TODDLER (1-3 YEARS)

TODDLER (1-3 YEARS)

-       Characterized by alternating rapid and slow growth and development

-       Usually bow-legged because of under develop muscles of the lower extremities

-       Characterized by marked curiosity, mobility and active

I.              Physical growth and development

a.     Weight

                                          i.    Birth weight quadruples by 2 ½ years

                                         ii.    Gain approximately 4-6 lbs per year

                                        iii.    Average weight at 2 years is 27 lbs

b.    Height

                                          i.    Increase approximately 3 inches per year

                                         ii.    Body proportion change; ar

                                        iii.    ms and legs grow at faster rate than trunk

                                        iv.    Average 2 year old height is about 34 inch (86.6 cm) tall

c.     Head circumference

                                          i.    Anterior fontanel closes at 12-18 months

                                         ii.    Increase 1 inch per year

d.    Teeth

                                          i.    At 2 years, 16 temporary teeth should be in

                                         ii.    Begin to visit the dentist at 2 ½ years

                                        iii.    Begin to brush at 2 years old

e.     Sleep

                                          i.    Very ritualistic, has favorite toy or blanket, thumb-sucking esp at bedtime

                                         ii.    Sleep with an average of 12 hours daily

                                        iii.    Nap once a day

f.     Nutrition

                                          i.    Objectives:

ü  Provide adequate nutrient intake to meet continuing growth and development needs

ü  Provide sufficient calories

ü  Provide a basis for support of psychosocial development in relation to food patterns, eating behavior and attitudes

                                         ii.    Diet

ü  Calorie and nutrients should increase with age

ü  Daily caloric requirement is 100 kcal/day

ü  Increase variety in types and textures of foods

ü  Increase involvement in the feeding process

ü  Consideration of the child’ appetite

                                        iii.    Possible nutritional problems:

ü  Anemia- increase foods containing iron

ü  Obesity or underweight

ü  Low intake of calcium, iron, vitamins A and C, usually caused by dietary fads

ü  Often omitting breakfast

ü  Influence of commercialism on selection of foods and emphasis on fast foods, “empty calorie,” snacks, and high carbohydrate convenience foods

II.             Developmental Theories

a.     Erickson

                                          i.    Autonomy vs. shame and doubt

ü  Autonomy: if achieve, toddler display cooperation, independence, self-control and expresses oneself

ü  Independence: without overprotection; be consistent; set limits

ü  Shame and doubt: display self-doubt, denial, dependency, low self-esteem, and loses self control

ü  Parents: significant person

                                         ii.    Toilet training

ü  Most important task of the toddler

b.    Freud

                                          i.    Anal stage

ü  Anus and buttocks: site of satisfaction thru retention and expulsion of waste products

ü  “hold on” and “let go”

ü  Task: learning to regulate elimination of bowel and bladder control

ü  Common coping skills: temper tantrums, negativism, playing with stools and urine, regressive behavior

ü  Management:

ü  Safety of the environment

ü  Decrease the number of questions that lead to a “NO” response

ü  Signs that the Child is ready for toilet training

a.     Able to sit, stand and walk

b.    Communicates with parents, able to verbalize toilet needs

c.     Retain urine for at least 2 hours

d.    Desire to please parents

                                                                                          i.    24-30 months (2- 2 ½ years)- usual age for toilet training

                                                                                         ii.    2 years – bowel and bladder control

                                                                                        iii.    3-4 years- night control

c.     Piaget

                                          i.    Pre-conceptual stage

ü  Concepts of ideas without logic

ü  Characterized by simple classification

ü  Trial and error experimentation

ü  Irreversible thinking

ü  Symbols

d.    Kohlberg

                                          i.    Pre-conventional

ü  Judgment is based on avoiding punishment and obtaining rewards

ü  Physical punishment – withholding privileges (1)

ü  Withholding love and affection (2)

ü  Punish immediately after a wrong doing

ü  Punish appropriately. Do not punish for accidents

ü  Provide simple explanation why certain behavior is unacceptable, use distraction and praise appropriate behavior

                                         ii.    Common fears: Separation anxiety, fear of big objects and loud sounds, fears and pain, going to sleep and large animals

                                        iii.    Management: Provide emotional support, comfort and simple explanation

III.            Play

a.     Parallel- a solitary play

ü  The child plays along side other children but not with them

ü  Mostly free and spontaneous, no rules or regulations

ü  Attention span is still very short and change of toys occurs at frequent intervals

b.    Imitation- is one of the most common forms of play

                                          i.    Purpose: To enhance locomotion skills(e.g. push-pull toys)

c.     Suggested toys:

ü  Play furniture, dishes, cooking utensils

ü  Play telephone and cloth books

ü  Puzzles with a few large pieces

ü  Pedal-propelled toys such as tricycle

ü  Straddle toys and rocking horses

ü  Clay, sandbox toys, crayons, finger paints

ü  Pounding toys, blocks

ü  Push-pull toys

IV.           Common Problems and Management

a.     Accidents

                                          i.    Falls

ü  Instruct parents to keep side rails up

ü  Place gates across stairways

ü  Secure screens on all open windows

ü  Supervise the toddler during play

                                         ii.    Poisoning  e.g. Lead Poisoning

ü  Encourage parents to lock all toxic substances away from the child’s reach

ü  Secure all medications

ü  Remove all easily aspirated objects from the toddler’s environment

ü  Instruct parents to keep the contact number of the Poison Control Center at all times

                                        iii.    Electrical and other types of burns

ü  Instruct parents to avoid using tablecloths

ü  Teach the toddler what HOT means, to store matches and lighters in locked cabinets out of reach

ü  Secure safety plugs in all electrical outlets

                                        iv.    Suffocation

ü  Encourage parents to teach the toddler water safety to prevent accidental drowning in bathtubs and pools

ü  Instruct families to avoid storing plastic bags and balloons within the toddler’s reach

b.    Common illnesses

                                          i.    Diarrhea

                                         ii.    Cough and colds

c.     Child abuse and neglect

d.    Motor vehicles and other accidents

ü  Instruct parents to continue using an appropriate-sized car seat at all times

ü  Advise parents to lock cabinets and drawers that contain hazardous items, such as knives, firearms

ü  Encourage parents to teach the toddlers how to cross street safely by holding parents’ hands and not to play in the street

ü  Urge parents to supervise tricycle riding and outdoor play