1. Chapter 24 Growth and Development of the Toddler: 1 to 3 Years

2. Growth and Development of the Toddler
Ages from 1 to 3 years
Soon after first birthday
Physical growth slows
Communication and mobility skills increase
Stubborn
Explorer
Dependence/fear of separation
Autonomy

3. Physical Development Gains 5 to 10 lb, about 3 in each year
Learns to chew food with continued eruption of teeth
Learns to stand alone and walk between 1 and 2 years
Most say their first words, refining language skills
By end of this period, may have learned toilet training

4. Psychosocial Development
Behavioral characteristics
Negativism
More an assertion of individuality
Ritualism
Used to help develop security
Dawdling
Serves the purpose of asserting independence

5. Psychosocial Development (cont.)
Behavioral characteristics (cont.)
Temper tantrums
Natural results of desire to be independent
Caregiver needs to remain calm
Do not yield the point
Must learn people cannot be controlled like this
May be accompanied by head banging and breath holding

6. Psychosocial Development (cont.)
Play
Moves from solitary play of the infant to parallel play
Much of playtime is imitation of role models
Doesn’t share toys until later toddler years
Toys
Should involve toddler’s new gross motor skills
Should refine fine motor skills
Carefully check toys for loose pieces and sharp edges

7. Psychosocial Development (cont.)
Discipline: To train or instruct to produce desired behavior pattern
Punishment: Penalizing someone for wrongdoing
Toddlers learn self-control gradually
2-year-olds: Begin to show signs of accepting responsibility for own actions
Consistency, timing are important
Hitting and biting
Calmly remove child from situation
Send unaccepting messages about behavior, not child

8. Psychosocial Development (cont.)
Discipline (cont.)
“Time out”
one minute per year
“Extinction”
Caregivers ignore the behavior
Spanking or physical punishment
Usually does not work well
Teaches that “hitting” is ok

9. Psychosocial Development (cont.)
Sharing with a new baby
Hard to prepare a toddler for a new baby
Frequently regresses
Most preparation done just prior to expected birth
“Our baby”
Reserve time for playing and cuddling with the toddler

10. Question
Toddlers are infamous for their use of the word “no.” What is this negativism indicative of?
a. Intention to disobey
b. Rebellion against parental boundaries
c. Assertion of individuality
d. Assertion of age-appropriate maturity

11. c. Assertion of individuality
Answer
c. Assertion of individuality
Rationale: Certainly the toddler’s response to nearly everything is a firm “no,” but this is more an assertion of individuality than an intention to disobey.

12. Nutrition

13. Nutrition (cont.) Common eating problems for this age
Toddler may want/require less food than previously
Normal
Due to slowed growth rate
Strong drive for independence and autonomy compels an assertion of will to prove individuality both to self and others
Appetite varies according to the kind of foods offered
“Food jags” are common

14. Nutrition (cont.) Messiness is to be expected – prepare for it
15 months
Can sit through meals
Wants to self-feed; prefers finger feeding
18 months
Improved spoon control
Returns spilled food to spoon

15. Nutrition (cont.) 24 months Appetite fair to moderate
Clearly defined likes and dislikes
Accepts no help
30 months
Refusals and preferences less evident
May hold utensils like an adult
Pursues last drop from cup

16. Health Promotion and Maintenance
Routine checkups
15 months for immunizations
Annually after that
Assess
Growth and development
Oral hygiene and toilet training
Daily health care
Caregiver–toddler relationship
Parenting skills

17. Health Promotion and Maintenance (cont.)
Family teaching
Bathing
Enjoys having tub toys to play with
Avoid using bubble bath: UTIs
Dressing
18 months: Remove shoes and socks
2 to 3 years: Starts putting on own clothes
Avoid criticism
Roomy clothing with easy buttons, Velcro and large zippers easiest

18. Health Promotion and Maintenance (cont.)
Family teaching (cont.)
Dental care
2 years
Brush after each meal or snack
Needs adult supervision
No toothpaste until child learns to spit it out
First visit to dentist to get acquainted
Subsequent first examination

19. Question Tell whether the following statement is true or false.
Nursing assessments that are made at well-child visits include the caregiver–child relationship and parenting skills.

20. Answer
True
Rationale: Routine physical checkups include assessment of growth and development, oral hygiene, toilet training, daily health care, the caregiver–toddler relationship, and parenting skills.

21. Health Promotion and Maintenance (cont.)
Family teaching (cont.)
Toilet training
Important part of socialization process
New routines make little sense to child
Timing important
Level of maturation needed usually achieved after 18 to 24 months
Offer small rewards

22. Health Promotion and Maintenance (cont.)
Family teaching (cont.)
Toilet training (cont.)
Stages
Readiness: Recognizing puddle on floor is something they did
Next: Indicate diaper is soiled; may bring clean diaper wanting to be changed
Serious training starts when child stays dry at least two hours

23. Health Promotion and Maintenance (cont.)
Family teaching (cont.)
Toilet training (cont.)
Don’t expect perfection, occasional lapses occur
Control at night may not be achieved until age 4 to 5
Use a comfortable potty chair; limit the time on the chair
Use “pull-up” type clothing

24. Health Promotion and Maintenance (cont.)
Family teaching (cont.)
Sleep
1 to 2 years: Total need 12 to 14 hours daily
3 years: Total need 10 to 12 hours daily
Naps
Bedtime rituals important
Regular schedules with consistent bedtimes

25. Health Promotion and Maintenance (cont.)
Accident prevention
Motor vehicle accidents
Most injuries and deaths preventable
Adults responsible for correct restraint
Drowning
Never leave the toddler alone, even for a moment
Home swimming pools; buckets

26. Health Promotion and Maintenance (cont.)
Accident prevention (cont.)
Burns
Most common
Scalds from immersions and spills
Exposure to uninsulated electrical wires or live extension cord plugs
Playing with matches
Left unattended in home when fire breaks out

27. Health Promotion and Maintenance (cont.)
Accident prevention (cont.)
Ingestion of toxic substances
Toddler curiosity
Poisoning most common medical emergency
“Mr. Yuk” labels helpful, insufficient
Place under lock and key or totally out of child’s reach

28. Health Promotion and Maintenance (cont.)
Accident prevention (cont.)
Ingestion of toxic substances (cont.)
Medications that commonly poison toddlers
Acetaminophen
Salicylates (aspirin)
Laxatives
Sedatives
Tranquilizers
Analgesics
Antihistamines
Cold medicines
Birth control pills

29. The Toddler in the Health Care Facility
Hospitalization is difficult and frightening; developmental stage of toddler intensifies
Issues a toddler must deal with
Need for autonomy
Inability to communicate well
Discomfort from pain
Separation from family
Presence of unfamiliar people and surroundings
Physical restraint
Uncomfortable or frightening procedures

30. The Toddler in the Health Care Facility (cont.)
Maintaining routine
Social assessment includes routines
Nursing care plan should provide opportunities for independence
Separation anxiety
Include caregiver in care but don’t neglect caring for toddler yourself

31. The Toddler in the Health Care Facility (cont.)
Maintaining routine (cont.)
Toddler needs security
Thumb
Special toy
When caregiver leaves, may leave personal item with toddler
Be concrete as to when caregiver will return

32. The Toddler in the Health Care Facility (cont.)
Special considerations
Maintain safety but allow toddler’s development to continue
Give toddler opportunity to remain continent
Do not automatically put toddler back in diapers
Toddler needs set limits
Eating problems may arise

33. The Toddler in the Health Care Facility (cont.)
Special considerations (cont.)
Ways to minimize eating problems
View mealtime as a social event
Encourage self-feeding
Do not push the child to eat
Allow others to eat with the child
Offer familiar foods
Provide fluids in small but frequent amounts

34. The Toddler in the Health Care Facility (cont.)
Special considerations (cont.)
Keep toddler safe
Allow toddler to explore and move about freely when possible

35. Question
Toddlers are curious, and often what is in their hands goes into their mouths. What is one of the most common substances involved in the poisoning of a toddler?
a. Shaving lotion
b. Birth control pills
c. Toxic plants
d. Multivitamins

36. Answer b. Birth control pills
Rationale: The following medications are most commonly involved in cases of childhood poisoning:
Acetaminophen, salicylates (aspirin), laxatives, sedatives, tranquilizers, analgesics, antihistamines, cold medicines, and birth control pills.