2. Prepared By Dr. Nahed Saied Al- nagger Assistant Professor of Nursing 1430– 1431 H

3. Learning Objectives Identify the general characteristics (biological development) of toddler. Discuss the developmental theories according to Erickson, Piaget and Freud). Mention needs of toddler. Identify some personality traits related to toddler. Discuss the common health promotion of toddler.

4. Introduction The term “Terrible twos’’ has been often used to describe the toddler years, the period from 12 to 36 months of age. It is a time of intense exploration of the environment as children attempt to find out how things work and how to control others through temper tantrums, and negativism. It is an important period for developmental achievement and intellectual growth.

5. I. Biological Development Proportional Changes. Sensory Changes. Maturation of body systems. Gross and fine motor development.

6. Proportional Changes Growth slows considerably during toddler hood. Steady growth that is step like rather than linear (straight). continue

7. Proportional Changes Weight: The average weight gain is 1.8 to 2.7 kg /year. The average weight at 2 years is 12kg. The birth weight is quadrupled by 2.5 years of age. Formula for calculates weight: Age multiply 2 +8. continue

8. Height The usual increase in height is 7.5 cm/ year, occurs mainly in elongation of the legs rather than trunk. The average height of a 2-years old is 86.6cm. Formula for calculates height : Age multiply 5 +80. continue

9. Head circumference Head circumference is usually equal to chest circumference by 1 to 2 years of age. Increase 2.5 cm during the second year, then the rate of increase is 1.25 cm/year until 5 years. The anterior fontanel closes at 12-18 months. continue

12. Chest circumference Increase in size and exceeds head circumference. After the second year the chest circumference exceeds the abdominal measurement. Leaner appearance in addition to “pot- bellied’’ appearance because of less developed abdominal musculature and short legs. continue

13. Teething Eight new teeth (the canines and the first molars) erupt during the second year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age.

15. Physical characteristics of toddlers. (A) Toddlers typically have a prominent abdomen. (B) Toddlers typically walk with an unsteady gait for better stability. (A) (B)

16. Sensory Changes Visual acuity Depth perception continues to develop but, because of the child's lack of motor coordination, falls from heights continue to be a persistent danger. Hearing, smell, taste, and touch Become increasingly well developed. continue

17. Maturation of body systems Body systems continue to mature during this time. Respirations slow slightly but continue to be mainly abdominal (20-30c/m). The heart rate slows from 90 to 110 b/m. Blood pressure increases to about 99/64 mmHg. continue

18. The brain develops to about 90% of its adult size. Stomach secretions become more acid; therefore, gastrointestinal infections also become less common.

19. Voluntary control of elimination : Bowel control start at 1 year and completed at 1.6 year. Bladder control during the day 2-2.6 year,& at night 3-5 years. IgG and IgM antibody production becomes mature at 2 years of age. The passive immunity obtained during intrauterine life is no longer operative.

20. Gross and fine motor development The major gross motor development is locomotion. AgeGross MotorFine Motor 15 months Walks alone well Can creep upstairs. Holds a cup with all fingers. 18 months Walk up& down stairs with one hand held. Run & jump In place. Remove simple clothes. Transfer objects from hand to hand.

21. Gross and fine motor development The major gross motor development is locomotion. AgeGross MotorFine Motor 24 months Walks up stairs alone still using both feet on same. Runs well. Open doors by turning doorknobs. Holds cup with one hand. Imitates circle. 30 months Jump down from chairs. Takes a few steps on tiptoe. Makes simple lines. Drink without assistance.

22. Milestones in Gross Motor Development

23. Ambulation 13 month old 12-months

24. Fine Motor Development 12-month-old

25. Toddlers

26. Language development A toddler typically begins to use short sentences and have about 300 words. A toddler tends to ask many questions (what ). AgeLanguage Development 15 monthsSays 4-6 words, mainly names. 18 monthsSays 7-20 words.

27. Language development AgeLanguage Development 24 monthsSays 50 words, 2 word sentences. 30 monthsverbal language increasing steadily, can name one color.

28. Language Development 18-20 months: 20 to 30 words – 50% understood by strangers 22-24 months: two words sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers

29. II. Emotional development Developmental type TheoristTerms Psychosocial“Eriksson”Autonomy vs. shame and doubt. Cognitive“Piaget” Reaction stage. Deferred imitation.

30. II. Emotional development Developmental type TheoristTerms Psychosexual“Freud”Self- concept as a girl or boy. Anal stage (libidinal pleasure).

31. Psychosocial development The toddler begins to master the environment through: Individualization (differentiation of self from others ). Separation from parents. Control of bodily functions.

32. Psychosocial development Communication with words. Acquisition of socially acceptable behavior. Egocentric interaction with others. Play : parallel play

33. Red Flags in toddler development Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years.

34. Needs of toddlers Love and security. Graded independence. Learning language. Elimination control or control of bodily functions.

35. Toilet Training Children might be frightened by the flushing of a toilet. Potty Training should begin when a child is about 2 years old. If a child resists toilet training, drop the subject for a while.

36. Personality Traits of Toddlers Negativism. Ritualistic behavior. Slowness in carrying order. Temper tantrums.

37. Care of Toddlers Brushing the teeth. Clothing bright and light color. Play is important for socialization.

38. Care of Toddlers Sleep: toddler sleep time 12-14 hours /day including a daytime nap 1-2 hours. Safety measures: for accident prevention. Nutrition: needs 1300 calories/day. Immunization.

39. Toddler Safety becomes a problem as the toddler becomes more mobile. Pilliterri, Lippincott

40. The End