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INTRODUCTION

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  • How do I counsel the parents of a toddler who is actively protesting bedtime routines?

  • How can I help parents set age-appropriate boundaries around family meals, snacking, and screen time?

  • What do I need to understand about the family system to help families make effective healthy lifestyle changes?

  • How do I conduct a behavioral and family assessment?

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Patient Care: This chapter will address the following American College of Graduate Medical Education competencies: patient care, medical knowledge, and interpersonal and communication skills.

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Anticipatory guidance around feeding and activity behaviors is an important component of well-child care and can result in increasing a family’s confidence in managing their child’s behavior. This chapter will help the pediatric health care provider implement this guidance with families of infants and toddlers.

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Medical Knowledge: This chapter will help pediatric health care providers understand the relationship of development to feeding and activity behaviors and the importance of being able to help parents set expectations for infant and toddler behavior, create appropriate boundaries, and develop a responsive parenting style.

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Interpersonal and Communication Skills: This chapter will help the pediatric health care provider understand how to gather information about the family system in a nonjudgmental and empathic manner and lay the groundwork for discussion of effective positive lifestyle change.

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UNDERSTANDING CHILD DEVELOPMENTAL LEVEL CHANGES IN THE FIRST YEARS OF LIFE

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A tremendous amount of development occurs in the first 2 years of life and these key developmental stages inform parent expectations and parenting practices. Communication or language, cognition, social development, and physical development are discrete but interdependent areas of development and are most effectively acquired during a critical period, built on existing knowledge or skills (scaffolding).1 It is important for the pediatric health care provider to provide guidance to parents that the specific ages at which children acquire certain skills can vary by individual, but that in the cases of significant deviations from the norm, the pediatric health care provider can provide referrals for additional assessment and intervention.

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Language

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Infants initially communicate about their basic needs via crying out, and attachment theories suggest that consistent and prompt responding by providing nurturing and basic needs (ie, food, safety, shelter) in response to crying will help children establish a healthy sense of safety.2 Crying out does not always mean a child is hungry, and learning to soothe children in other ways besides providing food is an important step toward establishing healthy eating routines and healthy self-soothing skills. The same principle of responsive parenting is true for older infants and toddlers (6 months-2 years). However, toddlers use more specific communication (eg, gestures, words) to indicate something they want, though they may not yet have the skills to accurately understand what they need. For example, a 15 month old gesturing for and saying “juice” may be thirsty, ...

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