TODDLERHOOD

NUR. 346Dr. Manal Kassab

27/3/2012

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1 – 3 years

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

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

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

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.

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

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

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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