Chapter 37

The Toddler and Family

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Promoting Optimal Growth and Development
z z z z

³The terrible twos´ Ages 12 to 36 months Intense period of exploration Temper tantrums/obstinacy occur frequently

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Biologic Development
z z

z z

Weight gain slows to 4 to 6 lb/year Birth weight should be quadrupled by 2½ 2½ Height increases about 3 inches/year inches/year Growth is steplike rather than linear

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. smell. Inc. 4 . taste. 2006. and touch increase in development Uses all senses to explore environment Mosby items and derived items © 2010. an affiliate of Elsevier Inc. 2002 by Mosby.Sensory Changes z z z Visual acuity of 20/40 acceptable Hearing.

2006. otitis media. 5 . an affiliate of Elsevier Inc.. Inc. 2002 by Mosby. and tonsillitis are common among toddlers Voluntary control of elimination  Sphincter control: ages 18 to 24 months Mosby items and derived items © 2010.Maturation of Systems z z z Most physiologic systems relatively mature by the end of toddlerhood Upper respiratory infections.

2002 by Mosby. Inc. 6 . 2006.. an affiliate of Elsevier Inc.Gross and Fine Motor Development z z z Locomotion Improved coordination: between ages 2 and 3 Fine motor development Improved manual dexterity: ages 12 to 15 months  Throw ball: by 18 months  Mosby items and derived items © 2010.

2002 by Mosby.. Typical toddling gait. Inc. 7 . 2006. Mosby items and derived items © 2010. an affiliate of Elsevier Inc. 37-1.Fig.

. developing sense of autonomy Autonomy vs. ego. 8 . 2002 by Mosby. superego/conscience Mosby items and derived items © 2010. Inc. shame and doubt Negativism Ritualization provides sense of comfort Id.Psychosocial Development z z z z z Erikson. 2006. an affiliate of Elsevier Inc.

9 . 2002 by Mosby. 2006. Inc.. sensorimotor and preoperational phase Awareness of causal relationships between two events Learn spatial relationships Mosby items and derived items © 2010. an affiliate of Elsevier Inc.Cognitive Development z z z Piaget.

2002 by Mosby. 2006.Invention of New Means Through Mental Combinations z z z Imitation of behaviors Domestic mimicry Concept of time still embryonic Mosby items and derived items © 2010. Inc.. 10 . an affiliate of Elsevier Inc.

. 37-2. 11 . Inc. 2006. an affiliate of Elsevier Inc. 2002 by Mosby.Fig. Mosby items and derived items © 2010. Domestic mimicry and sex-role behavior are common during toddlerhood.

an affiliate of Elsevier Inc. 12 .. 2006. Inc. 2002 by Mosby.Preoperational Phase z z z z Begins about age 2 Transition between self-satisfying behavior and selfsocialized relationships Preconceptual phase is a subdivision of the preoperational phase Preoperational thought implies children cannot think in terms of operations Mosby items and derived items © 2010.

2002 by Mosby. an affiliate of Elsevier Inc.Spiritual Development z z Spiritual routines can be comforting Religious teachings and moral development influence toddler behavior Mosby items and derived items © 2010. 2006. Inc. 13 ..

Inc. 14 . 2002 by Mosby. 2006. an affiliate of Elsevier Inc..Development of Body Image z z z Refer to body parts by name Avoid negative labels about physical appearance Recognize sexual differences by age 2 Mosby items and derived items © 2010.

. 2006.Development of Gender Identity z z z Exploration of genitalia is common Gender roles understood by toddler Playing ³house´ Mosby items and derived items © 2010. Inc. 15 . an affiliate of Elsevier Inc. 2002 by Mosby.

Social Development z z z Differentiation of self from mother and significant others Separation Individualization Mosby items and derived items © 2010.. 2006. Inc. 16 . an affiliate of Elsevier Inc. 2002 by Mosby.

an affiliate of Elsevier Inc. 17 . Mosby items and derived items © 2010. 2002 by Mosby. are sources of security to a toddler. 2006. such as a fuzzy stuffed animal.. Transitional objects.Fig. 37-3. Inc.

2002 by Mosby. Inc.. 2006. 18 .Language z z z z z Increasing level of comprehension Increasing ability to understand Comprehension is much greater than the number of words a toddler can say At age 1 uses one word sentences By age 2 uses multiword sentences Mosby items and derived items © 2010. an affiliate of Elsevier Inc.

playing. an affiliate of Elsevier Inc. dressing.. strong-willed. volatile behaviors strongSkills include feeding. 19 . 2002 by Mosby.Personal Social Behavior z z z Toddlers develop skills of independence Skills for independence may result in tyrannical. and undressing self Mosby items and derived items © 2010. 2006. Inc.

37-4. an affiliate of Elsevier Inc. 2006..Fig. Young children enjoy dressing up. 20 . Mosby items and derived items © 2010. 2002 by Mosby. Inc.

Inc.Play z z z z z z Magnifies physical and psychosocial development Interaction with others becomes more important Parallel play Related to emerging linguistic abilities Tactile play Selection of appropriate toys Mosby items and derived items © 2010. 21 .. an affiliate of Elsevier Inc. 2006. 2002 by Mosby.

2002 by Mosby. 2006. an affiliate of Elsevier Inc. Inc..Coping with Concerns Related to Normal Growth and Development z z z z z Toilet training Sibling rivalry Temper tantrums Negativism Regression Mosby items and derived items © 2010. 22 .

. 2006. To minimize sibling rivalry. 23 . parents should include the toddler during caregiving activities.Fig. Mosby items and derived items © 2010. 2002 by Mosby. 37-6. an affiliate of Elsevier Inc. Inc.

Inc. 24 .Assessing Readiness for Toilet Training z z z z z z Voluntary sphincter control Able to stay dry for 2 hours Fine motor skills to remove clothing Willingness to please parents Curiosity about adult¶s or sibling¶s toilet habits Impatient with wet or soiled diapers Mosby items and derived items © 2010. 2002 by Mosby.. 2006. an affiliate of Elsevier Inc.

Inc. 2006. A. 25 . Children may begin toilet training sitting on a small potty chair. 2002 by Mosby. Sitting in reverse fashion on a regular toilet provides additional security to a young child. B. 37-5.. Mosby items and derived items © 2010.Fig. an affiliate of Elsevier Inc.

Promoting Optimum Health During Toddlerhood z Nutrition Phenomenon of ³physiologic anorexia´  Dietary guidelines  z z Sleep and activity Dental health Regular dental examinations  Removal of plaque  Fluoride  Low-cariogenic diet Low Mosby items and derived items © 2010. 2002 by Mosby.. 2006. 26 . an affiliate of Elsevier Inc. Inc.

Inc. an affiliate of Elsevier Inc. Mosby items and derived items © 2010.. 37-7.Fig. 2006. 27 . Young children can participate in toothbrushing. but parents need to brush all the child's teeth thoroughly. 2002 by Mosby.

The most effective cleaning of the teeth is done by parents.Fig.. an affiliate of Elsevier Inc. 2006. 37-8. 28 . Inc. Mosby items and derived items © 2010. 2002 by Mosby.

29 . Nursing caries. 2002 by Mosby. Mosby items and derived items © 2010.Fig. an affiliate of Elsevier Inc. 2006. 37-9. Inc.. Note extensive carious involvement of maxillary primary incisors.

Injury Prevention z z z z z z z z Motor vehicle injuries: car seat safety Drowning Burns Poisoning Falls Aspiration and suffocation Bodily damage Anticipatory guidance Mosby items and derived items © 2010. Inc. 30 . an affiliate of Elsevier Inc. 2006.. 2002 by Mosby.

Fig. 31 . Use of locking clip. 2002 by Mosby. A. Mosby items and derived items © 2010. an affiliate of Elsevier Inc.. Inc. B. Convertible car safety seat in forward-facing position. 2006. 37-10.

A..Fig. 32 . Inc. 37-11. an affiliate of Elsevier Inc. Top tether. Rigid 2-point attachment with top tether. Lower anchors and tethers for children (LATCH). 2006. 2002 by Mosby. Mosby items and derived items © 2010. Flexible 2-point attachment with top tether. C. B.

Special plastic caps in electrical sockets prevent young fingers from exploring dangerous areas.. an affiliate of Elsevier Inc. 33 . Inc. Mosby items and derived items © 2010.Fig. 37-12. 2006. 2002 by Mosby.

plants. or diaper pail deodorants. 2002 by Mosby. Inc.. 34 .Fig. Mosby items and derived items © 2010. 37-13. an affiliate of Elsevier Inc. rat poison. Children are most likely to ingest substances that are on their level. such as cleaning agents stored under sinks. 2006.