you allow the child to adjust gradually and to size you up from a safe distance. Then turn your attention gradually to the child, at first to a toy or object the child is holding, or perhaps compliment a dress, the hair, or what a big girl or boy the child is. If the child is ready, you will note these signals: eye contact with you, smiling, talking with you, or accepting a toy or a piece of equipment
• A 2-year-old child does not like to take off his or her clothes; have the parent undress the child one part at a time.
• Children 1 or 2 years of age like to say “No.” Do not offer a choice when there really is none. Avoid saying “May I listen to your heart now?” When the 1- or 2-year-oold child says “No,” and you go ahead and do it anyway, you lost trust. Instead, use clear firm instructions, in a tome that expects cooperation, “Now it is tie for you to lied down so I can check your tummy.”
• Also, 1- or 2-year-old children like to make choices. When possible, enhance autonomy by offering the limited option, “Shall I listen to your heart next or your tummy?”
• Demonstrate the procedure on the parent
• Praise the child when he or she is cooperative
Sequence
- Collect some objective data during the history, which is a less stressful time. While you are focusing on the parent, note the child’s gross motor and fine motor skills and gait.
- Begin with “games, the Denver II test, or cranial nerve testing.
- Start with non-threatening areas. Save distressing procedures, such as examination of the head, ear, nose or throat, for last