1. Growth and Development Unit Eight Growth and Development of Toddler

2. Physical Growth: While toddlers are making great strides developmentally, their physical growth begins to slow. Weight: – A child gains only about 2.5 kg and 12cm a year during the toddler period. – A toddler‘s appetite decreases accordingly, yet adequate intake of all nutrients is still essential to meet energy needs.

3. Head circumference: – Increases only about 2 cm during the second year compared to about 12 cm during the first year. – Head circumference equals chest circumference at 6 months to 1 year of age; By 2 years, chest circumference has grown greater than that of the head. Physical Growth:

4. Body Contour: – Toddlers tend to have a prominent abdomen – because although they are walking well, their abdominal muscles are not yet strong enough to support abdominal contents. – They have a forward curve of the spine at the sacral area (lordosis). Physical Growth:

5. Body systems: – Body systems continue to mature during this time. – Respirations slow slightly but continue to be mainly abdominal. – The heart rate slows from 110 to 90 bpm; blood pressure increases to about 99/64 mm Hg. – The brain develops to about 90% of its adult size. – In the respiratory system, the lumens of vessels enlarged progressively so the threat of lower respiratory infection becomes less. Physical Growth:

6. Body systems: – Stomach secretions become more acids; therefore, gastrointestinal infections also become less common. – Stomach capacity increases to the point a child can eat three meals a day. – Control of the urinary and anal sphincters becomes possible with complete myelination of the spinal cord. – IgG and IgM antibody production becomes mature at 2 years of age. – The passive immunity obtain during intrauterine life is no longer operative. Physical Growth:

7. Teeth: – Eight new teeth (the canines and first molars) erupt during the 2 nd year. All 20 deciduous teeth are generally present by 2.5 – 3 years of age. Physical Growth:

8. Developmental Milestones: Language Development: – Toddler hood is a critical time for language development, although even this varies among children, because in order to master language, children need practice time. – A word that is used frequently by toddlers and that is a manifestation of their developing autonomy is a “no”. Toddlers may use the word to mean they are refusing a task, or they do not understand it.

9. Language Development: – To learn other words, children need exposure to conversation and need to be read to often. Language develops most quickly if parents respect what toddlers have to say so children grasp the use and purpose of language. – Urge parents to encourage language development by naming objects as they play with their child (ball, block, music box, doll) or when they give their toddler some thing. This helps children grasp the fact that words are not meaningless sounds. Always answering a child’s questions is another good way to do this. Be sure answers for toddlers are simple and brief because they have such a short attention span Developmental Milestones:

10. Emotional Development: – Autonomy: The developmental task of the toddler years according to Erikson is the development of a sense of autonomy vs. shame or doubt. To develop sense of autonomy is to develop a sense of independence. Children who are constantly told not to try things because they will hurt themselves maybe left with a stronger sense of doubt than confidence at the end of the toddler period. A healthy level of autonomy is achieved when parents are able to encourage independence while still maintaining consistently sound rules for safety. Developmental Milestones:

11. Emotional Development: – Socialization: Once toddlers are walking well, they become resistant to sitting in laps and being cuddled. Fifteen-month old children are still enthusiastic about interacting with people, providing those people are willing to follow them where they want to go. By 18 months, toddlers imitate the things they see a parent doing, such as “study” so they seek out the parents to observe and initiate interactions. By 2 or more years, children become aware of gender differences and may point to other children and identify them as “boy” or “girl” Developmental Milestones:

12. Planning and Implementation for Health Promotion of a Toddler and Family: Toddler tend to develop many upper respiratory and ear infections but otherwise come to health care facilities most often for health maintenance visits (recommended at 15, 18 and 24 months) and immunizations important at these times. Promoting Toddler Safety: – Accidents are the major cause of death in children of all ages. – Accidental ingestions (poisoning) are the type of accident that occurs most frequently in toddlers.

13. Promoting Toddler Safety: – Other accidents that occur frequently in toddlers include motor vehicle accidents, burns, falls and playground injuries. – Some 15-month-old children can climb over the side rails of their cribs and enjoy exploring the house early in the morning before anyone else is awake. – As the child reaches 2 years of age and begins to imitate housework or repairing a car, parents must be sure that the child does not use real cleaning compounds or sharp tools. Planning and Implementation for Health Promotion of a Toddler and Family:

14. Promoting Nutritional Health of a Toddler: – Toddlers usually do not like food that is “mixed up” such as casseroles; they often prefer that different foods do not touch one another on their plate. – Toddler Nutrition: Children ages 1 – 3 years should consume 1,300 kcal daily. Protein and carbohydrates needs are often easily met during the toddler period; diets in high sugar must be avoided. Planning and Implementation for Health Promotion of a Toddler and Family:

15. Promoting Toddler Development in Daily Activities: – Dressing: By the end of the toddler period, most children can put on their own socks, underpants and undershirt. When toddlers dress themselves, they invariably put shoes in the wrong feet and shirt and pants on backwards. – Sleep: They may begin the toddler period napping twice a day and sleeping 12 hours each night, and end it with one nap a day and only 8 hours sleep at night. Planning and Implementation for Health Promotion of a Toddler and Family:

16. Promoting Toddler Development in Daily Activities: – Bathing: The time for a toddler’s bath should depend on the parents and the child wishes and schedule. Toddlers usually enjoy bath time and parents should make an effort to make it fun by providing a toy such as rubber duck, boat or a toy fish. Remind parents that although toddlers can sit well in a bathtub, it is not safe to leave them unsupervised. Planning and Implementation for Health Promotion of a Toddler and Family:

17. Promoting Toddler Development in Daily Activities: – Care of Teeth: Toddlers need to have a tooth brush they recognized as their own. Toward the end of Toddler period, they can begin to do brushing themselves under supervision. Remind parents it is better for a child to brush thoroughly once a day, probably at bedtime, than do it poorly many times a day. After brushing, parents can use dental floss to clean between the child’s teeth and remove plaque. Urge parents to schedule a visit to a dentist skilled in pediatric dental care by 2.5 years of age for assessment of dentition Planning and Implementation for Health Promotion of a Toddler and Family:

18. Parental Concerns Associated with the Toddler Period: Toilet Training: – Toilet training is one of the biggest tasks a toddler must achieve. – Before children can begin to be toilet trained, they must have reached important developmental levels one physiologic and the other cognitive: They must have control of rectal and urethral sphincters, usually achieved at the time they walk well. They must have cognitive understanding of what it means to hold urine and stools until they can release them at a certain place and time.

19. Ritualistic Behavior: Negativism: – As part of establishing their identities as separate individuals, toddlers typically go through a period of extreme negativism. – They do not want to do anything a parent wants them to do. Their reply to every request is a definite “no.”

20. Discipline: – Remind parents that “discipline” and “punishment” are not interchangeable terms. – Discipline means setting rules or road signs so children know what is expected of them. – Punishment is a consequence that results from a breakdown in discipline, from the child’s disregard or the rules that were learned. – Two general rules to follow: Parents need to be consistent. Rules are learned best if corrected behavior is praised rather than wrong behavior punished. Ritualistic Behavior:

21. Separation Anxiety: – Fear of being separated from parents begins at about 6 months of age and persists throughout the preschool period. – This universal fear of this age group is known as separation anxiety. – Parents may ask what they can do about this problem. They believe they have a right to leave their child in a babysitter’s or center’ care. Ritualistic Behavior:

22. Temper Tantrums: – Almost every toddler has a temper tantrum at one time or another. – The child may kick, scream, stamp feet, shout “No,no,no” lie on the floor, flail arms and legs and bang the head against the floor. – Children may hold their breath until they become cyanotic and slump to the floor. Ritualistic Behavior: