COMPETENCY

APPRAISAL:
CASE #3

RLE 6.3A
MALIMBAN, Irish Queenie L.
MALLORCA, Mikaela Janelle D.
MANECLANG, Wenn Joyrenz U.
MANGAOANG, Sabrina Alexandra M.
MAPALO, Francesca Marie J.
Case # 3 In the orphanage are three brothers, Rafael aged 2 ½ and the twins Lorenzo
and Pedro, both age 5. They were all playing in the playroom when Nurse Ida heard Pedro,
one of the twins who is younger by 5 minutes, scream. She hurriedly went to check and she
saw the three of them fighting over a toy car. The brothers became dear to Ida as she was with
their parents when they had an accident a year ago where both parents died. Ida herself was
slightly injured. She took it to herself to be like the brothers’ own mother. She saw them in their
best and worst behavior.
Rafael, the toddler is noticed to be the most aggressive of the three boys. He is the one
who would not share his toy and seems to be the most hard-headed as he would refuse to do
most things requested from him. He also gets upset easily when he did not get what he wanted
and would throw fits on occasions. He prefers to be by himself when he plays and would have a
particular way of doing things like he will not sleep without a tattered blanket that he always
keep with him.
As for the twins, though identical, there are obvious differences between the two.
Lorenzo is a very active boy with lots of adventure stories to tell. He is often seen playing while
wearing his bath towel like a cape around his shoulder. He would say to anyone who ask him
that he is “Superman”. Nurse Ida loves talking with him although she finds it very tiring
sometimes because of the so many questions he asks. He is popular with most of the
volunteers because he wants to participate in all activities happening in the playroom.
Pedro on the other hand is a timid boy who would just look and not say anything even is
people talks to him. He has always been smaller by size than his older twin. He is oftentimes
very quiet except when he goes into tantrums which happens every so often especially if the
caretaker failed to notice him when he urinates while playing and if made to eat foods he does
not like. He is seen always holding his tattered blue blanket which he sleeps with too.

1. What stage of development are brothers in? What stage in Erikson’s, Freud’s and Piaget’s
theory do they belong. Describe a normal child in these stage according to the two theories
mentioned.
NAME PSYCHOSOCIAL PSYCHOSEXUAL COGNITIVE

Rafael Autonomy vs. Anal Preoperational

Shame and Doubt

Lorenzo and Initiative vs. Guilt Phallic Preoperational

Pedro
- In the psychosocial development, toddlers are faced with the mastery of several tasks. If the
need for basic trust has been satisfied, they are ready to give up dependence for control,
independence and autonomy. Some specific tasks include:
 Differentiation of self from others, particularly the mother or primary caregiver
 Toleration of separation from parents
 Ability to withstand delayed gratification
 Control over bodily functions
 Acquisition of socially acceptable behavior
  Verbal means of communication
 Ability to interact with others in a less egocentric manner
- On the other hand, preschoolers are already acquiring a sense of initiative. They play, work,
and live to the fullest and feel a real sense of accomplishment and satisfaction in their
activities. Also, development of the superego, or conscience, starts toward the end of
toddler years and is a major task for preschoolers. Learning right from wrong and good from
bad is the beginning of morality. Other manifestations include:
 Generally unable to understand why something is acceptable or unacceptable
 Aware of appropriate behavior primarily through punishment or reward
 Rely almost completely on parental principles for developing their own moral judgment
- For the psychosexual, toddlers are in Anal stage.
 They find pleasure in elimination function
 Toilet training is one of their major task
- For the cognitive development, there is an increase in the use of language as mental
symbolization.
PSYCHOSOCIAL PSYCHOSEXUAL COGNITIVE
(Initiative vs. Guilt) (Phallic) (Preoperational)
They play, work, and Oedipus complex Egocentrism –
LORENZO & live to the fullest and (Boy-mother) cannot take another
PEDRO feel a real sense of Electra complex (girl point of view
accomplishment and to father) Very imaginative
satisfaction in their Boys: Castration Magical thinking
activities Girls: Penis Envy

2. What are the behavior manifested by Rafael that typically shows him as a toddler? What
reasons for this behavior and how is the best way of dealing with it?
RAFAEL’S BEHAVIOR
REASON MANAGEMENT
TYPICAL OF A TODDLER
Negativism is defined as a Set limits
1. Aggressive negative response to a Ignore behavior
(Negativism) request. Toddlers also TIME OUT (1 min)
express rapid mood swings.
Negativism is also defined Offer acceptable choices
2. Hard=headed
as a toddler saying ”no” to a Set limits
(Negativism)
specific request
Negativism is also defined Set limits
as toddlers not being able to Ignore behavior
3. Gets upset when he do what they want. They TIME OUT (1 min)
does not get what he struggle to deal with
wants (Negativism) impulses of id, tolerate
frustration and learn socially
acceptable behavior
4. One who would not Toddlers play alongside, not Parallel play is normal at this
share his toys and with other children age
prefers to be by himself
when playing

5. Temper tantrums
Temper tantrums occur Ignore the behavior except if
because of their strong drive injurious
for mastery and autonomy Ensuring consistency in
and is frustrated by adult expectations
figures or lack of motor and Developing consequences
cognitive skills. They also do that are reasonable to the
child’s behavior
this to get parental attention,
get something they want or
avoid having to do some
things they do not want to
do.

3. What are the differences the types of twinning? What principle explains the differences
between the two twins inspite of the fact that they are identical twins?’
Identical or ‘monozygotic’ Fraternal or ‘dizygotic’
occurs because the fertilised egg divides in occurs when two separate eggs (ova) are
two while it is still a tiny collection of cells. fertilised by two separate sperm, resulting in
The self-contained halves then develop into fraternal or ‘dizygotic’ (two-cell) twins. These
two babies, with exactly the same genetic babies will be no more alike than siblings
information. Twins conceived from one egg born at separate times. The babies can be
and one sperm are called identical or either the same sex or different sexes, with
‘monozygotic’ (one-cell) twins. The biological the odds roughly equal for each.
mechanisms that prompt the single fertilised
egg to split in two remain a mystery.
Approximately one quarter of identical twins
are mirror images of each other, which
means the right side of one child matches
the left side of their twin.

- Principle that explains differences between twins

 Nature: refers to all of the genes and hereditary factors that influence who
we are, from our physical appearance to our personality characteristics.
Although identical twins share the same DNA they are frequently different in
many ways. This is even more so when epigenetic factors are considered. These
control the way genes are expressed and even though the DNA sequences are
the same, the way their genes work are almost certainly different. Genes don’t
determine your behavior. They set up propensities that lead you in one direction
or another
 Nurture: refers to all environmental variables that impact who we are,
including our early childhood experiences , how we were raised , our social
relationships and our surrounding culture. One twin can be larger than the
other from birth, indicating an unequal environment in the womb, and it is now
firmly established that identical twins can be born with very different health
prospects Recent studies have shown that many environmentally induced
differences are reflected in the epigenome
 4. Give 2 behavioral characteristics each of the twins typical of the stage of development
where they belong. Based on their behavior, are they both at par with the normal
characteristics of a 5-year old? Justify your answer.
PSYCHOSOCIAL STAGE PSYCHOSEXUAL STAGE COGNITIVE STAGE
(Initiative Vs. Guilt) (Phallic) (Preoperational)
 Energetic Learning  Oedipus  Social awareness and ability
 Imitative, Imaginative and complex/Electra to consider other viewpoints
Creative complex  Magical thinking
 Sexual curiosity and
exploration
Very active boy Asks so many questions Often seen playing while wearing
Have lots of adventure stories his bath towel like a cape around
LORENZO’S
to tell his shoulder and would say to
BEHAVIOR
Wants to participate in all anyone who ask him that he is
activities happening in the “Superman”
playroom
Timid he goes into tantrums
Very quiet except when he which happens every so
goes into tantrums which often especially if the
happens every so often caretaker failed to notice
especially if the caretaker him when he urinates while
PEDRO’S failed to notice him when he playing and made to eat
BEHAVIOR urinates while playing and foods that he does not like
made to eat foods that he
does not like
Always seen holding his
tattered blue blanket which he
sleeps with
ARE THEY AT PAR? JUSTIFY
YES. Because according to YES. Because at this YES. Because one aspect of
Erickson, the chief task of stage, children becomes preoperational stage is having
children in this period is curious wherein they ask a magical thinking wherein they
acquiring a sense of initiative lot of questions. believe that all thoughts are
wherein children are in a powerful
LORENZO
stage of energetic learning.
They play, work, and live to
the fullest and feel a real
sense of accomplishment and
satisfaction in their activities
NO. Because children at this NO. Because at this stage. YES. Pedro is always seen with
period should be in a stage of Children has the ability to his tattered blue blanket which is
energetic learning wherein verbalize their requests. considered a transitional object.
they play, work and should This provides security for young
acquire initiative. Pedro was children and are commonly
PEDRO observed to be a timid and observed among toddlers,
quiet boy who goes into however, it is also normal for
tantrums when his caregiver preschoolers to have their own
does not notice that he has transitional objects as it can help
urinated while playing. them from bridging the gap from
home to school
 TODDLER
Biologic Development
Growth slows considerably during toddlerhood. The average weight at 2 years is 12 kg (26.5
lbs). The average weight gain is 1.8 to 2.7 kh (4 to 6 lb) per year. The toddler retains a squat,
“potbellied” appearance because of the less well-developed abdominal musculature and short
legs. The legs retain a slightly bowed or curved appearance during the second hear from the
weight of the relatively large trunk.

Sensory Changes
Visual acuity of 20/40 is considered acceptable during the toddler years. Full binocular vision is
well developed, and any evidence of persistent strabismus should receive professional attention
as early as possible to prevent amblyopia. Also, the senses of hearing, smell, taste and touch
become increasingly well developed, coordinated with one another, and associated with other
experiences. Toddlers use all the sense to sxolore the environment.

Maturation of Systems
Most of the physiologic systems are relatively mature by the end of toddlerhood. By the end of
the first year, all the brain cells are present but continue to increase in size. Myelination of the
spinal cord is almost complete by 2 years of age, which parallels the completion of most of the
gross motor skills associated with locomotion. Brain growth is 75% completed by the end of 2
years.

The digestive processes are fairly complete by the beginning of toddlerhood. The acidity of the
gastric contents continuous to increase and has a protective function because it destroys many
types of bacteria. Stomach capacity increases to allow the usual schedule of three meals a day.

One of the more prominent changes of the gastrointestinal system is the voluntary control of
elimination. With complete myelination of the spinal cord, the toddler gradually achieves control
of anal and urethral sphincters. The physiologic ability to control the sphincters occurs
somewhere between ages 18 and 24 months. Bladder capacity also increases considerably. By
14 to 18 months of age the child is able to retain urine for up to 2 hours or longer.

The internal structures ot the ear and throat continue to be short and straight, and the lymphoid
tissue of the tonsils and adenoids continue to be large. As a rest otitis media, tonsillitis, and
upper respiratory tract infections are common. The respiratory and heart rates slow and the
blood pressure increases. Respirations continue to be abdominal.

The skin functionally matures during early childhood the epidermis and dermis are more tightly
bound together, increasing their resistance to infection and irritation and creating a more
effective barrier against fluid loss. The eccrine glands are functionals during early childhood and
react to changes in temperature, but they produce minimum amounts of sweat.

The defense mechanisms of the tissues and blood, particularly phagocytosis and chemotaxis,
are much more efficient in the toddler than in the infant. The production of antibodies is well
established. Immunoglobulin G, which neutralizes microbial toxins, reaches adult levels by the
end of the second year of life. Passive immunity from the maternal transfer during fetal life
disappear by the beginning of the toddlerhood.

Gross and Fine Motor Development

The major gross motor skill during the toddler years is the development of locomotion. Between
2 and 3 years of age, refinement of the upright, biped position is evident in improved
coordination and equilibrium.

Fine motor development is demonstrated in increasingly skillful manual dexterity. Once toddlers
achieve pincer grasp usually at 9 to 10 months of age, they combine this skill with other
developing sensory and cognitive abilities.

Psychosocial Development
Toddlers begin to discover that their behavior is their own and that it has a predictable, reliable
effect on others that leads to acquire a sense of autonomy. Although they are aware of their will
and control over others, they are confronted with the conflict of exerting autonomy and
relinquishing the much enjoyed dependence on others. The continued dependence creates a
sense of doubt regarding their potential capacity to control their actions. This doubt us
compounded by a sense of shame for feeling this urge to revolt against others’ will and a fear
that they will exceed their own capacity for manipulating environment.

Several characteristics, especially negativism and ritualism, are typical of toddlers in their quest
for autonomy. As toddlers attempt to express their will, they often act with negativism, giving a
negative response to requests. On the other hand, ritualism, the need to maintain sameness
and reliability, provides a sense of comfort. Without the comfortable rituals, they have little
opportunity to exert autonomy.

Erikson focuses on the development of the ego, which may be thought of as a reason or
common sense, during this phase of psychosocial development. The child struggles to deal with
the impulses of the of, tolerate frustration, and learn socially acceptable ways of interacting with
the environment. The ego becomes evident as the child is able to delay gratification.

This stage also sees a rudimentary beginning of the superego, or conscience, which is the
incorporation of the morals if society and the process of acculturation.

COGNITIVE DEVELOPMENT

Sensorimotor Phase (Piaget)

During this time the cognitive processes develop rapidly and at times seem similar to mature
thinking. However, reasoning skills are still primitive and need to be understood to effectively
deal with the typical behaviors of the toddlers. The main cognitive achievement of early
childhood is the acquisition of language, which represents metal symbolism.

Awareness of a causal relationship between two events is apparent. After flipping a light switch,
toddlers are aware that a response occurs. However, they are not able to transfer that
knowledge to new situations. This demonstrates the beginning of categorizing data into distinct
classes, subclasses, and so on.

Object permanence has also advanced. Although toddlers cannot still find an object that has
been displaced and is no longer visible or has been moved from under one pillow to another
without them seeing the change, toddlers are increasingly aware of the existence of objects
behind closed doors, in drawers, and under tables.

Imitation displays deeper meaning and understanding. Also the concept of time is still
embryonic, but children have some sense of timing in terms of anticipation memory and the
limited ability to wait.

Preoperational Phase (Piaget)

From ages 2 to 4 years children learn a variety of words and increasingly use language. In fact,
toddlers talk a lot. Speech is primarily of types: egocentric or socialized. Egocentric speech
consists of repeating words and sounds for the pleasure of hearing oneself and is not intended
to communicate. This collective monologue reflects the child’s lingering self-centeredness.

Preoperational thinking implies that children cannot think in terms of operations - the ability to
manipulate objects in relation to one another in a logical fashion. Rather, toddlers think primarily
based on their perception of an event. Problem solving is based on what they see or hear
directly rather than on what they recall about objects and events.

MORAL DEVELOPMENT
- Toddlers’ development of moral judgement is at most basic level because they only
have little, if any, concern for why something is wrong. Kohlberg’s theory of moral
development is influenced by Piaget’s theory of moral thought; the first phase of his theory is
called the Preconventional phase, and it involves punishment and obedience.
- Young children behave in accordance with freedom or restriction that is placed on
actions. In the punishment and obedience orientation, whether an action is good or bad
depends on whether it results in reward or punishment.
- E.g. A child is punished for his/her action, the action is bad. If he/she is not punished,
it is good.

SPIRITUAL DEVELOPMENT
- The child’s family and environment strongly influence his/her perception of the world
around him or her and this often includes spirituality. Toddlers begin to assimilate behaviors
 associated with the divine (e.g. folding hands in prayer). Routines such as saying prayer
before meals or at bedtime can be important and comforting.

DEVELOPMENT OF BODY IMAGE

- The development of body image closely parallels cognitive development. They
recognize the usefulness of body parts and gradually learn their respective names. They
also learn that certain body parts have various meanings; for example, during toilet training,
the genitalia become significant and cleanliness is emphasized. By 2 years of age, toddlers
recognize gender differences and refer to self by name and then by pronoun. Gender
identity is developed by age 3 years.
- It is evident that body integrity is poorly understood in young children and that
instrusive experiences are threatening such as:
o Examining ear or mouth
o Taking an axillary temperature
- The procedures itself does not hurt the child, but it represent intrusion into the child’s
personal space, which illicit a strong protest.

DEVELOPMENT OF GENDER IDENTITY

- Just as toddlers explore their environment, they also explore their bodies and find that
touching certain body parts is pleasurable; this process actually begins in infancy as infants
become aware of pleasurable effects of human touch. Genital fondling (masturbation) can
occur and involves manual stimulation and posturing movements. Other demonstrations of
pleasurable activities include rocking, swinging, and hugging people and toys.
- Parental reactions to toddlers’ behavior influence the children’s own attitudes and
should be accepting rather than critical. If such acts are performed in public, parents should
not condone or bring attention to the behavior but should teach the child that it is more
acceptable to perform the behavior in private.

SOCIAL DEVELOPMENT
1. Separation and Individuation
a. A major task of toddler period is differentiation of self from significant others,
usually the mother.
b. Separation is the children’s emergence from a symbiotic fusion with the
mother while Individuation are those achievements that mark children’s
assumption of their individual characteristics in the environment.
c. They begin to lose some of their resistance to separation, yet appear even
more concerned about parent’s whereabouts. They have learned from
experience that parents exist when physically absent. Repetition of events
such as going to bed without parents but waking up to find them again
reinforces the reliability of such brief separations
d. Toddlers also show less fear of strangers, but only when their parents are
present.
e. Transitional objects, such as favorite blanket or toy, provide security for
young children, especially when they are separated from parents, are dealing
 with new stress, or are just fatigued. Security objects often become so
important to toddlers that they refuse to let them be taken away. Such
behavior is normal; there is no need to discourage this tendency.
2. Language Development
a. Increasing level of comprehension of toddlers

Age Word Development

1 year “up” which can mean “pick me up” or “look up”

2 years “Mama go bye-bye” “all gone” ; simple phrases which consists 2-3 words

2 ½ years Can utter full name

3 years Simple sentences, grammatical rules, 5-6 new words daily, knows age
and gender, can count 3 objects correctly

3. Personal-Social Behavior
a. Toddlers are developing skills of Independence , which ae evident in all areas
of behavior.
b.
Age Development Notes

15 months Feed themselves, drink well from a

covered cup, manage a spoon with
considerable spilling, helps put the
arm r foot for dressing and pulls
shoes and socks off

18 months May be unable to unzip

24 months They use a spoon well and toddler
removes most articles of clothing
and puts on socks, shoes and pants
without regard for right or left and
back or front.
36 months May be using a fork
They eat with family and like to
help with chores such as setting
the table or removing dishes
from the dishwasher, but they
lack table manners and may find
it difficult to sit through the
family’s entire meal

4. Play
a. The solitary play of infancy progresses to parallel play
 b. The toddler plays alongside, not with, other children.
c. With less emphasis on sex-stereotypes toys, play objects such as dolls,
carriages, dollhouses, dishes, cooking utensils, trucks, etc.
d. Active play time should also be encouraged over the use of computer or
video games, which are more passive. Remember that toys are never
substitutes for the attention of devoted caregivers, but toys can enhance
these interactions.
e. Toddlers also enjoy “reading” stories from a picture book and imitating the
sounds of animals

TEMPERAMENT
- Predominate during toddlerhood
- More challenging, especially considering the typical negativistic traits of this age-
group.

COPING WITH CONCERNS RELATED TO NORMAL GROWTH AND DEVELOPMENT

TOILET TRAINING
- One of the major tasks of toddlerhood.
- The child must be able to recognize the urge to let go and hold on and be able to
communicate this sensation to the parents.
- Five markers that signal a child’s readiness to toilet train:
o Bladder readiness
o Bowel readiness
o Cognitive readiness
o Motor readiness
o Psychologic readiness
- Nighttime bladder control normally takes several months to years after daytime training
begins. This is because the sleep cycle needs to mature so the child can awake in time to
urinate.
- Bedwetting is normal in girls up to age 4 years and in boys up to 5 years.
- Bowel training is usually accomplished before bladder training because of its greater
regularity and predictability. The sensation for defecation is stronger than that for urination
and easier for children to recognize.
- Toilet training methods:
o Freestanding potty chair allows children a feeling of security
o Planting the feet firmly on the floor also facilitates defecation
o Portable seat attached to regular toilet which may ease transition from potty
chair to regular toilet
o Placing a small bench under the feet helps stabilize child’s position
o Best to keep potty in bathroom and to let child observe the excreta being
flushed down the toilet to associate these activities with usual practices.
o Practice sessions should only be limited to 5-8 minutes and a parent should
stay with a child, practicing sanitary habits after every session.
 o Praise children for cooperative behavior and successful evacuation.
SIBLING RIVALRY
- Natural jealousy and resentment of children to a new child in the family. It typically
involves the arrival of a new infant but may be associated with anyone who joins the family.
- Toddlers do not hate or resent the infant or new family member but do resent the
changes that this additional sibling brings, especially the separation from the mother during
birth.
- Toddlers need to have realistic idea of what the newborn will be like. Telling them that
a new playmate will come home soon sets up unrealistic expectations. Rather, parents
should stress the activities that will take place when the baby arrives home such as
diapering, bottle or breastfeeding, etc.
- Emphasize that routines will stay the same, such as reading stories or going to the
park.

TEMPER TANTRUMS
- May assert their independence by violently objecting to discipline..
- May lie down on floor, kick their feet, and scream as loud as possible.
- Particularly prone to tantrums because their strong drive for mastery and autonomy is
frustrated by adults figures or lack of motor and cognitive skills,
- Commonly occur when child is ill, hungry, frustrated, or tired; some children may use
temper tantrums to get parental attention, get something they want, or avoid having to do
some things they do not want to do.
- Best approach: consistency and developmentally appropriate expectations
- Take note of child’s safety due to some behaviors that could be injurious to the child.
- Other suggestions for handling tantrums:
o Offering the child options instead of an “all or none” position
o Picking one’s battles carefully and ignoring
o Giving comfort once child is able to control emotions but not giving in to the
original request
o Praising the child for positive behavior when he or she is not having a tantrum
NEGATIVISM
- Persistent negative response to every request.
- It is not an expression of being stubborn or disrespectful but a necessary assertion of
control.
- Reduce the opportunities to make the child answer “No”
- E.g. Instead of saying, “Do you want to go to sleep now”, exchange it with “When will it
be time to go to sleep?” and child may answer within a time frame like “after reading a
story”.
- Children make to like choices and when confronted with appropriate choices, child
may be likely to choose one instead of saying No.
Nutrition
During the period from 12 to 18 months of age the growth rate slows, decreasing the
child’s need for calories, protein and fluid. Toddlers usually require three meals and two snacks
per day; however, the portions consumed generally much smaller compared to those of older
children. Intake of a variety of foods was seen with advancing age in toddlers as their food
preferences changed.
At approximately 18 months of age most toddlers manifest this decreased nutritional
need with a decreased appetite, a phenomenon known as physiologic anorexia. They become
picky, fussy eaters with strong taste preferences.
The ritualism of this age also dictates certain principles in feeding practices.
Sleep and Activity
Total sleep time decreases only slightly during the second year and averages about 11
to 12 hours. Most toddlers take one nap a day, and by the end of the second or third year, many
relinquish this habit.The activity level is high, and rarely there is a problem with too little physical
exercise, provided that inappropriate restrictions are not instituted.
Toddlers are more prone to having bedtime resistance (refusal to go to bed) and
frequent night walking; during later toddlerhood this group of children may become more
resistant about going to bed and express fears about monsters.
Fears can be provoked by a child’s daily stressors such as pressure to toilet train,
frequent moves, sibling birth, experiences of loss, or separation from patients. Establishing a
regular bedtime is helpful, and providing transitional objects such as favorite stuffed animal or
blanket, can ease the child’s insecurity at bedtime.
Dental Health
Regular Dental Examinations
Every child must have an oral health examination by practitioner by 6 months of
age. Initial visits to the dentist should be nontraumatizing. Because toddlers react negatively to
new and potentially frightening experiences, the initial visit can center around meeting the
dentist, seeing the equipment, and sitting in the chair.
Removal of Plaque
Oral hygiene measures should be implemented in toddlers to remove plaque.
Poor oral hygiene and dietary habits are associated with the development of caries in children.
The most effective methods for plaque removal are brushing and flossing. Several brushing
techniques exist, although there is no universal agreement regarding the best method.
Safety Promotion and Injury Prevention
Unintentional childhood injury was the leading cause of death among children aged 1 to
19 years old in 2009, accounting for 37% of all deaths in this age group..
A major factor in the critical increase of injuries during early childhood compared with the
number in preschoolers and school-aged children is the unrestricted freedom achieved through
locomotion combined with an unawareness of danger within the environment.
Motor Vehicle Injuries
Motor vehicle injuries cause more accidental deaths in all pediatric age-groups
after 1 year than any other type of injury or disease and are responsible for a significant number
of all accidental deaths among children ages 1 to 4 years.
Many of the deaths are caused by injuries within the car when restraints have not
been used or age-related guidelines that have not been properly followed. Unrestrained children
riding in the vehicle’s front seat are at the highest risk for injury.
Approved restraints properly installed and applied can reduce the majority of
fatalities and injuries.
 Drowning
With well developed skills of locomotion, toddlers are able to reach potentially
dangerous areas such as bathtubs, toilets, buckets, swimming pools, hot tubs, and ponds or
lakes. Toddlers’ intense drive for exploration and investigation, combined with an unawareness
of the danger of water and their helplessness in water, makes drowning a viable threat.
Close adult supervision of children when near any source of water is essential;
any drowning in this age-group occur when a supervising adult becomes distracted.
Burns
Toddlers’ ability to climb, stretch, and reach objects above thei heads make any
hot surface a potential source of danger. Children pulling pots with hot liquids, especially oil and
grease, on top of themselves are a major source of burns
As a precaution, turn pot handles toward the back of the stove, and electric pots,
including cords should be placed out of reach.
Flame burns represent one of the most fatal type of burns and commonly occur
when children play with matches or lighters and accidentally set themselves (and the home) on
fire.
Electrical burns represent an immediate danger to children. With the ability to
manipulate small, thin object, they are able to insert hairpins or other ocnductive articles into
electrical sockets.
Scald burns are the most common type of thermal injury in children, especially 1-
and 2 year-olds. Scalding often occurs because the child is reaching toward a stove or other
surface and pulling hot water onto herself or because the child has spilled a hot liquid container
onto himself.
Accidental Poisoning
Toddlers are at the highest risk for accidental poisoning because of their innate
curiousity and ability to open “childproof” containers. Mouthing activities continues to be
prevalent after 1 year of age, and exploring objects by tasting them is part of children’s curious
investigation. The major reason for poisoning is improper storage.
Falls
Falls are still a hazard to children in this age group, although by the later part of
early childhood, gross and fine motor skills are well developed, decreasing the incidence of falls
down stairs or from chairs. However, playground injuries are common. Children need to learn
safety at play areas, such as no horseplay on high silides or jungle gyms, sitting on swings, and
staying away from moving swings.
Aspiration and Suffocation
Usually by 1 year of age children chew well, but they may have difficulty with
large pieces of food, such as meat or whole hot dogs, and with hard foods, such as nuts or dried
beans. Young children cannot discard pits from fruit or bones from fish like older children can.
Play objects for toddlers must still be chosen with an awareness of the danger
and small parts. Large, sturdy toys without sharp edges or removable parts are safest. Coins,
paper clips, pull tabs on cans cause significant harm if swallowed or aspirated. Because of the
danger of aspiration, parents should know emergency procedures for choking
Suffocation is less frequent from causes seen during infancy but is an ever-
present threat from old refrigerators, car trunks, ovens, and other large appliance. Toddlers may
suffocate when toy boxes with heavy, hinged lids accidentally close on their head or neck.
Advise parents of this danger and encourage them to buy storage chests with lightweight,
removable covers.
Bodily Harm
Toddlers are still clumsy in many of their skills and an seriously harm themselves
when walking while holding a sharp or pointed object or having food or objects such as spoons
in their mouths.
Toddlers are often unable to understand that all pets are not as safe as their
own; because of the toddlers’ height, they are often at the eye level of some dogs, and may be
bitten on the face. It is imperative to teach pet safety to toddlers and keep animals at a safe
distance because even the most loving pet may perceive a threat and react accordingly.
Toys can be a source of danger and safety must be a prime consideration when
selecting toys. Most toys have age ranges written on them to designate their safety, but parents
should also consider the specific child’s readiness.
Strategies for ensuring safety in households include the usual precautions
recommend for any age-group. An additional safeguard for young children is the use of safety
glass in doors, windows and tabletops and the application of decals on glasses areas to lesen
the likelihood of running through glass.
Also, children should not be allowed to run, jump, wrestle, or play ball in areas
where glass litter may be a hazard.

PRESCHOOLER
Biologic Development
The rate of physical growth slows and stabilizes during preschool years. The average
weight is 14.5kg at 3 years, 16.5kg at 4 years, and 18.5kg at 5 years. The average weight gain
remains approximately 2-3kg per year. Growth in height remains steady at a yearly increase of
6.5-9cm. The average height is 95cm at 3years, 103cm at 4 years and 110 cm at 5 years.
The preschooler is slender but sturdy, graceful, agile and posturally erect.
Gross and Fine Motor Behavior
At age 3, the preschooler rides the tricycle, walks on tiptoe, balances on one foot for a
few seconds, and broad jumps. At age 4, the child skips and hops proficiently at one foot and
catches a ball reliably. By age 5, the child skips on alternate feet, jumps rope, and begins to
skate and swing.
Achievement in fine motor development is evident in the child’s increasingly skillful
manipulation. Growing shows several advancements in the perception of shape and the
development of fine muscle coordination.
Psychosocial Development
Initiative vs. Guilt
Preschoolers are in a stage of energetic learning, they play, work, and live to the
fullest and feel a real sense of accomplishment and satisfaction of their activities. Development
of the superego is a major task for preschoolers. Learning right from wrong and good from bad
is the beginning of morality. Children in this age group are generally unable to understand why
something is acceptable or unacceptable. They are aware of appropriate behavior primarily
through punishment or reward and rely almost completely on parental principles for developing
their own moral judgment.
Conflict arises when children overstep the limits of their ability and inquiry and
experience guilt for not having behaved appropriately. Feelings of guilt, anxiety and fear may
also result from thoughts that differ from expected behavior.
Psychosexual Development
Oedipal Stage (Phallic)
One of the principal goals in further differentiation of oneself from others, is
learning sex differences and sexually appropriate behavior. Conflict arises when a boy realizes
that his father is much stronger and powerful than him and he wishes that his father were dead
so that he could marry his mother (oedipus complex). In relation to his feeling toward his father,
he feels guilty and makes him fear the same punishment of mutilation resulting in castration
complex. Concurrently, girls have similar wish to marry their father and kill their mother (electra
complex). However, girls do not fear castration, rather, they experience penis envy.
Cognitive Development
Preoperational Phase
Preoperational Phase is divided into two stages - preconceptual phase (2-4
years) and phase of intuitive thought (4-7 years). One the main transitions during these phases
is the shift from totally egocentric thought to social awareness and ability to consider other
viewpoints.
Preschoolers explain a concept as they have heard it described by others but
their understanding is limited. Also, their thinking is described as magical thinking wherein they
believe that all thoughts are powerful.
Development of Sexuality
Preschoolers form strong attachments to the opposite sex parent while identifying with
the same sex parent. Sex typing or the process by which an individual develops the behavior,
personality, attitude and beliefs appropriate for his/her culture and sex occurs through several
mechanisms. Sex role imitation and dressing up like mommy or daddy are important activities.
Sexual exploration may be more pronounced now, particularly in terms of exploring and
manipulating the genitalia.
Social Development
Preschoolers have overcome their anxiety associated with strangers and the fear of
separation of earlier years. They can cope with changes in daily routine much better than
toddlers but may develop more imaginary fears. They gain security and comfort from familiar
objects like toys and dolls and photographs of family members.
Language
Vocabulary increases dramatically. Preschoolers use longer sentences of 4 or 5
words and use more words to convey a message. They follow simple directional commands.
Personal-Social Behavior
The pervasive ritualism and negativism are already diminished. They are able to
verbalize their request for independence and perform independently because of their much-
refined physical and cognitive development. They need little assistance if any assistance is
needed.
Play
 Preschoolers enjoy associative play, group play, in similar or identical
activities but without rigid organization or rules. They can also play easy construction set, large
blocks of various sizes, alphabet number flash cards, and clay and other suitable toys. Although
their attention span. Probably the most characteristic and pervasive preschooler activity is
imitative, imaginative and dramatic play.
Coping With Concerns Related to Normal Growth and Development
Preschooler and Kindergarten Experience
One of the issues that parents face is the child’s readiness for preschool or
kindergarten. School readiness is influenced by myriad elements, including a child’s social
emotional and physical development; health status, ability and desire to learn, life experiences,
family environment and parental support.
Parents should promote a positive attitude towards learning, read to their
children, encourage their children to participate in a variety of activities, to explore their talents
and interests, and choose appropriate child care or preschool programs.
Preparing the Child
Before children begin school, parents should present the idea as exciting and
pleasurable. Talking to them about activities such as painting, building with blocks, or enjoying
swings, and other outdoor equipment allows children to fantasize about the forthcoming event in
a positive manner.
Sex Education
Although their thinking may not be mature, they search constantly for
explanations and reasons that are logical and reasonable to them. Two rules govern answering
sensitive questions about topics such as sex. The first is to find out what children know and
think. The second rule is to be honest.
Aggressions
It refers to a behavior that attempts to hurt the person or destroy property. It is
characterized by unprovoked physical attacks on other children and adults, destruction of
others’ property, frequent intense temper tantrums, extreme impulsivity, disrespect and non
compliance.
Sociocultural factors that are associated with childhood aggression include
exposure to community violence and violence in the media. Frustration, or the continual
thwarting of self satisfaction by parental disapproval, humiliation, punishment and insults, can
lead children to act out against others as a means of release.
Modelling or imitating the behavior of significant others, is a powerful influencing
force in preschoolers. Also, early harsh discipline may lead to aggressive behaviors. Another
significant source for modeling is media exposure. Reinforcement can also shape aggressive
and is closely associated with modeling “masculine” behavior.
Speech Problems
The most critical period for speech development occurs between two or four
years of age. During this period the children are using their rapidly growing vocabulary faster
than they produce words. A failure to master sensorimotor integration results in stuttering or
stammering as children try to say the way they are already thinking about. This is called
developmental stuttering. And is common during ages 2-5years.
The best therapy for speech problem is prevention and early detection.
 Fears
The greatest number and variety of real and imagined fears are present during
preschool years. They may fear the dark, being left alone, animals, ghosts, sexual matters, and
objects or persons associated with pain. The best way to help children overcome their fears is
by actively involving them in finding practical methods to deal with frightening experiences.
Exposing children to the feared object in a safe situation provides a type of conditioning or
desensitization. Successful training include muscle relaxation, guided imagery, positive self talk
or recitation of brave statements and thought stopping or repetition of reassuring statements.
Nutrition
For preschoolers, caloric requirements and fluid requirements may slightly decrease
while protein requirements increase with age. Some preschoolers still have food habits typical of
toddlers, such as food fads and strong taste preference. At age 4, they enter a stage of finicky
eating. By age 5, they are more agreeable to trying new foods.
Sleep and Activity
They sleep approximately 12 hours a night and infrequently takes daytime naps. Waking
during night is common throughout the early childhood.
Injury Prevention
Preschoolers are less prone to falls and is less reckless. But poisoning is still a danger.
Pedestrian motor vehicle injuries increase because of activities such as playing in the street,
riding tricycles, running after balls, or forgetting safety regulations when crossing streets.