1. Chapter 17
The Toddler

2. GENERAL CHARACTERISITCS
Toddler- 1-3 years
VS , 25, 90/56
No longer completely dependent on others
Rapid growth and development during infancy slows down

4. 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”
Discuss a situation or method in which a parent can provide the opportunity for socialization while providing a safe environment.
What situations and choices might a parent offer to distract the toddler?

5. 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
Have students offer examples of how a parent can assist the toddler in expressing anger.
What rituals could instill a sense of security in the toddler?
Audience Response Question #1
The first thing a toddler does when visiting his grandmother is to ask for a drink in his favorite cup. The nurse tells the parents he does this because:
1. it increases his sense of security.
2. it is a form of obsessive compulsive disorder.
3. he is thirsty.
4. toddlers require increased fluids.

6. Erickson’s Developmental Tasks
Autonomy vs Shame and Doubt
Trying out own powers of speech
Beginning acceptance of reality vs pleasure principle

7. Physical Development Birthweight quadruples by 2.5 years of age
Rate of brain growth slows
Musculoskeletal system grows and bones begin to ossify
Discuss why a toddler might not be ready for toilet training based upon age and development.
Audience Response Question #2
A parent should be concerned if his or her child is not bowel and bladder trained by age 3.
1. True
2. False

8. 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
Describe abdominal respirations versus thoracic respirations.
Discuss the eruption of teeth and proper oral hygiene.

9. Sensorimotor and Cognitive Development
Sensory and motor abilities do not function independently
Memory strengthens
Is able to assimilate information through trial, error, and repetition
Discuss how sensory and motor functions are synchronized.
Review Table 17-1 on page 407 with the class.
Give an example of how a toddler learns from trial and error.
What are examples of Piaget’s sensorimotor and preconceptual phases of development?

10. Sensorimotor and Cognitive Development (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
Discuss how the toddler has progressed to manage longer periods of time away from his or her parents.
What is an example of cause and effect?
Give examples of how toddlers model behavior.

11. Sensorimotor and Cognitive Development (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
What are essential and nonessential body parts?
Give an example of a situation in which a parent might provide love when a toddler has exhibited improper behavior.

12. 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

13. Speech Development Parallels cognitive growth
Expressive and receptive language continue to develop
Respond to tone of voice and facial expressions of those around them
Give an example of parallel cognitive growth.
What is receptive language?
Make facial expressions and ask students to identify the emotions behind them.

14. 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.

15. Walk up and downstairs, one foot on a step. Drink without assistance.
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.

16. 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

17. 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.

18. 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".

19. 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
Discuss the nurse’s role when assessing a toddler who might have autism.
How can the nurse communicate with a toddler who has autism?
Discuss the term pervasive developmental disorder (PDD).

20. 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
Give an example of how parents’ reactions to the toddler’s temper tantrum can affect the toddler’s behavior in the future.
What is an example of a limit and time-out for a toddler?

21. 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
Give an example of a household item which needs to be adjusted to meet the needs of the entire household.
Describe how flexibility with a household schedule assists the family (household) during the day.
Which clothing could interfere with toilet training?
What methods can be used to protect the toddler from sunburn?

22. 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
What are examples of proper and improper footwear for the toddler?

23. 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
Discuss methods that assist the toddler in toilet training.
What methods are detrimental to toilet training?
Give an example of a situation in which a parent is trying to force the toddler toward toilet independence.
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24. 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
Discuss why it is necessary to place the toddler on the toilet for just a few minutes.
What words might a toddler use to indicate defecation and/or urination?

25. Nutrition 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
Why is it important to limit milk intake?
Give an example of various foods to offer during a meal.
What are examples of finger-foods?
If well-nourished, the toddler shows steady and proportional gain in height and weight.

26. Day Care Must meet families’ Should be state-approved
Personal preferences
Cultural perspectives
Financial and special needs
Should be state-approved
Give an example of a personal preference a family might have and how it affects their choice of day care.
Which cultural issue could affect a toddler in the day care setting?
Discuss special needs a toddler might have and how this could affect the care provided in the day care setting.

27. 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
Give an example of a toddler’s attention span.
What is parallel play?

28. Injury 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
Give an example of age-appropriate risks for the toddler.
Provide an age-appropriate initiative by a parent to enhance safety in the home.
What is a curious activity a toddler might engage in within the home?
Audience Response Question #2
When a toddler is leaving the hospital, it is the nurse’s responsibility to ensure the child is appropriately buckled in his or her car seat.
1. True
2. False

29. Injury Prevention (cont.)
Discuss proper guidelines for car seats.

30. 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
Give an example of a toy parents might decide not to purchase for their toddler because of safety issues.
How is play toddler’s work?