PEDIA TOQUILAR

TODDLERHOOD (1-3 YEARS OLD)

Respiratory System - Lumens of vessels in the
BIOLOGIC AND PHYSICAL DEVELOPMENT respiratory system enlarge
- Average weight gain progressively
¬ 2.5kg (5-6lbs) per year • Increase in lung
¬ 4x the birth weight by 2 years old volume
- Average height increase Gastrointestinal System - Stomach secretions more
¬ 12cm or 5 inches per year acidic
¬ Occurs mainly in the elongation of the legs - Stomach capacity
rather than the trunk increases
» In preparation for walking • Tolerate more amount
- Average head circumference increase of food without
¬ 2cm during the second year indigestion
¬ Head circumference equals chest - Control of anal sphincter
circumference at 6 months to 1 year • Earliest time of toilet
» At 2 years old, there is increase in training should be 18
chest circumference than head months because the
circumference client would be able to
- Adult height stand, squat, sit, and
¬ Twice the 2-year-old child’s height express his desire to
- Subcutaneous tissues or baby fat begins to urinate and defecate
disappear Ears and Throat - Internal structures of the
- Decreased appetite ear and throat are short
¬ Physiologic anorexia due to and straight
preoccupation of play and other activities Urinary System - Control of urinary
¬ More focused on play sphincter
- At 2 years, chest circumference exceeds the head - 14 to 18 months of age –
and abdominal measurements the child can retain urine
- Body mass index (BMI) screening is completed at 24 up to 2 hours or longer
months to identify toddlers who are overweight or Immune System - Phagocytosis more
underweight. efficient
- IgG and IgM antibody
Body Contour production become
- Prominent abdomen mature at 2 years of age
¬ Their abdominal muscles are not yet strong - Passive immunity affects
enough to support abdominal contents from intrauterine life and
- “Pot-bellied” appearance no longer operative
¬ Slightly bowed and curved legs • Booster doses should be
- Lordotic – forward curve of the spine at the sacral provided
area (Liyad in Filipino)
- May waddle or walk with wide stance Teeth
- This stance seems to increase the lordotic curve, but - Eight new teeth erupt (canines and first molars)
it keeps them on their feet. - All 20 deciduous teeth are generally present by 2 ½
Maturation of the Body Systems to 3 years
Body System Details Sensory Changes
Vital Signs - RR slows but mainly - 20/40 visual acuity
abdominal ¬ 20/20 vision will be gained at school age
- HR slows from 110 to 90 - Full binocular vision
- BP increases to 99/64 ¬ Begins already at infancy
mmHg - Sense of hearing, taste, smell, and touch
Nervous System - Brain develops to 90% of increasingly well-developed
adult size - Development of specific taste preferences
- 18 to 24 months – ¬ Prefers sweet taste, but also preferences
complete myelination of over other tastes such as salty food (junk
the spinal cord food)

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DEVELOPMENTAL MILESTONES
PSYCHOSOCIAL DEVELOPMENT
- Described by Erikson as the stage of autonomy vs
shame and doubt
- Pride in new accomplishments
- Wants to be independent
- Children should be allowed to do their part
- Not all things are to be done for them
¬ Self-feeding
¬ Brushing their teeth (dental hygiene)
PSYCHOSEXUAL DEVELOPMENT
- Described as the anal phase by Sigmund Freud
¬ Toilet training
» Should be enjoyed by the client
(the act of defecating or urinating)
- Aware of gender differences
¬ Gender identification will be more in
preschool age
COGNITIVE DEVELOPMENT
- 15 months to 2 years
¬ Sensorimotor phase
» Client is acting or moving
according to their reflexes
» The client will be doing things
according to purpose because
there is cause and effect
¬ “little scientists”
¬ Able to remember an action then imitate it
later (deferred imitation)
- 2 to 3 years old
¬ Preoperational thought
» Magical thinking
» Whatever it is that they are doing,
we have to appreciate as long as it
is safe
¬ Deal constructively with symbols
¬ Assimilation
MORAL DEVELOPMENT
- Parents must not equate the child as being “good”
or “bad” if he cannot do a task such as walking,
voiding, or defecating in the proper place
- Material or emotional bribes rarely effective
- Punishment-obedience principle
• Preconventional – the client will do a good
act because he is expecting a reward or to
avoid punishment
SPIRITUAL DEVELOPMENT
« Intuitive-projective faith
« Faith and religion are learned from significant
others in the environment
« Development of conscience
« Behaves correctly to avoid punishment
LANGUAGE DEVELOPMENT
TOQUILAR
- Develops quickest
- Critical time for language development
- Greatly affected by the environment
- Requires intact physiologic structures and function,
intelligence, need to communicate, and stimulation
- At the age of 2, vocabulary increases from 300 to
2100 words at the end of 5 years old
- Gives and follows simple commands
- Nouns; verbs; adjectives; adverbs; pronouns;
gender words
- To master language:
Þ Practice talking
Þ Don’t baby talk
Þ Expose to conversation
Þ Read often
Þ Answer questions briefly and in simple
terms
- A child who is 2 years old and does not talk in two-
word, noun–verb simple sentences needs a careful
assessment to determine the cause because this
implies underdevelopment (Autism Specturm
Disorder ASD)
- Says the word “NO” manifesting development of
autonomy
- They are practicing sounds that have noticeable
effects on those around them
- Should be exposed to conversations and books
- Watching television promotes little learning in
toddlers because the activity is passive, and it is
difficult to discern how language causes action
- Still, other toddlers do not develop language readily
because they are not called on to use it.
¬ When they point at an object, someone
hands it to them
¬ when they climb into their high chair,
someone places a meal in front of them
EMOTIONAL DEVELOPMENT
ü Autonomy
§ Developmental task is to have a sense of
autonomy vs shame and doubt to develop
independence
§ Children who have learned to trust
themselves and others during infancy are
better prepared to do this
§ Balance independence with consistently
soung rules for safety
ü Socialization
§ When walking well, they become resistant
to sitting in laps and being cuddled
(function of independent)
§ 15 months
» Still enthusiastic about interacting
with people
§ 18 months
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» Imitate things they see a parent
doing
» Seek out parents to observe and
imitate
§ 2 years
» Become aware of gender
differences
ü Play Behavior
§ Parallel play – children playing beside
other children not with them
§ Not unfriendly, part of normal
developmental sequence
§ Parents must provide similar toys to other
kids because argument over one toy is
likely to happen
PLAY DEVELOPMENT
- Parallel play
- Toys that require action
- Parents should not correct children about the way a
toy is being used as long as it appears to give
satisfaction
¬ They like toys that they can control
- Giving them a sense of power in manipulation,
which is an expression of autonomy
ü 15 months of age
¬ Put-in, rake-out stage
¬ Enjoy stacks of boxes that fit inside
each other
ü 18 months of age
¬ Pull toys
¬ Toys should be strong enough to take
a great deal of abuse because
children this age may use toys in ways
other than those for which they are
designed for
¬ May show frustration because they
are holding it or using it incorrectly
ü 2 years old
¬ Imitate an adult
¬ Wrapping a doll and putting it to bed
¬ Driving a car
¬ Roughhousing and very active type of
play
¬ Encourage to play outdoors
SPECIAL NEEDS OF THE TODDLER AND THE
APPROACHES TO MEET THESE NEEDS
Love and Security
- Enables the toddler to grow up and reach out for
more mature roles
- The mother is still the one to turn for physical care
- The father is hardly known until the toddler stage
Security or Transitional Object
TOQUILAR
- An object which has an unusual importance, and
which seems to provide security for the child
(pillows, blankets, dolls)
Graded Independence
- Learned gradually and given only if he can guard
himself from trauma
- A very painful experience might make a child afraid
to try out new skills
- Develops a sense of self-reliance and adequacy of
autonomy
- Learns that there are many things he would like to
do, but cannot or may not
- An adult should never use shame or ridicule as a
means of punishment or of prevention of forbidden
activities
Learning Social Norms
- “standard”
- Learn simple and basic movements in washing and
bathing self
- Must understand discipline (setting rules or road
signs so children know what is expected of them)
§ Qualities of a Constructive Discipline
» Consistency
» Clarity
» Firmness
» Immediacy
» Encouragement of independence
§ Overdemanding and “laissez-faire” parents
fail in disciplining their children
§ Punishment – consequence that results
from breakdown in discipline or the child’s
disregard of the rules that were learned
- Taking time out
§ Technique to help children learnt that
actions have consequences
§ 1-minute addition for each year up to 5
minutes
§ Over 5 years; maximum of 5 minutes
CONTROL OF BODILY FUNCTIONS
Toilet Training
- Biggest task a toddle tries to achieve
- Requirements
• Physical Maturity
» Control of rectal and urethral
sphincter with complete
myelination of spinal cord
• Psychological readiness
» Recognition of the urge to hold on
and let go
Ä Ability to communicate
this to the mother
» Desire to please the mother (by
holding on) rather than to please
oneself by letting go
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» Developmental abilities (to sit or to
walk)
- Principles of Toilet Training
• Bowel training should be started first
before bladder training
• Toilet training should not be started earlier
than 18 months
• Bladder training should be started a
month or more after bowel
» Day bladder training – established
at 2 years
» Night bladder – established at 3
years
• Training should not be started when the
child is ill
» Can be stressful for the child
• Mother’s attitude
Steps in Toilet Training
1. Plan 1-2 weeks of psychological “readiness”
activities
2. Use training that can be pulled down
readily
3. Use comfortable child’s toilet seat/potty
chair
4. Practice session should be limited to 10
minutes usually at the time he defecated
5. Praise child if he urinates or defecates
6. Do not flush toilet while child is sitting on it
7. Do not give toys or food that may distract
him
8. When the child seems to be not ready yet,
return him to diapers then reschedule potty
training
9. When defecation has been mastered,
include urination this time
10. Do not pressure the child on nighttime
dryness
11. Do not wake up the child to urinate
Fecal Smearing
- 15 to 18 months
- Considers warm feces as gifts
- Parents should not express strong disapproval
- Parents could provide other safe substances of the
same texture
- Change diapers immediately after defecation
PROBLEM AREAS OF TODDLERS
Negativism
- 18 to 30 months
- Attempt to assert oneself as an individual
- A loud “NO” automatically, even if they mean yes
- Should not use opposition to overcome opposition
- Don’t ask questions that will require a yes or no
answer
TOQUILAR
- Participate (offer physical help)
- Recognize signs of independence
Ritualistic Behavior
- Make rituals of simple task
- Toddlers will make use of the same utensils in
eating, same clothes to wear, or doing the same
bedtime activities
- Express independence/autonomy
Temper Tantrums
- Toddlers don’t know how to express their feelings in
a more socially acceptable way
- Best managed by ignoring the behavior
- Remove cause; be calm and patient with no extra
attention
- Protect form harm/injury; avoid restraining
Dawdling
- Slowness in carrying a task
- Task may be difficult
- To avoid trying a task he knows he cannot do
- Confusion
- Provide specific instructions
- Help child perform task
Separation Anxiety
- Have difficulty accepting being separated from
primary caregivers
- Peaks at 8-9 months
- Greatest fear is abandonment
- Parents should say goodbye firmly, repeat the
explanation, then leave
- Give transitional object/security object
- “practice makes perfect”
BASIC NEEDS OF TODDLERS
1. Bathing
- Ensure safety
2. Clothing/Dressing
- Allow independence
3. Sleep and Exercise
- 12 hours of sleep including daytime nap of 1-2
hours
- With set of bedtime rituals
4. Dental Care
- Snacks should include fruits or high CHON food
- Assessment of dentition as early as 6 months but not
later than 24 months
- Dental services may begin at 3 years of age
5. Nutritional Needs
- Decrease rate of growth will decrease caloric
requirement, CHON, and fluid intake
- Manifested by decreased appetite known as
physiologic anorexia
- 100kcal/BW
- Eating time should be a happy time
- Points for feeding
» Serve food in small portion
» Needs 3 well balanced diet with snacks
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 TOQUILAR
» Chop or cut food in small pieces
» Food high in sugar should be avoided
» Fats should be kept to a minimum
6. Health Supervision
- Immunization
7. Accident Prevention
- Childproof the house
- Same interventions as for infants (refer to infancy
reviewer)

POINTS FOR FEEDING

• Serve food in small portion
• Needs 3 well-balanced diet with snacks
• Chop or cut food in small pieces
• Food high in sugar should be avoided
• Fats should be kept to a minimum

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