Toddlerhood

• Toddlerhood (1-3 years old)


  • Develops voluntary control to walk, speak and learn to control bladder and bowels
  • Loses baby look at 2 years old
  • Has a lumbar lordosis and a protruding abdomen
• Physical Development - Weight

  1. Weigh approximately four times their birth weight

  2. 1-2 years old weight gain is about 2 kg (5 lb)

  3. 2-3 years old about 1 to 2 kg (2 to 5 lb)

  4. At 3-year-old should weigh about 13.6 kg (30 lb)
• Physical Development - Height/Length

  1. Height is measured while the toddler stands

  2. Length is measured while the toddler is in a recumbent position

  3. 1-2 years, height is 10 to 12 cm (4 to 5 in.)

  4. 2-3 years it slows to 6 to 8 cm (2 1/2 to 3 1/2 in.)
• Physical Development - Head Circumference

  1. Increases about 2.5 cm (1 in.) each year

  2. By 24 months (2 years old) the head is 80% of the average adult size and the brain is 70% of its adult size
• Sensory Abilities - Visual Acuity

  • Fairly well established at 1 year
  • Acuity of 20/70 at 18 months
  • Acuity of 20/40 at 2 years old
  • Accommodation to near and far objects is fairly well developed by 18 months
  • At 3 years of age can look away from a toy prior to reaching out and picking it up
• Sensory Abilities - Hearing, Taste, Smell, Touch

  • Hearing in the 3-year-old is at adult levels
  • The taste buds of the toddler are sensitive to the natural flavors of food, and the 3-year-old prefers familiar odors and tastes
  • Touch is a very important sense and a distressed toddler is often soothed by tactile sensations
• Motor Abilities


  1. At 18 months can pick up raisins or cereal pieces and place them in a receptacle, hold a spoon and a cup, walk upstairs with assistance and crawl down the stairs

  2. At 2 years can hold a spoon and put it into the mouth, able to run, can balance on one foot and ride a tricycle

  3. At 3 years most children are toilet trained, although they still may have the occasional accident when playing or during the night
• Psychosocial Development - Sigmund Freud

  • Ages of 2 and 3 years represent the anal phase of development, when the rectum and anus are the especially significant areas of the body
• Psychosocial Development - Erik Erikson

  • 18 months to 3 years "autonomy versus shame and doubt"
  • Toddlers begin to develop their sense of autonomy by asserting themselves with frequent use of the word "no"
  • They are often frustrated by restraints to their behavior and between ages 1 and 3 may have temper tantrums
• Interventions for Temper Tantrums

  1. The guidance of their caregivers they slowly gain control over their emotions

  2. Parents/caregivers need to have a great deal of patience and understanding the importance of child developmental milestone

  3. Caregivers need to give the child some measure of control and at the same time be consistent in setting limits so that the child learns the results of misbehavior

  4. Provide toys suitable for the toddler, including some toys challenging enough to motivate but not so difficult that the toddler will fail

  5. Make positive suggestions rather than negative commands

  6. Avoid an emotional climate of negativism, blame, and punishment

  7. Give the toddler choices, all of which are safe; however, limit number to two or three

  8. When toddler has a temper tantrum, make sure the child is safe, and then leave

  9. Help the toddler to develop inner control by setting and enforcing consistent, reasonable limits

  10. Praise the toddler's accomplishments; give random and spontaneous feedback for positive behavior
• Self-concept


  An individual's perception of their identity, formed by interpersonal experiences, ability to perform tasks, academic performance, social acceptance, and physical appearance
• Toddlers develop a sense of self-concept through their immediate social environment, with parents playing a significant role
• If the children's social interactions with their parents are negative, the children may begin to see themselves as bad
• Parents need to give toddlers positive input so they can develop a positive and healthy self-concept
• With a healthy self-concept, the toddler is better able to deal with periodic failures later in life
• Although toddlers like to explore the environment, they always need to have a significant person nearby
• Acute Separation Anxiety


  The fear and frustration that come with parental absences, with abandonment being their greatest fear
• Regression or reverting to an earlier development stage may be indicated by bed-wetting or using baby talk
• Experience with separation helps the child cope with parental absences
• Children need room for exploration and interaction with other children and adults, while knowing the parental bond of a loving and close relationship remains secure
• Toddlers assert their independence by saying "no" or by dawdling
• During the toddler stage, receptive and expressive language skills develop quickly
• Cognitive Development - Piaget


  • Toddler completes the fifth and sixth stages of the sensorimotor phase and starts the preconceptual phase at about 2 years of age
  • In the fifth stage, the toddler solves problems by a trial-and-error process
  • By stage 6, toddlers can solve problems mentally
  • During Piaget's preconceptual phase, toddlers develop considerable cognitive and intellectual skills, learning about the sequence of time, having some symbolic thought, and forming concepts
• Motor Abilities


  1. At 18 months, babies can pick up raisins or cereal pieces and place them in a receptacle, hold a spoon and a cup, and walk upstairs with assistance

  2. At 2 years old, toddlers can hold a spoon and put it into the mouth correctly, are able to run, their gait is steady, and they can balance on one foot and ride a tricycle

  3. At 3 years old, most children are toilet trained, although they still may have the occasional accident when playing or during the night
• Moral Development - Kohlberg

  • Preconventional (1st level of moral development) - children respond to punishment and reward, recognize certain rituals, such as repeating phrases from prayers to elicit approval, which provides children with feelings of security
  • By 2 years of age, toddlers are learning what attitudes their parents hold about moral matters
• Spiritual Development - Fowler


  • The toddler's stage of spiritual development is undifferentiated, with a toddler repeating short prayers at bedtime, conforming to a ritual, because praise and affection result, which enhances the toddler's sense of security
• By the age of two, vocabularies can span between 50 and 100 words and children begin using two or more words in combination
• Health Risks


  • Toddlers experience significant health problems due to injuries, visual problems, dental caries, and respiratory and ear infections
  • Injuries are the leading cause of mortality of toddlers, with the most common causes being automobile crashes, drowning, burns, poisoning, and falls
• Health Promotion Guidelines for Toddlers - Health Examinations

  1. At 15 and 18 months and then as recommended by the primary care provider

  2. Dental visits starting at age 3 or earlier
• Health Promotion Guidelines for Toddlers - Protective Measures

  1. Immunizations: DTaP, IPV, pneumococcal, MMR, varicella, Haemophilus influenzae type B, hepatitis B, hepatitis A, influenza, and meningococcal vaccines as recommended

  2. Screenings for tuberculosis and lead poisoning

  3. Fluoride supplements if there is inadequate water fluoridation (less than 0.6 part per million)
• Health Promotion Guidelines for Toddlers - Toddler Safety

  1. Importance of constant supervision and teaching child to obey commands

  2. Home environment safety measures (e.g., lock medicine cabinet)

  3. Outdoor safety measures (e.g., close supervision near water and on sidewalks)

  4. Do NOT leave your toddler near or around water without someone watching her, fence off backyard pools

  5. Block off stairs with a small gate or fence, lock doors to dangerous places

  6. Ensure home is toddler proof by placing plug covers on all unused electrical outlets

  7. Keep kitchen appliances, irons, and heaters out of reach, turn pot handles toward the back of the stove

  8. Keep sharp objects such as scissors, knives, and pens in a safe place

  9. Lock up medicines, household cleaners, and poisons

  10. Do NOT leave your toddler alone in any vehicle

  11. Store any guns in a safe place out of his reach

  12. Appropriate toys

  13. Eliminate toxins in environment (e.g., tobacco, pesticides, herbicides, mercury, lead, arsenic in playground materials)

  14. Use smoke and carbon monoxide (CO) detectors in home
• Lead Poisoning


  Lead is a metal that occurs naturally in the earth's crust, but human activity — mining, burning fossil fuels and manufacturing that can affect children's development thus resulting in developmental alteration/delay, loss of appetite, irritability, learning difficulties
• Sources of Lead Poisoning


  • Lead in paint
  • Water pipes and imported canned goods, soil
  • Household dust/Pottery
  • Toys/Cosmetics
  • Herbal or folk remedies/Mexican candy
  • Lead bullets/Occupations
• Prevention of Lead Poisoning


  1. Wash hands and toys

  2. Clean dusty surfaces

  3. Remove shoes before entering the house

  4. Prevent children from playing on soil

  5. Eat a healthy diet

  6. Keep your home well-maintained
• Children are screened for high blood cholesterol levels due to the growing epidemic of obesity in children
• Nutrition


  Importance of nutritious meals and snacks, teaching simple mealtime manners, dental care
• Healthy Meal/Snack Options


  • Apples, thinly sliced if needed
  • Bananas
  • Berries (blueberries, strawberries, raspberries, blackberries)
  • Melon, mango, oranges, kiwi
  • Avocado, cubed or on bread, snap peas
  • Cucumbers, sliced or diced, Cherry tomatoes, halved
  • Shredded carrots or carrot slices/sticks (for older toddlers and kids)
  • Cereal (low sugar), Cubed chicken
  • Cheese, sliced, cubed, or string cheese, nuts, popcorn
• Elimination - Toilet Training


  1. Most children begin to show signs of readiness between 18 and 24 months old

  2. Develop control over their bowel and bladder by 18 months

  3. Assess readiness based on factors like staying dry for 2+ hours, recognizing urination/bowel movements, walking and sitting for short periods, becoming more independent, interested in watching others use the toilet, telling when they need to go, disliking wearing a nappy, having regular bowel movements, being able to pull pants up/down, following simple instructions, understanding things having their place

  4. Decide whether to use a potty or the toilet, make sure you have the right equipment, have a consistent routine with no big changes coming up
• Rest/Sleep


  Dealing with sleep disturbances
• Play


  • Parallel play, working on projects, putting together puzzles, coloring/painting, playing with blocks or a train set, playing in a play kitchen
  • Encouraging regular, vigorous physical activity
  • Toys that allow "acting on" behaviors and provide motor and sensory stimulation