Toddler Period

TODDLER PERIOD

Common Description • • • • • • • •

1 to 3 years of age Stubborn little persons (egocentric) 1st word is learned & continue to improve “No” and “Want” “terrible twos” / “terrific twos” The “explorer”; “ little scientist” Best imitator Developmental Task – Autonomy Vs. Shame and Doubt * temper tantrums

Nursing Assessment of Growth and Development of the Toddler

Physical Development • • • • • •

Slowed growth Rapid mental & emotional development Weight – 5 to 10 lbs, each year (2.26-4.53kg) Height – 3 inches (7.62cm each year) Learn to stand alone & walk Rate of development varies

• Body contour - prominent abdomen - forward curve of the spine at the sacral area (lordosis) - waddle or walk with wide stance • Body systems (continue to mature) - Respirations steady to - Heart rate slower - brain (90% of adult size) - stomach capacity = 3 meals/day - control of urinary and anal sphincter - IgG & IgM antibody production becomes mature

Growth of deciduous teeth Lower 6-10 mon. 10-16 mon. 17-23 mon. 14-18 mon. 23-31 mon.

Teeth Central Incisor Lateral Incisor Cuspid 1st Molar 2nd Molar

Upper 8-12 mon. 9-13 mon. 16-22 mon. 13-19 mon. 25-33 mon.

Psychosocial Development Developmental task “Autonomy Vs. Shame & Doubt” • Behavioral Characteristics of the Toddler: - Negativism - Ritualism - Dawdling - Temper Tantrums - Separation Anxiety

Developmental Milestones - less numerous - period of slow and steady - not sudden growth - influenced by social contact - to explore & experience - new degrees of independence

Language Development • Critical time • 2 yrs = two-word, noun-verb simple sentences • Autonomy – “No” • Explore to conversation • To be read often • Always answer question • Name object as they play

• Some toddlers do not develop language because they are not called on to use it • Assessment – ask parents what happened if they want something

• Reading the exact words in a book is not as important as pointing to the pictures that accompany them

• Comprehensive Vocabulary • Expressive Vocabulary • Re enforce language by rewording a question • Learn language from imitating what they hear • Pronouns are difficult for them to use correctly (I, me, him and her) • Bilingual children interchange words from both languages

Emotional Development a) Developmental task “Autonomy Vs. Shame & Doubt” • Sense of autonomy • Sense of trust to self and others • Sense of independence - sense of doubt (confidence) - felling of shame (autonomy) -maintain consistent sound rules for safety

• Negativistic, obstinate & difficult to manage (period of differentiation) • Parents’ misinterpretation of child’s independent activities b) Socialization • Resistant to sitting in laps & being cuddled • Enthusiastic in interacting people • Best imitator (18 mon) • Becomes aware of gender differences

c) Play behavior • Parallel – playing side by side - avoid argument over one toy • Toys that require action • Toys should be checked for loose parts & sharp edges • Toys that gave them power of manipulation – an expression of autonomy • Toys that represents household activities *rough out-door play

Cognitive Development • Stage of Tertiary Circular Reaction (Piaget,1969) • Toddlers – little scientist • Problem solving or symbolic thought • Deferred imitation • Preoperational thought - constructive symbol - use of assimilation process

Planning & Implementation for Health Promotion of the Toddler & Family

PROMOTING TODDLERS’ SAFETY

• Health maintenance visit - 15, 18 & 24 mon. - immunizations - assessment of any health problems or development delays - parenting skills - toilet training - caregiver-toddler relationship - guidelines for health promotion for toddlers *

• Prevention of Accidents - Motor vehicles - falls - aspiration - drowning - animal bites - poisoning - burns - (general)

Promoting Nutritional Health of the Toddler • Eating problems - slow growth rate - sense of autonomy - appetite varies – kind of food offered - “food jags” -”messiness”

• 15 mon. old = prefers finger feeding - self feed • 18 mon. old = appetite; able to use spoon & cup but may throw them; spills less often • 24 mon. old = appetite is fair to moderate; - clearly defined dislikes and food jags; - accepts NO help; still spills • 30 mon. old = refusals & preferences are less evident; can hold spoon like an adult; - tilts the head back to get the very last drop of food from a cup

Teaching Tips on Feeding Toddlers • • • • • •

Serve small portion at a time Allow substitution for dislike food Simply prepared food; warm or cool Provide social atmosphere Allow to use spoon and fork Plan regular mealtimes w/ small nutritious snacks between meals

• Suggested nutritious snacks: - milk - cheese cubes - crackers - pieces of fruit - peanut butter • Promote adequate intake of vegetarian diet (pieces of oranges, peaches, raisins, chickpeas, tomatoes & crackers) • Mealtimes should not exceed 20 min. • Dawdling is common – ignore unless stretches to unreasonable time Do not make desserts as a reward for • good eating habits.

• Reminder: The total amount eaten each day is more important than the amount eaten at a specific meal

Promoting Toddler Development in Daily Activities • Dressing - clothing easy for the toddler to handle (roomy w/ easy buttons, large smooth running zippers, velcro) - putting on underpants, shirts or sacks may end up backwards* - avoid hard soled shoes; high top is unnecessary

• Sleep - gradually decreases - 1 nap/day; 8 hrs. sleep at night* - routines prior to sleeping - feel secured • Bathing - timing depends on established routine - should be fun but w/ caution - avoid bubble baths (girls)

• Care of Teeth - dental caries is a major problem - good dentition promotes sound nutrition - avoid sugar/ sweets (can be neutralized by other food) - Age 2 – should be taught to brush* teeth, rinse mouth after eating - water should be used if not able to spit out tooth paste.

• Use of fluoride toothpaste is recommended • Visit to the dentist 1st = 2yrs. Of age, to get acquainted* 2nd = preliminary examination subsequent visits = 2x/ yr. check up • Tooth extraction (6-7 y.o.) – No other temporary teeth will replace the deciduous teeth • Encourage fruits and protein foods rather than high carbohydrates for snacks. • Calcium is especially important – strong teeth

Promoting Healthy Family Functioning with the Toddler • Discipline – to train or instruct to produce a particular behavior pattern, especially moral or mental improvement & self control *NEVER punishment – penalizing for a wrong doing

How to Impose Discipline in Toddlers

• Consistency and timing • Firm but friendly approach • Methods: - explaining (informing the result of bad action) - “time out chair” (isolation) - Extinction (ignoring undesirable behavior, but give compliment for a child's growing up behavior)

How to manage Toddler Characteristics • • • • •

Temper Tantrums Negativistic Ritualistic Separation Anxiety Dawdling

•Toilet Training • Guidelines for assessment for READINESS:

- Physical readiness - Mental readiness - Psychologic readiness - Parental readiness

Suggestions for toilet training: • • • • • • •

Potty chair Caregivers’ availability Good hygiene practices Approval or no comment Appropriate dressing Positive role model No comment on messiness * potty should be emptied unobtrusively

• Do not flush the toilet while the child is sitting on it • Should not be teased* • The caregiver should not expect perfection*

• Sharing with a New Baby • • • •

Stressful Rival for mother’s affection Regression Preparation: - Moving to a larger bed (pride as grown –up) - Involve child in activities as preparation for the coming of the new baby (“our baby, not just mommy’s baby”) - let the other members of the family take care of the new baby*

Toddler in a Health Care Facility • Goal – continue to establish a sense of autonomy - Nutrition - Dressing Changes - Medication - Rest - Hygiene - Pain - Stimulation - Elimination

CRITICAL THINKING EXERCISES • A mother of a toddler told you that her child refuses to do anything she tells him to do. What are the three questions you would want to ask his mother to help her explore the problem?

• A parent told you that her toddler eats “almost nothing”. What is the best way to evaluate if the child's’ intake is adequate? Why does the intake of toddlers decrease from what it was during the infant year?

Good Luck!

Grow up!

Aim High!!!