1. Promoting optimum health during toddler hood

2. 1. Nutrition During the period from 12 to 18 months,the growth rate slows. The protein and caloric are still relatively high to meet the demands for muscle tissue growth and high activity level. The need for minerals such as iron, calcium, and phosphorus is still high

3. Nutrition Physiologic anorexia : is a phenomenon that most toddler at approximately 18 months of age manifest decreased nutritional need with a decreased appetite. Toddlers are increasingly aware of the nonnutritive function of food: the pleasure of eating, the social aspect of mealtime, and the control of refusing food. If a family member refuses to eat some timing, toddlers are likely to imitate that response. By 12 months of age most children are eating the same food prepared for rest of family.

4. Nutritional counseling Eating habits established in the first 2 or 3 years of life. If food is used as a reward or sign of approval, a child may overeat for nonnutritive reasons. Mealtimes should been joyable rather than times for discipline or family argument. The social aspect of mealtime may be distracting for young children. Calling the toddlers from play 15 minutes before mealtime allows them ample opportunity to get ready for eating while setting down their active minds and bodies.

5. Nutritional counseling The method of serving food also takes on more importance during this period. The ritualism of this age also dictates certain principles in feeding practices, like the same dish, cup. Or spoon every time of eat. If one food touches another, they often refuse to eat it. Mixed foods are rarely favorites. Best to use is plastic dishes and cups, for both economy and safety. large round foods should be avoided (hot dogs, grasps, peas, carrots). large round foods should be avoided (hot dogs, grasps, peas, carrots). Active play while eating should be discouraged to prevent choking.

6. Dietary guideline Iron deficiency anemia is a significant health concern during the second year of life. whole cow's milk is low in iron and interferes with iron absorption Iron deficiency anemia has been associated with impaired mental status and psychomotor development during the first 2 years of life. Iron deficiency anemia has been associated with impaired mental status and psychomotor development during the first 2 years of life. Iron fortified cereals and iron-rich foods are recommended for all children beyond 6 months of age. Iron rich diet as meats fish, green leafy vegetables, dried fruit, beans.

7. Dietary guideline Calcium and vitamin D are essential for healthy bone development. Adequate intake of calcium for the child 1to 3 years of age is 500 mg. Sources for calcium : whole milk, cheese, yogurt, beans, and vegetables. Adequate vitamin D intake is essential to prevent rickets, a recommended dose is 200 IU daily. Sources of vit D: fish, fish oils, egg yolks, Vit C enhances iron absorption (fruit juice)

8. 2. Sleep and activity Total sleep decreases only slightly during the second year and averages about 12 hours a day. Most children take one nap a day. Children reach an adult pattern of sleep by 3 years of age. Sleep problems are common: - Going to bed. - Falling sleep. - Response to fear: can be provoked by a child's daily stressors such as pressure to toilet train, moves, sibling birth, experiencing a loss, or separation from parents. - Awareness of separation.

9. Sleep problems Management of sleep problems: - Establishing a regular bedtime and routine. - Providing transitional objects,such as a favorite stuffed animal or blanket. - Limit prolonged bedtime rituals by defining a length of time and set of activities (one more story).

10. 3. Dental health Regular dental examinations :the American Academy of pediatrics(2003) now recommends that every child have an oral health examination by 6 months of age if the child is in high-risk category for caries. Removal of plaque : soft bacterial deposits that adhere to the teeth and cause dental caries (decay or cavities) and gum disease. - Poor oral hygiene and poor dietary habits are associated with the development of caries in children. - The most effective methods for plaque removal are brushing and flossing. several brushing techniques exist.

11. Dental health For effective cleaning a small toothbrush with soft rounded multitufted nylon bristles that are short and uniform in length is recommended. Introduce toothpaste around 2 years of age. When using toothpaste, children should select the flavor they like to encourage the brushing habit.. After the teeth have been cleaned, flossing with dental floss is done to remove plaque and debris from between the teeth and below the gum margin. Ideally the teeth should be cleaned after each meal and especially before bedtime

12. Dental health Fluoride supplementation should be considered for any child over the age of 6 months whose drinking water is deficient in fluoride. Low-Cariogenic Diet : - Diet is critical to developing good teeth because the carious process depends primarily on fermentable sugars, especially sucrose. - Table sugar, honey. Dried fruit are highly cariogenic. - Suggestions can be helpful to eliminate the problem: 1.The frequency with which sugar is consumed is more important than the total amount eaten.

13. Dental health 2. the form of sugar is important. the more cariogenic foods are those that are sticky or hard, because they remain in the mouth longer 2. the form of sugar is important. the more cariogenic foods are those that are sticky or hard, because they remain in the mouth longer Nursing caries :nursing bottle caries: bottle-: mouth caries: which occurs when the child is - routinely given a bottle of milk or juice at nap or bedtime, - use a bottle as a pacifier while awake. - Frequent nocturnal breast – feeding for prolonged periods. - The practice of coating pacifiers in honey can also to contribute to caries or botulism poisoning

14. Dental health Prevention involves: eliminating the bedtime bottle completely, - Feeding the last bottle before bedtime, - Not using the bottle as a pacifiers. - Never coating a pacifiers in sweet substances. - Juice should always be offered in a cup. - Toddler should be encouraged to drink from a cup at the first birthday and weaned from a bottle by 14 months of age.

15. 4. Injury prevention Motor vehicle injuries. Drawing.Burns.Poisoning.Falls. Aspiration and suffocation. Bodily damage. Terrorism/violence. See table 12- 3 p 406

16. Anticipatory guidance-care of families See family home care p 414