1. Chapter 17
The Toddler
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

2. Lesson 17.1 Objectives
Describe the physical, psychosocial, and cognitive development of children from 1 to 3 years of age, listing age specific events and guidance when appropriate.
Describe the task to be mastered by the toddler according to Erikson’s stages of growth and development.
List two developmental tasks of the toddler period.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

3. General Characteristics (p. 406)
A toddler is between 1 to 3 years of age
No longer completely dependent on others
Rapid growth and development during infancy slows down
Erikson’s stage of autonomy versus shame and doubt
Discuss Erikson’s stage of autonomy versus shame and doubt as based on a continuum of trust established during infancy.
Ask students to give examples of autonomy, shame, and doubt in the toddler.
Ask students how lack of trust can likely affect the toddler’s growth and development.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

4. General Characteristics (cont.) (p. 406)
Major parental responsibility
Maintaining safety for the toddler while allowing the opportunity for social and physical independence
Maintain positive self-image and body image in child
Negativism can be countered by offering limited choices and the use of distraction in handling toddlers whose favorite word is “no”
Discuss a situation or method in which a parent can provide the opportunity for socialization while providing a safe environment.
What situations and choices might a parent offer to distract the toddler?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

5. General Characteristics (cont.) (p. 406)
Developing self-control and socially acceptable outlets for aggression and anger are important in the formation of personality and behavior
Ritualism increases the toddler’s sense of security by making compulsive routines of simple tasks
Have students offer examples of how a parent can assist the toddler in expressing anger.
What rituals could instill a sense of security in the toddler?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

6. Physical Development (p. 406)
Birthweight quadruples by 2.5 years of age
Rate of brain growth slows
Body proportions change
Head and trunk grow more slowly
Musculoskeletal system grows and bones begin to ossify
Protuberant abdomen flattens when muscle fibers increase in size and strength
Myelination of spinal cord nearly complete by 2 years
Bowel and bladder control usually complete by 2.5 to 3 years of age
Discuss why a toddler might not be ready for toilet training based upon age and development.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

7. Physical Development (cont.) (p. 407)
Respirations still mainly abdominal but shift to thoracic as child reaches school-age
Capable of maintaining stable body temperature
Eruption of deciduous teeth complete by 2.5 years
Defense mechanisms of the skin and blood are more effective
Digestive processes and stomach capacity increase to allow three-meal-a-day schedule
Describe abdominal respirations versus thoracic respirations.
Discuss the eruption of teeth and proper oral hygiene.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

8. Sensorimotor and Cognitive Development (p. 408)
Sensory and motor abilities do not function independently
Memory strengthens
Is able to assimilate information through trial, error, and repetition
Piaget’s sensorimotor and preconceptual phase of development emerges rapidly in this age group
Discuss how sensory and motor functions are synchronized.
Review Table 17-1 on p. 407 with the class.
Give an example of how a toddler learns from trial and error.
What are examples of Piaget’s sensorimotor and preconceptual phases of development?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

9. Sensorimotor and Cognitive Development (cont.) (p. 408)
Able to tolerate longer periods of separation from parents to explore environment
Aware of cause and effect
Concept of spatial relationships develops
Begins to internalize standards of behavior
Copies words and roles of the models seen in the home
Discuss how the toddler has progressed to managing longer periods of time away from his or her parents.
What is an example of cause and effect?
Give examples of how toddlers model behavior.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

10. Sensorimotor and Cognitive Development (cont.) (p. 408)
May confuse essential with nonessential body parts/functions
Expelling feces and urine and then flushing it down the toilet may be upsetting as the toddler may see it as flushing a part of themselves away
Nurse should teach parents skills that will enable the toddler to feel loved even if behavior is not acceptable
What are essential and nonessential body parts?
Give an example of a situation in which a parent might provide love when a toddler has exhibited improper behavior.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

11. Lesson 17.2 Objectives Discuss speech development in the toddler.
Discuss the principles of guidance and discipline for a toddler.
Discuss how adults can assist small children in combating their fears.
Identify the principles of toilet training (bowel and bladder) that will assist in guiding parents’ efforts to provide toilet independence.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

12. Speech Development (p. 408)
Parallels cognitive growth
Comprehension exceeds verbalization
Expressive and receptive language continue to develop
Respond to tone of voice and facial expressions of those around them
Showing empathy toward the toddler who is trying to communicate verbally will help minimize frustrations
Give an example of parallel cognitive growth.
What is receptive language?
Make facial expressions and ask students to identify the emotions behind them.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

13. Screening for Signs of Autism (p. 410)
Preliminary symptoms may include
No pointing, gesturing (e.g., bye-bye) by 12 months
No single words by 16 months
No spontaneous two-word phrases by 24 months
Loss of achieved language or social skills
Important to rule out lead poisoning, hearing deficit, neurological disorders, musculoskeletal diseases, and inborn errors of metabolism.
Discuss the nurse’s role when assessing a toddler who might have autism.
How can the nurse communicate with a toddler who has autism?
Discuss the phrase pervasive developmental disorder (PDD).
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

14. Guidance and Discipline (p. 408)
Goal is to teach, not punish
Discipline involves guidance
Parent responses to temper tantrums can either reinforce the desirability of, or the risks involved in, such behavior
Expectations must be in line with the child’s physical and cognitive abilities
Limit-setting
Time-outs
Give an example of how parents’ reactions to the toddler’s temper tantrum can affect the toddler’s behavior in the future.
What is an example of a limit and time-out for a toddler?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

15. Guidance and Discipline (cont.) (pp. 408-409)
Child seeks approval
Use positive approach whenever possible
Approval increases self-confidence
Use of fear or physical aggression with a toddler does not foster self-control
Can lead to physical and emotional abuse
Give examples of positive reactions to a toddler’s behavior by the parents.
Discuss how the parents’ reaction to a toddler’s behavior affects the toddler’s self-confidence.
How can physical aggression and fear tactics affect the toddler negatively?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

16. Guidance and Discipline (cont.) (p. 410)
Fear-provoking event affects extent of toddler’s reaction
If alone, fear may be greater
Once fear has been learned, it is more difficult to eliminate
Stress increases fear of separation
Self-consoling behaviors include favorite possession or repetitive rituals
Give an example of a fear-evoking event.
What self-consoling behavior might a toddler implement when dealing with fear and separation?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

17. Daily Care (p. 410)
Adults should be at eye level when talking to toddler
Seem less overwhelming
Flexible schedule organized around needs of entire household is best
Clothing should be easily put on and removed
Sunburn protection
Give an example of a household item that needs to be adjusted to meet the needs of the entire household.
Describe how flexibility with a household schedule assists the family (household) during the day.
Which clothing could interfere with toilet training?
What methods can be used to protect the toddler from sunburn?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

18. Daily Care (cont.) (p. 410)
Shoes should fit shape of foot and be ½ inch longer and ¼ inch wider than the foot
Important for toddler to wear their regular shoes to the clinic as it shows the health care provider how the body is being used
Posture is greatly influenced by that of other family members
What are examples of proper and improper footwear for the toddler?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

19. Toilet Independence (p. 412)
Much depends on temperament of the toddler and the person guiding toilet training
Voluntary control of anal and urethral sphincters begins around 18 to 24 months of age
Discuss methods that assist the toddler in toilet training.
What methods are detrimental to toilet training?
Give an example of a situation in which a parent is trying to force the toddler toward toilet independence.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

20. Toilet Independence (cont.) (p. 412)
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21. Toilet Independence (cont.) (p. 412)
Use potty chair or place the child on the toilet facing the tank
Bowel training usually attempted first
Do not leave toddler on toilet for more than a few minutes at a time
Bladder training can begin when toddler stays dry for about 2 hours
If toddler has special words for defecation or urination, be sure to tell other health care providers and document in care plan for toddler
Discuss why it is necessary to place the toddler on the toilet for just a few minutes.
What words might a toddler use to indicate defecation and/or urination?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

22. Lesson 17.3 Objectives
Describe the nutritional needs and self-feeding abilities of a toddler.
List two methods of preventing the following: automobile accidents, burns, falls, suffocation and choking, poisoning, drowning, electric shock, and animal bites.
Describe the characteristic play and appropriate toys for a toddler.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

23. Nutrition Counseling (p. 413)
Caloric needs decline to about 100 calories/kg/day
Limit milk intake to no more than 24 ounces (720 mL) per day
Serving size is 1 tablespoon of solid food per year of age
Food is chopped into fine pieces
Various foods are offered
A 2-year-old likes finger foods
Why is it important to limit milk intake?
Give an example of various foods to offer during a meal.
What are examples of finger foods?
If well-nourished, the toddler shows steady and proportional gain in height and weight.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

24. The Picky Eater Versus a Feeding Disorder (p. 413)
“Picky eater” selective about food color, taste, texture, or smell but will eat to maintain growth and development
“Feeding disorder” refuses to eat to maintain growth and development, leads to weight loss and developmental delays
According to DSM V, a “feeding disorder” is relabeled to be an “avoidance/resistance to food intake” that occurs before 6 years of age. Discuss what else should be done before using additional strategies or interventions to increase the child’s food and fluid intake.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

25. Day Care (p. 414) Must meet families’ Should be state-approved
Personal preferences
Cultural perspectives
Financial and special needs
Should be state-approved
Give an example of a personal preference a family might have and how it affects their choice of day care.
Which cultural issue could affect a toddler in the day care setting?
Discuss special needs a toddler might have and how this could affect the care provided in the day care setting.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

26. Day Care (cont.) (p. 414) Differs for toddlers because
Shorter attention span
Tendency to engage in parallel play rather than group play
Need closer supervision to maintain safety
Give an example of a toddler’s attention span.
What is parallel play?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

27. Nursing Tip (p. 414)
It is a major task for parents is to “let go” and allow the toddler to interact with influences outside the family in day care centers or preschools
Give an example of how parents might have to release their inhibitions and allow others to influence their toddler.
Discuss the facility’s responsibility to provide an environment which does not influence the toddler negatively.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

28. Injury Prevention (p. 414)
Best prevention is knowledge of age-appropriate risk and anticipatory guidelines
Parents need to understand their child’s activities at certain ages in order to prevent injuries by taking appropriate precautions
Toddlers are curious and mobile
Give an example of age-appropriate risks for the toddler.
Provide an age-appropriate initiative by a parent to enhance safety in the home.
What is an activity a curious toddler might engage in within the home?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

29. Injury Prevention (cont.) (pp. 414-415)
Discuss proper guidelines for car seats.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

30. Consumer Education (p. 416)
Federal Government and private organizations regulate variables to prevent injuries
Nonflammable sleepwear
Childproof caps on medicine bottles
Maximum temperatures for water heaters
Smoke and carbon monoxide detectors
Slat space in infant cribs
Car seats
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

31. Toys and Play (p. 417)
Parents must be taught to inspect toys and to buy toys suitable to the age, skills, and abilities of their child
Play is the work of toddlers
Through play they learn how to
Manipulate and understand their environment
Socialize
Explore their world
Give an example of a toy parents might decide not to purchase for their toddler because of safety issues.
How is play toddler’s work?
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

32. Toys and Play (cont.) (p. 418)
Social development takes form
Egocentric thinking
Parallel play gradually leads to cooperative play
Protect the child from sunburn, mosquitoes, and other vectors
Childproofing the home is also important
Discuss egocentric thinking.
Discuss other vectors within your community from which the toddler must be protected.
What methods would you use to childproof a home?
Discuss childproofing the grandparent’s and/or sitter’s home.
Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.