I.

INTRODUCTION
EARLY CHILDHOOD CARE
• INCREASINGLY COMMON, EARLY CHILDHOOD CARE PLAYS AN IMPORTANT ROLE IN CHILDREN’S DEVELOPMENT AND PROVIDES A
VALUABLE SUPPORT TO FAMILIES WITH YOUNG CHILDREN. IT IS THEREFORE IMPORTANT TO UNDERSTAND THE IMPACT OF THESE
SERVICES AND TO ENSURE THEIR QUALITY AND ACCESSIBILITY.
• HIGH QUALITY CHILD CARE CAN HAVE A POSITIVE INFLUENCE ON CHILDREN’S DEVELOPMENT AND SCHOOL READINESS BY
PROVIDING VALUABLE EDUCATIONAL AND SOCIAL EXPERIENCES. HIGH QUALITY CHILD CARE IS CHARACTERIZED AS:
• HAVING WELL-QUALIFIED, WELL-PAID, STABLE STAFF, LOW CHILD-ADULT RATIOS, AND EFFICIENT MANAGEMENT.
• OFFERING A PROGRAM THAT COVERS ALL ASPECTS OF CHILD DEVELOPMENT (PHYSICAL, MOTOR, EMOTIONAL, SOCIAL,
LANGUAGE AND COGNITIVE DEVELOPMENT).
FIVE AREAS OF CHILD DEVELOPMENT
• PHYSICAL HEALTH, WELL-BEING, AND MOVEMENT SKILLS
THESE ACTIVITIES ARE DESIGNED TO HELP DEVELOP YOUR CHILD’S LARGE AND SMALL MUSCLE CONTROL, HER
COORDINATION, AND HER OVERALL PHYSICAL FITNESS.
• SOCIAL AND EMOTIONAL DEVELOPMENT
ACTIVITIES IN THIS AREA TARGET YOUR CHILD’S ABILITY TO MAKE AND KEEP SOCIAL RELATIONSHIPS, BOTH WITH
ADULTS AND WITH OTHER CHILDREN. HE WILL LEARN TO RECOGNIZE AND EXPRESS HIS OWN FEELINGS MORE
EFFECTIVELY. HE WILL GAIN EXPERIENCE UNDERSTANDING AND RESPONDING TO THE EMOTIONS OF OTHERS.
• APPROACHES TO LEARNING
CHILDREN DIFFER IN HOW THEY APPROACH NEW TASKS, DIFFICULT PROBLEMS, OR CHALLENGES. THESE ACTIVITIES
WILL SPARK YOUR CHILD’S CURIOSITY, INTEREST, AND ATTENTION AND THE ABILITY TO STAY ON TASK. RESEARCH
SUGGESTS STRONG LINKS BETWEEN POSITIVE APPROACHES TO LEARNING AND SUCCESS IN SCHOOL.
• THINKING ABILITIES AND GENERAL KNOWLEDGE
THE SUGGESTIONS IN THIS AREA HELP YOUR CHILD FIGURE OUT HOW THE WORLD WORKS AND HOW THINGS ARE
ORGANIZED. YOUR CHILD WILL EXPERIENCE “LEARNING HOW TO LEARN,” IMPROVING PROBLEM-SOLVING
ABILITY AND ABSTRACT THINKING.
• COMMUNICATION, LANGUAGE AND LITERACY
THESE ACTIVITIES WILL HELP YOUR CHILD LEARN TO EXPRESS HIMSELF AND TO UNDERSTAND WHAT OTHERS SAY.
EARLY READING AND WRITING SKILLS ARE ALSO TARGETED.
DEFINITION OF CHILD HEALTH CARE
• CHILD HEALTH: THE CARE AND TREATMENT OF CHILDREN. CHILD HEALTH IS THE PURVIEW
OF PEDIATRICS, WHICH BECAME A MEDICAL SPECIALTY IN THE MID-NINETEENTH CENTURY.
BEFORE THAT TIME THE CARE AND TREATMENT OF CHILDHOOD DISEASES WERE INCLUDED
WITHIN SUCH AREAS AS GENERAL MEDICINE, OBSTETRICS, AND MIDWIFERY. CHILDREN'S
HEALTH ENCOMPASSES THE PHYSICAL, MENTAL, EMOTIONAL, AND SOCIAL WELL-BEING OF
CHILDREN FROM INFANCY THROUGH ADOLESCENCE.
SCOPE OF HEALTH CARE FOR CHILDREN FROM BIRTH THROUGH AGE 21
THE OPTIMAL HEALTH OF CHILDREN CAN BEST BE ACHIEVED BY PROVIDING ACCESS TO COMPREHENSIVE
HEALTH CARE BENEFITS. THIS POLICY STATEMENT OUTLINES AND DEFINES THE RECOMMENDED SET OF
HEALTH INSURANCE BENEFITS FOR CHILDREN THROUGH AGE 21. THESE SERVICES ENCOMPASS MEDICAL
CARE, CRITICAL CARE, PEDIATRIC SURGICAL CARE, BEHAVIORAL HEALTH SERVICES, SPECIALIZED SERVICES
FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS, AND ORAL HEALTH. IT REPLACES THE 1997 STATEMENT,
“SCOPE OF HEALTH CARE BENEFITS FOR NEWBORNS, INFANTS, CHILDREN, ADOLESCENTS, AND YOUNG
ADULTS THROUGH AGE 21 YEARS.”
ALL INFANTS, CHILDREN, ADOLESCENTS, AND YOUNG ADULTS THROUGH 21 YEARS OF AGE MUST HAVE
ACCESS TO COMPREHENSIVE HEALTH CARE BENEFITS THAT WILL ENSURE THEIR OPTIMAL HEALTH AND WELL-
BEING. THESE BENEFITS SHOULD BE AVAILABLE THROUGH MEDICAID, THE STATE CHILDREN'S HEALTH
INSURANCE PROGRAM (SCHIP), AND PRIVATE HEALTH INSURANCE PLANS. SOME OF THESE BENEFITS SHOULD
ALSO BE AVAILABLE THROUGH THE EDUCATIONAL AND PUBLIC HEALTH SYSTEMS FOR CHILDREN WITH
SPECIAL NEEDS AND FOR CHILDREN WHO ARE UNINSURED OR HAVE INADEQUATE COVERAGE.
• THESE SERVICES SHOULD BE DELIVERED IN A COMPREHENSIVE MEDICAL HOME, THE
SETTING FOR PRIMARY CARE DELIVERED OR DIRECTED BY WELL-TRAINED PHYSICIANS WHO
ARE KNOWN TO THE CHILD AND FAMILY, WHO HAVE DEVELOPED A PARTNERSHIP OF
MUTUAL RESPONSIBILITY AND TRUST WITH THEM, AND WHO PROVIDE ACCESSIBLE,
CONTINUOUS, COORDINATED, AND COMPREHENSIVE CARE. SERVICES PROVIDED IN OTHER
SETTINGS SHOULD BE COORDINATED THROUGH THE CHILD'S MEDICAL HOME. THESE
SERVICES SHOULD INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING.
MEDICAL CARE
• THE PROVISION BY A PHYSICIAN OF SERVICES RELATED TO THE MAINTENANCE OF HEALTH,
PREVENTION OF ILLNESS, AND TREATMENT OF ILLNESS OR INJURY.

CRITICAL CARE
• CRITICAL CARE IS A TYPE OF CARE FOR CHILDREN WHO HAVE ILLNESSES OR INJURIES THAT
REQUIRE A CLOSE AND CONSTANT WATCH BY A TEAM OF SPECIALLY-TRAINED CAREGIVERS.
CHILDREN WHO NEED CRITICAL CARE ARE TREATED IN OUR PEDIATRIC INTENSIVE CARE UNIT
(PICU). THE ICU MEDICAL STAFF AND CONSULTING SERVICES ARE PREPARED FOR ANY MEDICAL
AND SURGICAL DIAGNOSIS AND/OR CRISIS, AND PROVIDE A FULL RANGE OF SERVICES AND
INTERVENTIONS FOR NEWBORNS THROUGH TEEN-AGERS.
PEDIATRIC SURGICAL CARE
• OUR PEDIATRIC SURGEONS PERFORM INPATIENT AND OUTPATIENT SURGERY ON CHILDREN OF ALL AGES FOR A WIDE RANGE OF
CONDITIONS. THEY WORK CLOSELY WITH OTHER PEDIATRIC SPECIALISTS— A TEAM APPROACH THAT GIVES CHILDREN THE CARE
THEY NEED TO HEAL AS QUICKLY AS POSSIBLE.

BEHAVIORAL HEALTH SERVICES

• BEHAVIORAL HEALTH SERVICES (BHS) IS A NOT-FOR-PROFIT COMMUNITY-BASED HEALTHCARE ORGANIZATION PROVIDING
MEDICAL SERVICES, SUBSTANCE ABUSE, MENTAL HEALTH, DRUG-FREE TRANSITIONAL LIVING, HOUSING FOR WOMEN WITH HIV,
AND PREVENTION SERVICES FOR THE LOCAL COMMUNITY.

PEDIATRIC ORAL HEALTH

• TAKE GOOD CARE OF YOUR CHILD'S BABY TEETH. THEY DO EVENTUALLY FALL OUT BUT UNTIL THEY DO, BABY TEETH PLAY AN
IMPORTANT ROLE IN HELPING YOUR CHILD BITE AND CHEW FOOD, AND SPEAK CLEARLY. MANY OF THE SAME TREATMENT AND
EVALUATION OPTIONS THAT ADULTS HAVE ARE ALSO AVAILABLE TO KIDS. THESE INCLUDE X-RAYS, DENTAL SEALANTS,
ORTHODONTIC TREATMENT AND MORE.
 B. COMMUNITY CHILD CARE
COMMUNITY CHILD HEALTH CARE
• COMMUNITY CHILD HEALTH IS THE LARGEST PEDIATRIC SUBSPECIALTY FOCUSING ON THE
CARE OF VULNERABLE CHILDREN AND FAMILIES, CHILDREN WITH LONG-TERM CONDITIONS
AND CHILD PUBLIC HEALTH. COMMUNITY CHILD HEALTH IS THE CARE OF CHILDREN
OUTSIDE HOSPITAL. IT IS REWARDING AND CHALLENGING - EVERY DAY IS DIFFERENT.
COMMUNITY PEDIATRICIANS SEE CHILDREN AS OUTPATIENTS FOR A VARIETY OF
REASONS.
WHAT MAKES A COMMUNITY CHILD HEALTH PEDIATRICIAN?
• A COMMUNITY CHILD HEALTH PEDIATRICIAN IS A DOCTOR WHO HAS EXPERTISE IN WORKING WITH
VULNERABLE GROUPS OF CHILDREN AND THEIR CARES. THIS INCLUDES CHILDREN WITH DEVELOPMENTAL
DISORDERS AND DISABILITIES, THOSE WITH COMPLEX BEHAVIORAL ISSUES AND THOSE WHO ARE AT RISK
OF ABUSE OR ARE BEING ABUSED. THEY ALSO HAVE A PARTICULAR ROLE WITH CHILDREN WHO ARE
“LOOKED AFTER” OR ARE IN THE PROCESS OF BEING ADOPTED.
• THEY HOLD CLINICS IN A VARIETY OF SETTINGS WITH AN EMPHASIS ON CONTINUITY OF CARE AND HAVE
STRONG SKILLS IN MULTI-AGENCY WORKING PARTICULARLY WITH EDUCATION AND SOCIAL CARE.
COMMUNITY PEDIATRICIANS HAVE A VITAL ROLE IN PLANNING AND IMPLEMENTING LOCAL STRATEGIES
TO IMPROVE THE HEALTH OF ALL CHILDREN IN THEIR AREA INCLUDING SAFEGUARDING POLICY AND
UNIVERSAL AND TARGETED LIFESTYLE PROGRAMS.
CHILD HEALTH SERVICE
• THE CHILD HEALTH SERVICE PROVIDES A RANGE OF COMMUNITY HEALTH AND SUPPORT SERVICES FOR
CHILDREN AND THEIR PARENTS/CARERS TO GIVE EVERY CHILD THE BEST POSSIBLE START IN LIFE.
• SERVICES MAY BE OFFERED IN THE HOME, OR IN CHILD HEALTH CENTERS, AND SOME COMMUNITY
CENTERS, FREE OF CHARGE.

SERVICES CAN INCLUDE:

• HEALTH ASSESSMENTS (SURVEILLANCE AND SCREENING)
• GROWTH AND DEVELOPMENT CHECKS
• EARLY FEEDING SUPPORT
• NUTRITIONAL INFORMATION AND ONGOING INFANT/CHILD FEEDING SUPPORT
• IMMUNIZATION INFORMATION AND IMMUNIZATION CLINICS
• PARENTING SUPPORT (SEMINARS, GROUPS AND INDIVIDUAL INTERVENTIONS)
C. PRIMARY CHILD CARE APPROACH TO CHILD HEALTH
THE PRIMARY HEALTH CARE APPROACH

• THE PRIMARY HEALTH CARE APPROACH IS BOTH A PHILOSOPHY OF HEALTH CARE AND AN
APPROACH TO PROVIDING HEALTH SERVICES. THE PRIMARY HEALTH CARE APPROACH
EMBRACES FIVE TYPES OF CARE: PROMOTIVE; PREVENTIVE; CURATIVE; REHABILITATIVE; AND
SUPPORTIVE/PALLIATIVE. IN DELIVERING EACH TYPE OF CARE, UNDER THE PRIMARY HEALTH
CARE APPROACH, THE FOCUS IS ON PREVENTING ILLNESS AND PROMOTING HEALTH. THE
PRIMARY HEALTH CARE APPROACH IS EFFECTIVE IN RESPONDING TO THE NEEDS OF VARIOUS
CLIENT GROUPS FROM INDIVIDUALS THROUGH FAMILIES AND COMMUNITIES TO POPULATIONS.
THE PRINCIPLES OF PRIMARY HEALTH CARE ARE ACCESSIBILITY, PUBLIC PARTICIPATION, HEALTH
PROMOTION, APPROPRIATE TECHNOLOGY AND INTERSECTORAL COOPERATION
• ACCESSIBILITY MEANS THAT THE FIVE TYPES OF HEALTH CARE ARE UNIVERSALLY AVAILABLE TO ALL
CLIENTS REGARDLESS OF GEOGRAPHIC LOCATION. IN MANY CASES, THE PRINCIPLE OF ACCESSIBILITY CAN
BEST BE OPERATIONALIZED BY HAVING COMMUNITIES DEFINE AND MANAGE NECESSARY HEALTH CARE
SERVICES. DISTRIBUTION OF HEALTH PROFESSIONALS IN RURAL, REMOTE AND URBAN COMMUNITIES IS
KEY TO THE PRINCIPLE OF ACCESSIBILITY. ACCESSIBILITY MEANS THAT CLIENTS WILL RECEIVE APPROPRIATE
CARE FROM THE APPROPRIATE HEALTH CARE PROFESSIONAL, WITHIN A TIME FRAME THAT IS
APPROPRIATE.

• PUBLIC PARTICIPATION MEANS CLIENTS ARE ENCOURAGED TO PARTICIPATE IN MAKING DECISIONS ABOUT
THEIR OWN HEALTH, IN IDENTIFYING THE HEALTH NEEDS OF THEIR COMMUNITY, AND IN CONSIDERING THE
MERITS OF ALTERNATIVE APPROACHES TO ADDRESSING THOSE NEEDS. ADOPTION OF THE PRINCIPLE OF
PUBLIC PARTICIPATION ENSURES RESPECT FOR DIVERSITY. IT ALSO MEANS THAT THE DESIGN AND DELIVERY
OF HEALTH CARE IS FLEXIBLE AND RESPONSIVE. PARTICIPATION ENSURES EFFECTIVE AND STRATEGIC
PLANNING FOR, AND THE EVALUATION OF, HEALTH CARE SERVICES IN A COMMUNITY.
• HEALTH PROMOTION INVOLVES HEALTH EDUCATION, NUTRITION, SANITATION, MATERNAL AND CHILD HEALTH CARE, IMMUNIZATION,
PREVENTION AND CONTROL OF ENDEMIC DISEASE. THE GOAL OF HEALTH PROMOTION IS TO REDUCE THE DEMANDS FOR CURATIVE AND
REHABILITATIVE CARE. THROUGH HEALTH PROMOTION, INDIVIDUALS AND FAMILIES BUILD AN UNDERSTANDING OF THE DETERMINANTS OF
HEALTH. INDIVIDUALS AND FAMILIES THEREBY DEVELOP SKILLS TO IMPROVE AND MAINTAIN THEIR HEALTH AND WELL-BEING. SCHOOL
HEALTH PROGRAMS ARE AN IMPORTANT METHOD OF PROMOTING HEALTH AND SELF-ESTEEM.

• APPROPRIATE TECHNOLOGY MEANS THAT MODES OF CARE ARE APPROPRIATELY ADAPTED TO THE COMMUNITY’S SOCIAL, ECONOMIC
AND CULTURAL DEVELOPMENT. THE ADOPTION OF THE PRINCIPLE OF APPROPRIATE TECHNOLOGY HIGHLIGHTS THE IMPORTANCE OF
IMPROVED KNOWLEDGE AND OF ON-GOING CAPACITY BUILDING TO THE DESIGN AND DELIVERY OF HEALTH CARE SERVICES. IT MEANS
CONSIDERATION OF ALTERNATIVES TO HIGH-COST, HIGH-TECH SERVICES. THE PRINCIPLE OF APPROPRIATE TECHNOLOGY RECOGNIZES THE
IMPORTANCE OF DEVELOPING AND TESTING INNOVATIVE MODELS OF HEALTH CARE AND OF DISSEMINATING THE RESULTS OF RESEARCH
RELATED TO HEALTH CARE.

• INTERSECTORAL COOPERATION RECOGNIZES THAT HEALTH AND WELL-BEING IS LINKED TO BOTH ECONOMIC AND SOCIAL POLICY.
INTERSECTORAL COOPERATION IS NEEDED TO ESTABLISH NATIONAL AND LOCAL HEALTH GOALS, HEALTHY PUBLIC POLICY, AND THE
PLANNING AND EVALUATION OF HEALTH SERVICES. THE ADOPTION OF THE PRINCIPLE OF INTERSECTORAL COOPERATION WILL ENSURE
THE PROVIDERS FROM DIFFERENT DISCIPLINES COLLABORATE AND FUNCTION INTERDEPENDENTLY TO MEET THE NEEDS OF HEALTH CARE
CONSUMERS AND THEIR FAMILIES. IT ALSO MEANS THAT HEALTH PROFESSIONALS WILL PARTICIPATE IN GOVERNMENT POLICY
FORMULATION AND EVALUATION, AS WELL AS IN THE DESIGN AND DELIVERY OF HEALTH CARE SERVICES. IT ALSO MEANS THAT SERVICES
MUST BE DELIVERED AND EVALUATED IN AN INTEGRATED AND CONGRUENT FASHION.
 II. TODDLER

A. GROWTH AND DEVELOPMENT OF THE TODDLER

 PHYSICAL GROWTH
PHYSICAL GROWTH
• WHILE TODDLERS ARE MAKING GREAT STRIDES
DEVELOPMENTALLY, THEIR PHYSICAL GROWTH BEGINS TO
SLOW
 WEIGHT, HEIGHT, AND HEAD
CIRCUMFERENCE
• PLOT WEIGHT AND HEIGHT ON A STANDARD GROWTH CHART
AT EACH HEALTH CARE VISIT TO DETERMINE IF PROGRESS IS
NORMAL FOR EACH INDIVIDUAL CHILD. A CHILD GAINS ONLY
ABOUT 5 TO 6 LB (2.5 KG) AND 5 IN(12 CM) A YEAR DURING
THE TODDLER PERIOD . AS SUBCUTANEOUS TISSUE OR BABY
FAT, BEGINS DISAPPEAR TOWARD THE END OF THE SECOND
YEAR, THE CHILD CHANGES FROM A PLUMP BABY INTO LEARNER
, MORE MUSCULAR LITTLE GIRL OR BOY. A TODDLER’S APPETITE
DECREASES ACCORDINGLY, YET ADEQUATE INTAKE OF ALL
NUTRIENTS IS STILL ESSENTIAL TO MET ENERGY NEEDS (DUDCK
2005)
HEAD CIRCUMFERENCE INCREASES ONLY ABOUT 2CM
DURING THE SECOND YEAR COMPARED TO ABOUT
12CM DURING THE FIRST YEAR. HEAD
CIRCUMFERENCE EQUALS CHEST CIRCUMFERENCE AT
6MONTHS TO 1 YEAR OF AGE. BY 2 YEARS, CHEST
CIRCUMFERENCE HAS GROWN GREATER THAN THAT
OF THE HEAD.
 BODY CONTOUR
TODDLERTEND TO HAVE A PROMINENT ABDOMEN___A POUCHY
BELLY BECAUSE ALTHOUGH THEY ARE WALKING, THEIR ABDOMINAL
MUSCLES ARE NOT YET STRONG ENOUGH TO SUPPORT
ABDOMINAL CONTENTS AS WELL AS THEY WILL LATER
THEY ALSO HAVE A FORWARDED CURVE OF THE SPINE AT THE
SACRAL AREA (LORDOSIS). AS THEY WALK LONGER, THIS WILL
CORRECT ITSELF NATURALLY.
TODDLERS WADDLE OR WALK WITH WIDE STANCE. THIS STANCE
SEEMS TO INCREASE THE LORDOTIC CURVE BUT KEEPS THEM ON
THEIR FEET.
 BODY SYSTEM
• BODY SYSTEM CONTINUE TO MATURE DURING THIS TIME:
RESPIRATIONS SLOW SLIGHTLY BUT CONTINUE TO BE MAINLY
ABDOMINAL
THE HEART RATE SLOWS FROM 110 TO90 BPM; BP INCREASES TO ABOUT
99/64 MMHG
THE BRAIN DEVELOPS TO ABOUT 90% OF ITS ADULT SIZE
THE LUMENS OF VESSEL INCREASE PROGRESSIVELY SO THE THREAT OF
LOWER RESPIRATORY INFECTION IS LOWER. (RESPIRATORY SYSTEM)
STOMACH CAPACITY INCREASES TO THE POINT THAT THE CHILD CAN EAT
3 MEALS A DAY
 BODY SYSTEM
STOMACH SECRETION BECOME MORE ACIDIC; THEREFORE
GASTROINTESTINAL INFECTIONS ALSO BECOME LESS
COMMON
CONTROL OF URINARY AND ANAL SPHINCTERS BECOMES
POSSIBLE WITH COMPLETE MYELINATION OF THE SPINAL CORD
IGG AND IGM ANTIBODY PRODUCTION BECOMES MATURE AT
2 YEARS OF AGE. THE PASSIVE IMMUNITY EFFECTS FROM
INTRAUTERINE LIFE ARE NO LONGER OPERATIVE.
 DEVELOPMENT MILESTONE
• A. LANGUAGE DEVELOPMENT
AGE (MONTHS) FINE MOTOR GROSS MOTOR LANGUAGE PLAY
 15  PUTS SMALL  WALKS ALONE  4-6 WORDS  CAN STACK 2
PELLETS INTO WELL; CAN BLIOCKS;
SMALL SEAT SELF IN ENJOY BEING
BOTTLES. CHAIR; CAN READ TO;
SCRIBBLES CREEP DROPS TOYS
VOLUNTARILY UPSTAIRS FOR ADULT TO
WITRH A RECOVER
PENCIL OR (EXPLORING
CRAYON. SENSE OF
HOLDS A PERMANENCE
SPOON WELL
BUT MAY STILL
TURN IT
UPSIDE DOWN
 LANGUAGE DEVELOPMENT
AGE (MONTHS) FINE MOTOR GROSS MOTOR LANGUAGE PLAY
 18  NO LONGER  CAN RUN AND  7-20 WOR,  IMITATES
ROTATE A JUMP IN USES HOUSE HOLD
SPOON TO PLACE. CAN JARGONING; CHORES,
BRING IT TO WALK AND NAMES/ BODY DUSTING,ETC.;
MOUTH DOWN STAIRS PARTS BEGINS
HOLDING PARALLEL
ONTO A PLAY (PLAYING
PERSON’S BESIDE NOT
HAND POR WITH
RAILING. ANOTHER
TYPICALLY CHILD)
PLACES BOTH
FEET ON ONE
STEP BEFORE
ADVANCING
 LANGUAGE DEVELOPMENT
AGE (MONTHS) FINE MOTOR GROSS MOTOR LANGUAGE PLAY
 24  CAN OPEN DOORS  WALKS UP STAIRS  50 WORDS, 2-WORD  PARALLEL PLAY
BY TURNING DOOR ALONE STILL USING SENTENCES (NOUN- EVIDENT
KNOBS, UNSCREW BOTH FEET ON PRONOUN AND
LIDS SAME STEP AT THE VERD), SUCH AS
SAME TIME “DADDY GO”, “ME
COME”

 30  MAKES SIMPLE  CAN JUMP DOWN  VERBAL LANGUAGE  SPENDS TIOME

LINES OR STROKES FROM CHAIRS INCREASING PLAYING HOUSE,
FOR CROSSES WITH STEADILY. KNOWS IMITATING
A PENCIL FULL NAME I PARENTS’ ACTIONS;
COLOR AND HOLDS PLAY IS “ROUGH-
UP FINGERS TO HOUSING” OR
SHOW AGE ACTIVE
 COGNITIVE AND PSYCHOSOCIAL DEVELOPMENT
AGE IN MONTHS STAGE TASK
COGNITIVE
 12-18  SENSORIMOTOR 5  CHILD EXPERIMENTS BY
TRIAL AND ERROR
 18-24  SENSORIMOTOR 6 METHODS
 CAN PRETEND AND USE
DEFFERED IMITATION;
 24  PREOPERATIONAL OBJECT PERMANENCE IS
THOUGHT COMPLETE
 ABLE TO USE ASSIMILATIPN
PHYCHOSOCIAL OR CHANGE SITUATION TO
 24-36 FIT THOUGHTS
 AUTONOMY VS. SHAME
OR GUILT  LEARN INDEPENDENCE
AND THE BEGINNING OF
PROBLEM SOLVING
 EMOTIONAL DEVELOPMENT
DEVELOPMENT TASK: AUTONOMY VERSUS SHAME OR DOUBT
ACCORDING TO ERIKSON (1993), THE DEVELOPMENTAL TASK OF TODDLER PERIOD IS TO
LEARN A SENSE OF AUTONOMY OR INDEPENDENCE.
TODDLERS WHO DO NOT DEVELOP A SENSE OF AUTONOMY MAY MANIFEST FEELINGS
SHAME OR DOUBT.
CHILDREN WHO HAVE LEARNED TO TRUST THEMSELVES AND THE OTHERS DURING THE
INFANT YEAR ARE BETTER PREPARED TO DO THIS THAN THOSE WHO CANNOT TRUST
THEMSELVES OR OTHERS.
TO DEVELOP A SENSE OF AUTONOMY IS TO DEVELOP A SENSE OF INDIPENDENCE
CHILDREN WHO ARE CONSTANTLY TOLD NOT TRY THINGS BECAUSE THEY WILL HURT
THEMSELVES MAY BE LEFT WITH STRONGER SENSE OF DOUBT THAN CONFIDENCE AT THE END
OF THE TODDLER PERIOD.
 EMOTIONAL DEVELOPMENT
A HEALTHY LEVEL OF AUTONOMY IS ACHIEVED WHEN PARENTS ARE ABLE TO ENCOURAGE
INDEPENDENCE WHILE STILL MAINTAINING CONSISTTENTLY SOUND RULES FOR SAFETY
INFANTS APPEAR TO HAVE DIFFICULTY DIFFERENTIATING BETWEEN THEIR BODIES AND THOSE
OF OTHERS; THEY THINK OF THEIR BODIES AS EXTENSIONS OF THEIR PARENTS OR THEIR
PRIMARY CAREGIVERS
WHEN INFANTS APPROACH TODDLERHOOD THEY BEGIN TO MAKE THE DIFFERENTIATION. AS
THEY RECOGNIZE THAT THEY ARE SEPARATE INDIVIDUALS, THEY REALIZE THEY DO NOT
ALWAYS HAVE TO DO WHAT OTHERS WANT THEM TO DO. FROM THIS REALIZATION COMES
THE REPUTATION TODDLERS HAVE FOR BEING NEGATIVISTIC, OBSTINATE, AND DIFFICULT TO
MANAGE.
 EMOTIONAL DEVELOPMENT
• SOCIALIZATION.
ONCE TODDLERS ARE WALKING WELL, THEY BECOME RESISTANT TO SITTING IN LAPS AND
VBEING CUDDLED. THIS IS NOT LACK OF DESIRE FOR SOCIALIZATION BUT A FUNCTION OF
BEING INDEPENDENT
15 MONTHS OLD CHILDREN ARE STILL ENTHUSIASTICS ABOUT INTERACTING WITH PEOPLE,
PROVIDING THOSE PEOPLE ARE WILLING TO FOLLOW THE TODDLERS WHERE THEY WANT TO
GO
BY 18 MONTHS, TODDLERS IMITATE THE THINGS THEY SEEK OUT PARENTS TO OBSERVE AND
INITIATE INTERACTIONS
BY 2 OR MORE YEARS, CHILDREN BECOME AWARE OF GENDER DIFFERENCES AND MAY POINT
TO OTHER CHILDREN AND IDENTIFY THEM AS ”BOY” OR “GIRL”
 EMOTIONAL DEVELOPMENT
• PLAY BEHAVIOR
ALL DURING THE TODDLER PERIOD, CHILDREN PLAY BERSIDE THE CHILDREN NEXT TO THEM.
(SIDE BY SIDE PLAY A.K.A PARALLEL PLAY)
THE TOYS TODDLERS ENJOY MOST ARE THOSE THEY CAN PLAY WITH THEMSELVES AND THAT
REQUIRE ACTION. TRUCKS THEY CAN MAKE GO, SQUEAKY FROGS THEY CAN SQUEEZE,
WASDDLING POUND, BLOCKS THEY CAN STACK, AND A TOY TELEPHONE THEY CAN TALK ON
ARE ALL FAVORITES.
THESE ARE ALL TOYS CHILDREN CAN CONTROL, GIVING THEM MANIPULATION, AN
EXPRESSION OF AUTONOMY
15 MONTHS OLD CHILDREN ARE STILL PUT-IN, TAKE OUT STAGE, SO THEY CONTINUE TO
ENJOY STACKS OF BOXES OR BALLS THAT FIT INSIDE EACH OTHER. THEY ENJOY THROWING
TOYS OUT OF PLAYPEN OR FROM A HIGH CHAIR TRAY AS LONG AS SOMEONE WILL PICK
THEM UP AND RETURN THEM AGAIN AND AGAIN
 EMOTIONAL DEVELOPMENT
18 MONTHS OLD CHILD ENJOYS PULL TOYS. TOYS SHOULD BE STRONG ENOUGH TO TAKE A
GREAT DEAL OF ABUSE, BECAUSE THERE ARE MANY THINGS IN THE WORLD TODDLERS DO
NOT RECOGNIZE OR KNOW ABOUT.
THIS CAUSES THEM TO USE TOYS IN WAYS OTHER THAN THOSE FOR WHICH THEY WHERE
DESIGNED. PARENTS SHOULD NOT CORRECT CHILDREN ABOUT THE WAY A TOY IS BEING
USED AS LONG AS IT APPEARS TO GIVE SATISFACTION.
BY AGE 2, TOODLERS BEGIN TO SPEND TIME IMITATING DULT ACTIONS IN THEIR PLAY; EX:
WRAPPING A DOLL AND PUTTING IT TO BED, “SETTING THE TABLE” OR “DRIVING THE CAR”.
THEY USE FEWER TOYS THAN BEFOERE; IMITATING ACTIONS THEY SEE PARENTS DOING HAS
REPLACED THEM
BOTH BOYS AND GIRLS BEGIN TO LIKE ROUGH-HOUSING AND SPEND ATLEAST PART OF
EVERY DAY IN THIS VERY ACTIVE, STIMULATING TYPE OF PLAY
PLANNING AND IMPLEMENTATION FOR
HEALTH PROMOTION OF THE TODDLER
AND FAMILY
• TODDLERS TEND TO DEVELOP MANY UPPER RESPIRATORY
AND EAR INFECTIONS BUT OTHERWISE COME TO A HEALTH
CARE FACILITY MOST OFTEN FOR HEALTH MAINTENANCE
VISITS (RECOMMENDED AT 15, 18 AND 24 MONTHS) AND
THE IMMUNIZATIONS IMPORTANT AT THESE TIME.
• THESE VISIT ALLOW A NURSE TO FOCUS ON HEALTH
PROMOTION AND PROVIDE AN OPPORTUNITY FOR
EARLY DETECTIONS OF ANY GROWTH AND
DEVELOPMENT DELAYS.
HEALTH MAINTENANCE SCHEDULE, TODDLER PERIOD
AREA OF FOCUS METHODS FREQUENCY

DEVELOPMENT History, observation

Formal Denver Every visit
Development Screening 18th months visit
test (DDST II)

GROWTH HEIGHT,WEIGHT PLOTTED

ON STANDARD GROWTH
MILESTONES CHART,PHYSICAL
EVERY VISIT
EXAMINATION

NUTRITION HISTORY, OBSERVATION;

HEIGHT/WEIGHT
INFORMATION
EVERY VISIT

PARENT-CHILD HISTORY, OBSERVATION

RELATIONSHIP EVERY VISIT
BEHAVIOR PROBLEMS HISTORY, OBSERVATION EVERY VISIT

• VISION AND HEARING HISTORY, EVERY VISIT

DEFECTS OBSERVATION
• DENTAL HEALTH HISTORY, PHYSICAL EVERY VISIT; FIRST AT
EXAMINATION; FIRST 24 MONTHS
DENTAL APPOINTMENT
• ANEMIA HEMATOCRIT/HEMAGLOB 24TH-MONTH VISIT
IN
•LEAD SCREENING WHOLE BLOOD LEAD DEPENDING ON RISK
LEVEL LEVEL;24-MONTH VISIT
•TUBERCULOSIS PPD TEST DEPENDING ON
PREVALENCE IN
COMMUNITY
 URINALYSIS CLEAN- CATCH URINE 24TH-MONTH VISIT

IMMUNIZATIONS
MEASLES,MUMPS AND CHECK HISTORY AND 12TH-OR 15TH MONTHS
RUBELLA PAST RECORD; VISIT
INFORMATION
CAREGIVER ABOUT ANY
RISK AND SIDE EFFECTS

HAEMOPHILUS ADMINISTRATIVE 12TH-OR 15TH

INFLUENZA TYPE B(HIB) IMMUNIZATION IN
ACCORDANCE WITH
HEALTH CARE AGENCY
• DIPHTHERIA, TETANUS, 15TH – OR 18TH- MONTH
AND PERTUSSIS; VISIT
INACTIVATE
POLIOMYELITIS

•VARICELLA 12TH – OR 18TH MONTH

VISIT

ANTICIPATORY

• TODDLER CARE ACTIVE LISTENING AND EVERY VISIT

HEALTH TEACHING
•EXPECTED GROWTH EVERY VISIT
AND DEVELOPMENTAL
MILESTON BEFORE NEXT
VISIT

•POISON AND ACCICENT PROVIDE SYRUP OF EVERY VISIT

PREVENTION IPECAC TO BE USED IN
CASE OF POISONING;
COUNSELING.

PROVIDE TELEPHONE
NUMBER AND LOCATION
OF NEAREST POISON
CONTROL CENTER.
PROBLEM SOLVING

ANY PROBLEMS ACTIVE LISTENING AND EVERY VISIT

EXPRESSEDBY HEALTH TEACHING
CAREGIVER DURING REGARDING TEMPER
COURSE OF THE VISIT TANTRUMS, TOILET
TRAINING, NEGATIVITY
 PROMOTING TODDLER SAFETY
ACCIDENTS ARE THE MAJOR CAUSE OF DEATH IN CHILDREN OF ALL AGES
ACCIDENTAL INGESTIONING (POISONING) ARE THE TYPE OF ACCIDENTS THAT OCCUR MOST
FREQUENTLY IN TODDLERS.
ASPIRATION OR INGESTION OF SMALL OBJECTS SUCH AS WATCH OR HEARING AID
BATTERIES, PENCIL, ERASER, CRAYONS IS ALSO A MAJOR DANGER FOR CHILDREN OF THIS
AGE. URGE PARENTS TOCHILDPROOF THE HOUSE BY PUTTING ALL THE POISON PRODUCTS,
DRUGS, AND SMALL OBJECTS OUT OF REACH BYNTHE TIME INFANT IS CRAWLING, AND
CERTAINLY BY THE TIME AN INFANT IS WALKING
OTHERS ACCIDENTS COMMON TO TODDLERS INCLUDE MOTOR VEHICLE ACCIDENTS, BURNS,
FALLS, AND PLAYGROUND INJURIES.
TO PREVENT INJURIES PARENTS MUST BE ALERT AND KNOW WHAT THEIR TODDLER IS DOING
AT ALL TIMES
 PROMOTING TODDLER SAFETY
 SOME 15 MONTHS OLD CHILDREN CAN CLIMB OVER THE SIDE RAILS OF THEIR CRIBS AND
ENJOY EXPLORING THE HOUSE EARLY IN THE MORNING BEFORE ANYONE ELSE IS AWAKE.
PARENTS MIGHT HAVE TO MOVE A REGULAR BED WITH SIDERAILS AS EARLY AS 15 MONTHS
TO KEEP TODDLER FROM FALLING WHEN CLIMBING OUT THE CRIB.
A SAFETY GATE ON THE DOOR OF THE ROOM IS ANOTHER WAY TO KEEP THE TODDLER
CONTAINED AND SAFE.
AS THE CHILD REACHES 2 YEARS, THEY BEGIN TO IMITATE HOUSEWORKS OR REPAIRING THE
CAR, PARENTS MUST BE SURE THE CHILD DOES NOT USE REAL CLEANING COMPOUNDS OR
SHARP TOOLS
LEAD POISONING IS CAUSED BY EATING, CHEWING, OR SUCKING AN OBJECTS SUCH AS
WINDOWSILLS, PAINT CHIPS, OR FURNITURE THAT ARE COVERED WITH LEAD-BASED PAINT.
 PROMOTING TODDLER SAFETY
ADDITIONAL SOURCES OF LEAD POISONING CAN INCLUDE:
1. SOIL AROUND THE EXTERIOR OF THE HOUSE AND POTENTIALLY CONTAMINATED FOOD
GROWN THERE
2. DUST OR FUMES CREATED BY HOME RENOVATION
3. POTTERY MADE WITH LEAD GLAZES
4. COLORED PRINT IN NEWSPAPER
5. OLD WATER PIPES
6. LEAD-BASED GASOLINE__CHILDREN WHO LIVE IN HIGH TRAFFIC AREAS ARE HIGH RISK IN
CONTAMINATION BY LEAD FUMES
7. LEAD DUST BROUGHT HOME ON THE CLOTHING OF PARENTS WHO WORKS WITH LEAD
PRODUCTS
A DIET HIGH IN FAT AND LOW CA, MG, FE, Z, AND CU MAY INCREASE THE ABSORPTION OF
LEAD BECAUSE LEAD IS TOXIC TO BODY TISSUE AND CAN CAUSE SERIOUS DAMAGE TO
BRAIN, NERVOUS SYSTEM, KIDNEYS AND RED BLOOD CELLS.
 KNOWLEDGE, CHILD SAFETY

APPROPRIATE ACTIVITIES FOR THE CHILD’S DEVELOPMENT LEVEL

DROWNING HAZARDS AND PREVENTIVE MEASURES
USE OF BICYCLE HELMENTS
FIRST AID TECHNIQUES AND CPR (INCLUDING DEMONSTRATION)
METHODS TO PREVENT PLAYGROUND ACCIDENTS
PROPER SURVEILLANCE OF OUTDOOR ACTIVITIES
TEACHING ABOUT STRANGER AWARENESS
 TODDLER SAFETY
• 13 TO 18 MONTHS
SUPERVISING CHILD OUTDOORS
EDUCATING CHILD ABOUT DANGERS OF THROWING, HITTING, SAFE WAYS TO INTERACT
WITH PETS
PREVENTING ACCESS TO ELECTRIC OUTLETS, CORDS, AND APPLIANCES OR TOOLS
SECURING GATES OR DOORS
MAINTAINING WATER HEATER TEMP. AT 120-130 DEGREE F
19 TO 24 MONTHS
USING CAR SEAT ACCORDING TO MANUFACTURER’S INSTRUCTION
INSTRUCTING CHILD ON STREET DANGERS
STORING ALL CHEMICALS, CLEANERS, AND PERSONAL CARE PRODUCTS OUT CHILD’S REACH
ENSURING MULTIPLE BARRIERS TO POOLS AND HOT TUBS
 TODDLER SAFETY
• 25 TO 36 MONTHS
INSTRUCTING CHILD ON DANGERS OF WEAPONS AND FIRES AND ALSO HOW TO GET HELP
WHEN FEELING SCARED OR IN DANGER
SELECTING TOYS ACCORDING TO MANUFACTURER’S RECOMMENDATIONS
STORING ,MATCHES AND LIGHTERS OUT OF CHILD’S REACH
SUPERVISING CHILD WHEN NEAR SWIMMING POOL, PONDS, OR HOT TUBS
INSTRUCTING CHILD ABOUT STRANGER, DANGER AND GOOD TOUCH/ BAD TOUCH
USING APPROPRIATE HELMET FOR BIKE RIDING
SUPERVISING CHILD CLOSELY WHEN IN PUBLIC SETTINGS
 HEALTH PROMOTION OF THE TODDLER AND FAMILY
BECAUSE GROWTH SLOWS ABRUPTLY AFTER THE FIRST YEAR OF LIFE, THE TODDLER’S
APPETITE IS SMALLER THAN THE INFANT. IF FEEDING PROBLEMS BEGINS, IT IS OFTEN
BECAUSE PARENTS ARE UNAWARE THAT THEIR TODDLER’S APPETITE HAS DECREASED
AND FOOD CONSUMPTION IS LESS. BECAUSE THE ACTUAL AMOUNT OF FOOD EATEN
DAILY VARIES FROM ONE CHILD TO ANOTHER, PARENTS SHOULD PLACE AMOUNT OF
FOOD ON APLATE AND ALLOW THE CHILD TO EAT AND ASK FOR MORE RATHER THAN
SERVE A LARGE PORTION THAT THE CHILD CANNOT FINISH.

TODDLERS INSIST ON FEEDING THEMSELVES AND WILL RESIST EATING IF A PARENT

INSIST ON FEEDING THEM. ALLOWING SELF FEEDING IS A MAJOR WAY TO
STRENGTHEN INDEPENDENCE IN A TODDLER.
RECOMMENDED DAILY DIETARY ALLOWANCES
CHILDREN AGES 1 TO 3 YEARS SHOULD CONSUME 1, 300 KCAL DAILY. PROTEIN AND
CARBOHYDRATE NEEDS ARE OFTEN EASILY MET DURING THE TODDLER PERIOD; DIET
HIGH IN SUGAR SHOULD BE AVOIDED. FATS SHOULD GENERALLY NOT BE
RESTRICTED FOR CHILDREN UNDER 2 YEARS OLD; HOWEVER, CHILDREN OVER 2
YEARS OLD SHOULD CONSUME NO MORE THAN 30% OF TOTAL DAILY CALORIES
FROM FAT. ADEQUATE CALCIUM AND PHOSPHORUS INTAKE IS IMPORTANT FOR
BONE
 MOTOR VEHICLES
MAINTAIN CHILD IN CAR SEAT; DO NOT BE
DISTRACTED FROM SAFE DRIVING BY A CHILD IN A CAR
SUPERVISE TODDLER WHO IS TOO YOUNG TO BE
LEFT ALONE ON A TRICYCLE
 FALLS
 PLACEGATES AT TOP AND BOTTOM OF STAIRS.
SUPERVISE AT PLAYGROUNDS
DO NOT ALLOW CHILD TO WALK WITH SHARP OBJECT
IN HAND OR MOUTH
 ASPIRATION
EXAMINE TOYS FOR SMALL PARTS
THAT COULD BE ASPIRATED; REMOVE
TOYS THAT APPEAR DANGEROUS
DO NOT FEED TODDLER POPCORN,
PEANUTS, ETC. URGE CHILDREN NOT
TO EAT WHILE RUNNING. DO NOT
LEAVE TODDLER ALONE WITH A
BALLOON
 DROWNING
DO NOT LEAVE TODDLER
ALONE IN A BATHTUB OR NEAR
WATER (INCLUDING BUCKETS
OF CLEANING WATER AND
WASHING MACHINES.)
 POISONING
NEVER PRESENT MEDICATION AS CANDY. BUY
MEDICATIONS WITH CHILDPROOF CAPS; PUT AWAY
IMMEDIATELY AFTER USE.
-NEVER TAKE MEDICATION IN FRONT OF CHILD
-NEVER LEAVE MEDICATION AND POISONS IN LOCKED
CABINETS OR OVERHEAD SHELVES WHERE CHILD CAN
NOT REACH THEM.
-ALWAYS STORE FOOD OR SUBSTANCES IN THEIR
ORIGINAL CONTAINERS.
 BURNS

BUY-FLAME-RETARDANT CLOTHING
MONITOR TODDLERS CAREFULLY WHEN THEY ARE NEAR LIT
CANDLES
DO NOT LEAVE TODDLERS UNSUPERVISED NEAR HOT-WATER
FAUCETS.
NEVER DRINK HOT BEVERAGES WHEN A CHILD IS SITTING ON
YOUR LAP OR PLAYING WHITIN REACH.
KEEP ELECTRIC WIRES AND CORDS OUT OF TODDLER’S REACH;
COVER ELECTRICAL OUTLETS WITH SAFETY PLUGS.
 GENERAL

KNOW WHEREABOUTS OF TODDLER AT ALL TIMES. TODDLERS CAN CLIMB

ONTO CHAIRS, STOOLS, ETC., THAT THEY COULD NOT MANAGE BEFORE; CAN
TURN DOOR KNOBS AND GO PLACES THEY COULD NOT GO BEFORE. BE
AWARE THAT THE FREQUENCY OF ACCIDENTS INCREASES WHEN THE FAMILY IS
UNDER STRESS AND THEREFORE LESS ATTENTIVE TO CHILDREN. SPECIAL
PRECAUTIONS MUST BE TAKEN AT THESE TIMES. BE AWARE SOME CHILDREN
ARE MORE ACTIVE, CURIOUS, AND IMPULSIVE AND THEREFORE MORE
VULNERABLE TO ACCIDENTS THAN OTHERS.
 PROMOTING TODDLER DEVELOPMENT IN DAILY
ACTIVITIES

THE TODDLER’S NEW INDEPENDENCE AND DEVELOPING ABILITIES IN SELF-

CARE, SUCH AS DRESSING, EATING, AND TO LIMITED EXTENT HYGIENE, PRESENT
SPECIAL CHALLENGES FOR PARENTS. LEARNING HOW TO PROMOTE
AUTONOMY YET MAINTAIN A SAFE, HEALTHFUL ENVIRONMENT IS A MAJOR
GOAL FOR THE FAMILY.
 DRESSING

• BY THE END OF THE TODDLER PERIOD, MOST CHILDREN CAN PUT ON THEIR OWN SOCKS,
UNDERPANTS, AND UNDERSHIRT. SOME MAY ALSO BE ABLE TO PULL ON SLACKS, PULLOVER SHIRTS
OR SIMPLE DRESSES. PARENTS MAY BE RELUCTANT TO ENCOURAGE TODDLERS TO DRESS
THEMSELVES. IT IS OFTEN MUCH EASIER AND QUICKIER TO PUT THEIR CLOTHES ON FOR THEM, AND
THE TODDLER WHO IS DRESSED PARENTS USUALLY BE WEARING CLOTHES IN THE CORRECT WAY.
WHEN TODDLER DRESS THEMSELVES, THEY INVARIABLY PUT SHOES ON THE WRONG FEET AND
SHIRT AND PANTS ON BACKWARDS. ENCOURAGE PARENTS TO GIVE UP PERFECTION FOR THE
BENEFITS OF THE CHILD’S DEVELOPING SENSE OF AUTONOMY. IF THE PARENT FEEL THEY MUST
CHANGE THE CHILD’S CLOTHES, THEY SHOULD BEGIN WITH A POSITIVE STATEMENT, SUCH AS “YOU
DID A GOOD JOB” BEFORE MAKING SWITCH.
 SLEEP

• THEY MAY BEGIN THE TODDLER PERIOD NAPPING TWICE A DAY AND SLEEPING
12 HOURS EACH NIGHT, AND END IT WITH ONE NAP A DAY AND ONLY 8
HOURS SLEEP AT NIGHT. A PARENT’S INSISTENCE THAT THE CHILD MORE SLEEP
MAY LEAD TO SLEEPING PROBLEMS OR REFUSAL TO SLEEP AT ALL. IF THE CHILD
CANNOT FALL ASLEEP AT NIGHT, MAYBE IT IS TIME TO OMIT OR SHORTEN AN
AFTERNOON NAP.
 BATHING

• - THE TIME FOR A TODDLER’S BATH SHOULD DEPEND ON THE PARENTS AND THE CHILD’S
WISHES AND SCHEDULE. SOME PARENTS PREFER TO BATHE A TODDLER BEFORE THE EVENING
MEAL BECAUSE IT HAS A QUIETING EFFECT AND PREPARES THE CHILD FOR EATING; OTHERS
AND HELPS THE CHILD SLEEP. THE TIME, HOWEVER, IS NOT AS IMPORTANT AS THE ATTEMP TO
ESTABLISH A SENSE OF ROUTINE, A SENSE THAT LIFE HAS ORDER. LEARNING TO BE
INDEPENDENT IS SOMETIMES FRIGHTENING, AND THERE IS SECURITY IN KNOWING THAT
CERTAIN EVENTS ARE PREDICTABLE.
 CARE OF TEETH

• BETWEEN-MEAL SNACKS ARE IMPORTANT FOR GROWING CHILDREN. ENCOURAGE PARENTS

TO OFFER FRUIT (BANANAS, PIECES OF APPLE, ORANGE SLICES) OR PROTEIN FOODS (CHEESE
OR PIECES OF CHICKEN) RATHER THAN MORE TRADITIONAL HIGH CARBOHYDRATE ITEMS FOR
SNACKS. SUCH FOODS NOT ONLY ARE NUTRITIOUS BUT ALSO REDUCE DENTAL DECAY BY
LIMITING EXPOSURE OF THE CHILD’S TEETH TO CARBOHYDRATE. CALCIUM (FOUND IN LARGE
AMOUNTS IN MILK, CHEESE, AND YOGURT) IS ESPECIALLY IMPORTANT TO THE DEVELOPMENT
OF STONG TEETH. IN ADDITION, CHILDREN SHOULD CONTINUE TO DRINK FLUODIRATED
WATER, IF IT IS AVAILABLE, SO THAT ALL NEW TEETH FORM WITH CAVITY-RESISTANT ENAMEL.