THE FAMILY WITH A TODDLER o Forward curve of the spine (lordosis),

will correct itself as they walk longer.

Toddler
 Waddle or walk w/ a wide stance, unsteady gait
Period from age 1 to 3 years – for better stability

 Enormous changes take place in a child and Body systems continue to mature this time:
family
 Respiratory System
 Accomplish a wide array of developmental tasks
o Lumens of vessels enlarge – threat of
 Changes from largely immobile, preverbal and
respiratory infection less
 dependent infants to walking, talking young
 Respiratory Rate:
children w/
o slow slightly but continue to be mainly
 a growing sense of autonomy
abdominal
 Parents must also grow -Patience and
 Heart Rate: Slows from 110 to 90 bpm
Sensitivity
 Blood Pressure: Increases – 99/64 mmHg
GROWTH AND DEVELOPMENT  Brain: Develops to about 90% of its adult size
 Body systems continue to mature this time:
 While making great strides developmentally,
 Stomach
 Physical growth begins to slow Height and
o Secretion become more acidic-
Weight
therefore, GI infection becomes less
 Plot on a standard growth chart each health
o Stomach capacity increases to a point a
 care visit
child can eat 3 meals a day
 Gains only 5 – 6 lb (2.5 kg) and 5” (12 cm) a year
 Urinary system:
during toddler period
o Control of urinary and anal sphincters
 Subcutaneous fat or baby fat begins to
become possible with complete myelination
disappear – end of 2nd year
of spinal cord- therefore, toilet training is
o From plump to leaner, more muscular
possible
 IgG and IgM antibody production:
o Becomes mature at 2 years of age,
passive immunity during intrauterine
life no longer operative.

The developmental milestone of the toddler years is

less numerous but no less dramatic than those of the
infant.

 It is 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

 Appetite decreases
o Adequate intake still essential to meet
energy needs
 Head Circumference:
o Increases only about 2 cm (2nd year)
 Chest circumference: Now greater than head
 Body Contour LANGUAGE DEVELOPMENT
o Prominent (“Pouchy”) abdomen,
although walking well, still weak Toddlerhood is a critical time for language
abdominal muscles – not enough to development
support abdominal contents. Varies among children
12-15 months (Listening & Attention)
 Attends to music and singing
 Enjoys sound - making toys / objects
Understanding
 Understands single words in context, e.g. cup,
milk, daddy
 Understands more words than they can say
 Understands simple instructions, e.g. ‘kiss
mummy’, ‘stop’
Speech Sounds & Talk
 Says around 10 single words, although these
may not be clear
 Reaches or points to something they want
whilst making speech sounds
15-18 months (Listening & Attention)
 Listens and responds to simple information /
instructions e.g. ’Ben, put on shoes’,
 ’Mohammed, give to daddy’
Understanding
 Understands a wide range of single words and
some two-word phrases, e.g. ‘give me’, ‘shoe
on’
 Recognizes and points to objects/pictures in
books if asked
 Gives names familiar objects to adults, e.g. coat,
apple
Speech Sounds & Talk
 Still babbles but uses at least 20 single words
correctly, although may not be clear
 Copies gestures and words from adults
 Constant babbling and single words used during
play
 Uses intonation, pitch and changing volume
when ‘talking’
18.24 months (Listening & Attention)
 Focuses on an activity of their own choice but
finds it difficult to be directed by an adult
 Use of child’s name beginning to help them to
attend to what an adult says, e.g. ‘Sarah, eat
sandwiches’
Understanding
 Understanding of single words develops rapidly
during this stage: anything between 200—500
words are known
 Understands more simple instructions, ’Get
your bricks’
Speech Sounds & Talk
 Uses up to 50 words
 Begins to put two or three words together
 Frequently asks questions, e.g. the names of
people / objects
24-36 months (Listening & Attention)
 Beginning to listen to talk with interest, but
easily distract.
 Listens to talk addressed to him/her, but finds it
difficult if prompts are not provided, e.g. use of
name, stop and listen
Understanding
 Developing understanding of simple concepts
including In / on / under , big / little
 Understands phrases like ’put teddy in the box’
 Understands simple ’who’ and ‘what’ and
‘where’ questions but not why.
 Understands simple story when supported with
pictures
Speech Sounds & Talk
 Uses 300 words including descriptive language
 Links four to five words together
 Uses pronouns (me, him, she) plurals &
prepositions (in, on, under)
EMOTIONAL DEVELOPMENT (Autonomy vs Shame
and 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 a sense of
independence
 Parents should encourage independence
while still maintaining consistently sound
rules for safety.
 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.
o May be misinterpreted ad
disobedience by parents
Socialization
 Once toddler are walking well – they
become resistant to sitting on laps and
being cuddled. By 18 months –they seek out
parents doing, “Study” or “sweep” -imitate
things
  By 2 or more years – become aware of
gender differences and may point to other
children and identify them as “boy” or
“girl”.
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 months – put-in, take-out
 18 months – 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 Development of the Toddler
Stage 5- Sensorimotor: (12 – 18 months)
 Tertiary Circular reaction stage -“little
scientists”
 Interested in trying to discover new ways to
handle objects or new results that different
actions can achieve
 Experiments by trial and error methods
 Retrieving articles that rolled under a chair
 15 months – follow a different path ( walk in
back of the chair ) to obtain the object.
 Object permanence starting
Stage 6- Sensorimotor: (18 – 24 months)
 Deferred imitation-able to remember can action
and imitate later
 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
 Object permanence complete
Preoperational Thought
 End of toddler period (24 months)
 Second major period of cognitive development
 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
PSYCHOLOGICAL DEVELOPMENT
Erikson’s Psychosocial Development of the Toddler
 Children at this stage are focused on developing
a greater sense of self-control.
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
 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
 Toddler have 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 tbsp full is a
good start
 Allow self-feeding, nutritious finger foods,
pieces of chicken, slices of banana, cheese,
crackers
 Don’t like “mixed up” food
 Consume 1,300 kcal daily
 CHON and CHO needs often met during toddler
period
 Avoid diets high in sugar
  Fats should not be restricted for children less
than 2 years old; >2 years – should be no more
than 30% of total daily calories from fat
 Adequate calcium and phosphorous
o Important for bone mineralization
o Whole milk until age 2 years
Dressing
 Most toddlers by end of toddlers period, can
put on own socks, underpants, undershirts
 Independence
 Parents should be encouraged to give up
perfection
 Sneakers ideal toddler shoes – soles hard
enough for rough surfaces and arch support is
limited
IN Daily activities
Sleep
 From napping 2x a day; sleeping 12 hours/night
to 1 nap/day and only 8 hours sleep at night
 Naturally fall asleep when tired
 Resist naptime as part of negativism
o Naptime as part of lunch time and not
as separate activity
o Give secondary choices
o Loves bedtime routine – bath, pajamas,
story, tooth brushing, etc
o 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
o Sense of security knowing certain
events are predictable
 Provide fun, bath toys
 Don’t leave toddlers in bath tub unsupervised
o 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
o All new teeth form with cavity-resistant
enamel
 Must have own toothbrush
o May do own brushing towards end of
toddler period, under supervision
 2.5 years old = schedule for 1st dental care visit
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
Parental concerns
3 important development 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
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
o Pulling or tugging on soiled diapers
 Must be able to give up immediate pleasure
 Ex:. relieving themselves whenever they have
the urge so as to gain other pleasure later on
o Improved physical comfort and another
step in growing up
RITUALISTIC BEHAVIOR
When to TOILET TRAIN?
 Will use only “their” spoon at mealtime, only
“their” washcloth at bath time
 Will not go outside unless mother or father
locates favorite cap
 Child who seems to need excessive number of
objects to cling to or an excessive number of
routines
o 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 number of questions asked of the child
o Make statements instead of asking a
question
 Give Secondary choices
o “Its 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
o setting rules or road signs so children
know what is expected of them
 Punishment
o Consequence that results from a
breakdown in discipline, from the
child’s disregard of the rules that were
learned
 Parents should instill discipline early in life
o Partly to set safety limits and to protect
others or property
Discipline
2 General Rules to follow:
1. Parents must be consistent.
2. Rules are learned best if correct behavior is
praised rather than wrong behavior punished.
 “Timeout”
o Technique of helping children learn that
actions have consequences
o Parents need first to be certain child
understands the rule they are trying to
enforce
o 1 minute/year of age
SEPARATION ANXIETY
 Fear of being separated from parents or
primary care giver
 Starts 6 mos. – persists throughout preschool
period
 Dawdling – slowness in accomplishing a task
o Assess child’s ability to accomplish a
task first
o Give child ample time to accomplish a
task
o Be patient
TEMPER TANTRUMS
 Occur as a natural consequence of toddler’s
development.
 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
Differentiating temper tantrums, breath holding,
seizures
HOLDING BREATH SPELL
What Is a Breath-Holding Spell?
 A breath holding spell is when a child holds
their breath, usually after being angry,
frustrated, startled, or in pain. Sometimes the
breath holding leads to the child passing out.
 It can be frightening to watch a breath-holding
spell, but they aren’t harmful and usually last
less than a minute. Kids outgrow the spells
without any treatment.
What Are the Types of Breath-Holding Spells?
Two types of breath-holding spells:
 If the child’s face turns blue, it’s called a
cyanotic breath-holding spell. Usually the child
cries very hard and then has the spell. Cyanotic
breathholding spells are usually caused by
anger or frustration.
 If the child’s face turns white, it’s called pallid
breath-holding spell. The child may cry a little
bit or not at all before having the spell. Pallid
breathholding spells are usually caused by the
child being startled or in pain.
What to do if a Child has a Breath-Holding Spell?
 If your child has a breath-holding spell:
o Lay your child in the crib or on the floor.
o Keep your child away from anything
hard or sharp.
o Stay with your child.
 If your child passes out:
o Try to stay calm and reassure yourself
that your child is safe.
o Check your child's mouth for food or
any object that could cause choking.
 If this is your child's first breath-holding spell,
get medical care. Although the spells are not
harmful, it is good to get your child checked
out.