THE FAMILY WITH A TODDLER

Toddler

• Period from age 1 to 3 years old

• Changes from largely immobile, favorable and dependent infants to walking, talking
young children with a growing sense of autonomy.
• Enormous changes take place in a child and family.
• Toddlers accomplish a wide array of developmental tasks.
• Parents must also grow patience and sensitivity.
• This toddler age is the time of intense exploration of the environment as children
attempt to find out how things work and how to control others through temper
tantrums, negativism and obstinacy.
• It is an extremely important period for developmental achievement and intellectual
growth.

Growth and Development

• Physical growth begins to slow while making great strides developmentally.

• It is important that on each healthcare visit, plot on a standard growth chart.
• Height and Weight
Gains only 5 – 6 lb (2.5 kg) and 5” (12 cm) a year during toddler period.
Subcutaneous fat or baby fat begins to disappear by the end of the 2nd year.
From plump to leaner, more muscular.
• Appetite decreases
Adequate intake is still essential to meet energy needs.
• Head Circumference
Increases only about 2 cm (2nd year).
• Chest Circumference Now greater than head.
• Body Contour
Prominent (pouchy) abdomen.
Forward curve of the spine (lordosis). It will correct itself as they walk longer.
Although the toddler is walking well, they are still weak in abdominal muscles
because the abdominal contents still do not have enough support.
Waddle or walk with a wide stance, unsteady gait – for better stability.

• Body systems continue to mature

1. Respiratory rate
Slow slightly but continue to be mainly abdominal.

2. Heart rate
Shows from 110 to 90 bpm.

3. BP
Increases over 99/64 mmHg.

4. Brain
 Develops to about 90% of its adult size.

5. Respiratory system
Lumens of vessels enlarge, there is less threat of respiratory infection.

6. Stomach
Secretes more acid – G.I. infection less common.

7. Stomach capacity
Increases; can eat three meals a day.

8. Control of urinary and anal sphincters becomes possible with complete

myelination of spinal cord.

9. IgG and IgM production

Mature at two years of age.
Passive immunity during intrauterine life – no longer operative.

Developmental Milestones

• Influenced to some extent, by amount of social contact;

• The number of opportunities children how to explore and experience new degrees of
independence;
• And strongly influenced by individual readiness for a new skill.

Emotional Development

• Autonomy vs. Shame and Doubt

 Erickson’s developmental task of toddlers.
Develop a sense of autonomy; a sense of independence.
Parents should encourage independence while still maintaining consistently
sound rules for safety.
Infants who have learned to trust are better prepared to do this than those who
cannot trust themselves or others.
• As they recognize they are separate individuals, they realize they cannot always have to
do what others want them to do. Thus, the reputation for:
Being negativistic
Obstinate
Difficult to manage (maybe misinterpreted as disobedience by parents).
• Socialization
Once walking well, resistant to sitting on laps and being cuddled.
18 months – dash imitating things they see parents doing such as “study” or
“sweep.”
By two or more years – toddlers become aware of gender differences and may
point to other children and identify them as “boy” or “girl.”
• Play Behavior
Parallel play
Toys o They can play by themselves, that requires
action;
o They can control – giving them a sense of power in manipulation =
expression of autonomy.
5 months – put in, take out
18 months – walking securely enough to enjoy pull toys.
2 years – imitating adult actions.
End of toddler period – rough - housing, very active, stimulating type of play;
rough and tumble play.

Cognitive Development

• Piaget’s Cognitive and Psychosocial Development of the Toddler

Tertiary Circular Reaction Stage o Stage 5 (12 to 18 months) o “Little
scientists”
Interested in trying to discover new ways to handle objects or new results that
different actions can achieve.
Experiments by trial-and-error methods. o Retrieving articles that rolled under
a chair o 15 months – follow a different path o Object permanence starting

• Deferred Imitation
Stage 6 (18 to 24 months)
Able to try out various actions mentally rather than to actually perform them.
o Beginning of problem-solving or symbolic thought.
Remembers an action and imitates it later.
o Pretend to drive a car or put baby to sleep because they have seen this
just previously but at a past time.
o Object permanence complete.

• Preoperational Thought
 End of toddler period (24 months)
Second major period of cognitive development.
Deal much more constructively with symbols than while still in sensory-motor
period.
Begins to use a process called ASSIMILATION.
o Not able to change thoughts to fit a situation. o They learn to change
situations or how they perceive it to fit their thoughts.
o Causes toddlers to use toys in the “wrong” way.

Psychosocial Development

• 24 – 36 months
• Autonomy vs. Shame and Doubt
Learn independence and the beginning of problem-solving.

Promoting Toddle Safety

• Accidents – major cause of death in all ages. Occur most frequently in toddlers.
• Accidentally ingestion (poisoning)
Cleaning products
Aspiration or ingestion of small objects – watch or hearing aid batteries
Pencil erasers
Crayons
• Childproof house
Putting all poisonous products, drugs, and small objects out of reach.
• Motor vehicle accidents
• Burns
• Falls
• Playground injuries
Toddler’s motor ability jumps ahead of his or her judgment.
• Lead poisoning
Eating, chewing, sucking objects covered with lead-based paint.

Promoting Nutritional Health

• Smaller appetite than infants.

• Sit and play with food.
• Place a small amount of food on plate, allow child to eat it, and ask for more.
1 tablespoonful is a good start.
Pieces of chicken, slices of banana, cheese, crackers.
• Allow self-feeding, nutritious finger foods.
• Don’t like “mixed up” food.
• Toddler Nutrition
 Consume 1300 kcal daily.
CHON and CHO needs often met during toddler period.
Avoid diets high in sugar.
Fats should not be restricted for children below 2 years old.
> 2 years old – should be no more than 30% of total daily calories from fat.
Adequate calcium and phosphorus. o
Important for bone mineralization.
o Whole milk until age 2 years.

Daily Activities

• Dressing
Most toddlers – by the end of the toddler’s period, they can put on socks,
underpants, undershirts.
Parents should be encouraged to give up perfection.
Sneakers – ideal toddler shoes. Soles hard enough for rough surfaces and arch
support is limited since toddlers often tiptoe.

• Sleep
From napping 2x/day and sleeping 12/hours/night to 1 nap/day and only 8
hours sleep at night.
Naturally fall asleep when tired.
Resist naptime as part of negativism. o Naptime as part of lunchtime
and not as separate activity. o Give secondary choices. o Loves
bedtime routine – bath, pajamas, story, toothbrushing, etc.
o Needs feeling of security – reliable and consistent parents.

• Bathing
Should depend on parents’ and the child’s wishes and scheduling.
Establishing a sense of routine is important.
o Sense of security knowing certain events are predictable. Provide fun,
bath toys.
Don’t leave toddlers in bathtub unsupervised.
o The child might slip and get their head underwater or reach and turn on
hot water faucet.

• Care of Teeth
Fruit or protein foods rather than high CHO.
Calcium – important for the development of teeth.
Drink fluoridated water if available.
o All new teeth form with cavity-resistant enamel.
Must have own toothbrush.
o May do own brushing towards end of toddler period, under supervision.
2.5 years old = schedule for first dental care visit.

Parental Concerns

• Toilet Training
 One of the biggest tasks a toddler must achieve.
Individualized task for each child.
Begin and be completed according to a child’s ability to accomplish and not
according to a set schedule.
• 3 Important Developmental Levels Before Toilet Training

1. Control a rectal and urethral sphincters.

Usually achieved by the time they walk well.
2. Have a cognitive understanding of what it means to hold urine and stools.
Until they can release them at a certain place and time.
3. Desire to delay immediate gratification.
For a more socially accepted action.
• When to Toilet Train?
As a rule, children are ready for toilet training not only when they can
understand what their parents want them to do but also when they begin to be
uncomfortable in wet diapers.
o Pulling or tugging on soiled diapers.
Must be able to give up immediate pleasure.
o Ex: relieving themselves whenever they have the urge so as to gain other
plans for later on. This improves physical comfort and another step in
growing up.
• Ritualistic Behavior
Will use only their “spoon” at meal time, only their “washcloth” at bath time.
Will not go outside unless mother or father locates the favorite cap.
Children who seem to have or need excessive number of objects to cling to or
an excessive number of routines.
o Maybe trying to say, “I need more guidelines, more rules. Don’t let me
be quite so independent.”
• Negativism
Establishing their identities as separate individuals.
Reply to every quest is a very definite “NO.”
It is important for them to pass this stage so that they can grow up to be people
who are independent and able to take care of their own needs and desires.
How to resolve negativism?
o Limit number of questions asked of the child.
- Make statements instead of asking a question.
o Give secondary choices.
- “It’s time now” then says “Do you want to take your duck or
your toy boat.”
o Help smooth out friction caused by negativism.
• Discipline
“Discipline” and “Punishment” not interchangeable.
Discipline o Setting rules or road signs so children know what is expected
of them.
Punishment
o Consequence that results from a breakdown in discipline, from
the child’s disregard of the rules that were learned. Parents should instill
discipline early in life.
o Partly to set up safety limits and to protect others or property.
 • 2 General Rules to Follow
Parents must be consistent. (1)
Rules are learned best if correct behavior is praised rather than
wrong behavior punished. (2) o “Timeout”
- Technique of helping children learn that actions have
consequences.
o Parents first need to be certain that the child understands the role they’re
trying to enforce.
o 1 minute/year of age.
• Separation Anxiety
Fear of being separated from parents or primary caregiver.
Starts at six months and persist throughout preschool
period. Dawdling – slowness in accomplishing a task. o Assess
the child’s ability to accomplish a task first. o Give child ample time
to accomplish a task.
o Be patient.

Temper Tantrums

• Occur as a natural consequence of toddler’s development.

• They know what they want but do not have the vocabulary or wisdom to express their
feelings in a more socially acceptable way.
• Maybe a response to unrealistic request by a parent.
• Parents saying “NO” too frequently.