Chapter 17

The ToddlerThe Toddler

GENERAL CHARACTERISITCS

• Toddler- 1-3 years

• VS- 70-110, 25, 90/56

• No longer completely dependent on others

• Rapid growth and development during infancy slows down

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General Characteristics (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 (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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Erickson’s Developmental Tasks

• Autonomy vs Shame and Doubt– Trying out own powers of speech

– Beginning acceptance of reality vs pleasure principle

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Physical Development• Birthweight quadruples by 2.5 years of age

• Rate of brain growth slows

• Musculoskeletal system grows and bones begin to ossify

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Physical Development (cont.)

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

• 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

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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

• 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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Fine Motor - Toddler

• 1 year old: transfer objects from hand to hand• 2 year old: can hold a crayon and color vertical

strokes• Turn the page of a book• Build a tower of six blocks

• 3 year old: copy a circle and a cross – build using small blocks

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Speech Development

• Parallels cognitive growth

• Expressive and receptive language continue to develop

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

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Gross - Motor of Toddler At 15 months, the toddler can:• Walk alone.• Creep upstairs.• Assume standing position without falling.• Hold a cup with all fingers grasped around it.

At 18 months:• Hold cup with both hands.• Transfer objects hand-to hand at will.

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At 30 months: the toddler can:

• Jump with both feet.• Jump from chair or step.• Walk up and downstairs, one foot

on a step.• Drink without assistance.

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Issues in Parenting – Toddler (Emotional Development)

• Stranger anxiety – should dissipate by age 2 ½ to 3 years

• Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3

• Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely

• Thumb sucking • Toilet Training

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Cognitive Development:• Up to 2 years, the toddler uses his senses

and motor development to different self from objects.

• The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive development (2-4 years), where he is still egocentric and can not take the point of view of other people.

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Social Development:

• The toddler is very social being but still egocentric.

• He imitates parents.• Notice sex differences and know own sex.• According to Erikson,• The development of autonomy during this

period is centered around toddlers increasing abilities to control their bodies, themselves and their environment i.e., "I can do it myself".

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Screening 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

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Guidance and Discipline

• Goal is to teach, not punish

• 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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Daily 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

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Daily Care (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

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Toilet 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

23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Toilet Independence (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

• Food is chopped into fine pieces

• Various foods are offered

• A 2-year-old likes finger foods

• Calm child down before eating

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Day Care

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

• Should be state-approved

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Day Care (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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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 (cont.)

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Toys 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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