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

2. Growth and Development of the Toddler
The toddler tries to assert his or her independence, is curious about the world around him or her, and at times fears separation from family caregivers.
Because of the toddler's new-found independence, parenting can be frustrating and a challenge, especially related to creating a safe environment and disciplining the child.
Erikson's developmental task for the toddler is autonomy (independence) while overcoming doubt and shame. The toddler seeks independence, wavers between dependence and freedom, and gains self-awareness.

3. Physical Development
The toddler's physical growth slows while motor, social, and language development rapidly increase.
Each year the toddler gains 5 to 10 lb (2.26 to 4.53 kg) and about 3 in (7.62 cm).

4. Psychosocial Development
Using negativism, the toddler often responds “no” to almost everything to assert individuality.
To develop security, the toddler likes to follow specific sets of routines; this is referred to as “ritualism.”
Dawdling occurs when toddlers follow their own desires, rather than the caregiver's wishes and routines.
Temper tantrums are an aggressive display of temper, in which the child reacts with rebellion to the wishes of the caregiver.

5. Psychosocial Development (cont.)
The toddler's play is often parallel play, in which the toddler plays alongside other children but not with them.
Playtime involves imitation of the people the child sees as role models.
The toddler learns self-control gradually, and the development from an egotistic being into a person who understands and respects the rights of others is a long, involved process, which the child must be taught.

6. Psychosocial Development (cont.)
Toddlers want and need limits.
Consistency and timing are important in the family caregivers' approach to disciplining the child.
The toddler frequently regresses to more infantile behavior when a new sibling arrives.
Special preparation and parental attention is necessary to show that there is room in the parents' lives for both children.

7. 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

8. 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.

9. Nutrition (cont.)
Nutritional concerns and eating problems occur in the toddler because of a slower growth rate, a drive for independence, “food jags,” and variations in appetite.
A balanced diet should be planned with an understanding of the toddler's developing feeding skills.
The toddler progresses from finger feeding and tilting the cup to being able to hold a spoon and handle a cup in an adult manner.

10. Health Promotion and Maintenance
The toddler undergoes routine checkups at 15 months of age for immunization boosters and at least annually thereafter.
Reinforcing family teaching includes aspects of everyday life with a toddler.
A regular time for a bath helps give the toddler a sense of security. Caregivers should avoid using bubble bath, especially for girls, because it can create an environment that encourages the growth of organisms that cause bladder infections.

11. Health Promotion and Maintenance (cont.)
Encourage the family caregiver to take a relaxed attitude as the toddler learns to dress himself or herself.
Bacteria forms dental plaque on teeth because of the presence of sugar in foods. By the age of 2 years, a toddler can be taught to brush his or her teeth by following the example of adults. Around this same age, the toddler should visit the dentist to be introduced to the process of a dental checkup.

12. Health Promotion and Maintenance (cont.)
Toilet training can be started when the child's sphincter muscles have developed enough so the child can control them; this usually occurs at age 18 to 24 months. Perfection should not be expected. To aid in training, the caregiver leaves the child on the potty chair for only a short time. If the child has a bowel movement or urinates after leaving the potty, this is ignored. The child should not be teased, and the potty chair should not be emptied until the child has gone back to playing or other activities.

13. 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.

14. 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.

15. Health Promotion and Maintenance (cont.)
A child needs a total of 12 to 14 hours of sleep daily in the first year of toddlerhood; this need decreases to 10 to 12 hours by 3 years of age.
A bedtime ritual provides structure and a feeling of security.

16. Health Promotion and Maintenance (cont.)
The leading causes of death in toddlers are accidents involving motor vehicles, drowning, burns, and poisons.
Toddlers should always be secured in a car seat when in a motor vehicle.
Supervision is important when toddlers are near motor vehicles, streets, bathtubs, and swimming pools.
Toxic substances should be stored out of reach and in childproof containers.
The most common medications involved in child poisonings are acetaminophen, aspirin, laxatives, sedatives, tranquilizers, analgesics, antihistamines, cough/cold medicines, and birth control pills.

17. The Toddler in the Health Care Facility
Keep in mind the toddler's developmental tasks and needs.
When the toddler is hospitalized, it is important to know their specific habits, terms used, patterns, and rituals. Maintaining as much as possible the pattern, schedule, and rituals that the toddler is used to helps to provide security.
The curious toddler needs to be watched closely to maintain safety, but should not be unnecessarily prohibited from exploring.

18. 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

19. 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.