THE NORMAL TODDLER GROWTH AND DEVELOPMENT

The toddler period extent from the age 1 yr to approximately 3 yrs of age. During this time the
individual emerges from the total dependency of infancy into beginning independence or
autonomy.The toddler who learn to trust the parents during infancy now can use this trust in
exploration and investigation of a wold beyond parents arms.

PHYSICAL GROWTH AND DEVELOPMENT:

It includes

 BIOLOGIC GROWTH
 MOTOR DEVELOPMENT
 SENSORY DEVELOPMENT.

1.BIOLOGIC GROWTH

Rate of biologic growth slows down compared to that of infancy.

Weight and height : toddler rate of weight gain declines markedly in comparison with that of
infant. Although the toddler gains weight about 1.8 to 2.7kg a year, this gain occurs in steps or
short spurts rather than being uniform over the months . The average weight at 2yrs of age is 12
kg at 2 ½ yr child weighs 4 times that at birth. This slowing of weight gain leads to a reduced
metabolic rate which results in a decreased appetite.

The gain in height is grater than that of weight in toddler period. Height increases 10 to
12.5cm /yr and its because of growth in length of legs. The height at 2 yrs is about 85cm .Boys
tend to be slightly taller than that of girls.

Body proportions : The young toddler has a relatively large compared to the size of rest of the
body. The head circumference during the second year increases by 2.5cm .By 2 years of age the
chest circumference exceeds that of head. The rate of increase in head circumference then
decreases so that by 5 yrs of age the increase in circumference is less than 1.25cm each year.

The trunk is long in relation to the length of the legs. As the circumference of the chest increases
the transverse diameter also increases and becomes greater than the anteroposterior diameter.
The abdomen protrudes making the child appear pot-bellied because of the immature abdominal
musculature. The legs are relatively short but they grow rapidly because of growth at their
epiphysis centers The legs may appear slightly bowed during the second year because of the
weight of the rest of the body.

Dentition :

At 2yrs toddler will have 16 teeth. At 2 ½ yrs the full set of 20 temporary teeth has erupted.
Physiologic development:

The physiologic function of body is mature except endocrine and reproductive system.

Integumentary system:

The resistance of skin to infection and its ability to prevent fluid loss increases during early
childhood as the epidermis and dermis are tightly connected to each other. The sweat glands
produce small amount od perspirations in responseto warm tremperatures. But sebum production
is inadequate leading to dry skin. Fine body hair begins to grow on the arms and legs. The hair
on the head becomes coarser and darkens as it gradually approaches the eventual mature color.

Cardiovascular system

The pulse rate decreases and the blood pressure increases during the toddler period. The heart
and blood vessals increase in size. The capillaries increasingly constrict in response to cold and
dilate in response to warmth. Regulation of the core body temperature is more effective than
during infancy.

Blood values

Sufficient intake of dietary iron enables the toddler to maintain adequate levels of heamoglobin.
Slightly higher RBC count the childs ability to fight ind=fection has increased and although the
number of WBC has decreased, there effectiveness has been improved.

Respiratory system

Respiratory system

The structure of the respiratory tract increase in size with an increase in thorasic volume leading
to decreased respiratory rate. Because of the short straight Eustachian tubes through which
infection can reach the ears from the nasopharynx, the toddler continues to develop ottitis media
as an complication of nasopharyngitis. Respirations are still abdominal.

Gastrointestinal system

Salivary glands have reached functional maturity by the end of second year. The toddler can
chew food and keep it in the mouth so that the salivary enzymes can begin to act upon it.
Capacity of the stomach increases and the rapidity with which the food passes through the GI
tract decreases so that the toddler can and be satisfied with less frequent feedings. HCL
secreation in the stomach increases proving protection against various types of organisms.

Genitourinary system

With continuing maturation of kidney by two years of age toddler is able to conserve water and
to concentrate urine on a level similar to that of the adult.
Immune system

Because passive immunity from the mother decreases during infancy immunization is essential
for the protection of the child. The production of immunoglobulin which respond to such
immunization reaches adult level during the latter part of the first year of life. Adult level of
immunoglobulin is reached by the middle of the toddler period.

Nervous system

The number of brain cells is complete by the beginning of toddler period. They continue to grow
until the brain has reach two third of its adult size at two years of age and three quarters of adult
size by three years of age. As the child matures specific areas of brain develop such as Broca’s
area for speech other areas of cerebral cortex develop as the child achieves motor control of the
extremities and sphincters. This increase maturation of the brain together with opportunity to
explore the world contribute to the toddlers emerging intellectual abilities. Rapid development of
the brain development leads to increasing control of behavior but initially results in some
disorganization in young toddlers manifested by a very short attention span. Nervous system can
handle only one incoming stimulus at a time. Myelination of the spinal cord is achieve gradually
as toddlers show increasing ability to exert control over posture and co-ordinad movements as a
result the child is able to stand alone before being able to walk and walk before achieving the
skills of running and jumping.

Motor Development

Muscle grows faster than bone during the toddler period. The size of the muscle as well as their
specificity of movement increases as a result of use. As a toddler, walks, runs and climbs the
muscle used in these activities increase rapidly in strength.

Sensory Development

Although the binocular vision is fully develop by the end of infancy depth perception does not
appear completely until childhood. So the toddler cannot identify the distance fron the crib or
high chair to the floor and must be protected from falling. Visual acuity is 20/40 at two years of
age and 20/30 at 2 ½ years of age. Increase visual acuity permits the learning of depth perception
and color discriminations. Functional amblyopia is usually caused by a child not using the eye to
avoid double vision due to strabismus. The other senses hearing, taste, smell and touch continue
to develop during the toddler period. The ears of a healthy toddler permit good hearing. The
capacity to smell is linked to that of taste. It is influenced by cultural attitude, voluntary control
and cognitive development. The sensation of pain and touch are more fully developed than in the
infant.
Psycho social or Emotional development:

According to Erickson the developmental phase achieved during the toddler period is a sense of
autonomy. This sense of autonomy or the feeling that the toddler is an independent human being
is a pervasive ,at the same time each child recognizes the need to accept and utilize help and
guidance from others. This creates a struggle during the toddler period. children want to assert
themselves their minds and wills and the same time they need to help from others. So the
primary role of care giver is to help the children to acquire a sense of self and self control
without loosing the sense of self esteem. Toddlers can be given chances to make their own
choices. If they are criticized for their choices it may create a sense of shame and doubt.

Behavioral characteristics:

The behavioral characteristics observed during the toddler period include negativism , temper
tantrums ,ritualistic behavior and ambivalence .

Negativism and Temper tantrums:

During the toddler period child begin to get separate from the primary care giver. At the same
time toddler exhibits negativism the propensity to do the opposite of that which is requested or of
what ones normal desires would suggest. The child exerts power as an individual through
negativism over these family members. Negativism is a behavioral manifestation of frustration
when the toddler cannot express autonomy. Four developmental steps in relation to frustration
may be described as passive acceptance , physical aggression ,verbal aggression and socially
acceptable behavior .

Each toddler goes through a period of negativism during the developmental struggle through
maturity. The “No no” age also called the terrible two’s . negativism reaches uts peak during the
second or third year of life and then gradually declines between 3 and 6 yrs of age.

Support of the toddlers during temper tantrums:

The child should be observed and protected from self injury and injuring others. Physical
restraint only serves as a cause of frustration. The frustration can be reduced by removing the
child from the immediate cause of tantrum, to a quite place in a calm ,patient and loving way.

Ritualistic behavior :

Ritualism a repetitive acts performed to relieve anxiety ,provides a way for the toddler to to
maintain sameness and stability in sometimes confusing world. Rituals can help the child to feel
secure in the face of uncertainty ritualistic behaviors occurs most commonly between the age of
18 months and 4 yrs .s reaching a peak at about 2 ½ yrs of age. Care givers recognize these
rituals in such activities as bathing ,eating and sleeping . when the toddler get hospitalized they
may not be able to carry out these rituals can create stress and regression of behavior
Ambivalence :

It is the simultaneous existence of conflicting attitudes of love and hate towards the same object.
A typical of the toddlers to achieve the autonomy . The behavioral characteristic of holdings on
and letting go also develop con currently with muscular development including the control of
anal and urethral sphincters.

Psycho sexual development:

Psycho sexual development of toddlers according to Freud the child begins to operate on the
basis of ego, the toddler begin to have a conscious sense of self and must deals with the impulse
of the id while while learning to tolerate frustration and display socially acceptable ways of
behaving .

The Anal stage

Mouth is no longer the major source of satisfaction. As increased myelination of the nervous
system occurs the toddler will experience pleasure from the distended bladder ,from the masses
of feces in the rectum and from the release of contents of this organs. This is so called anal stage
coincides with the period of toilet training. The attitude of parents concerning with the feces and
urine and their feelings concerning toilet training also influence child’s personality development.

Sexuality during toddler period

The individuals core gender identity by which one identifies as male or female occurs during the
toddler period

Sibling rivalry

The children between the age of 2 and 5 yrs will show a great difficulty to adjust with the
pregnancy of their mother. They wont readily understand the emotional changes in the family.
Parents should prepare the toddler for the arrival of new child but don’t give any false promises
regarding the sex and appearance of the infant. Children should be encouraged to express teir
concern and feelings through play activities. Make arrangement for the older sibling to visit the
baby in the hospital and also provide opportunity for the mother to take care of the older child
along with the infant and include them also in the care of infant.

Symptoms of jealousy, rejection ,termed sibling rivalry. During the early months the toddler may
show irritability ,crying ,clingining , regressive behaviors ,as well as direct and indirect action .
direct action may include dislike of the baby or child may appear to love the baby more than the
normal this lays the foundation for a martyr attitude that may persist throughout the life.
Displacement of anger to anyone who cares the baby is also seen. Indirectly the child may be
clumsy in contact with the infant . if unable to express the jealousy the child may drop the infant
if given it to hold. The problem grows when the infant become mobile the toddler become more
aggressive and selfish taking the toys away from the infant ,hitting or bumping it . the closer the
infant and toddler are in age the more intense the rivalry.

Spiritual development:

During the toddler period the child has intuitive –projective faith that is faith derived primarily
from the parents or significant others. The child imitates religious behaviours such as bowing the
head in prayer , but doesn’t understand the meaning. The world of toddler consist of concrete
things and persons that can be seen and touched abstract concepts are not understood.

Intellectual or cognitive development:

According to piaget the sensorimotor stage composed of six sub stages occurs during infancy and
the early toddler period.

Substage v (12 to 18 months )

The teritiary circular reaction occurs during this stage .instead of choosing accidental events the
child chooses to vary them. By experimenting this way the child will find new solutions to old
problems. Also develops variations in old responses in approaching a new object.

Substage VI( 18 months to 2 yrs)

The invention of new means through mental combinations occurs during this stage. The toddler
shows evidence of the beginnings of mental representation of events. The child thinks about
problems ,no longer using only trial and error to solve them. Some solutions to problem appear
in a quick insightful manner. The toddler develops deferred imitation during this period.
Invisible displacement implies not only object permanence but also the presence of thought .
according to the childs behavior existence of punishment was known even though it could not be
seen. Thought was necessary to infer where it could be found.

Pre operational stage :

It is divided into two sub stages

Pre conceptual phase

Toddler is ego centric the child thinking based on concrete perception and on actions in the
immediate environment. The child uses one word to indicate several rather similar persons or
actions instead of using a word to identify one class of objects. Toddlers have learned that
objects have permeance , existing even when out of sight which leads to autonomy

Fears :
At 2 yrs of age they continue to have these fears and are also afraid of strange places and people
and of sudden un expected occurrence and changes in lightning as well as the expression of
anger by the care givers.

The most appropriate response of care giver is to hold the child close and give re assurance to the
child. Help the children to overcome the fears in relation to their personalities instead of shaming
them.

Moral development:

Moral development during toddler period include pre conventional morality which can be
divided into two stages

Stage 0 (birth to 2 yrs )

During this stage toddler will function on the basis of “ the good is what I like and want ” the
egocentric judgement will occur.

Stage 1 (2 to 3 yrs )

During this period of punishment obedience orientation the child believes that if I will be hurt of
doing it ,it must be wrong. If i will not be hurt it must be right .

Language and speech development :

The level of comprehension of children during this period is greater than the number of words
they can speak. They may still use gestures. Although approximately four words are spoken at 1
yrs of age ,the childs vocabulary increases to about 300 words at 2years of age. The childs first
one word speech is an expression of what is wanted. This one word speech is followed the use of
word or phrases that indicate ideas or what the child thinks the function of objects to be.

A plateau stage in learning to speak occurs ,during which the toddler makes little apparent
progress. Comprehension of speech continue to occur .

Building the vocabulary

The child will build a vocabulary of nouns of one syllable and then with the use of more difficult
nouns relating to object and people in the environment. Verbs denoting some form of action are
used. They will start to use adjectives ,adverbs ,pronouns etc.

Sentence formation

The childs first attempt at making sentences consist in combining two or more words into a
phrase and supplementing them with gestures.
Stimulating language and speech development

Listening to the childs utterences

Recasting the toddlers 2-3 word sentences into adult sentences

Being verbally enthusiastic about things that interest the child

Indirectly correcting the childs use of language by the correct manner of speaking.

Reading and telling stories.

Encouraging the child to interact verbally with other adults and children

Delayed speech

If the child doesn’t speak by 2 ys of age it needs investigation