Prepared ByDr. Nahed Saied Al- nagger

Assistant Professor of Nursing1430– 1431 H

Learning ObjectivesIdentify 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.

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.

I. Biological Development

• Proportional Changes.• Sensory Changes.• Maturation of body

systems.• Gross and fine motor

development.

Proportional Changes

Growth slows considerably during toddler hood.

Steady growth that is step like rather than linear (straight).

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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.

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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.

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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.

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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.

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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 .

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

)A ) )B )

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.

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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.

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• The brain develops to about 90% of its adult size.

• Stomach secretions become more acid; therefore, gastrointestinal infections also become less common.

• 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.

Gross and fine motor development

The major gross motor development is locomotion.

Age Gross Motor Fine 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.

Gross and fine motor development

The major gross motor development is locomotion.

Age Gross Motor Fine 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.

Milestones in Gross Motor Development

Ambulation

13 month old 12-months

Fine Motor Development

12-month-old

Toddlers

Language development • A toddler typically begins to use short sentences and have about 300 words.• A toddler tends to ask many questions (what ).

Age Language Development

15 months Says 4-6 words, mainly names.

18 months Says 7-20 words.

Language development

Age Language Development

24 months Says 50 words, 2 word sentences.

30 months verbal language increasing steadily, can name one color.

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

II. Emotional development

Developmental type

Theorist Terms

Psychosocial “Eriksson” •Autonomy vs. shame and doubt.

Cognitive “Piaget” • Reaction stage.•Deferred imitation.

II. Emotional developmentDevelopmental

typeTheorist Terms

Psychosexual “Freud” •Self- concept as a girl or boy.

•Anal stage (libidinal pleasure).

Psychosocial development • The toddler begins to master the

environment through: Individualization )differentiation of

self from others ).Separation from parents.Control of bodily functions.

Psychosocial development

Communication with words.Acquisition of socially acceptable behavior. Egocentric interaction with others.

• Play : parallel play

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.

Needs of toddlers

• Love and security.

• Graded independence.

• Learning language.

• Elimination control or

control of bodily

functions.

Toilet TrainingToilet 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.

Personality Traits of Toddlers

• Negativism.

• Ritualistic behavior.

• Slowness in carrying order.

• Temper tantrums.

Care of Toddlers

• Brushing the teeth.• Clothing bright and light color.• Play is important for socialization.

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.

Toddler

Safety becomes a problem asthe toddler becomes moremobile.

Pilliterri, Lippincott

The End