Toddler (1-3 years)

Learning Guide - 4

Text Book
Kozier & Erbs Fundamentals of Nursing
concepts, process and practice. 8th edition.
Chapter 21
Pages: 373 - 377.

Toddler (1-3 years)

Physical
development
Appearance:
Chubby with short
legs and a large
head. Face is small
compared to the
skull. Abdomen is
protruding and has
lordosis.

Toddler (1-3 years)

Physical development
Weight: Birth weight becomes 4 times by 2 years.
Weight gain is 1-2 Kg/year. Weight at 3 years is
13.6 Kg.
Height: Between 1& 2 years increase in height is
10-12 cm and between 2 & 3 years 6-8 cm. Height
at 2 years is half of the adult height.
Head circumference: Head circumference
increases by 2.5 cm in a year. By 2 years the size
of head is 4/5 of the adult head and brain 70% of
its adult size.
Dentition: 16 teeth at 2 years and 20 teeth at 2 1/2
years.

Sensory abilities: Visual acuity improves

and accommodation to near and far objects
is well developed.
Toddler can look away from a toy prior to
reaching out and picking it up.
The sense of hearing, taste, smell and
touch become increasingly developed.
Hearing is at the adult level by 3 years.

Physiological development
Skin: Ability to prevent fluid loss increases. Eccrine
sweat glands produce small amounts of perspiration.
Sebum production is inadequate, leading to dry skin.
Cardiovascular system: Pulse rate decreases and
BP increases. Thermoregulation by capillaries is more
effective.
Blood values: RBC count is slightly higher. WBC
count comes down but the ability to fight infections is
increased.
Respiratory system: Respiratory rate decreases.
Eustachian tube is short and straight and infections
from the nasopharynx easily reach to the ears. Toddler
develops Otitis media as a complication of
nasopharyngitis.

Gastrointestinal system: Stomach capacity

increases and the feeding interval is prolonged. HCl
secretion in the stomach increases and gives
protection against infectious diarrheas.
Genitourinary system: By 2 years kidneys can
conserve water and can concentrate urine. The
bladder capacity increases and child gradually
learns to control urethral sphincter
Immune system: IgM immunoglobulin reaches the
adult level. Toddler is still susceptible to infections
when exposed to new antigens.
Nervous system: Rapid development of brain
leads to increasing control of behavior. Young
toddlers can handle only one command at a time.

Motor development
Fine muscle coordination and gross motor skills
improve during toddler hood. Also, most children
are toilet trained by 3 years

Motor development -15 months

Gross motor development
Walks without help.
Creeps upstairs
Kneels without support.
Fine motor development
Builds tower of 2 cubes.
Scribbles
Holds two cubes in one hand.
Releases pellets into a narrow mouthed
bottle.
Uses cup well.

Motor development -18 months

Gross motor
Runs clumsily and falls.
Walks upstairs with one hand held.
Pulls and pushes toys.
Jumps in place with both feet.
Seats self on chair.
Throws ball over hand.
Fine motor
Builds a tower of 3-4 cubes.
Turns pages in a book 2 or 3 at a time.
Manages spoon without rotation.

Aaaaaa

Motor development -24 months

Gross motor
Goes up and down stairs alone
with two feet on each step.
Runs fairly well.
Picks up objects without falling.
Kicks ball forward without
over balancing.
Fine motor
Builds tower of 6-7 blocks.
Aligns 2 or more cubes like a train.
Turns pages of a book one at a time.
Makes vertical and circular strokes.
Turns door knob.
Unscrews lid.

Motor development -30 months

Gross motor
Jumps with both feet.
Jumps from chair or step.
Stands on one foot for a few moments.
Take a few steps on tiptoe.
Fine motor
Builds tower of 8 cubes.
Adds chimney to train of cubes.
Holds crayon with fingers.
Moves fingers independently.
Makes 2 or more strokes similar to a cross.

Psychosocial development: Erikson

Developmental task: Autonomy vs. shame and doubt.
Toddlers develop their autonomy by asserting themselves with the
frequent use of the word no. They are frustrated by the use of
restraints to their behavior and may have temper tantrums.
Temper tantrum: Display of anger by screaming, kicking, throwing
things, hitting and rolling on floor.
Parents need a lot of patience while dealing with toddlers. Give the
child some measure to control and at the same time be consistent
in setting limits so that the child learns the results of misbehavior.
If the childs social interactions with the parents are negative (eg.
Constant disapproval regarding eating, toilet training or other
behaviors) the child begins to see himself as bad and leads to a
negative self-concept. Parents need to give praise and approval to
the toddler for their accomplishments so that they can develop a
positive and healthy self-concept.

Characteristics of psychosocial
development
Negativism: Responding with no.
Temper tantrums
Ritualistic behavior: Repetitive acts performed by the child.
It is a way of relieving anxiety for them. E.g. Prefers sitting
on a chair, prefers a plate or cup. Parents can follow the
same rituals at the same time everyday so as to make the
child care easier.
Ambivalence: Coexistence of love and hate towards the
same person or object. E.g. Toddler wants to push the
mother away and at the same time wants to cling to her.
Separation anxiety: Fear and frustration that comes with
parental absences.
Regression: Reverting to an earlier developmental stage.
Eg. Restarting bed-wetting, using baby talk.

Promoting psychosocial development

Provide suitable toys.
Give positive suggestions rather than commands.
Avoid emotional climate of negativism, blame and
punishment.
Give 2 or 3 choices, which are safe.
When toddler has a temper tantrum, make sure that the
child is safe and then leave.
Set consistent, reasonable limits.
Praise the toddlers accomplishments.

Psychosexual development: Freud

Toddler is in the anal stage of development. After weaning
mouth is not the major source of sensuous satisfaction. As
the nervous system matures and sphincter controls
develop toddlers find pleasure from the feeling of
distended bladder and rectum and from the release of the
contents of these organs. This is the time of toilet training
and it should be a pleasant experience for the child.
Problems with the toilet training can affect personality
development in the later years leading to possessiveness
or compulsive cleanliness.
During the toddler period the child develops gender
identity. Identifies self as boy or girl. Also learns gender
roles from parents.

Cognitive development: Piaget

Toddler period passes through two phases of
cognitive development
Sensory motor phase ( up to two years )
Pre-conceptual phase ( from two years )

Sensory motor phase:

Stage V ( 12 to 18 months ): Tertiary circular
reaction. Instead of producing accidental events
child choose to vary them.
Stage VI ( 18 months to 2 years ): Inventions of
new means. Finds solutions from insight. They
can remember events occurred days before and
can imitate them.

Pre-conceptual stage (2 & 3 years)

At this stage they have concrete thinking.
E.g. They can understand a table or chair but not
furniture.
They have learned object permanence. They are
ego centric in nature and develop the concept of
I.

Language development
15 months
Uses expressive jargon
Says 4 to 6 words
Ask for objects by pointing
Understands simple commands

Language development
18 months
Says 10 or more words
Points to a common objects shoes or ball
Points 2 or 3 body parts

Language development
24 months
vocabulary of 300 words
uses 2 to 3 word phrases
uses pronouns I, me, you
understands directional commands
says first name
refers to self by name
verbalizes need for food or toileting

Language development
30 months
gives first and last name
refers to self by appropriate pronoun
uses plurals
names one color.

Moral development: Kohl berg

Pre-conventional level
Children respond to labels of good or bad.
Activities which give affection or approval of
parents are good and which lead to
punishment are bad. By 2 years children
develop attitudes parents hold about moral
matters.

Spiritual development: Fowler

Stage 0 (Undifferentiated)
They repeat the actions of parents and
follow their religious practices. As part
of ritual they may say short prayers at
bedtime.

Health promotion of the toddler

1)

Nutrition

Toddlers need less food because the growth rate

slow down.
Children are fussy about food and develop
physiologic anorexia .
Caloric requirement for toddlers is 110 120
KCal/kg/day.
Diet should well balanced with vitamins and
minerals especially iron to prevent deficiencies.

Health promotion of the toddler

2) Toilet training

By 21/2 years the child develops daytime toilet

training.
Children are ready for toilet training when they
are able to walk and balance well, climb on to the
potty and undress and dress themselves.
Encourage potty use several times a day, praise
the childs behavior and do not scold or punish
the child for undesired behavior.

Health promotion of the toddler

3) Rest and sleep
10 to 14 hours of sleep per day.

If the child is having nightmares or fear of

darkness keep a night-light.
When children are awakened the parents should
talk to them are reassure them that they are all
right and that the parents are close by.
Other methods to promote sleep are encouraging
security objects ( soft toy or blanket ).
Encourage bed time rituals like short prayers or
kisses.

Use bed with side rails

Health promotion of the toddler

4) Play and stimulation

Toddlers are very active and constantly

exploring the environment. This activity is
important for their muscular development and
improvement of motor and social skills.

Functions of play

Physical development ( running, jumping, climbing )

Psychosocial development ( give and take )
Cognitive development ( shapes, size, texture )
Moral development ( not to hurt while playing, share things
)
Language and speech development ( reading, singing )
Therapeutic value ( ventilate feelings like anger )
Cognitive stimulation: Provide opportunities for play and
playing simple games and puzzles that promote social
interactions.

Types of play
On looker play ( watching TV )
Unoccupied play ( involvement in independent
activities like climbing on a chair )
Solitary play ( play alone with toys )
Parallel play ( child sits with other children but not
cooperating or interacting with them )
Associate play ( playing with other children,
sharing things eg: building a tower with another
child )

Prevention of accidents
Select safe toys
No sharp or rough edges
No small removable parts
No beads, marbles or coins which can be
aspirated
Toys should not be flammable nor coated with
lead paint

Prevention of accidents
Do not leave the child alone without the
supervision of adults
Keep containers, doors, refrigerator, cabinets,
drawers and gates locked
Keep windows and balconies screened
Keep the floor cleaned
Sharp objects should be kept out of children reach
Supervise while climbing heights

Prevention of accidents
Teach the child the meaning of No and
Dont . Make the child understand that this
means danger.
Place hot pots on back burners with
handles turned inward
Lock up cleaning lotions, insecticides and
medicines
Use low bed
Cover electrical outlets with safety cover or
plugs
Teach child not to put objects in the mouth,
ear or nose

Health problems
Infections: Should be vaccinated against
common childhood infections.
Vaccinations- DPT , Hib & OPV booster at 18
months
Meningitis at 2 years
OPV 21/2years
Amblyopia: Decreased visual acuity of one eye.
Strabismus: Cross-eye

Dental caries:
Avoid excessive
sweets.
Do not keep milk
bottle in the mouth
while sleeping.
Brushing the teeth
and cleaning after
feeds.
Regular dental
check up.

Developmental problems

Negativism
Temper tantrum
Ritualism
Ambivalence
Sibling rivalry
Bed wetting
Sleep problems nightmares, fear of darkness
Separation anxiety