Chapter 37

The Toddler and Family

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
 Promoting Optimal
Growth and Development
 “The terrible twos”
 Ages 12 to 36 months
 Intense period of exploration
 Temper tantrums/obstinacy occur
frequently

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 2
 Biologic Development
 Weight gain slows to 4 to 6 lb/year
 Birth weight should be quadrupled
by 2½
 Height increases about 3 inches/year
 Growth is steplike rather than linear

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 3
 Sensory Changes
 Visual acuity of 20/40 acceptable
 Hearing, smell, taste, and touch increase in
development
 Uses all senses to explore environment

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 4
 Maturation of Systems
 Most physiologic systems relatively mature by
the end of toddlerhood
 Upper respiratory infections, otitis media, and
tonsillitis are common among toddlers
 Voluntary control of elimination
 Sphincter control: ages 18 to 24 months

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 5
 Gross and Fine Motor
Development
 Locomotion
 Improved coordination: between ages 2 and
3
 Fine motor development
 Improved manual dexterity: ages 12 to 15
months
 Throw ball: by 18 months

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 6
Fig. 37-1. Typical toddling gait.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 7
 Psychosocial Development
 Erikson; developing sense of autonomy
 Autonomy vs. shame and doubt
 Negativism
 Ritualization provides sense of comfort
 Id, ego, superego/conscience

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 8
 Cognitive Development
 Piaget; sensorimotor and preoperational
phase
 Awareness of causal relationships between
two events
 Learn spatial relationships

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 9
 Invention of New Means
Through Mental Combinations
 Imitation of behaviors
 Domestic mimicry
 Concept of time still embryonic

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 10
Fig. 37-2. Domestic mimicry and sex-role behavior are common during toddlerhood.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 11
 Preoperational Phase
 Begins about age 2
 Transition between self-satisfying behavior and
socialized relationships
 Preconceptual phase is a subdivision of the
preoperational phase
 Preoperational thought implies children cannot
think in terms of operations

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 12
 Spiritual Development
 Spiritual routines can be comforting
 Religious teachings and moral
development influence toddler behavior

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 13
 Development of Body Image
 Refer to body parts by name
 Avoid negative labels about physical
appearance
 Recognize sexual differences by age 2

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 14
Development of Gender Identity
 Exploration of genitalia is common
 Gender roles understood by toddler
 Playing “house”

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 15
 Social Development
 Differentiation of self from mother and
significant others
 Separation
 Individualization

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 16
Fig. 37-3. Transitional objects, such as a fuzzy stuffed animal, are sources of security to a toddler.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 17
 Language
 Increasing level of comprehension
 Increasing ability to understand
 Comprehension is much greater than
the number of words a toddler can say
 At age 1 uses one word sentences
 By age 2 uses multiword sentences

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 18
 Personal Social Behavior
 Toddlers develop skills of independence
 Skills for independence may result in
tyrannical, strong-willed, volatile behaviors
 Skills include feeding, playing, dressing, and
undressing self

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 19
Fig. 37-4. Young children enjoy dressing up.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 20
 Play
 Magnifies physical and psychosocial
development
 Interaction with others becomes more
important
 Parallel play
 Related to emerging linguistic abilities
 Tactile play
 Selection of appropriate toys

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 21
Coping with Concerns Related to
Normal Growth and Development
 Toilet training
 Sibling rivalry
 Temper tantrums
 Negativism
 Regression

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 22
Fig. 37-6. To minimize sibling rivalry, parents should include the toddler during caregiving
activities.
Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 23
 Assessing Readiness
for Toilet Training
 Voluntary sphincter control
 Able to stay dry for 2 hours
 Fine motor skills to remove clothing
 Willingness to please parents
 Curiosity about adult’s or sibling’s toilet
habits
 Impatient with wet or soiled diapers

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 24
Fig. 37-5. A, Sitting in reverse fashion on a regular toilet provides additional security to a young
child. B, Children may begin toilet training sitting on a small potty chair.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 25
Promoting Optimum Health
During Toddlerhood
 Nutrition
 Phenomenon of “physiologic anorexia”
 Dietary guidelines
 Sleep and activity
 Dental health
 Regular dental examinations
 Removal of plaque
 Fluoride
 Low-cariogenic diet

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 26
Fig. 37-7. Young children can participate in toothbrushing, but parents need to brush all the
child's teeth thoroughly.
Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 27
Fig. 37-8. The most effective cleaning of the teeth is done by parents.
Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 28
Fig. 37-9. Nursing caries. Note extensive carious involvement of maxillary primary incisors.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 29
 Injury Prevention
 Motor vehicle injuries: car seat safety
 Drowning
 Burns
 Poisoning
 Falls
 Aspiration and suffocation
 Bodily damage
 Anticipatory guidance

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 30
Fig. 37-10. A, Convertible car safety seat in forward-facing position. B, Use of locking clip.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 31
Fig. 37-11. Lower anchors and tethers for children (LATCH). A, Flexible 2-point attachment with
top tether. B, Rigid 2-point attachment with top tether. C, Top tether.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 32
Fig. 37-12. Special plastic caps in electrical sockets prevent young fingers from exploring
dangerous areas.

Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 33
Fig. 37-13. Children are most likely to ingest substances that are on their level, such as cleaning
agents stored under sinks, rat poison, plants, or diaper pail deodorants.
Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 34