Physical Development of The Toddler

Nursing Care of a Family With a
Toddler
Learning Objectives
•After mastering the contents of this chapter,
you should be able to:
1. Describe normal growth and development of
a toddler as well as common parental
concerns.
2. Assess a toddler for normal growth and
development milestones.
Toddler
Learning Objectives
3. Formulate nursing diagnoses related to
toddler growth and development or parental
concerns regarding growth and
development.
4. Identify expected outcomes for nursing care
of a toddler.
5. Plan nursing care to meet a toddler’s growth
and development needs.
Toddler
Learning Objectives
6. Implement nursing care to promote normal
growth and development of a toddler, such
as discussing toddler developmental
milestones with parents.
7. Evaluate expected outcomes for
achievement and effectiveness of care.
Body growth and development
• do not grow as quickly as the first
year
• grow at different rates

(height and weight)
-heredity
-environment
Years 1 to 3
• Babies triple their birth weight during

the first year
• Toddlers gain only 5 – 6 lbs. of BW/yr
• Gains 5 in. in height/ yr.
• Most girls reach 53% of their adult
height by age 2
• Most boys reach 50% of their adult
height by age 2
THEREFORE…
It is usually true that a tall two-year-old
will be a tall adult.
Christopher is 24 months old.

He is currently 34 ½ in. tall.
How tall will he be?
34.5 ÷ 50% = 69 in. (5’9)
If Paula is 32 in. tall at 2 y.o.,

how tall will she be when she
becomes an adult?
32 ÷ 53% = 60 in. (5 ft)
 Body contour
 Prominent abdomen (pouchy belly or
pot-bellied)
– Abdominal muscles not yet strong enough
to support abdominal contents
 bow leggedness
 Lordotic posture
 Vision - 20/50 (by 3 years)
 Body systems:
 RR slows slightly; continue to be
abdominal
 HR slows from 110 to 90 bpm
 BP increases 99/64 mmHg
 Lumen in resp. system enlarged.
 Stomach secretions become more
acidic
 Body systems:
 Stomach capacity increases
 Urinary & Anal sphincter control possible with
complete myelination of the spinal cord.
 IgG and IgM antibody production becomes
mature @ 2 yrs. of age.
– Teeth:
 8 new teeth erupt (canines & 1st molars) during
2nd yr.
 All 20 desiduous teeth are generally present by
2.5 to 3 yrs. of age.
Developmental Milestones
 Language Development
– “NO” , a manifestation of their developing
autonomy.
 How to encourage Language Dev.:
1. Urge parents to name objects as they play
with their child.
2. Answering child’s questions
 Should be simple & brief bec. They have short
attention span
3. Reading aloud.
 Language Development
– 12 – 18 mos.
 Starts to combine 2 words
 18 – 22 word vocabulary
– 18 mos. To 2 yrs.
 Articulation lags behind
 270 – 300 word vocabulary
– 2 – 3 yrs.
 Uses consonants & pronouns
 900 – word vocabulary
 Emotional Development
– Autonomy vs. Shame & Doubt (by Erikson)
– Autonomy sense of independence
– They are negativistic,
 Bec. they realize they are separate individuals,
they don’t have to do what others want them
to do.
– 15 mos.
 Fears being alone, being abandoned,
strangers, objects, and places
 Expresses independence by trying to
feed and undress self.
– 18 mos.
 Negativism predominates
 Fears water
– 18 mos.
 Tempertantrums
 Awareness of own gender begins
– 24 mos.
 May resist bedtime & naps
 Fears the dark and animals
 Temper tantrums, negativism, and
dawdling continue
– 24 mos.
 Bedtime rituals important
 Explores genitalia
 Shows readiness for bowel and bladder
control.
– 36 mos.
 Temper tantrums, negativism, and
dawdling behavior subsides.
– 36 mos.
 Self esteem increases due to increased
independence in eating, elimination &
dressing.
 Explores many emotions in pretend
play.
 Separation anxiety subsides may
develop fear of monsters.
 Elimination
– Ready to toilet train between 18 – 24
mos.
– Bladder control more difficult to
control than bowel control
– Signs of readiness for toilet training:
1) Awareness of wet diaper
2) Able to follow directions
3) Able to communicate elimination needs
 Elimination
– Signs of readiness for toilet training:
4) Able to remain dry for longer period
5) Able to independently dress & undress
6) Able to sit, squat, walk well.
 Socialization
– Become resistant to sitting in laps
– 15 mos. old
 Enthusiastic
interacting with other people
provided those people are willing to follow
them where they want to go.
– 18 mos. old
 Imitate the things they see
– 2 or more yrs.
 Childrenbecome aware of gender
differences.
– Identifies other children as girl/boy.
 Play Behavior
– Parallel play
– Types of toys:
 Toys that require action
 Trucks they can make go
 Rocking horses they can ride
 Blocks they can stack
 Toy telephone
 Puzzles
 Cognitive Development
 12 – 18 mos. Old
– Stage 5 Tertiary Circular Reaction
 Toddler is called “little scientist”
 Child experiments by trial & error
 Many children at 15 mos. Are able to follow a rolling
object in different path.
 18 – 24 mos. Old
– Stage 6 invention of new means through mental
combination
– Able to remember action & imitate them later
(deferred imitation).
 18 – 24 mos. Old
combination
 Transitional phase to the preoperational thought
period.
 Uses memory and imitation to act (deferred
imitation).
 Object permanence become complete.
 Able to think through actions or mentally project the
solution to a problem
 18 – 24 mos. Old
combination
 Able to think through actions or mentally project the
solution to a problem
 E.g. If given a box, a toddler will investigate how the
top of the box can be removed.
 E.g. If given a 2nd box, with different shape, the
child can foresee how the top can be removed.
 2 – 7 yrs. old
– Preoperational Thought
 Children deal more constructively with symbols.
 They begin to use a process termed “assimilation”.
– They learned to change the situation (or how
they perceived it) to fit their thoughts.
– Toddlers use toys in the “wrong” way.
– E.g. Given a toy hammer, instead of pounding
with it, they might shake it to see if it rattles.
Health Promotion for Toddlers
• Promoting Toddler Safety
– Accidents
• Major cause of death in children of all ages.
1)Accidental ingestion (poisoning)
– Occurs most frequently in toddlers
2)Aspiration or ingestion of small objects
3)MVA
4)Burns
5)Falls
6)Drowning
7)Playground injuries
8)Lead poisoning
Promoting Nutritional Health
• Calories
– 1,300 kcal/day ÷ 3 meals a day
– Avoid high sugars in the diet
– Appetite becomes smaller
• Allow self-feeding to strengthen independence
• Offer nutritious finger food
– E.g. chicken, slices of banana, cheese & crackers
Promoting Toddler
Development
 Dressing
– Consider self-dressing features to help them
get dressed by themselves.
– Consider safety, comfortable fabric and
construction, growth features, durability,
attractive style, and easy care.
– Always praise the child after doing activities.
Promoting Toddler Development
 Bathing
– Bath every other day unless
needed more frequently.
 Sleeping
– Gradually decreases
– Napping 2x/day; sleeping 12 hrs./night
– Nightmares are common
– Needs bedtime rituals
 Care of the Teeth

– Encourage children to offer fruits (bananas,
pieces of apple, orange slices) or protein
foods rather than high carbohydrate items
for snacks such as cookies.
– Calcium is especially important to the
development of strong teeth.
– Should continue to drink fluoridated water.
– Children below 8 y.o. need some supervision
in brushing their teeth.
 Care of the Teeth

– Schedule a first visit to a pediatric dentist
by 2 ½ yrs. of age for assessment of
dentition.
Walking (18 mos.)
 most begin within two to three months

after first birthday
 learn to walk at different ages
 Beginning
 stand with feet wide apart
 turn feet outward and flex knees
 tiptoes
 arms out
Climbing (18 mos.)
• Toddlers climb onto furniture and
other objects
• Walk up and down stairs with help
• Put both feet on each stair
• Climbing relates to accessibility and
courage
Running (2 yrs.)
 True running begins around 2 years

 Not skilled
 Cannot start or stop quickly
Jumping (2 ½ yrs.)
 Not much before 2 years

 At 2 ½ years- jump off low objects with
both feet
 Move arms backwards
 Rides tricycle by 3 yrs.
Parental Concerns
 Toilet Training
– Children must have reached 3 important
developmental levels; 1 physiologic, 2
Cognitive:
1) Must have control of rectal & urethral
sphincters, usually achieved at the time they
walk well.
Parental Concerns
 Toilet Training
– Children must have reached 3 important
developmental levels; 1 physiologic, 2
Cognitive:
2) Must have understanding of what it means to
hold urine and stools until they can release
them at a certain place & time.
3) Must have a desire to delay immediate
gratification for a more socially accepted
action.
Parental Concerns
 Infants live by a pleasure principle:
– “They want what they want when they want
it.”
– Before they can complete toilet training,
they must be able to give up an immediate
pleasure;
 Relieving themselves whenever they have an urge.
Parental Concerns
 Ritualistic Behavior
– They will use only “their” spoon at
mealtime;
– They will use only “their” washcloth” at
bath time.
– They will not go outside unless mother or
father locates their favorite cap.
Parental Concerns
 Negativism
– Is NOT an expression of being stubborn
but a necessary assertion of self control.
– One method to deal with negativism is to
reduce the opportunities for a “NO”
answer.
Parental Concerns
 Discipline
– Means setting rules or road signs so
children know what is expected of them.
 “punishment” is a consequence that results
from child’s disregard of the rules that were
learned.
– It involves setting safety limits and
protecting others or property.
Parental Concerns
 Discipline
– Example:
 “stayaway from the fireplace”.
 “must not go into the street”.
– 2 General Rules to follow:

1) Parents need to be consistent
2) Rules are learned best if correct behavior is
praised, rather than wrong behavior punished.
Parental Concerns
 Discipline
– “Timeout”
A technique to help children learn that actions
have consequences.
– To use “timeout” effectively:
1) Parents must be certain their child
understands the rule they are trying to
enforce.
2) Parents should give one warning.
Parental Concerns
 Discipline
– To use “timeout” effectively:
3) If the child repeats the behavior, parents
select an area that is non-stimulating, such as
a corner of a room, or a hallway.
4) The child is directed to go immediately to the
“timeout” space and sit there for a specified
period of time.
 1 min./yr. of age
Parental Concerns
 Separation Anxiety
– Begins at about 6 mos. of age and persist
throughout the preschool period.
– Give them fair warning that they will have
a babysitter.
– It helps if parents say goodbye firmly and
briefly.
– Sneaking out strengthen fear of
abandonment.
Parental Concerns
 Temper Tantrums
– Toddlers do not have the wisdom to
express their feelings in a more socially
acceptable way.
– May be a response to an unrealistic request
by a parent.
– May occur if parents are saying “NO” too
frequently.
Parental Concerns
 Temper Tantrums
– Best approach:
 Parents to tell a child simply that they
disapprove of the tantrum and ignore it.

Physical Development of The Toddler

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Physical Development of The Toddler

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Nursing Care of a Family With a

• grow at different rates

• Babies triple their birth weight during

Christopher is 24 months old.

If Paula is 32 in. tall at 2 y.o.,

 Care of the Teeth

 Care of the Teeth

 most begin within two to three months

 True running begins around 2 years

 Not much before 2 years

– 2 General Rules to follow:

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