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TODDLERHOOD TODDLERHOOD

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Age: 1 – 3 yearsAge: 1 – 3 years Looks leaner and more Looks leaner and more

muscular.muscular. Steady growth curve steplike Steady growth curve steplike

rather than linear (straight)rather than linear (straight) Has pot-bellied abdomen: Has pot-bellied abdomen:

immature abdominal immature abdominal muscles.muscles.

Lordosis: forward curve of Lordosis: forward curve of the spine at the sacral area.the spine at the sacral area.

Walks with their feet spread Walks with their feet spread a part (bowleggedness): from a part (bowleggedness): from the weight of the relatively the weight of the relatively large trunklarge trunk

General AppearanceGeneral Appearance

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Weight, Height & H.C.Weight, Height & H.C.

Weight: gain 2.0-2.8 kg/yr.Weight: gain 2.0-2.8 kg/yr. Quadruples birth weight at Quadruples birth weight at

2-2.5 yrs.2-2.5 yrs. Height: gain 12cm/yr.Height: gain 12cm/yr. Height at 2yrs=88cmHeight at 2yrs=88cm HC = CC by 1 – 2 yearsHC = CC by 1 – 2 years HC increases about 3.5cm HC increases about 3.5cm

during the toddler years.during the toddler years. CC continues to increase in CC continues to increase in

size and exceeds HC size and exceeds HC during the toddler years. during the toddler years. The transverse or lateral The transverse or lateral diameter exceeds the diameter exceeds the anterioposterior diameteranterioposterior diameter

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System maturation System maturation Blood volume is 90 ml/kg.Blood volume is 90 ml/kg. Innocent murmurs are common.Innocent murmurs are common. Less respiratory infections: the Less respiratory infections: the

lumen of vessels increases.lumen of vessels increases. The internal structures of the The internal structures of the

ear and throat continue to be ear and throat continue to be short & straight and the short & straight and the lymphoid tissue of the tonsils lymphoid tissue of the tonsils and adenoids continues to be and adenoids continues to be large as a result otitis media, large as a result otitis media, tonsillitis, and upper respiratory tonsillitis, and upper respiratory tract infections are commontract infections are common

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Brain Brain Brain cells are present but continue to increase Brain cells are present but continue to increase

in size.in size. Myelination of the spinal cord is almost complete Myelination of the spinal cord is almost complete

by 2 years of age which parallels the completion by 2 years of age which parallels the completion of most of the gross motor skills associated with of most of the gross motor skills associated with locomotion. locomotion.

Brain growth is 75% completed by the end of 2 Brain growth is 75% completed by the end of 2 yearsyears

Development of various areas of the brain Development of various areas of the brain seems to correspond with the progressive seems to correspond with the progressive intellectual capacity.intellectual capacity.

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Urinary systemUrinary system

By the end of infancy kidneys reach By the end of infancy kidneys reach anatomical maturity.anatomical maturity.Sufficient development of the glomerular Sufficient development of the glomerular

filtration with adequate urine concentration.filtration with adequate urine concentration.Complete CNS myelination increases Complete CNS myelination increases

neuromuscular maturation that allow for neuromuscular maturation that allow for sphincter control.sphincter control.

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Immune system Immune system Increase in size of lymphatic Increase in size of lymphatic

tissues. Hyperplasia of tissues. Hyperplasia of lymphoid tissue is common lymphoid tissue is common finding.finding.

IgG & IgM production IgG & IgM production becomes mature at 2 years.becomes mature at 2 years.

Immunoglobulines A, D & E Immunoglobulines A, D & E increases gradually, not increases gradually, not reaching adult levels until later reaching adult levels until later childhood childhood

Endocrine System:Endocrine System: Functionally mature by Functionally mature by

toddlerhood period, except for toddlerhood period, except for the reproductive system.the reproductive system.

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Gastrointestinal SystemGastrointestinal System::Stomach capacity increase to Stomach capacity increase to

500 cc.500 cc.Gastric secretions are more Gastric secretions are more

acidic (protective function): acidic (protective function): less GI infections.less GI infections.

With complete myelination of With complete myelination of the spinal cord, control of anal the spinal cord, control of anal & urethral sphincters is & urethral sphincters is gradually achieved.gradually achieved.

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Senses Senses

Visual acuity: 20/40 is acceptableVisual acuity: 20/40 is acceptable Full binocular vision is well Full binocular vision is well

developeddeveloped Toddlers will visually inspect an Toddlers will visually inspect an

object by turning it over, they may object by turning it over, they may taste it, smell it and touch it several taste it, smell it and touch it several times before they are satisfied with times before they are satisfied with their investigationtheir investigation

The senses of hearing, smell, taste The senses of hearing, smell, taste and touch become increasingly and touch become increasingly well developed, coordinated with well developed, coordinated with each othereach other

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Gross Motor Development Gross Motor Development

By 12 to 13 months of By 12 to 13 months of age toddlers walk aloneage toddlers walk alone

At 18 months: Run & At 18 months: Run & jump in placejump in place

Walks up & down stairs Walks up & down stairs holding a person’s hand.holding a person’s hand.

At 24 months: climbing At 24 months: climbing stairs a lonestairs a lone

Riding a tricycle.Riding a tricycle.

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Fine Motor DevelopmentFine Motor Development

At 15 months: Holds At 15 months: Holds spoon well, but may spoon well, but may still turn it upside still turn it upside down.down.

At 24 months: Hold At 24 months: Hold pencil, open doors, pencil, open doors, feed self, wear shoes, feed self, wear shoes, dress self & zip a dress self & zip a zipperzipper

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Language DevelopmentLanguage Development12 Months12 Months Uses one or more words Uses one or more words

with meaning with meaning Understands simple Understands simple

instructions instructions 18 Months18 Months Has vocabulary of Has vocabulary of

approximately 5-20 approximately 5-20 words words

Use jargoning: speaks in Use jargoning: speaks in what sounds like a what sounds like a foreign language, but foreign language, but only one word is only one word is intelligible.intelligible.

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Language DevelopmentLanguage Development24 Months24 Months Can name a number of objects Can name a number of objects

common to his surroundings common to his surroundings Approximately 2/3 of what child says Approximately 2/3 of what child says

should be intelligibleshould be intelligible Vocabulary of approximately 150-300 Vocabulary of approximately 150-300

wordswords36 Months36 Months Knows chief parts of body and should Knows chief parts of body and should

be able to indicate these if not namebe able to indicate these if not name Handles three word sentences easilyHandles three word sentences easily Has 900-1000 wordsHas 900-1000 words About 90% of what child says should About 90% of what child says should

be intelligiblebe intelligible

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1. Sensorimotor Stage (birth- 1. Sensorimotor Stage (birth- 2years):2years): Stage 5 Stage 5 tertiary circular reactiontertiary circular reaction

(12-18 months): active (12-18 months): active experimentation (little scientist) , trial experimentation (little scientist) , trial and error.and error.

Stage 6 Stage 6 Invention of new meansInvention of new means (18-24 months): beginning of (18-24 months): beginning of problem solving and symbolic problem solving and symbolic thought. Deferred imitation thought. Deferred imitation (remember actions and imitate them (remember actions and imitate them later). Beginning sense of time later). Beginning sense of time

Cognitive Development (Piaget)Cognitive Development (Piaget)

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Imitative LearningImitative Learning

Imitative learning: A way of learning new Imitative learning: A way of learning new behaviors by copying others’ behaviors.behaviors by copying others’ behaviors.

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• Preoperational Stage (2-7 Preoperational Stage (2-7

Years): Children begin to Years): Children begin to

use language and think use language and think

symbolically, BUT their symbolically, BUT their

thinking is still intuitive and thinking is still intuitive and

egocentric.egocentric.• Intuitive: Makes little use Intuitive: Makes little use

of reasoning and logic.of reasoning and logic.• Egocentric: Child is Egocentric: Child is

unable to accommodate unable to accommodate

viewpoints of othersviewpoints of others..

Cognitive Development (Piaget)Cognitive Development (Piaget)

“Cut it up into A LOT of slices, Mom. I’m really hungry!!”

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The Psychosocial Crisis (The Psychosocial Crisis (EriksonErikson): ): Autonomy versus Shame and Autonomy versus Shame and DoubtDoubtAutonomy - the ability to behave Autonomy - the ability to behave

independently, to perform actions on independently, to perform actions on one’s ownone’s own

Shame and Doubt – Some children Shame and Doubt – Some children fail to emerge from toddlerhood with fail to emerge from toddlerhood with a sense of masterya sense of masteryShame is an intense emotion Shame is an intense emotion

that can result from social ridicule that can result from social ridicule or criticism and internal conflictor criticism and internal conflict

Doubt is a lack of self-confidence Doubt is a lack of self-confidence and worth, accompanied by a and worth, accompanied by a constant sense of failureconstant sense of failure

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Moral DevelopmentMoral Development

Preconventional stage: Preconventional stage: (punishment and obedience (punishment and obedience orientation) toddlers cannot orientation) toddlers cannot understand right and wrong understand right and wrong but can differentiate between but can differentiate between acceptable and not acceptable acceptable and not acceptable according to parental according to parental standards; activity is not standards; activity is not acceptable if one is punished.acceptable if one is punished.

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Parallel play characterizes Parallel play characterizes the 2-year-old.the 2-year-old.

Associative play and Associative play and interaction are common in 2- interaction are common in 2- to 3-year-olds to 3-year-olds

Enjoy toys that require Enjoy toys that require action: trucks, blocks, action: trucks, blocks, telephone, throwing toys)telephone, throwing toys)

Imitating actions by 2-yrImitating actions by 2-yr Symbolic play, or pretend Symbolic play, or pretend

play (Fantasy Play), appears play (Fantasy Play), appears around 2 years of age; A around 2 years of age; A vivid mental image of an vivid mental image of an action permits them to copy action permits them to copy what they recall rather than what they recall rather than what they seewhat they see

Play Play ActivitiesActivities

2020

Separation anxiety Separation anxiety continue.continue.

Fear of water.Fear of water.Fear of lonenessFear of lonenessFear of strange Fear of strange

peoplepeopleFear of strange Fear of strange

objectsobjectsFear of large animalsFear of large animals

Emotional Development & Emotional Development & FearsFears

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Parental concerns associated Parental concerns associated with toddlerhood periodwith toddlerhood period

Negativism.Negativism.Temper tantrums.Temper tantrums.Toilet training.Toilet training.Discipline.Discipline.

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NegativismNegativism

Answer with NO to Answer with NO to every questions.every questions.

Not being stubborn Not being stubborn but assertion of but assertion of control.control.

Reduce the Reduce the opportunity of “no” opportunity of “no” answers; give answers; give choices.choices.

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Temper TantrumsTemper Tantrums• Child may kicks, screams, stamps feet Child may kicks, screams, stamps feet

and shouts, bangs head against the and shouts, bangs head against the floor, holds breath.floor, holds breath.

• It’s a way to release their tension: they It’s a way to release their tension: they do not have the vocabulary to express do not have the vocabulary to express their feelings.their feelings.

• Usually occurs when they’re tired, Usually occurs when they’re tired, before bedtime, hungry, during long before bedtime, hungry, during long shopping trip or visit.shopping trip or visit.

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What to do?What to do?

It is important that parents remain calm It is important that parents remain calm in the midst of a tantrum.in the midst of a tantrum.

Take a few seconds to evaluate the Take a few seconds to evaluate the situation before you decide on an situation before you decide on an action. action.

Let the child know that you understand Let the child know that you understand he/she is upset, but also let him/her he/she is upset, but also let him/her know there is a better way of handling know there is a better way of handling it. it.

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Do not try to talk or Do not try to talk or reason with your child reason with your child when she is in the throes when she is in the throes of a tantrum of a tantrum

An out of control child An out of control child can be a danger to can be a danger to himself or others. If this himself or others. If this is the case, calmly take is the case, calmly take the child into your arms the child into your arms until the tantrum until the tantrum subsides. Speak to him subsides. Speak to him in a soothing voice. in a soothing voice.

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Toilet trainingToilet training ability develops by 18 monthsability develops by 18 months usually complete by 2 to 3 years (day before usually complete by 2 to 3 years (day before

night)night) Bedwetting is commonBedwetting is common

Signs of potty training readiness: Signs of potty training readiness: Expresses an interest in the pottyExpresses an interest in the potty Express the need to go potty (verbally or through Express the need to go potty (verbally or through

body language)body language) Able to dress and undressAble to dress and undress Uncomfortable in wet diapers Uncomfortable in wet diapers Stays dry for two hoursStays dry for two hours Imitates family membersImitates family members Interested in big kid underwear Interested in big kid underwear Has regular bowel movementsHas regular bowel movements

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Setting rules and guidelines for Setting rules and guidelines for behaviorbehavior Limit-setting: (e.g., parents should Limit-setting: (e.g., parents should

set limits on the amount of time set limits on the amount of time children spend watching TV)children spend watching TV)

Types of disciplines:Types of disciplines: Reasoning: explaining why Reasoning: explaining why

the act is wrongthe act is wrong Using rewards for Using rewards for

encouraging children to encouraging children to behave in specified waybehave in specified way

Ignoring behaviorIgnoring behavior Consequences : Consequences :

Parent should be consistent: Parent should be consistent: Consequences should be Consequences should be appropriate for the situationappropriate for the situation

Time outTime out Punishment Punishment

DisciplineDiscipline

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Feeding SkillsFeeding Skills

Toddlers are able to Toddlers are able to use a cup and spoon use a cup and spoon but not very well, they but not very well, they prefer to use their prefer to use their handshands

Beginning attempts at Beginning attempts at self-feeding are messy, self-feeding are messy, but are an important but are an important step in developmentstep in development

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Feeding SkillsFeeding Skills

Between 12 – 18 months toddlers Between 12 – 18 months toddlers learn to chew with rotary rather learn to chew with rotary rather than up and down movements, than up and down movements, allowing toddlers to handle soft allowing toddlers to handle soft table foodtable food

At 18 – 24 months toddlers gain At 18 – 24 months toddlers gain well developed rotary chewing well developed rotary chewing movements, allowing toddlers to movements, allowing toddlers to handle meats, raw fruits, handle meats, raw fruits, vegetables and multiple texturesvegetables and multiple textures

                                   

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Whole Cow’s MilkWhole Cow’s Milk

After 12 months of age whole cow’s milk is After 12 months of age whole cow’s milk is recommended until 24 months of agerecommended until 24 months of age

Low-fat milk or limiting other sources of Low-fat milk or limiting other sources of dietary fat is not recommended until for dietary fat is not recommended until for toddlers under 2 years of agetoddlers under 2 years of age

Toddlers less than 2 years of age need the Toddlers less than 2 years of age need the calories for their rapid growth ratecalories for their rapid growth rate

3131

Transition to Table FoodTransition to Table Food

Transition from pureed and strained foods Transition from pureed and strained foods to regular table foods. By 12 months to regular table foods. By 12 months toddlers have most of their baby teeth, and toddlers have most of their baby teeth, and so foods with more texture and chewiness so foods with more texture and chewiness can be usedcan be used

Nutritious snacks should be used instead Nutritious snacks should be used instead of sweetened beverages, snack foods or of sweetened beverages, snack foods or dessertsdesserts

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Nutrient NeedsNutrient Needs

AppetiteAppetiteToddler’s growth rate is slower than Toddler’s growth rate is slower than

infancy which results in a decreased infancy which results in a decreased appetite and interest in foodappetite and interest in food

It is important to understand a It is important to understand a decreased appetite is normaldecreased appetite is normal

Toddlers can self-regulate their calorie Toddlers can self-regulate their calorie intakeintake

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Nutrient NeedsNutrient Needs CaloriesCalories

Calorie needs of toddlers reflect their decreased growth Calorie needs of toddlers reflect their decreased growth raterate

The RDA for 1-3 year olds is 102 calories per kg body The RDA for 1-3 year olds is 102 calories per kg body weight weight

ProteinProtein The RDA for protein for 1-6 year olds is 1.2 grams per kg The RDA for protein for 1-6 year olds is 1.2 grams per kg

body weight. This amount can easily be met with a body weight. This amount can easily be met with a typical diettypical diet

Adequate calories are needed to spare protein so it is Adequate calories are needed to spare protein so it is used for growth and tissue repair instead of energyused for growth and tissue repair instead of energy

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Nutrient NeedsNutrient Needs

FatFatDietary fat intake should not be restricted for Dietary fat intake should not be restricted for

toddlers under 2 years of agetoddlers under 2 years of ageToddlers need the calories from fat to fuel Toddlers need the calories from fat to fuel

their rapid growththeir rapid growthLow fat and skim milk do not provide enough Low fat and skim milk do not provide enough

caloriescalories

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Vitamins and MineralsVitamins and Minerals

Most children from birth to 5 years of age Most children from birth to 5 years of age meet the recommended intakes for most meet the recommended intakes for most vitamins and minerals, with the exception vitamins and minerals, with the exception of iron, calcium and zincof iron, calcium and zinc

Recommended intakes for 1-3 year oldsRecommended intakes for 1-3 year olds Iron 7 mg/dayIron 7 mg/day Zinc 3 mg/dayZinc 3 mg/day Calcium 500 mg/dayCalcium 500 mg/day

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Nutrient NeedsNutrient Needs

IronIronRapid growth along with Rapid growth along with

inadequate intake of iron puts inadequate intake of iron puts toddlers at the highest risk for iron toddlers at the highest risk for iron deficiencydeficiency

Recommendations for children 1-5 Recommendations for children 1-5 years of age drink are to drink no years of age drink are to drink no more than 24 ounces (more than 24 ounces (1 ounce = 1 ounce = 28.35 grams) 28.35 grams) of milk each day due of milk each day due to the low iron content to the low iron content

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Nutrient NeedsNutrient Needs

CalciumCalciumAdequate calcium intake in childhood affects Adequate calcium intake in childhood affects

peak bone mass which protects against peak bone mass which protects against osteoporosis later in lifeosteoporosis later in life

Many children do not consume enough Many children do not consume enough calciumcalcium

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Nutrient NeedsNutrient Needs

FiberFiberAdequate dietary fiber helps prevent Adequate dietary fiber helps prevent

constipation in young children and is part of a constipation in young children and is part of a healthy diethealthy diet

However, excessive fiber intake should be However, excessive fiber intake should be avoided because excessive intake of high avoided because excessive intake of high fiber foods can cause diarrhea and can fiber foods can cause diarrhea and can displace other nutrient dense foodsdisplace other nutrient dense foods

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Tooth DecayTooth Decay

A major cause of tooth decay is continual A major cause of tooth decay is continual use of a bottle with milk or juice at bedtime use of a bottle with milk or juice at bedtime or through the dayor through the day

Carbohydrate foods that stick to the teeth Carbohydrate foods that stick to the teeth can also cause tooth decay. Rinsing the can also cause tooth decay. Rinsing the mouth with water or brushing teeth to mouth with water or brushing teeth to remove carbohydrate can lower the risk of remove carbohydrate can lower the risk of tooth decaytooth decay

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ConstipationConstipation

Constipation is a common problem among Constipation is a common problem among toddlers toddlers

Diets containing adequate fiber Diets containing adequate fiber appropriate for the child’s age can lower appropriate for the child’s age can lower the risk of constipationthe risk of constipation

Adequate fluid intake can also lower the Adequate fluid intake can also lower the risk of constipationrisk of constipation

4141

Overweight and ObesityOverweight and Obesity

Weight loss is not Weight loss is not appropriate for toddlersappropriate for toddlers

Adequate nutrients must Adequate nutrients must be provided for normal be provided for normal growth and developmentgrowth and development

Recommendations are to Recommendations are to stay close to the same stay close to the same weight until the toddler weight until the toddler grows tallergrows taller

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Overweight and ObesityOverweight and Obesity

Avoid overfeedingAvoid overfeedingDo not force a toddler to eatDo not force a toddler to eatEncourage physical activityEncourage physical activityUse appropriate serving sizesUse appropriate serving sizesChoose snacks carefullyChoose snacks carefullyLimit intake of juiceLimit intake of juiceDo not use food as a rewardDo not use food as a reward