RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

Mr. VISHWAS JOG. K

I Year M.Sc Nursing,

Padmashree Institute of Nursing

Nagarbhavi Bengaluru-72.

2 NAME OF THE INSTITUTE Padmashree Institute of NursingBangalore

3 COURSE OF THE STUDY AND SUBJECT

I Year M.Sc NursingChild Health Nursing.

4 DATE OF ADMISSIONJune 2007

5 TITLE OF THE STUDY Assessment of effectiveness of

structured teaching programme on

knowledge regarding behavioral

problems of toddlers among

mothers at selected community of

Bengaluru.

.

1

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

"Whatever they grow up to be, they are still our children, and the one most

important of all the things we can give to them is unconditional love. Not a love

that depends on anything at all except that they are our children"1

Toddlers are learning to think. They have opinions and ideas. They want to

do things their own way. They have learned how to say no, and they can

physically resist what they do not want. However, they are still too young to

understand how their actions affect others, to see danger, and to think before they

act. It is important for children to become independent. We want them to grow up

to follow their own ideas. However, we must keep children safe. We also must

teach them to .consider the needs of others, to mind parents about important

things, and to say no in acceptable ways. 2

Behavior problems in toddlers are common, and they most commonly result from

the child's need for autonomy and exploration behavior problems, toddlers, hitting,

biting, temper tantrums. These needs arise from the child's newly acquired

mobility and communication skills. 3

Behavior problems of toddlers are many most commonly seen problems are

temper tantrum, aggression, bed-wetting, thumb-sucking, biting and hitting, sleep

problems, specific eating problems etc. 3

2

One can notice behavior like this beginning around child's first birthday. It

may happen more and more before the second birthday. At this age, most children

do not yet have good language skills. They often misunderstand what parents want

them t do, and they cannot speak many words to express their feelings and needs. 7

Most children gradually become more cooperative between 3 and 5 years

old. They can think and remember better. They learn more about using and

listening to words. They get better at controlling their emotions and their behavior.

Moreover, they learn what adults expect of them. 4

Mothers will play an important role in early identifications of toddlers'

behavioral problems while they are spending time with the child. Many of the

mothers have fear of their children's behavior in negative way. Amy. M. Smith

(2004) states that over reactive mothers are also cause behavioral abnormalities

among toddlers. 6

The diagnosis of behavioral problems of toddlers like temper tantrum,

thumb sucking, bed-wetting, biting and hitting, aggression are made only by

parental reporting or if child hospitalized can be observed by the health team

members mainly by nurses. 5

Teaching toddlers is only measure can take to treat behavioral problems.

First, parents need to model these examples themselves. The old saying "Do what

I say, not what I do" is poppycock. Kids pay attention to their parent's actions.

Having examples from us will help toddler understand the concept much easier.

3

More than any other member of the health team, nurse have the most

frequent and direct contact with families; therefore, they can provide parents with

education regarding behavioral problems of toddlers.

6.2 NEED FOR THE STUDY

Behavioral problems are most frequent in toddler age group of children. It

almost all children have some other kind of behavioral problems. Most children

can adjust to their natural and social environments within normal range. Mothers

are having more opportunity to observe the behavioral problems of their toddlers. 5

Most commonly, a toddler exhibits behavioral problems such as temper

tantrum, aggression, thumb-sucking, biting and hitting, sleep problems, specific

eating problems are certain unwanted behaviors that need immediate attention as

well as analysis of situation4

A study was done on influence of maternal smoking on behavioral

problems of toddlers, the findings suggest that maternal smoking during

pregnancy has an adverse effect on the child's behavioral problem, and that a

decrease in maternal smoking during pregnancy might expected to lead to a

decrease in the child's behavioral problem. The relationship of maternal smoking

during pregnancy and early childhood negativity to other problem behaviors

remains to explore. 8

A study was done on persistence of parent-reported social-emotional and

behavioral problems in infants and toddlers. Findings indicate that infant-toddler

social-emotional/behavioral problems are not transient and highlight the need for

early identification, multidomain and family assessment, and effective early

intervention.8

4

A study was done on testing a maternal attachment model of behavior

problems in early childhood. The study concluded that, there are meaningful

associations between attachment insecurity and behavior problems as assessed not

only by mothers but also by caregivers. 10

Another study was done on effect of television watching on aggressive

behavior of toddler shows that, toddlers who watched too much television become

aggressive and suffered from poor attention span. It also found that the number of

children who were spending more time in front of television is also raised. 11

In terms of time spent with the child, mother has more opportunities than

father does to influence her offspring's psycho-social growth and behavior, since

child rearing in our culture is generally recognized as primarily the mother's

privilege and responsibility.

The toddler's age group said to be the most active period in child

development. He is at his creative best. This rapid pace of development is also

accompanied by behavioral change in the child. Mothers have to be made aware

about their child’s developmental stages, what problems can expect? And how to

manage them? 6

In light of above facts with the personal experience of the investigator

working as staff in caring toddlers have encountered many parents specially

mothers with the complaints of various unwelcome behaviors of their toddler

children. So this has created interest in investigator to provide a structured

teaching programme on behavioral problems of toddlers to mothers of the

toddlers.

5

63 STATEMENT OF THE PROBLEM

A study to assess the effectiveness structured teaching programme on

knowledge regarding behavioral problems of toddlers among mothers at selected

community of Bengaluru.

6.4 OBJECTIVES

1 .To assess the pretest knowledge regarding behavioral problems of toddlers

among mothers.

2. To assess the post test knowledge regarding behavioral problems of toddlers

among mothers.

3. To evaluate the effectiveness of structured teaching programme on knowledge

regarding behavioral problems of toddlers among mothers

4. To associate posttest knowledge regarding behavioral problems of toddlers

among mothers with their selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

1. Knowledge:

It refers to level of understanding regarding behavioral problems of toddlers

among mothers

2. Effectiveness:

It refers to the improvement in knowledge of mothers regarding behavioral

problems of toddlers

3. Structured teaching programme:

6

It refers to systematically organized teaching strategy for duration of 45

mins to one hour for mothers on behavioral problems of toddlers by verbal

interaction with the use of flash cards.

4. Behavioral problems:

In this study behavioral problem refers to certain selected problems like

temper tantrum, thumb sucking, aggression, negativism, sibling rivalry.

5. Toddlers:

Toddlers are children of age group between one to three years.

6. Mother:

A mother is a biological and/or social female parent of a toddler.

6.6 ASSUMPTIONS

1. Mothers may have inadequate knowledge regarding behavioral problems of

toddlers.

2. Structured teaching programme will improve the knowledge regarding

behavioral problems of toddlers.

3. Mother's knowledge may vary with selected demographic variables.

6.7 RESEARCH HYPOTHESES

7

H1: There is a significant difference between mean pre test and post test

knowledge regarding care behavioral problems of toddlers among mothers.

H2: There is a significant association between the knowledge of the mothers with

their selected demographic variable.

6.8 REVIEW OF LITERATURE

A study done on Phonological Behavior in Toddlers with slow expressive

language development Toddlers, were compared to normally speaking age-mates

on three global measures of phonological behavior: the average level of

complexity of their syllable structures, the number of different consonant

phonemes produced, and the percentage of consonants correctly produced in

intelligible utterances. The groups were found to differ significantly on all three

variables. Detailed analyses of the range of phonemes and syllable structures

produced, as well as the appearance of phoneme classes within syllable structures

and positions, revealed that late talkers showed a delayed rather than a deviant

pattern of phonological development. The implications of these findings for

identifying and monitoring expressive delay in toddlers are discussed.

A study done on temper tantrum in children, analyzed 335 children of aged

18 to 16 months Modal tantrum durations were 0.5 to 1 minute; 75% of the

tantrums lasted 5 minutes or less. If the child stamped or dropped to the floor in

the first 30 seconds, the tantrum was likely to be shorter and the likelihood of

parental intervention less. A novel analysis of behavior probabilities that permitted

grouping of tantrums of different durations converged with our previous

statistically independent results to yield a model of tantrums as the expression of

two independent but partially overlapping emotional and behavioral processes:

8

Anger and Distress. Anger rises quickly, has its peak at or near the beginning of

the tantrum, and declines thereafter. 13

A study done on sucking habits of toddler and effects on primary dentition

This study determined the prevalence of non-nutritive sucking habits and the

effects on the developing dentition within a longitudinal observational cohort. The

Children in Focus Longitudinal Study of Pregnancy and Childhood was studied.

Questionnaire data on non-nutritive sucking habits were collected on the children

at 15 months, 24 months, and 36 months of age. Dental examinations were

performed on the same children at 31 months, 43months, and 61 months of age.14

A study was done on how toddler eating problem relate their eating

behavior .Eating problems are a common cause of concern for the parents of

toddlers, but few studies have examined the correlates, of eating problems or the

growth patterns associated with them in a large population-based sample. Goal of

study was to examine the distribution of eating behaviors in a large representative

sample of toddlers and their mothers' approach to feeding. In addition, describe the

prevalence of parentally perceived eating problems and how they relate to specific

behaviors, food preferences, and growth in the child.15

A study was done on mothers over reacting discipline and toddlers

externalizing behavior examine over 500 mothers who are over reactive in terms

of their toddlers discipline on behaviors. The study concluded that there is an

association between mothers over reactive discipline and toddler's externalizing

behaviors in the form of temper tantrum and many other psychological problems. 16

A study was done on Parenting of temper tantrum toddler in this study 108

temper tantrum toddlers were studied and mothers were assessed for their method

9

of parenting toddlers during there visit to the care center by there interaction with

their toddlers. Study concluded that behaviors of mother have significant effects

on toddlers temper tantrum. And the management of these kinds of problems can

be achieved only by changing mother's behaviors. 17

A study was done on Prevalence of social and behavioral problems of

infants and toddlers. The studies done on children of age group 1 to 2 years and of

1280 of samples were included for this study. Social and behavioral problems of

toddler parent questioner were used. The study concluded that 80% of selected

samples are affected with some form of clinical and sub clinical symptoms of

social and behavioral problems. A significant need for early identification of social

and behavioral problems in very young children is highlighted.18

A study was done on effect of prenatal stress on behavioral problems of

toddlers; the study was conducted on 200 prenatal mothers and assessed for there

stress levels by examining level of cortisone in saliva. Children assessed by direct

observation while their mother's interview to the hospital. The study concluded

that there is an increase chance of behavioral problems of toddlers with prenatal

stress and increased levels of maternal prenatal stress appear to be associated with

temperamental and behavioral problems in toddlers. 19

A study was done on toddler aggressiveness associated with parenting and

maternal relations. This study examined the relation among parenting factors,

marital relations, and toddler aggression. A structured questionnaire was

administered to both parents of 254 2-year-olds. Results showed that the maternal

child-rearing and parental aggression domains had a direct effect on toddler

aggression. 20

10

A study was done on behavioral problems of toddlers associated with

alcoholic parents. This study examined the relationship between paternal

alcoholism and toddler behavior problems from 18 to 36 months of age, as well as

the potential moderating effects of 12-month infant-mother attachment security on

this relationship. Children with alcoholic fathers had higher levels of internalizing

and externalizing behavior than children of nonalcoholic fathers. 21

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected, from the mothers of toddlers in selected community,

Bengaluru.

7.2 METHODS OF COLLECTION OF DATA

i. Research design

Quasi-Experimental - one group pretest posttest design

ii. Research variables

Dependent variables:

Level of knowledge of mothers on behavioral problems of toddlers.

Independent variables:

Structured teaching programme on knowledge regarding behavioral problems of

toddlers.

iii. Setting

11

The study will be conducted in selected community at Kengeri Upanagara,

Bengaluru.

iv. Population

All the mothers having children of age group between one to three years in

selected community.

v. Sample

Mothers who fulfill inclusive criteria and sample size are 60.

vi. Criteria for sample selection

Inclusive criteria:

The study includes:

1. Mothers of children age group between one to three years.

2. Mothers who are available at the time of data collection.

Exclusive criteria:

The study will exclude:

1. Mothers, who cannot understand Kannada/English language.

2. Mothers who are not willing to participate

vii. Sampling technique

Non- probability convenient sampling technique.

12

viii. Tool for data collection

The tool consists of two sections:

Section A:

Demographic variable such as age, education, family income, religion,

occupation, number of children, age of marriage.

Section B:

Structured questionnaire is used to assess the knowledge of mothers on

behavioral problems of toddlers.

ix. Method of data collection.

After obtaining the permission from the concerned authorities and informed

consent from the samples the investigator will collect the data in following three

phases.

Phases-One - Pre test will be given to assess the existing knowledge of mothers on

behavioral problems with the help of structured questionnaire.

Phases-Two - On the same day structured teaching programme will be given to

mothers on behavioral problems by using flash card for 45mt -1 hr duration.

Phases-Three - Same questionnaire will be administered on behavioral problems

of toddlers to mothers after 7 days.

Duration of the data collection is 4 to 6 weeks.

x. Plan for data analysis

13

The data collected will be analyzed by means of descriptive statistics and

inferential statistics.

Descriptive statistics:

Frequency and percentage distribution of demographic variables will be

analyzed. Mean, and standard deviation will be used to assess the level of

knowledge of mothers regarding behavioral problems of toddlers.

Inferential statistics:

Paired-'t' test will be used to compare the pretest and posttest knowledge

regarding behavioral problems of toddlers among mothers; chi-square test will be

used to associate posttest knowledge on behavioral problems of toddlers with

selected demographic variable.

xi. Projected outcome

Structured teaching will improve the knowledge of mothers regarding

behavioral problems of toddlers. This will enable the mothers to improve their

self-help skills in their activities of daily living.

7.3 Does the study require any investigation or interventions to be conduct on

patients or other human or animals?

Yes, structured teaching programme will be administered for mothers on

behavioral problems of toddlers in selected community at Bengaluru.

7.4 Has ethical clearance been obtained from your institution?

14

Yes, permission will be obtained from concerned authority and informed consent

will be obtained from samples.

List of references:

1. Rosaline Dickson quotes Available from: URL: .http//www.thinkexist.com

2. Rekha Anup Kumar. Child Health Action. 2006 July; volume 19 (issue no.7):

30-31.

3. Dorothy R Marlow, Barbara A Redding. Text book of pediatric nursing;

behavioral characteristics of toddlers. Philadelphia: Elsevier, 2005.733-34

4. Hockberry, Wilson, winkelsteina, kelin, Wong's. Nursing Care of New bom

and Children: health promotion of toddlers, Philadelphia: Elsevier, 2005. 601, 05,

07, & 09a

5. O.P.Ghai, Piyush Gupta, U.K. Paul. Essentials of Pediatrics: Developmental

Problems, Delhi: O.P.Ghai, 2005. 55-56

6. Rekha Anup Kumar. Know Your Child Better. Health Action. 2006 September;

volume 19 (issue no.9): 23-24

7. L. Warren, available from: URL http://www.associatedcontent.com

8. Judith S. Brook, David W. Brook, MD; Martin Whiteman, the Influence of

Maternal Smoking During Pregnancy on the Toddlers Arch Pediatr Adolsec med

Apr-2000 vol 154, P.No. 381- 385. Available from: URL: archpedi.ama-assn.org

15

9. Briggs gowan, Margaret J. carter, Alices S. Bosson heenan John BA et.al.

Social emotional problems infants and toddlers, July 2006 Volume 849-858.

10. Me Cartney K, Owen M T Booth C L Clarke- Stewart, A. Vandell D L Testing

maternal attachment model of behavior problems in early childhood. Journal of

Child Psychology and Psychiatry. May- 2004 .Volume.45.(issue no.4).765-778.

11. S. Harring K, Gray J Taffe, D Sweeny S. Einfeld, Effect of Television

Watching on Toddler's Aggressiveness. University of New south wells;

2006.Volumel8. 1365-2788.

12. Gail S. Ross Language delay and Behavioral problems in toddlers. Weill-

Comell University Medical College. August.2007.Vol.50. 1063- 1078.

13. Potegal M, Kosork MR, Davidson RJ. Temper Tantrum in children.

Department of Psychology, University of Wiscosin.

December.2001 .Volume.43:651-61.

14. Dukan K, McNamara. C, Ireland AJ, Sandy JR. Sucking, sucking habits of

toddler and effects on primary dentition. School Of Dental Care Professionals,

University of Bristol, May.2008.Volume.l8(issue no.3):178-88.

15. Wright CM, Parkinson KN, Shiptona D Drewett RF, how toddler eating

problem relate to their eating behavior. Glasgow University,

Glasgow.2007.october.(issue no. 4).1069-75.

16. Springer Netherlands Mothers over reacting discipline and toddlers

externalizing behavior. Journal of abnormal child

psychology.2001.november.5:331-341

16

17. Kenneth H Rubin, Kirn B Burgees & Poul D. Hastings. Parenting of temper

tantrum toddler. University of Maryland. 2002.volume.24(issueno.3):

140-47

18. Sarah McCue Horwith, Prevalence of social and behavioral problems of

infants and toddlers. Journal of the American Academy of Child & Adolescents.

2001. July .Volume-40.(issue no.7):811-19

19. Gutteling BM, de Werth. C. Prenatal Stress on Behavioral Problems of

Toddlers, Eru Child Psychiatry. Feb.2005.Volumel4(issue no.l).41-51

20. Brook JS, Zehag L,Whiteman M, Brook DW. Toddler aggressiveness

associated with parenting and maternal relations. Mount Sinai School of

Medicine.2001.Feb.Volume-162(issueno.2):228-41

21. Edwards EP, Eiden RD Leonard KE. Behavioral problems of toddlers

associated with alcoholic parents. Research Institute. 2006.Vomme.l8(issue2):395-

407

17