NR602_W2_ClinicalPearlWorksheet

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Dec 6, 2023

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NR602 Clinical Pearl Worksheet Name: Carefully read the assignment guidelines and rubric and complete each section of the worksheet below. Topic 1 Topic name Cognitive developmental milestones Negative interactions/behav iors The mother is frustrated that the toddler can not complete a jigsaw puzzle. She got upset with the toddler when he was playing on her phone. The mother uses a bottle, pop, and TV to occupy the toddler. Positive interactions/behav iors The mother brought the toddler in because she was concerned that the toddler could not complete a jigsaw puzzle. The mother reads stories to her child. The toddler was familiar with the book, and when the mother asked him to turn the page, the toddler did. The mother used a soft, pleased tone and told the toddler, "Good job." The mother reports the toddler uses 2-3 words. Verbalizes what he 0320 RB/KK

wants by pointing or saying "milk-milk, wa-wa." The toddler imitates the mother by playing with pots and pans, pretending to cook per mom. Guidelines and recommendations During this stage, children learn to sound words, recognize objects, follow simple directions, and imitate what they see. Reading daily is recommended for cognitive development. Jigsaw puzzles are recommended for four years old and up (Centers for Disease Control and Prevention, n.d.). For cognitive development, open-ended toys are recommended (Cankaya et al., 2023). Bottle, sugary drinks, and TV will be addressed later in the conversation. Professional/ethic al communication I am glad you brought your child in today to discuss his cognitive development. You are doing great by reading him stories. Brain development up to 5 years of age is significant. It sets the tone for how well your child will read and excel in his later years. You may also want to replace the jigsaw puzzle with blocks, matching shapes, and interactive toys, which are great for cognitive development. As your child presses the pic of a dog, the toy will say “dog.” I know toys can be expensive. You can always find things from a second- hand store or Dollar Tree. If you get toys from a second-hand store, 0320 RB/KK

disinfect the toy before allowing your toddler to play with it. You can help your toddler by sounding out what he is trying to say. For example, you said your toddler says wa-wa; if he refers to water, you can say, “Yes! Water! Good job!” APA reference Cankaya, O., Rohatyn-Martin, N., Leach, J., Taylor, K., & Bulut, O. (2023). Preschool Children’s Loose Parts Play and the Relationship to Cognitive Development. Journal of Intelligence , 11 (8), 151. https://doi.org/10.3390/jintelligence11080151 Centers for Disease Control and Prevention. (2021, February 22). Child Development Toddlers 1-2 Years Old . https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/ toddlers.html Topic 2 Topic name Social-emotional developmental milestones Negative interactions/behaviors The mother carries an open bottle of alcohol in her purse. She also has prescription drugs in her bag, which, during the interview, placed the meds near the child, and the toddler did get access to the 0320 RB/KK

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drugs. The mother reports feeling anxious, tired, and in pain due to a recent car accident she was involved in. She also says she is unemployed at this time. She is preoccupied with her phone during the interview. She did turn her back to the toddler multiple times, leaving the toddler at risk for injury. The mother grabbed the bottle from the toddler's hands and repeatedly asked for a kiss. Then she said, “he doesn’t want to kiss me.” The mother often uses a loud voice. The mother's tone is angry. She uses hand gestures combined with a loud voice towards the child. She uses a bottle and TV to keep the child occupied. The toddler did not smile or interact with the interviewer. He did not attempt to get up from the exam table. He did not display affection toward his mother. Positive interactions/behaviors The mother did stroke the toddler's head. She did praise him when the toddler turned the page in a book with a "Good Job." Guidelines and recommendations Social-emotional development can be affected by childhood traumas, known as ACEs. ACEs later in life can lead to drug abuse, depression, cardiac and respiratory issues. For healthy emotional- social development, a calm and nurturing environment is desired 0320 RB/KK

(Illinois Department of Public Health, n.d; Loveday et al., 2022). Professional/ethical communication Obviously, you love your child, and your child can feel that through your touch and soft tone of voice. When you praise him and stroke his head, positive interaction with your toddler will strengthen your bond. Your toddler is learning his social-emotional cues from you. Children will develop and display their personality by being friendly or quiet at this stage. They will play side by side instead of direct play (Cankaya et al., 2023). It is essential to answer your toddler's needs so he can grow to trust you. I recommend you don’t leave your phone out if you do not want him to play with it. A toy phone is appropriate for his age (Cankaya et al., 2023). Your toddler is learning how to respond to stressful situations by watching you. So, I recommend setting up playtime with your son and turning off other distractions like phones or TVs. During this play time, you can pretend play, take turns, and display healthy emotions. I want to mention that it is vital to watch your interactions with others around your toddler as they are learning to imitate what they 0320 RB/KK

see (Loveday et al., 2022; Cankaya et al., 2023). APA reference Cankaya, O., Rohatyn-Martin, N., Leach, J., Taylor, K., & Bulut, O. (2023). Preschool Children’s Loose Parts Play and the Relationship to Cognitive Development. Journal of Intelligence , 11 (8), 151. https://doi.org/10.3390/jintelligence11080151 Illinois Department of Public Health. (2023). Positive and Adverse Childhood Experiences (PCEs/ACEs) . https://dph.illinois.gov/topics- services/life-stages-populations/maternal-child-family-health- services/child-health/adverse-childhood-experiences.html Loveday, S., Hall, T., Constable, L., Paton, K., Sanci, L., Goldfeld, S., & Hiscock, H. (2022). Screening for adverse childhood experiences in children: A systematic review. Pediatrics , 149 (2). https://doi.org/10.1542/peds.2021- 051884 Topic 3 Topic name Safety 0320 RB/KK

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Negative interactions/be haviors The mother turned her back to the toddler multiple times during the interview. She was preoccupied with her phone and left the child unattended. She left a prescription bottle that was not completely shut in the toddler's reach. The toddler did access the pills, and when the drugs fell on the table and the floor, the mother did not remove the pills from the child's proximity. She further asked the toddler to pick up the pills and put them back into the medication bottle. The mother reports the toddler, "Always throwing my pills away." She admits to leaving cigarettes all over the house, and the toddler does access the cigarettes and chews. The mother states, "It's okay if he chews it because I know he is teething as long as he does not swallow." She admits to smoking around the house, including in the rooms where the child plays and eats, like the kitchen area and the living room. Positive interactions/be haviors The mother has the poison control phone number programmed on her phone and readily available around the house. She had reached out to poison control when she was not sure if the toddler consumed cigarettes. 0320 RB/KK

She does not smoke around the toddler, and she also does not smoke where the toddler sleeps. Safety gates are at the bottom and top of the stairs and the basement entrance. She also cooks on the back burner and has the pot handles facing away. The mother states, "I know he can reach up there and get burned." The mother supervises the toddler during bathing and around any water. Guidelines and recommendati ons Poison control should immediately be contacted if the child has chewed or swallowed tobacco products or, consumed any amount of medication that was not prescribed specifically for the person, or accidentally given more than the ordered dose (Illinois Poison Center, n.d.a,b). It is recommended medications, cleaning supplies, and sharp objects be locked. Another recommendation is to use child-proof medication bottles to decrease easy access by children (Illinois Poison Control, n.d.b). CDC recommends that all the rooms in the house should be smoke-free, even if the toddler is not accessing that one designated smoking room. Smoke can travel through the ventilation systems. Smoking in the car with windows open is no longer recommended. The wind carries the smoke particles back into the car (Centers for Disease Control and Prevention, 0320 RB/KK

n.d.). Guidelines and laws are in place to protect children and the public from second-hand smoke. The Smoke-Free Act in IL became law in 2008. The 10 ILCS 82 prohibits smoking indoors in public or private establishments like restaurants, schools, and bus stops, and must be 15 feet away from the establishment's windows or doors. Violators can be fined from $100 to $2500 (Illinois General Assembly, n.d.). Professional/et hical communicatio n You might have saved your child's life by contacting the poison control. Great job, MOM! Keeping cigarettes out of his reach is very important. Chewing tobacco can also cause harm to your toddler. It is highly toxic. The poison enters your toddler's bloodstream through absorption inside his cheeks and saliva. It can also get into his eyes. Signs of tobacco poisoning are vomiting, sleepiness, extreme sweating, and seizure, which can lead to death (Illinois Poison Control, n.d.a). So, again, great SAVE! Another thing I wanted to mention is that when your child dropped the medication bottle, you were asking him to put it back into the bottle; you were teaching him to pick up after himself, and that's great. But, it is imperative for his safety that he does not have any access to medications, 0320 RB/KK

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even Tums or Maylanta. Tums are not going to cause significant harm except discomfort and constipation, but prescription drugs can cause liver damage, retardation, overdose, and death (Illinois Poison Control n.d.b ). Toddlers are highly quick to put things in their mouths. The moment you turn your back to your toddler, those pills may go into his mouth. They say the best treatment is prevention. Medications, cleaning supplies, and sharp objects should be locked. Also, use child-proof medication bottles (Illinois Poison Control, n.d.b). I think it is great that you are not smoking around your child to protect him from upper respiratory infections or developing asthma or cancers later on in life. Many studies have documented that second-hand smoke exposure can stunt the child's growth, cause asthma ( Nadhiroh et al., 2020), and increase ear infections (Johnson et al., 2021.) You also want to protect your toddler from second-hand marijuana. Second-hand smoke exposure to marijuana has been growing upper respiratory infections (Johnson et al., 2021). I know you are not smoking around your toddler or in his room, but recent studies have found that the smoke particles travel from room to room 0320 RB/KK

through vents around the house and that air purifiers are not enough to trap the carcinogenic particles. So, it is now recommended not to smoke indoors, even in parks or cars with open windows, because the particles can be carried up to 15 feet. You can further protect your toddler from second- hand smoke exposure by asking people not to smoke in your house and inquire about the smoking policies at the daycare center (Centers for Disease Control and Prevention, n.d.). If you are dropping off your child to a babysitter, you can request they don't smoke in the house or, if possible, have them babysit in your non-smoking home. I know this might not always be feasible. You are doing your best. APA reference Centers for Disease Control and Prevention. (n.d.). How We Can Protect Our Children from Second Hand Smoke. Retrieved from https://www.cdc.gov/tobacco/basic_information/secondhand_smo ke/protect_children/pdfs/general-population-p.pdf Illinois General Assembly. (2008, January 1). Public Health 410 ILCS 82/ Smoke Free Illinois Act. Retrieved from https://www.ilga.gov/legislation/ilcs/ilcs3.asp? ActID=2893&ChapterID=35 Illinois Poison Center. (n.d.a). Chewing Tobacco . https://www.illinoispoisoncenter.org/my-child- 0320 RB/KK

ate/chewing-tobacco Illinois Poison Center. (n.d.b). Medication safety . https://www.illinoispoisoncenter.org/health- safety/medications-and-first-aid/medication-safety Johnson, A. B., Wang, G. S., Wilson, K., Cline, D. M., Craven, T. E., Slaven, S., Raghavan, V., & Mistry, R. D. (2021). Association Between Second- hand Marijuana Smoke and Respiratory Infections in Children. Pediatric Research , 91 (7), 1769- 1774. https://doi.org/10.1038/s41390-021-01641-0 Nadhiroh, S., Djokosujono, K., & Utari, D. M. (2020). The Association Between Second-hand Smoke Exposure and Growth Outcomes of Children: A Systematic Literature Review. Tobacco Induced Diseases , 18 (12). https://doi.org/10.18332/tid/117958 Topic 4 Topic name Temper tantrums and discipline 0320 RB/KK

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Negative interactions/behaviors The mother uses "no" and a loud voice to discipline the toddler. She admits to telling the child "no, repeatedly and don't do that, stop" and reports "he still does not listen." The mother grabbed the phone from the toddler and said the child was always on her phone. Positive interactions/behaviors The mother replaced the phone with a puzzle. However, the jigsaw puzzle is not appropriate for his age. Guidelines and recommendations As toddlers become more independent, you might notice more mischievous behaviors. It is recommended to set rules and stick to them. Tantrums may last up to 4 years of age. Assessing your child to see why they are throwing a tantrum is recommended. Does he need to be changed, lack of sleep, hunger, or wants the other toy? If his temper lasts more than 15 min, or he is biting and kicking others or himself, let the PCP know (Child Mind Institue, n.d; Cleveland Clinic, n.d.). Professional/ethical communication When you took the phone away from your toddler, you gave him puzzles, which was great. In a way, you were using a re-direction approach. I also noticed you provided positive reinforcement when your child turned the page like you asked. The re-direct approach replaces the word "no." Instead of telling your toddler No, try saying in a very upbeat, happy voice, "You can 0320 RB/KK

play with the puzzles,” "Now mommy needs her phone, thank you, good job." This approach will provide the child with some control over the situation. You will see more positive behaviors as you praise your toddler for good behavior. You want to model what you want to see (Child Mind Institute, n.d.). APA reference Child Mind Institute. (2023, October 23). How to Handle Tantrums and Meltdowns . https://childmind.org/article/how-to-handle- tantrums-and-meltdowns/ Cleveland Clinic. (2021, May 2). Temper Tantrums . https://my.clevelandclinic.org/health/articles/14406- temper-tantrums Topic 5 Topic name Sleep routines Negative interactions/behavior s The toddler does not have a sleep schedule. The mother has difficulty waking the toddler from his sleep. She reports "pushing and pushing on him." She has a difficult time putting him to sleep. 0320 RB/KK

The toddler has a TV in his room, and the mother uses the TV as a sleep aid. She is taking Xanax herself and admits to not hearing the toddler while she is sleeping. She admits to giving the toddler soda and a bottle. Positive interactions/behavior s The mother is concerned about her son's sleeping patterns. She is inquiring about Xanax or Benadryl as a sleep aid for the toddler, and she did not administer any sleep aid without a PCP consult. She admits to being anxious, and she is seeking help. She does brush the toddler's teeth in the am and at bedtime. Guidelines and recommendations It is recommended for children to have a bedtime routine to promote good sleep hygiene and prevent sleep disorders (American Academy of Sleep Medicine, n.d.). TV and screen time should be limited and not recommended at bedtime. Studies show that bedtime TV reduces duration and sleep quality (Janssen et al., 2020). It is recommended that total sleep time, including two naps in 24 hours, is 10 to 14 hours for toddlers (Centers for Disease Control and Prevention, n.d.a) Professional/ethical communication It is good parenting that you are monitoring your child's sleep. 50% of children can have sleep disorders. Lack of sleep can cause your child to be cranky, have poor attention, bed wetting, and later might even 0320 RB/KK

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affect his performance in school ( American Academy of Sleep Medicine, n.d.). Let's address your concerns about your toddler's sleep habits. First, I don't want you to worry about him sleeping for 10 hours. Toddlers sleep 11 to 14 hours in 24 hours. So your toddler can sleep 10 hours at night and take 2 hours a mid-morning nap and another 2 hours mid-afternoon nap (Centers for Disease Control and Prevention, n.d.a). You mentioned you are having difficulty getting him to sleep and are inquiring about Xanax or Benadryl for your toddler to sleep. You also said being tiered and anxious because when we are overwhelmed or exhausted, we might not be in the best head space to make good decisions. So, I applaud you for not just giving your child the Benadryl to sleep since this is OTC. Benadryl is not recommended for children under six years of age. Also, remember to use the measuring cup included for safe dose administration (American Academy of Pediatrics, n.d.). 0320 RB/KK

You are taking the right actions by including brushing your child's teeth in his bedtime routine. After two years of age, you can use pea- size fluoride toothpaste to decrease tooth decay (Centers for Disease Control and Prevention, n.d.b). Caring for a toddler without a good sleep cycle can be challenging. I want to share some recommended tips that should help tremendously. Reduce the toddler's sugar intake. Soda pop is not recommended. You might even want to dilute the juice with water to decrease the sugar content. Sweets provide your child with energy, can lead to childhood obesity, and are known to cause tooth decay. Water and milk are the best options for your toddler. It provides the hydration and nutrients he needs (Centers for Disease Control and Prevention, n.d.b). A warm bath can be soothing before bedtime (American Academy of Sleep Medicine, n.d.). But if you are too tired, this does not have to be part of your routine. 0320 RB/KK

Include potty time before bed, reducing your child's need to get out of bed multiple times. Instead of TV or screen time before bed, read a bedtime story, gently stroke his back, dim the lights, white noise, or a soft sleep lullaby can induce sleep and relaxation for your toddler ( American Academy of Sleep Medicine, n.d.; Janssen et al., 2020). Have a set sleep and wake-up time for your toddler. A fixed bedtime and having a routine provide your child with emotional stability. Also, sticking to a bedtime schedule helps your child's body physically and mentally anticipate that it's time to sleep (American Academy of Sleep Medicine, n.d.). APA reference American Academy of Pediatrics. (2023). Diphenhydramine Dosing Table . https://www.healthychildren.org/English/safety-prevention/at- home/medication-safety/Pages/Diphenhydramine-Benadryl- Antihistamine.aspx American Academy of Sleep Medicine. (2023, February 22). Sleep 0320 RB/KK

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Disorders in Children . https://sleepeducation.org/sleep-disorders-in- children/ Centers for Disease Control and Prevention. (2022, September 14a). How Much Sleep Do I Need? https://www.cdc.gov/sleep/about_sleep/how_much_sleep.ht ml Centers for Disease Control and Prevention. (2023, February 1b). Children's Oral Health . https://www.cdc.gov/oralhealth/basics/childrens-oral- health/index.html Janssen, X., Martin, A., Hughes, A. R., Hill, C. M., Kotronoulas, G., & Hesketh, K. R. (2020). Associations of Screen Time, Sedentary Time and Physical Activity with Sleep in Under 5s: A Systematic Review and Meta-Analysis. Sleep Medicine Reviews , 49 , 101226. https://doi.org/10.1016/j.smrv.2019.101226 0320 RB/KK

NR602_W2_ClinicalPearlWorksheet

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