1. Promoting Optimum Health During Toddlerhood
By: Dr. Omayyah Nassar

2. Objectives
By the end of this topic the students will be able to: Assess the nutritional needs for toddler Discuss the sleep and activity pattern among toddlers Discuss the dental care for toddlers Discuss Safety promotion and Injury Prevention during infancy

3. Nutrition
During the period from 12 to 18 months ,the growth rate slows decreasing the child's need for calories, protein, and fluid.

4. Nutrition
The protein(13 g/day) and caloric intake requirements are still relatively high to meet the demands for muscle tissue growth and high activity level .
The need for minerals such as iron, calcium, and phosphorus may be difficult to meet due to eating habits of toddlers
Toddler require three meals and two snacks per day

5. Physiologic anorexia
Physiologic anorexia: is a phenomenon that most toddler at approximately 18 months of age manifest decreased nutritional need with a decreased appetite.

6. Physiologic anorexia
They become fussy eaters, picky, and have strong taste preferences.
They may eat large amounts one day and almost nothing the next day.

7. Nutrition Toddlers demonstrate the following habits regarding food:
A- They are aware of the nonnutritive function of food such as
- the pleasure of eating
- the social aspect of mealtime

8. Nutrition
B- They are influenced by factors other than taste when choosing food.
C- They imitate family members habits
D- They refused is overfilled, plate
E- They refused nonappetizing food

9. EPB
Picky eating period during toddlerhood is considered a developmental phase
(Parks,et al., 2016)

10. Ritualism
Ritualism influence certain principles of feeding among toddler such as have the same dish, cup, and spoon every time they eat

11. Nutrition
By 12 months of age, most toddler are eating the same food prepared for rest of family.
Some toddlers may have mastered using a cup with occasional dropping

12. Nutrition
Toddlers cannot skillfully use a spoon until 18 months of age or later
Toddlers prefer using their fingers.

13. Nutritional counseling
Lifetime eating habits may be established during toddlerhood
Cardiovascular diseases and obesity can be prevented by healthy eating habits of toddlers and their families

14. Nutritional counseling
If food is used as a reward or sign of approval , a toddler may overeat for nonnutritive reasons.
Mealtimes should be joyable rather than times for discipline or family argument.

15. Nutritional counseling
Mixed foods are rarely favorites.
Use plastic dishes and cups, for both economy and safety.
Avoid eating during play to prevent choking.

16. large round foods should be avoided (hot dogs, grasps, peas, carrots).
Why?????
Because mastication skills continue to mature and this put toddler at risk of chocking

17. Nutritional counseling
Small amount of vegetables and meat supply greater nutritional value than a large eating of potato or bread

18. Dietary Guideline 2- 3 years: Calories intake 1000-1400 After 2 years:
Children can be given low-fat milk to reduce daily fat intake to 30%

19. Dietary guideline My Plate:
A colorful plate shows the five main food groups
Grains, fruits , vegetables, protein and diary

20. Dietary guideline Milk intake should be 2-3 servings per day
Iron fortified cereals and iron- rich foods are recommended for all children beyond 6 months of age.

21. Dietary guideline
Provide an iron-rich diet that includes heme and non-heme iron sources (red meats, poultry الدواجن, fish, green leafy vegetables, dried fruit, beans)
limit whole milk consumption.
Iron supplementation may be necessary in some cases.

22. Dietary guideline
Adequate intake of calcium for the child 1to 3 years of age is 500 mg.
Sources for calcium : whole milk, cheese, yogurt, beans, and vegetables (broccoli, collard greens ,الكرنب)

23. Dietary guideline
Adequate vitamin D intake is essential to prevent rickets, a recommended dose is 400 IU daily.
Sources of vit D: fish, fish oils, egg yolks,
Vit C enhances iron absorption (fruit juice)

24. Dietary guideline
It is recommended that toddlers have one cup of fruit servings each day.
Vitamin C enhances iron absorption.
Glass of fruit juice equals one fruit serving

25. Dietary guideline
High intake of juice can contribute to diarrhea, over nutrition or under nutrition, and the development of caries
Fat restriction is not appropriate for toddlers.
Thirty percent of calories should come from fat.

26. Sleep and activity
Total sleep decreases only slightly during the second year and averages about 12 hours a day.
Most children take one nap a day.
Children reach an adult pattern of sleep by 3 years of age.
Sleep problems are common:
Going to bed.
Falling sleep.

27. Sleep and activity Toddlers have bedtime resistance such as:
Refusal to go to be
Frequent night waking
Providing transitional objects, such as a favorite stuffed animal or blanket, can help ease the toddler insecurity at bedtime

28. EBP
Consistent bedtime routine is associated with better sleep pattern and decreased waking (Mindell, Li, Sadeh, et al., 2015)

29. Toddler may need light snack before bedtime
Heavy meal immediately before bed time may interfere with the ability to sleep

30. Suggestions for better sleep
Keeping television out of child room
Making hour before bedtime quite time of reading story
Avoid stimulation activities bedtime such as computer games

31. Toddler Activity A toddler's activity level is high
There is rarely a problem with too little physical exercise
Parents should not apply inappropriate restrictions on toddler activity

32. Toddler Activity
Toddlers who being cared out side home in centers or (e.g., Kindergartens) should be encouraged to paly in outdoor safe environment or in a large indoor play area

33. Dental Health
Regular dental examinations By American Academy of Pediatric Dentistry (2014)
Every child have an oral health examination by dentist at 6 months old
If toddler is in high-risk category for caries, the visit should be by 6 month old or within 6 month of the eruption of first tooth

34. Dental Health Initial visits to dentist should be:
1- non-traumatizing.
2- Focused around meeting the dentist, seeing the equipment, and sitting in the chair

35. Dental Health
3- If the child is cooperative, the dentist may just look at the teeth but reserve a more thorough examination for another visit.
4- Modeling such as observing procedures performed on the parent or a cooperative sibling, can also be effective

36. Removal of plaque
Plaque is a soft bacterial deposits that adhere to the teeth and cause dental caries (decay or cavities) and gum disease.
Poor oral hygiene and poor dietary habits are associated with the development of caries in children.

37. several brushing techniques exist
The most effective methods for plaque removal are brushing and flossing.
several brushing techniques exist

38. Dental Health
A small toothbrush with soft rounded multitufted nylon bristles that are short and uniform in length is recommended.

39. Dental Health American Academy of Pediatric Dentistry (2014):
Water is used only for cleaning before 3 years old
Introduce a smear or rice size toothpaste for children younger than 3 years old
Pea size toothpaste should be used by age 3-6 years

40. Dental Health
Toddler should select the flavor of toothpaste to encourage the brushing habit..
Flossing is used to remove plaque and debris from between the teeth and below the gum margin.
The teeth should be cleaned after each meal and especially before bedtime

41. Fluoride supplementation
Should be considered for any child over the age of 6 months whose drinking water is deficient in fluoride.
The nurse should have a knowledge of the fluoride content of the community water supply and provide instruction to parents regarding correct administration of fluoride drops or tablets

42. Dietary Factors Low-Cariogenic Diet: Diet is critical for dents health
The carious process depends primarily on fermentable sugars, especially sucrose.
Some types of food should be restricted such as table sugar,, Dried fruit and honey because they are highly cariogenic.

43. Dietary Factors Suggestions can be helpful to eliminate the problem:
1.The frequency with which sugar is consumed is more important than the total amount eaten
2. the form of sugar is important. the more cariogenic foods are those that are sticky or hard, because they remain in the mouth longer

44. Dietary Factors
Causes of Early Childhood Caries (ECC) or called Nursing caries :
Give a bottle of milk or juice at nap or bedtime
Use a bottle as a pacifier while awake.

45. Dietary Factors
Frequent nocturnal breast – feeding for prolonged periods.
The practice of coating pacifiers in honey can also to contribute to caries or botulism poisoning

46. Dietary Factors Prevention of ECC:
Eliminating the bedtime bottle completely
Feeding the last bottle before bedtime
Not using the bottle as a pacifiers.
Never coating a pacifiers in sweet substances.

47. Dietary Factors Juice should always be offered in a cup .
Toddler should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age

48. Safety Promotion and Injury Prevention
Motor vehicle injuries.
Drawing.
Burns.
Accidental Poisoning.
Falls.
Aspiration and suffocation.
Chocking and Suffocation
Bodily Injury

49. Safety Promotion and Injury Prevention TABLE 11-2 Page: 371
Interactive Discussion

50. Https://www. google. jo/search
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51. References
Hockenberry, M. J.,Wilson, D. & Rodgers, C., (2017). Wong's Essentials of Pediatric Nursing (10th ed.). St. Louis, MO: Elsevier Mosby