1. TODDLERS & PRESCHOOLERS
Health Promotion

2. Age and Characteristics
Toddlers: 12 to 36 months of age;
intense exploration of the environment
negativism
terrible twos/teriffic twos
parents need support & guidance
need to set limits

3. Age and characteristics (cont)
Preschooler: 3-5 years old
preparation for entering school
refine tasks mastered during toddler years
increase control over bodily functions
increase attention span & frustration limits
Caution! muscle development & bone growth still not mature; overexertion can injure delicate tissue

4. Bodily Changes Weight Toddler Birth weight quadrupled by 2.5 years
2 yr. 12 kg (27#)
Preschooler
3 yr kg (32#)
4 yr kg (36.75#)
5 yr kg (41.25#)
Growth slows to approx. 4-6 lbs ( kg) per year

5. Height
Toddler
The adult height is = to approximately 2 times the child’s at 2 yrs
2 yrs 86.6 cm (34”)
Preschooler
3 yrs 95 cm (37.25”)
4 yrs 103 cm (40.5”)
5 yrs 110 cm (43.25”)
Growth slows to ~ 3” /yr (7.5 cm); mainly in legs, not trunk

6. Toddler Changes Head Circumference = Chest Circumference @ 1-2 years,
then Chest Circumference>Head Circumference
Anterior Fontanelle Closes at months.
Visual acuity 20/40
Persistent Strabismus – REFER
Hearing, smell, taste & touch become more developed
Develop taste preferences—finicky eater
Physiologic anorexia

7. Toddler Maturation of Systems
Brain growth
Myelination of spinal cord at 2 years allows for control of bowel and bladder
RR and HR slows & BP increases
Resp. sys. growth leads to less infections
Ear and throat structures still immature so URI, otitis media, tonsillitis common
Pot belly (toddler tummy) and bow legged until after 2nd year

8. Toddler Maturation of Systems
GI/GU: gastric acidity now protective
Bladder capacity increase
Skin: tightly bound now
Body temp regulation no longer problem
Defense mechanisms more effective
Dentition complete – all 20 deciduous teeth by 30 mos

9. Toddler Gross Motor 12-15 m walk alone w/wide stance
18 m try to run but falls easily
2 yr walk up and down stairs
2.5 yr jump w/ both feet
3 yr tricycle, walk on tiptoe, balances on 1 foot for few seconds, broad jumps
4 yr skips & hops w/1 foot; catches ball
5 yr skips w/alt. feet, jumps rope, skates, swim

10. Preschooler Gross Motor
3 year old
tricycle,
walk on tiptoe,
balances on 1 foot for few seconds
broad jumps
4 year old
skips & hops w/1 foot
catches ball
5 year old
skips w/alt. feet,
jumps rope,
skates,
swim

11. Toddler Fine Motor 12 months grasps very small object
15 months drops raisin into narrow neck bottle; put round object in hole; scribble
18 months can throw ball overhand keeping balance; build tower of 3-4 blocks
24 months builds tower of 6-7 blocks; imitate circular stroke & vertical line
30 months builds tower of 8 blocks or more
Activities done to produce a purposeful result

12. Preschooler Fine Motor
3 year old
copies circle
imitates cross
holds pen with fingers, not fist
4 year old
trace cross & diamond
copies square
uses scissors
adds 3 parts to stick figure
5 year old
copies diamond & triangle
adds 7-9 parts to stick figure
prints a little
Scribbling & drawing essential for development & readiness skills for school

13. Psychosocial Development
Infancy: Trust vs mistrust (Erickson)
Toddler: Autonomy vs shame & doubt (Erikson)
Need limit setting, consistent discipline; negativism & ritualism part of autonomy
Ego overcomes id (Freud)
Learn to delay gratification; rudimentary start of superego (conscience)

14. Psychosocial Development
Preschool: Initiative vs guilt (Erikson)
Time of learning & accomplishment; learning right from wrong
Wishes same-sex parent dead –resolves during school age as identifies with parent
Major guilt and long lasting problems if parent actually dies during this time period
Superego continues to develop; good vs bad; beginning of morality
Should be allowed to question & disagree

15. Oedipal Stage (Freud) Age 3-6
Result of learning separateness as persons
Oedipus complex – male wishes father dead so can marry his mother
Castration complex – thinks girls lost their penis due to wrongdoing so worries same will happen because of bad thoughts
Electra complex – female wishes mother dead so can marry her father
Penis envy – desire to have a penis
Masturbation common as they discover their sexuality

16. Cognitive Development Piaget
12-24 m: main goal is acquisition of language
Differentiation of oneself from objects
Aware of causal relationships but can’t transfer knowledge to new situations
Spatial awareness – nesting boxes
Object permanence advanced – know it exists even when it is gone

17. Cognitive (cont)
19-24 m:object permanence: will search in several hiding places, not just original one
Domestic mimicry: household tasks
Time: still immature; developing some sense in terms of anticipation
Egocentrism: every event in reference to self, unable to see from another’s perspective

18. Toddler Rules of possession
If I like it’s mine
If it’s in my hand it’s mine
If I can take it from you it’s mine
If I had it a little while ago it’s mine
If I am building something with it, it’s mine
If I had it before it’s mine
If you set it down, it’s mine
If it’s broken, you can have it, it’s yours

19. Cognitive (cont)
Preoperational Phase (Piaget): 2-7 yrs. bridges egocentric behavior & rudimentary social awareness of latency
Egocentric speech – repeats to hear oneself, only communicates about themselves “I do”
Animism: lifelike qualities to inanimate objects especially begins in toddlers
Magical thinking – believe thoughts are all powerful and can cause events. Play most effective for understanding children’s thinking. May misconstrue fantasy and reality.

20. Moral Development Preconventional or Premoral (Kohlberg)
Punishment & obedience orientation 2-4 years
Good/bad depends on reward/punishment
Type of discipline affects moral development
Use power (physical) – neg. view of morals, especially authority figures
Withdraw love – behave out of guilt
Explain & use positive approaches & limit setting
More likely to internalize & be less hostile

21. Spiritual Development
Toddler: idea of God is vague; routines and rituals are important and comforting
Preschoolers: concrete thinking; God w/physical characteristics like imaginary friend; books are helpful
Important to view God as unconditional love vs judge of good or bad behavior esp. if ill or in hospital

22. Body Image By 2 years recognizes sexual differences
Words used to describe appearances become part of body language and image,
Unclear body boundaries – fear blood & insides will leak out – need Band-Aid (Book Parts)
Preschoolers recognize difference in skin color
Vulnerable to learning prejudices & biases

23. Sexuality Toddlers: explore bodies and find pleasure
May fondle or masturbate; don’t label “dirty”
Preschoolers: very important time for sexual identity; strong attachment to opposite sex parent while identify with same sex parent
Childrearing practices & imitation are powerful ways to learn their identity

24. Social Development
Individuation-Separation: major accomplishments as toddler – completed by preschool age.
Tolerating & mastering brief periods of separation is imp.devel.task of this age
Very upset when parents leave; must prepare children ahead of time
Transitional objects provide security
Preschoolers cope better esp w/preparation & can work thru anxieties/fears through play

25. LANGUAGE 1 yr: 4 words 2 yr: 300 words, 2-3 word sentences
3 -4 yrs: use 3-4 word sent. & incl. only words needed to get message across – telegraphic. Can give and follow simple commands
4-5 yrs: longer sent. w/more words to convey message; Follow simple directional commands, but only 1 at a time
By 5: 2100 words; comprehension even greater; even if bilingual. By 6 uses all parts of speech.

26. Personal-Social Behavior
15 months: feed selves; covered cup; spoon; helps dress, takes shoes & sox off
18 months: removes gloves, may unzip
24 months: use spoon well; removes clothes & puts on sox, shoes, pants
36 months: using fork
2-3 years: eats w/family, helps, but no table manners, hard to sit thru meal
4-5 years: need little or no help w/dressing, eating, or toileting

27. Play Toddlers
Toddlers: parallel play; need wide variety of play interactions, environments, activities Inspects toy, talks to toy, tests strength & durability, invents several uses for it Imitation: dress up, houses, farms, trucks, etc. Locomotive skills (balls, riding toys); fine motor (paints, chalk, puzzles), interlocking blocks Talking is play; imitating animal sounds, reading books, appropriate child’s TV shows Tactile play: water, sand, finger paints, clay

28. Play Preschoolers
Preschoolers: associative play; group play without rigid rules or organization
Begin to enjoy crafts; one simple project per year of age
Dramatic play: 4-5 year olds especially.
Imaginary playmates: between 2.5 & 3 years
Purposes: friends when lonely, accomplish what child is still trying to do, experience what child wants to forget or remember.

29. NUTRITION
Growth slows and caloric, protein, & fluid requirements decrease
Vits/mineral needs increase
Milk: 2-3 cups/day; >qt. limits other food intake; Fe defiency as well as others
After 2 years can be skim or low fat
Around18 m physiologic anorexia: picky, fussy, eaters w/strong taste preferences; social aspect of meals and control of refusing food; happens again about 4 years.

30. Nutrition
1 Tbsp. solid food per year of age Eating habits first 2-3 years have lasting effect
Older toddler and preschooler: quality more imp. than quantity
Toddlers – ritualism – same dish, cup, etc
Juice – 4-6 oz/day; not replace fruits
Allow to give up bottle when ready
By 5, total fat < 30% and > 20% total calories
Daily Ca 800 mg. 4-8 yrs. old

31. Sleep and Activity Average 12 hr. sleep
Naps may stop by end of 2nd or 3rd year
Bedtime rituals, transitional objects help with fears and trouble getting to sleep
Don’t put child in bed with parent
Sleep terror : 1-4 hours after falls asleep; thrashing, yelling; goes right back to sleep
Nightmares: 2nd half of night; scary dream; wakes up and hard to go back to sleep

32. Dental First see dentist at 1 yr., then q 6-12 m
Complete eruption of deciduous teeth by beginning of preschool period
Toddlers can help but parents do most brushing and all flossing
Preschoolers still need supervision and flossing done by parents
Fluoridation of water most cost-effective

33. Injury Prevention Child protection & adult ed. are crucial
Preschoolers especially imitate what they see so must be good role models (bike helmets)
MVA: ½ all accidental death ages 1-4; restraints not used or not used properly
Each state has different rules. In Illinois the child is rear facing position until age 2 or no longer fits in rear facing car seat. Car seat or booster until fits in adult restraint or to age 12.
> 3 year involved more in pedestrian traffic injuries due to increased locomotion and unaware of dangers
Must teach safe ways to cross street and role model
Safest: middle of back seat; never in front w/air bag unless emergency w/seat back
Always stress correct use

34. DROWNING
Drowning: leading cause of unintentional death in 1-4 yr old (CDC, 2014)
Near-drowning one of leading causes of “vegetative” state in young children
Encourage parents to learn CPR
Supervising near ANY source of water is a must: tubs, pools, ditches, hot tubs, toilets
Teaching to swim <4 not “drown proof” but may give false sense of security
Death occurs within minutes
Electrical burns: may explore outlets by sticking things in them or mouthing them
Scald burns: very common; tap water, tea, coffee, or pans on stove pulled down on them

35. Burns Burns: a leading cause of death
Flame burns - one of most fatal; play w/matches & set self and home on fire
Scald burns: Keep hot water heater
<49° C (120°F) takes 10 minutes for burn to occur
usually kept at 54° C(130° F) takes 30 seconds for burn to occur
Electrical burns: may explore outlets by sticking things in them or mouthing them
Scald burns: very common; tap water, tea, coffee, or pans on stove pulled down on them

36. Poisoning Highest incidence is 2 yr. olds
Morbidity such as esophageal stricture
Major problem – improper storage
Locomotion and curiosity – only a locked cabinet is safe
Have poison control number: nationwide

37. Dental No fluoride supplement before 6 months
Fluorosis: excess; causes cosmetic problems if occurs b/ yrs.
Use pea size amt. of toothpaste for child
Cariogenic foods: honey, molasses, dried fruits, raisins, complex carbs
Baby bottle tooth decay (BBTD) may need crowns; juice always should be in cup

38. Other Injuries Playground injuries common
Falling from stairs – head injuries
Falls from open windows or leaning against screens
Falls from cribs; once 35” tall, need bed
No top bunk until at least 6 years
Aspiration/suffocation: Hot dogs still need to be cut up!
Traumatic asphyxiation: electric garage doors, drawstrings on jackets or hoods
Suffocation: old refrigerator, ovens, toy boxes w/heavy hinged lids
Avoid nuts, dried beans, pits from fruit
Small parts from play objects

39. Bodily Damage
Walking while holding sharp or pointed object: fork, scissors, etc.
Walking w/food or objects in mouth such as a spoon or toothbrush
All firearms must be locked up
Workshop tools locked up
Keep indoors while mowing
Teach safety w/ animals
Only have toys of appropriate age range

40. Temper Tantrums Common in toddler; not <1 or >4
Fatigue contributes
Breath holding usually not a problem
Head banging IS a problem
Ignore but stay close during tantrum
Reward post tantrum behavior

41. Toilet Training 18-25 mos, girls earlier than boys
Day by 30-36mos; nite 37-48mos
Limit time on toilet to 5-10 min.
Bowel before bladder usually
Motivation – want to please parents
Readiness signs p. 620 (9th ed.), p. 501 (10th ed.)
Physical
Mental
Psychologic
Parental

42. Negativity Part of development Provide less chance to say “no”
Give choices
Use humor
Play games to distract

43. Stress Limited ability to cope; prevention is best
Be aware of signs: regression, aggression
Prepare children for changes
Allow play to work things through
↑ rest periods; gentle music
Older children: imagery & relaxation

44. Sex Education By 3, aware of anatomic differences
Remember the 2 rules:
What do they know and think?
Be honest and use exact terminology
Like to talk about bodily functions; watch others go potty
Curious – may play “doctor”
Masturbation – normal occurrence
Distract with alternate acceptable behaviors

45. Aggression
Behavior that attempts to hurt persons, animals, or destroy property
Depends on quantity, severity, distribution, onset & duration (at least 4 wks)
Contributing factors: parenting practices, frustration, modeling, reinforcement

46. Speech Problems Most critical time 2-4 yrs.
Stuttering at this time is normal & usually passes unless emphasis put on it
Causes of speech problems: hearing loss, developmental delay, lack of verbal stimulation
3 year-old talks incessantly, time of great exploration of new vocabulary

47. Fears
Fear of dark, being left alone (bed time), animals, people, objects, loss of blood or other body parts or insides, etc.
Parent induced – these fears may become instilled and long lasting
Help find practical ways to deal with: desensitization, modeling, etc.
If do not subside & disrupt family - refer