# Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for pneumonia. His mother must care for his newborn sister at home and can visit him only for about an hour each evening. On the day of admission, the boy pushes the cup away and shouts "No!" each time the nurse brings his oral antibiotic. Which approach BEST suits his developmental stage?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629416  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for pneumonia. His mother must care for his newborn sister at home and can visit him only for about an hour each evening.

On the day of admission, the boy pushes the cup away and shouts "No!" each time the nurse brings his oral antibiotic. Which approach BEST suits his developmental stage?

## 보기

1. Explain that the medicine kills the germs in his chest
2. Promise him a sticker once he has swallowed the dose
3. Ask him, "Would you like to take your medicine now?"
4. Offer a choice of two juices to drink after the dose **✔ 정답**

**정답: 4**

## 해설

A toddler working on autonomy asserts independence by saying "no"; this negativism is normal, not defiance. The nurse supports autonomy and a sense of control by offering simple, real choices while the medicine itself stays non-negotiable. A choice that does not exist, a causal explanation he cannot yet grasp, or a reward for compliance does not meet this need for control.

## 심화 해설

Developmental context

A 20-month-old child is in the middle of toddlerhood, roughly 12–36 months, a period marked by a strong push for autonomy and visible negativism [1][2]. Saying “No!” and pushing the cup away is not misbehavior or defiance; it is the child’s way of asserting that he has some control over his own body and actions [2]. During the second year of life, the need for autonomy grows rapidly, and children become more complex in how they express it [3]. When a toddler is hospitalized, separated from his mother, and asked to take an unpleasant-tasting medicine, this normal drive for independence can become even more intense.

Why the correct answer works

Offering a choice of two juices after the dose gives the toddler a real, simple decision he can make without changing the non-negotiable part—taking the antibiotic. The medicine itself is not up for negotiation, but the child still gains a sense of control over what happens next. This approach reflects autonomy support, which is a key dimension of positive parenting and caregiving that promotes a child’s cooperation and engagement during a demanding request [4]. The choice must be concrete and limited; a toddler cannot weigh many options, but choosing between two juices is developmentally appropriate.

Why the other options fall short

| Option | Developmental mismatch |
| --- | --- |
| 1. Explain that the medicine kills germs | A toddler does not yet grasp abstract causal explanations about infection or microscopic organisms. Cognitive development at this age centers on immediate, visible experience rather than invisible mechanisms [2]. |
| 2. Promise a sticker after swallowing | A reward treats the refusal as a compliance problem. It does not address the toddler’s need for autonomy and may turn medication into a bargaining exchange rather than a supported routine. |
| 3. Ask, “Would you like to take your medicine now?” | This offers a choice that does not really exist, because the medicine must be taken regardless of the answer. Asking a yes/no question invites “No!” and escalates the power struggle instead of supporting real control. |

Key point! A toddler’s “No!” is a developmental milestone, not a discipline issue. The nurse’s job is to preserve safety and treatment while giving the child a genuine but limited choice. Watch out! Do not offer a choice about whether to take the medicine; offer a choice about something that can truly be chosen, such as which juice to drink afterward. Autonomy support—not explanation, reward, or a false choice—is what reduces resistance and builds cooperation in a toddler.References (research sources)

- [1]Toddler Development and Autonomy: Baby-Led Weaning, Neophobia, and Responsive Parenting.Research articleBlack MM (2020) · DOI: 10.1159/000511518

- [2]Toddler development.Research articleColson ER, Dworkin PH (1997) · DOI: 10.1542/pir.18-8-255

- [3]Parental sensitivity to toddler's need for autonomy: An empirical study on mother-toddler and father-toddler interactions during feeding and play.Research articleBallarotto G, Murray L, Bozicevic L, Marzilli E, Cerniglia L, Cimino S (2023) · DOI: 10.1016/j.infbeh.2023.101892

- [4]Enlisting toddler cooperation through structure and autonomy support: The amplifying role of suboptimal relationship mutuality.Research articleMolitor A, Hsu HC, Eulau K, Brewster RA (2024) · DOI: 10.1002/imhj.22140

## 임상 시나리오

Toddler Medication AdministrationSupporting autonomy during non-negotiable care tasks
A toddler's negativism—saying "No!" and pushing things away—is a normal expression of autonomy, not defiance. Hospitalization and separation from parents can intensify this drive for control.

The most effective approach is to keep the medicine non-negotiable while offering a real, limited choice about something else, such as selecting between two juices to drink after the dose.

CautionDo not offer a choice that does not exist, such as asking if the child wants to take the medicine. Avoid abstract explanations about germs and avoid using rewards for compliance, as these do not meet the toddler's developmental need for control.

## 핵심 개념

- **Negativism** — A normal toddler behavior characterized by saying 'no' and resisting demands as a way of asserting independence and autonomy.
- **Autonomy** — Erikson's developmental stage for toddlers (12-36 months) where the child strives for independence and self-control over their body and actions.
- **Non-negotiable** — A care task, such as taking prescribed medication, that must be completed regardless of the child's preference or resistance.
- **Limited choice** — Offering a toddler a simple decision between two concrete options to provide a sense of control without overwhelming them.

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