Download - 6. toddlerhood
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TODDLERHOOD
NUR. 346Dr. Manal Kassab
27/3/2012
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1 – 3 years
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General Appearance
• Age: 1 – 3 years• Looks leaner and more muscular.• Steady growth curve steplike rather than
linear (straight)• Has pot-bellied abdomen: immature
abdominal muscles.• Lordosis: forward curve of the spine at the
sacral area.• Walks with their feet spread a part
(bowleggedness): from the weight of the relatively large trunk
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Weight, Height & H.C.
• Weight: gain 2.0-2.8 kg/yr.• Quadruples birth weight at 2-2.5 yrs.
• Height: gain 12cm/yr.• Height at 2yrs=88cm• HC = CC by 1 – 2 years• HC increases about 3.5cm during the toddler
years.
• CC continues to increase in size and exceeds HC during the toddler years.
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System maturation • Blood volume is 90 ml/kg.• Innocent murmurs are common.
• Less respiratory infections: the lumen of vessels increases.
• The internal structures of the ear and throat continue to be short & straight
• lymphoid tissue of the tonsils and adenoids continues to be large as a result otitis media, tonsillitis, and upper respiratory tract infections are common
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Brain
• Brain growth is 75% completed by the end of 2 years
• Brain cells are present but continue to increase in size.
• Myelination of the spinal cord is almost complete by 2 years of age which parallels the completion of most of the gross motor skills associated with locomotion.
• Development of various areas of the brain seems to correspond with the progressive intellectual capacity.
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Urinary system
• By the end of infancy kidneys reach anatomical maturity.– Sufficient development of the glomerular
filtration with adequate urine concentration.
– Complete CNS myelination increases neuromuscular maturation that allow for sphincter control.
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Immune system • Increase in size of lymphatic tissues. Hyperplasia of
lymphoid tissue is common finding.
• IgG & IgM production becomes mature at 2 years.
• Immunoglobulines A, D & E increases gradually, not reaching adult levels until later childhood
Endocrine System:• Functionally mature by toddlerhood period, except for the
reproductive system.
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Gastrointestinal System:• Stomach capacity increase to 500 cc
• Gastric secretions are more acidic (protective function): less GI infections
• With complete myelination of the spinal cord, control of anal & urethral sphincters is gradually achieved.
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Senses
• Visual acuity: 20/40 is acceptable
• Full binocular vision is well developed
• Toddlers will visually inspect an object by turning it over, they may taste it, smell it and touch it several times before they are satisfied with their investigation
• The senses of hearing, smell, taste and touch become increasingly well developed, coordinated with each other
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Gross Motor Development
• By 12 to 13 months of age toddlers walk alone
• At 18 months: Run & jump in place
• Walks up & down stairs holding a person’s hand.
• At 24 months: climbing stairs a lone
• Riding a tricycle.10
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Fine Motor Development
• At 15 months: Holds spoon well, but may still turn it upside down
• At 24 months: Hold pencil, open doors, feed self, wear shoes, dress self & zip a zipper
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Language Development12 Months• Uses one or more words with meaning
• Understands simple instructions
18 Months• Has vocabulary of approximately 5-20 words • Use jargoning: speaks in what sounds like a
foreign language, but only one word is intelligible.
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Language Development24 Months• Can name a number of objects common to his
surroundings • Approximately 2/3 of what child says should be
intelligible• Vocabulary of approximately 150-300 words
36 Months• Knows chief parts of body and should be able to indicate
these if not name
• Handles three word sentences easily
• Has 900-1000 words
• About 90% of what child says should be intelligible13
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Cognitive Development (Piaget)1. Sensorimotor Stage (birth- 2years):
– Stage 5 tertiary circular reaction (12-18 months): active experimentation (little scientist) , trial and error.
E.g.: Trying out new ways of interacting, rather than simply repeating familiar patterns of behaviour
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Cognitive Development – Piaget
• Sensorimotor Stage– Sub-stage 6 – Invention of New Means Through Mental Combinations
• 18-24 months• Transition stage between sensorimotor development and the
development of symbolic thought• Beginning of problem solving and symbolic thought.• External exploration is replaced by mental exploration
– E.g.: 1. play with shape box; searching for right hole for the shape before trying; succeeding!
2. Begin to manipulate and recognize small numbers.By 18 mos, child may also use imitation to symbolize a plan of actionAlso begin to exhibit concept of deferred imitation
– Imitation of an action that may have occurred hours, days, or even weeks earlier (remember actions and imitate them later).
– Beginning sense of time
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Imitative Learning
Imitative learning: A way of learning new behaviors by copying others’ behaviors.
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in order to placea toy in a drawer which is partially closed, he can pull the drawer open withouthaving to experiment with it or the toy, because he can call up the memory of havingdone so before.
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Cognitive Development (Piaget)
Preoperational Stage (2-7 Years):
Children begin to use language and
think symbolically, BUT their thinking
is still intuitive and egocentric.
Intuitive: Makes little use of
reasoning and logic.
Egocentric: Child is unable to
accommodate viewpoints of
others.
e.g. uses toy car as hairbrush - indicating that internal symbolic scheme is dominant.
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• The Psychosocial Crisis (Erikson):
• Autonomy versus Shame and Doubt http://www.youtube.com/watch?v=PxwWr6T_O6s&feature=related
– Autonomy - the ability to behave independently, to perform actions on one’s own
– Shame and Doubt – Some children fail to emerge from toddlerhood with a sense of mastery
• Shame is an intense emotion that can result from social ridicule or criticism and internal conflict
• Doubt is a lack of self-confidence and worth, accompanied by a constant sense of failure
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Moral Development
• Preconventional stage:
• (punishment and obedience orientation) • Toddlers cannot understand right and
wrong but can differentiate between acceptable and not acceptable according to parental standards
• activity is not acceptable if one is punished.19
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Play Activities
• Parallel play characterizes the 2-year-old
• Associative play and interaction are common in 2- to 3-year-olds
• Enjoy toys that require action: trucks, blocks, telephone, throwing toys)
• Imitating actions by 2-yr
• Symbolic play, or pretend play (Fantasy Play), appears around 2 years of age;
• A vivid mental image of an action permits them to copy what they recall rather than what they see
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Emotional Development & Fears
• Separation anxiety continue
• Fear of water
• Fear of loneness
• Fear of strange people
• Fear of strange objects
• Fear of large animals
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Parental concerns associated with toddlerhood period
• Negativism.• Temper tantrums.• Toilet training.• Discipline.
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Negativism
• Answer with NO to every questions
• Not being stubborn but assertion of control
• Reduce the opportunity of “no” answers; give choices.
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Temper Tantrums
• Child may kicks, screams, stamps feet and shouts, bangs head against the floor, holds breath.
• It’s a way to release their tension: they do not have the vocabulary to express their feelings.
• Usually occurs when they’re tired, before bedtime, hungry, during long shopping trip or visit.
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What to do?
– It is important that parents remain calm in the midst of a tantrum
– Take a few seconds to evaluate the situation before you decide on an action
– Let the child know that you understand he/she is upset, but also let him/her know there is a better way of handling it.
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– Do not try to talk or reason with your child when she is in the throes of a tantrum
– An out of control child can be a danger to himself or others. If this is the case, calmly take the child into your arms until the tantrum subsides.
– Speak to him in a soothing voice.
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• Toilet training– ability develops by 18 months– usually complete by 2 to 3 years (day before night)– Bedwetting is common
• Signs of potty training readiness: – Expresses an interest in the potty– Express the need to go potty (verbally or through
body language)– Able to dress and undress– Uncomfortable in wet diapers – Stays dry for two hours– Imitates family members– Interested in big kid underwear – Has regular bowel movements
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• Setting rules and guidelines for behavior– Limit-setting: (e.g., parents should set limits on
the amount of time children spend watching TV)
• Types of disciplines:– Reasoning: explaining why the act is
wrong– Using rewards for encouraging children
to behave in specified way– Ignoring behavior
– Consequences : • Parent should be consistent: Consequences
should be appropriate for the situation• Time out• Punishment
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DisciplineDiscipline
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Feeding Skills
• Toddlers are able to use a cup and spoon but not very well, they prefer to use their hands
• Beginning attempts at self-feeding are messy, but are an important step in development
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Feeding Skills
• Between 12 – 18 months toddlers learn to chew with rotary rather than up and down movements, allowing toddlers to handle soft table food
• At 18 – 24 months toddlers gain well developed rotary chewing movements, allowing toddlers to handle meats, raw fruits, vegetables and multiple textures
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Whole Cow’s Milk
• After 12 months of age whole cow’s milk is recommended until 24 months of age
• Low-fat milk or limiting other sources of dietary fat is not recommended until for toddlers under 2 years of age
• Toddlers less than 2 years of age need the calories for their rapid growth rate
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Transition to Table Food
• Transition from pureed and strained foods to regular table foods.
• By 12 months toddlers have most of their baby teeth, and so foods with more texture and chewiness can be used
• Nutritious snacks should be used instead of sweetened beverages, snack foods or desserts
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Nutrient Needs
• Appetite– Toddler’s growth rate is slower than
infancy which results in a decreased appetite and interest in food
– It is important to understand a decreased appetite is normal
– Toddlers can self-regulate their calorie intake
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Nutrient Needs• Calories
– Calorie needs of toddlers reflect their decreased growth rate– The Recommended Daily Intake (RDA) for 1-3 year olds is
102 calories/ kg body weight
• Protein– The RDA for protein for 1-6 year olds is 1.2 grams per kg body
weight. This amount can easily be met with a typical diet
– Adequate calories are needed to spare protein so it is used for growth and tissue repair instead of energy
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Nutrient Needs
• Fat– Dietary fat intake should not be restricted for
toddlers under 2 years of age
– Toddlers need the calories from fat to fuel their rapid growth
– Low fat and skim milk do not provide enough calories
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Vitamins and Minerals
• Most children from birth to 5 years of age meet the recommended intakes for most vitamins and minerals, with the exception of iron, calcium and zinc
• Recommended intakes for 1-3 year olds– Iron 7 mg/day– Zinc 3 mg/day– Calcium 500 mg/day
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Nutrient Needs
• Iron– Rapid growth along with inadequate intake of
iron puts toddlers at the highest risk for iron deficiency
– Recommendations for children 1-5 years of age milk drink is to drink no more than 24 ounces (1 ounce = 28.35 grams) of milk each day due to the low iron content
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Nutrient Needs
• Calcium– Adequate calcium intake in childhood affects peak
bone mass which protects against osteoporosis later in life
– Many children do not consume enough calcium
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Nutrient Needs
• Fiber– Adequate dietary fiber helps prevent constipation
in young children and is part of a healthy diet
– However, excessive fiber intake should be avoided because excessive intake of high fiber foods can cause diarrhea and can displace other nutrient dense foods
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Tooth Decay• A major cause of tooth decay is continual use of a
bottle with milk or juice at bedtime or through the day
• Carbohydrate foods that stick to the teeth can also cause tooth decay.
• Rinsing the mouth with water or brushing teeth to remove carbohydrate can lower the risk of tooth decay
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Constipation
• Constipation is a common problem among toddlers
• Diets containing adequate fiber appropriate for the child’s age can lower the risk of constipation
• Adequate fluid intake can also lower the risk of constipation
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Overweight and Obesity
• Weight loss is not appropriate for toddlers
• Adequate nutrients must be provided for normal growth and development
• Recommendations are to stay close to the same weight until the toddler grows taller
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Overweight and Obesity
• Avoid overfeeding• Do not force a toddler to eat• Encourage physical activity• Use appropriate serving sizes• Choose snacks carefully• Limit intake of juice• Do not use food as a reward
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