Chapter 32 The Toddler and Family All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 “The terrible twos”  Ages 12 to 36 months  Intense period of environmental exploration  Temper tantrums/obstinacy/negativism Promoting Optimal Growth and Development 2 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Proportional changes  Weight gain slows to 4 to 6 lb/year  Birth weight should be quadrupled by age 2½ years  Height increases about 3 inches/year  Elongation of legs rather than trunk  Growth is steplike rather than linear Biologic Development 3 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Sensory Changes  Visual acuity of 20/40 is acceptable  Hearing, smell, taste, and touch continue developing  All senses are used to explore environment Biologic Development (Cont.) 4 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Maturation of Systems  Most physiologic systems are relatively mature by the end of toddlerhood  Upper respiratory infections, otitis media, and tonsillitis are common among toddlers  Body temperature is maintained  Child is physiologically able to control elimination  Defense mechanisms of skin are intact Biologic Development (Cont.) 5 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Gross and fine motor development  Locomotion  Refinement of coordination Between ages 2 and 3 years  Fine motor development  Improved manual dexterity Ages 12 to 15 months  Throwing ball By 18 months Biologic Development (Cont.) 6 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Biologic Development (Cont.) 7 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Developing sense of autonomy (Erikson)  Autonomy vs. shame and doubt  Negativism  Ritualization, which provides sense of comfort  Id, ego, superego/conscience Psychosocial Development 8 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Sensorimotor and preoperational phase (Piaget)  Cognitive processes develop rapidly between ages 12 and 24 months  Tertiary circular reactions Active experimentation Applying knowledge to new situations Learning spatial relationships Cognitive Development 9 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Invention of new means through mental combinations  Final sensorimotor stage: ages 19 to 24 months  Imitation of behaviors  Domestic mimicry  Concept of time: still embryonic Cognitive Development (Cont.) 10 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cognitive Development (Cont.) 11 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Preoperational phase  Begins about age 2 years  Lasts until age 4 years  Is the transition between self-satisfying behavior and socialized relationships  Preconceptual phase is a subdivision of the preoperational phase  Preoperational thought implies children cannot think in terms of operations Cognitive Development (Cont.) 12 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Evolution of spirituality often parallels cognitive development  Family and environment influence a child’s perception of the world  Intuitive-projective phase is experienced  Fowler’s faith construct  Spiritual routines can be comforting Spiritual Development 13 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Development of body image parallels cognitive development  Child refers to body parts by name  Child recognizes words used to describe appearance  Adults should avoid negative labels about physical appearance  Child recognizes gender differences by age 2 years Development of Body Image 14 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Exploration of genitalia is common  Genital fondling can occur  Parental reaction should be accepting  Gender roles are understood by toddler  Playing “house”  Gender identity is formed by age 3 years Development of Gender Identity 15 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Separation  Differentiation of self from mother and significant others  Individualization  Achievements that mark the child’s expression  Major achievements: occur in the toddler years  Transitional objects Social Development 16 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Social Development (Cont.) 17 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Level of comprehension increases  Ability to understand increases  Comprehension is much greater than the number of words a toddler can say  At age 1 year, child uses one-word sentences  By age 2 years, child uses multiword sentences Language 18 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Toddlers develop skills of independence  Skills for independence may result in determined, strong-willed, volatile behaviors  Skills include feeding, playing, dressing, and undressing self  Toddlers develop concern for the feelings of others Personal Social Behavior 19 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Magnifies physical and psychosocial development  Interaction with others: becomes more important  Parallel play  Imitation  Tactile play  Selection of appropriate toys Play 20 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Play (Cont.) 21 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Toilet training  Sibling rivalry  Temper tantrums  Negativism  Regression Coping with Concerns Related to Normal Growth and Development 22 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Coping with Concerns Related to Normal Growth and Development (Cont.) 23 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Coping with Concerns Related to Normal Growth and Development (Cont.) 24 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Nutrition  Phenomenon of “physiologic anorexia”  Nutritional counseling  Dietary guidelines  Vegetarian diets  Complementary and alternative medicine  Sleep and activity  Sleep problems Promoting Optimum Health During Toddlerhood 25 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Dental health  Regular dental examinations  Removal of plaque  Fluoride  Dietary factors  Early childhood caries Promoting Optimum Health During Toddlerhood (Cont.) 26 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Toddlerhood (Cont.) 27 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Toddlerhood (Cont.) 28 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Toddlerhood (Cont.) 29 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

 Motor vehicle safety  Car seat restraints  Motor vehicle–related injuries  Drowning  Burns  Accidental poisoning  Falls  Aspiration and suffocation  Bodily injury Safety Promotion and Injury Prevention 30 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention (Cont.) 31 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention (Cont.) 32 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention (Cont.) 33 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention (Cont.) 34 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention (Cont.) 35 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

A characteristic of a toddler’s language development at age 18 months is: A. Vocabulary of 25 words. B. Increasing level of comprehension. C. Use of holophrases. D. Approximately one third of speech understandable. Question 36 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.