Chapter 17Chapter 17

The ToddlerThe Toddler

ObjectivesObjectives

• Describe the physical, psychosocial, and cognitive development of children from 1 to 3 years of age, listing age-specific events and guidance when appropriate.

• Discuss speech development in the toddler.

• Describe the task to be mastered by the toddler according to Erikson’s stages of growth and development.

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Objectives Objectives (cont.)(cont.)

• List two developmental tasks of the toddler period.

• Discuss the principles of guidance and discipline for a toddler.

• Discuss how adults can assist small children in combating their fears.

• Identify the principles of toilet training (bowel and bladder) that will assist in guiding parents’ effort to provide toilet independence.

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Objectives Objectives (cont.)(cont.)

• Describe the nutritional needs and self-feeding abilities of a toddler.

• List two methods of preventing the following; automobile accidents, burns, falls, suffocation and choking, poisoning, drowning, electric shock, and animal bites.

• Describe the characteristic play and appropriate toys for a toddler.

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General CharacteristicsGeneral Characteristics

• A toddler is between 1 to 3 years of age

• No longer completely dependent on others

• Rapid growth and development during infancy slows down

• Erikson’s stage of autonomy versus shame and doubt

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General Characteristics General Characteristics (cont.)(cont.)

• Major parental responsibility– Maintaining safety for the toddler while

allowing the opportunity for social and physical independence

– Maintain positive self-image and body image in child

• Negativism can be countered by offering limited choices and the use of distraction in handling toddlers whose favorite word is “no”

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General Characteristics General Characteristics (cont.)(cont.)

• Developing self-control and socially acceptable outlets for aggression and anger are important in the formation of personality and behavior

• Rituals increase the toddler’s sense of security by making compulsive routines of simple tasks

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Physical DevelopmentPhysical Development

• Birthweight quadruples by 2.5 years of age• Rate of brain growth slows• Body proportions change

– Head and trunk grow more slowly• Musculoskeletal system grows and bones begin to

ossify• Protuberant abdomen flattens when muscle fibers

increase in size and strength• Myelination of spinal cord nearly complete by 2

years• Bowel and bladder control usually complete by 2.5

to 3 years of age

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Physical Development Physical Development (cont.)(cont.)

• Respirations still mainly abdominal but shift to thoracic as child reaches school-age

• Capable of maintaining stable body temperature• Eruption of deciduous teeth complete by 2.5

years• Defense mechanisms of the skin and blood are

more effective• Digestive processes and stomach capacity

increase to allow three-meal-a-day schedule

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Sensorimotor and Cognitive Sensorimotor and Cognitive DevelopmentDevelopment

• Sensory and motor abilities do not function independently

• Memory strengthens

• Is able to assimilate information through trial, error, and repetition

• Piaget’s sensorimotor and preconceptual phase of development emerges rapidly in this age group

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Sensorimotor and Cognitive Sensorimotor and Cognitive Development Development (cont.)(cont.)

• Able to tolerate longer periods of separation from parents to explore environment

• Aware of cause and effect

• Concept of spatial relationships develops

• Begins to internalize standards of behavior

• Copies words and roles of the models seen in the home

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Sensorimotor and Cognitive Sensorimotor and Cognitive Development Development (cont.)(cont.)

• May confuse essential with nonessential body parts/functions

• Expelling feces and urine and then flushing it down the toilet may be upsetting as the toddler may see it as flushing a part of themselves away

• Nurse should teach parents skills that will enable the toddler to feel loved even if behavior is not acceptable

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Speech DevelopmentSpeech Development

• Parallels cognitive growth

• Expressive and receptive language continue to develop

• Respond to tone of voice and facial expressions of those around them

• Showing empathy toward the toddler who is trying to communicate verbally will help minimize frustrations

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Screening for Signs of AutismScreening for Signs of Autism

• Preliminary symptoms may include– No pointing, gesturing (e.g., bye-bye) by 12 months – No single words by 16 months– No spontaneous two-word phrases by 24 months– Loss of achieved language or social skills

• Important to rule out lead poisoning, hearing deficit, neurological disorders, musculoskeletal diseases and inborn errors of metabolism.

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Guidance and DisciplineGuidance and Discipline

• Goal is to teach, not punish

• Discipline involves guidance

• Parent responses to temper tantrums can either reinforce the desirability of or the risks involved in such behavior

• Expectations must be in line with the child’s physical and cognitive abilities– Limit-setting– Time-outs

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Guidance and Discipline Guidance and Discipline (cont.)(cont.)

• Child seeks approval– Use positive approach whenever possible– Approval increases self-confidence

• Use of fear or physical aggression with a toddler does not foster self-control– Can lead to physical and emotional abuse

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Guidance and Discipline Guidance and Discipline (cont.)(cont.)

• Fear-provoking event affects extent of toddler’s reaction– If alone, fear may be greater– Once fear has been learned, it is more difficult

to eliminate

• Stress increases fear of separation– Self-consoling behaviors include favorite

possession or repetitive rituals

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Daily CareDaily Care

• Adults should be at eye level when talking to toddler – Seems less overwhelming

• Flexible schedule organized around needs of entire household is best

• Clothing should be easily put on and removed

• Sunburn protection

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Daily Care Daily Care (cont.)(cont.)

• Shoes should fit shape of foot and be ½ inch longer and ¼ inch wider than the foot

• Important for toddler to wear their regular shoes to the clinic as it shows the health care provider how the body is being used

• Posture is greatly influenced by that of other family members

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Toilet IndependenceToilet Independence

• Much depends on temperament of the toddler and the person guiding toilet training

• Voluntary control of anal and urethral sphincters begins around 18 to 24 months of age

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Toilet Independence Toilet Independence (cont.)(cont.)

• Use potty chair or place the child on the toilet facing the tank

• Bowel training usually attempted first• Do not leave toddler on toilet for more than a few

minutes at a time• Bladder training can begin when toddler stays

dry for about 2 hours • If toddler has special words for defecation or

urination, be sure to tell other health care providers and document in care plan for toddler

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Nutrition CounselingNutrition Counseling

• Caloric needs decline to about 100 calories/kg/day

• Limit milk intake to no more than 24 ounces (720 mL) per day

• Serving size is 1 tablespoon of solid food per year of age

• Food is chopped into fine pieces

• Various foods are offered

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Day CareDay Care

• Must meet families’ – Personal preferences– Cultural perspectives– Financial and special needs

• Should be state-approved

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Day Care Day Care (cont.)(cont.)

• Differs for toddlers because– Shorter attention span– Tendency to engage in parallel play rather

than group play– Need closer supervision to maintain safety

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Nursing TipNursing Tip

• A major task for parents is to “let go” and allow the toddler to interact with influences outside the family in day care centers or preschools

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Injury PreventionInjury Prevention

• Best prevention is knowledge of age-appropriate risk and anticipatory guidelines

• Parents need to understand their child’s activities at certain ages in order to prevent injuries by taking appropriate precautions

• Toddlers are curious and mobile

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Injury Prevention Injury Prevention (cont.)(cont.)

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Toys and PlayToys and Play

• Parents must be taught to inspect toys and to buy toys suitable to the age, skills, and abilities of their child

• Play is the work of toddlers

• Through play they learn how to– Manipulate and

understand their environment

– Socialize– Explore their world

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Toys and Play Toys and Play (cont.)(cont.)

• Social development takes form

• Egocentric thinking

• Parallel play gradually leads to cooperative play

• Protect the child from sunburn, mosquitoes, and other vectors

• Childproofing the home is also important

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Question for ReviewQuestion for Review

• What are the three stages of separation anxiety?

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ReviewReview

• Objectives

• Key Terms

• Key Points

• Online Resources

• Critical Thinking Question

• Review Question

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