The Family with a TODDLER

Chapter 29

Toddler
Period from age 1 to 3 years
Enormous changes take place in a child and, family
Accomplish a wide array of developmental tasks
Changes from largely immobile, preverbal and dependent infants to walking, talking young
children w/ a growing sense of autonomy
Parents must also grow
Patience and sensitivity
Growth and Development
While making great strides developmentally,
Physical growth begins to slow
Height and Weight
Plot on a standard growth chart each health care visit
Gains only 5 – 6 lb (2.5 kg) and 5” (12 cm) a year during toddler period
SC fat or baby fat begins to disappear – end of 2nd yr
From plump to leaner, more muscular
Growth and Development
Appetite decreases
Adequate intake still essential to meet energy needs
Head Circumference:
áes only about 2 cm (2nd year)
Chest circumference:
Now greater than head
Growth and Development
Body Contour
Prominent (“Pouchy”) abdomen
Altho’ walking well, still weak abdominal muscles – not enough to support abdominal
contents
Forward curve of the spine (lordosis)
Will correct itself as they walk longer
Waddle or walk w/ a wide stance, unsteady gait – for better stability
Body systems continue to mature
RR:
slow slightly but continue to be mainly abdominal
HR:
Slows from 110 to 90 bpm
BP
áes – 99/64 mmHg
Brain
Develops to about 90% of its adult size
Rspiratory system
Lumens of vessels enlarge – threat of respiratory infection less
Stomach
Secretions more acid – GI infection less common
Stomach capacity
áes – can eat 3 meals a day
Control of urinary and anal sphincters becomes possible w/ complete myelination of spinal cord
IgG and IgM production
 mature@ 2 yrs of age
Passive immunity during intrauterine life – no longer operative
Developmental Milestones
Influenced to some extent, by amount of social contact and
The number of opportunities children have to explore and experience new degrees of
independence
And strongly influenced by individual readiness for a new skill
Emotional Development
Autonomy vs shame or doubt
Erickson’s developmental task of toddlers
Infants who have learned to trust are better prepared to do this than those who cannot trust
themselves or others
Develop a sense of autonomy = develop a sense of independence
Parents shd encourage independence while still maintaining consistently sound rules for safety
Emotional Development
As they recognize they are separate individuals – they realize they do not always have to do what
others want them to do
Thus, the reputation for:
Being NEGATIVISTIC
Obstinate, and
Difficult to manage
May be misinterpreted ad disobedience by parents
Emotional Development
Socialization
Once walking well – resistant to sitting on laps and being cuddled
18 months – imitate things they see parents doing
“Study” or “sweep”
By 2 or more years – become aware of gender differences and may point to other children and
identify them as “boy” or “girl”
Emotional Development
Play Behavior
Parallel play
Toys
they can play by themselves, that require action;
they can control – giving them sense of power in manipulation = expression of autonomy
15 mos – put-in, take-out
18 mos – walking securely enough to enjoy pull toys
2 years – imitating adult actions
End of toddler period – rough-housing, very active, stimulating type of play; rough and tumble
play
Cognitive development
Piaget’s Cognitive and Psychosocial Development of the Toddler
Tertiary Circular reaction stage
Stage 5 (12 – 18 months)
“little scientists”
Intersted in trying to discover new ways to handle objects or new results that diff. actions can
achieve
Experiments by trial and error methods
Retrieving articles that rolled under a chair
15 mos – follow a different path
Object permanence starting
Cognitive development
Deferred imitation
Stage 6 (18 – 24 months)
Able to try out various actions mentally rather than to actually perform them
Beginning of problem-solving or symbolic thought
Remembers an action and imitates it later
Pretend to drive a car or put baby to sleep
Coz have seen this just previously but @ a past time
Object permanence complete
Cognitive development
Preoperational thought
End of toddler period (24 months)
Second major period of cognitive devt.
Deal much more constructively w/ symbols than while still in sensorimotor period
Begin to use a process – ASSIMILATION
Not able to change thoughts to fit a situation – they learn to change situation (or how they
perceive it) to fit their thoughts
Causes toddlers to use toys in the “wrong” way
Psychosocial development
24 – 36 months
Autonomy vs shame or guilt
Learn independence and the beginning of problem solving
Promoting Toddler Safety
Accidents – major cause of death in all ages
Accidental ingestion (poisoning)
Occurs most frequently in toddlers
Cleaning products
Aspiration or ingestion of small objects – watch or hearing aid batteries
Pencil erasers, crayons
Childproof house – putting all poisonous products, drugs, and small objects out of reach
Promoting Toddler Safety
Motor vehicle accidents
Burns
Falls
Playground injuries
Toddler’s motor ability jumps ahead of his/her judgment
Lead Poisoning
Eating, chewing, sucking objects covered with lead-based paints
Promoting Nutritional Health
Smaller appetite than infants’
Sit and play with food
Place a small amount of food on plate, allow child to eat it, and ask for more
1 tbspful is a good start
Allow self-feeding, nutritious finger foods
Pcs of chicken, slices of banana, cheese, crackers
Don’t like “mixed up” food
Toddler Nutrition
Consume 1,300 kcal daily
CHON and CHO needs often met during toddler period
Avoid diets high in sugar
 Fats shd not be restricted for children <2 yrs old; >2 yrs – shd be no more than 30% of total daily
calories from fat
Adequate calcium and phosphorous
impt. for bone mineralization
Whole milk until age 2 years
Daily Activities
Dressing
Most toddlers – by end of toddlers period, can put on own socks, underpants, undershirts
Independence
Parents shd be encouraged to give up perfection
Sneakers ideal toddler shoe – soles hard enough for rough surfaces and arch support is limited
Sleep
From napping 2x/day; sleeping 12 hours/night to 1 nap/day and only 8 hours sleep @ night
Naturally fall asleep when tired
Resist naptime as part of negativism
Naptime as part of lunch time and not as separate activity
Give secondary choices
Loves bedtime routine – bath, pajamas, story, toothbrushing, etc
Need feeling of security – reliable and consistent parents
Bathing
Should depend on parents’ and the child’s wishes and scheduling
Establishing a sense of routine is important
Sense of security knowing certain events are predictable
Provide fun, bath toys
Don’t leave toddlers in bath tub unsupervised
Might slip and get head under water or reach and turn on hot-water faucet
Care of Teeth
Fruit or protein foods rather than high CHO
Calcium – important for the development of teeth
Drink fluoridated water if available
All new teeth form w/ cavity-resistant enamel
Must have own toothbrush
May do own brushing towards end of toddler period, under supervision
2.5 years old = schedule for 1st dental care visit
Parental Concerns
Toilet Training
One of the biggest task a toddler must achieve
Individualized task for each child
Begin and be completed according to a child’s ability to accomplish and not according to a set
schedule
3 important developmental levels before toilet training:
1. Control of rectal and urethral sphincters
Usually achieved by the time they walk well
2. Have a cognitive understanding of what it means to hold urine and stools
Until they can release them @ a certain place and time
3. Desire to delay immediate gratification
For a more socially accepted action
When to TOILET TRAIN?
As a rule:
Children are ready for toilet training not only when they can understand what their parents want
them to do but also when they begin to be uncomfortable in wet diapers
 Pulling or tugging on soiled diapers
Must be able to give up immediate pleasure
E.i. relieving themselves whenever they have the urge so as to gain other pleasure later on
Improved physical comfort and another step in growing up
Ritualistic Behavior
Will use only “their” spoon @ mealtime, only “their” washcloth @ bath time
Will not go outside unless mother or father locates favorite cap
Child who seems to need excessive # of objects to cling to or an excessive # of routines
May be trying to say, “I need more guidelines, more rules. Don’t let me be quite so
independent.”
Negativism
Establishing their identities as separate individuals
Reply to every request is a very definite “NO”
Important they pass this stage so they grow up to be persons who are independent and able to take
care of their own needs and desires
How to resolve negativism?
Limit # of questions asked of the child
Make statements instead of asking a question
Give 2ndary choices
“Its time time now” then says “Do you want to take your duck or your toy boat?”
Helps smooth out friction caused by negativism
Discipline
“discipline” and “punishment” not interchangeable
Discipline
setting rules or road signs so children know what is expected of them
Punishment
Consequence that results from a breakdown in discipline, from the child’s disregard of the rules
that were learned
Parents shd instill discipline early in life
Partly to set safety limits and to protect others or property
2 general rules to follow:
Parents must be consistent
Rules are learned best if correct behavior is praised rather than wrong behavior punished
“Timeout”
Technique of helping children learn that actions have consequences
Parents 1st need to be certain child understands the rule they are trying to enforce
1 minute/year of age
Separation Anxiety
Fear of being separated from parents or primary care giver
Starts 6 mos. – persists throughout preschool period
Temper Tantrums
Occur as a natural consequence of toddler’s devt.
They know what they want but do not have the vocabulary or wisdom to express their feelings in a
more socially acceptable way
May be a response to unrealistic requests by a parent
Parents saying “NO” too frequently