Growth and Development of Toddlers

Toddler: Usually considered to be from age 1 to 3 years of age
Children accomplish a wide array of developmental task
The parent's task is to support their child's growing independence

Physical Growth
Weight, Height and Head Circumference
A child gains only about 5 to 6 lb (2.5 kg) and 5 in (12 cm) a year. The subcutaneous tissue begins to disappear toward the end of the second year. A toddler's appetite decreases accordingly. Head circumference increases only about 2 cm (during the second year). Head circumference equals chest circumference at 6 months to 1 year of age. Chest circumference has grown greater than that of the head.

Body contour
Toddlers tend to have a prominent abdomen- a pouchy belly. They also have lordosis (forward curve of the spine at the sacral area). They waddle or walk with a wide stance.

Body systems
  • Respirations slow slightly but continue to be mainly abdominal.
  • Heart rate slows from 110 to 90 bpm; blood pressure increases to about 99/64 mm Hg.
  • The brain develops to about 90% of its adult size.
  • Lumens of vessels enlarge progressively so the threat of lower respiratory infection becomes less.
  • Stomach secretions become more acid; therefore, gastrointestinal infections also become less common.
  • Stomach capacity increases to the point a child can ear three meals a day.
  • Control of the urinary and anal sphincters becomes possible with complete myelination of the spinal cord.
  • lgG and lgM antibody production becomes mature at 2 years of age.

Eight new teeth erupt during the second year. All 20 deciduous teeth are generally present by 2.5 to 3 years of age.

Developmental Milestones
Toddlerhood is a critical time for language development. A 2-year old child who does not talk in two-word, noun-verb simple sentences needs a careful assessment. A word that is frequently used is "no". To learn other's words, children need exposure to conversation and need to be read to often. Urge parents to name objects as they play with their child or when they give their toddler something. Always answering a child's questions is another good way to do this. Children learn language from imitating what they hear; they will speak more like those around them.

The developmental task of the toddler years according to Erikson is the development of a sense of autonomy versus shame or doubt. A healthy level of autonomy is achieved when parents are able to encourage independence while still maintaining consistently sound rules for safety. When children approach toddlerhood, they begin to make differentiation.

Fifteen-month-old children are still enthusiastic about interacting with people, providing those people willing to follow them where they want to go. By 18 months, toddlers imitate the things they see a parent doing. By 2 or more years, children become aware of gender differences and may point to other children and identify them as "boy" or "girl".

Play behavior:
During the toddler period, children play beside the children next to them, not with them. This side-by-side play (parallel play) is a normal development sequence. Caution parents that if two toddlers are going to play side by side, they must provide duplicate toys or an argument may occur. The toys that toddlers most enjoy are the ones can play with themselves and requires action. 

These toys that a child can control, giving them a sense of power in manipulation, an expression of autonomy. There's no need for parents to correct children about the way they are using a toy as long as it appears to give satisfaction. By age 2, the act of imitating has become their play. By the end of the toddler period, both boys and girls begin to like rough-housing and spend at least past of everyday in this very active, stimulating play.

A toddler enters the fifth and sixth stages of sensorimotor thought. The stage 5, tertiary circular reaction stage, describes a toddler as "a little scientist" because of the child's interest in trying to discover new ways to handle objects or new results that different actions can achieve. By stage 6, toddlers are able to try out various actions mentally rather than having to actually perform them - the beginning of problem solving or symbolic thought. 

Children at this stage are also able to remember an action and imitate it later (deferred imitation). At then end of the toddler period, children enter a second major period of cognitive development: preoperational thought. During this period, children deal much more constructively with symbols. They begin to use a process termed assimilation. They learn to change the situation to fit their thoughts.

Toddler Health and Safety
  • Toddlers tend to develop many upper respiratory and ear infections but otherwise come to health care facilities most often for health maintenance visits and the immunizations important at these times.
  • Accidental ingestions (poisoning) are the type of accident that occurs most frequently in toddlers. Urge parents to childproof their house by putting all poisonous products, drugs, and small objects out of reach. Other accidents that occur frequently in toddlers include motor vehicle accidents, burns, falls, and playground injuries. To prevent serious injury, teach parents to be alert to know what their toddler is doing at all times.
  • All children between the ages of 6 months and 6 years should be tested periodically for the presence of too much lead in their body.

Nutritional Health of a Toddler
  • A toddler's appetite becomes smaller than the infant's because of the slow growth.
  • Teach parents to place a small amount of food on a plate and allow the child to eat it and ask for more rather than serve a large portion the child cannot finish.
  • Allowing self-feeding is a major way to strengthen independence in a toddler.
  • Toddlers may insist on the same type of food over and over because of the sense of security the food offers.
  • Toddlers usually do not like food that is "mixed up". They often prefer that different food do not touch one another on their plate.
  • Children ages 1 to 3 years should consume 1, 300 kcal daily.
  • Protein and carbohydrate needs are often easily met during the toddler period; diets high in sugar should be avoided.
  • Fats should not be restricted to children under 2 years old; children over 2 years old should consume no more than 30% of total daily calories from fat.
  • Adequate calcium and phosphorus intake are important for bone mineralization.
  • Milk should be whole milk until age 2 years.
  • Vegetarian diets are adequate for toddlers if parents are well-informed about needed vitamins and minerals.

Toddler Development in Daily Activities
Most children can put on their own socks, underpants and undershirt by the end of the toddler period. Encourage parents to give up perfection for the benefit of the child's developing sense of autonomy. Children need shoe soles that are firm enough to provide protection from rough surfaces. Sneakers are an ideal toddler shoe because the soles are hard enough for rough surfaces and arch support is limited.

The amount of sleep children need gradually decreases as they grow older. They begin period napping twice a day and sleeping 12 hours each night and end it with one nap a day and only 8 hours' sleep at night. A toddler loves a bedtime routine. Parents must be careful not to let a child maneuver them into such a long procedure that sleep is delayed considerably past the time initially set. Remind parents to stress that sleeping in a regular bed does not give children the right to get in and out of bed. Dressing the child in warm pajamas or putting a blanket on the floor might be solutions.

The time should depend on the parent's and the child's wishes and schedule. Toddlers usually enjoy bath time, and parents should make an effort to make it fun by providing a toy. Remind parents that although toddlers can sit well in a bathtub, it is still not safe to leave them alone unsupervised.

Care of Teeth
Calcium is especially important to the development of strong teeth. ln addition, children should continue to drink fluoridated water, so that all new teeth form with cavity-resistant enamel. Toddlers need to have a toothbrush they recognize as their own. Remind parents it is better for a child to brush thoroughly once a day, probably at bedtime, than to do it poorly many times a day. Parents can use dental floss. Urge parents to schedule a first visit to a dentist by 2.5 years of age.

Toddler's Healthy Family Functioning
  • Learning self-reliance is the primary goal of a child during the toddler period.
  • Some parents may find it difficult to have their authority challenged by a toddler.
  • Caution some parents not to begin to function at the same level as their toddler.
  • Teach parents that refusing to accept help is not refusing to accept love.

Other Concerns Associated with the Toddler Period
Toilet Training
lt is one of the biggest tasks a toddler must achieve. lt should begin and be completed according to a child's ability to accomplish it, not according to a set schedule. They must have reached three important developmental levels such as control of rectal and urethral sphincter, cognitive understanding of what it means to hold urine and stools until they can release them at a certain time and place and desire to delay immediate gratification for a more socially accepted action. Some toddlers smear or play with feces. Teach parents to accept this behavior for what it is: enjoyment of the body and of the self, and the discovery of a new substance.

Ritualistic Behavior
Toddlers enjoy ritualistic patterns. They will use only "their" spoon at mealtime, only "their" washcloth" at bath time. They will not go outside unless mother and father find their favorite cap.

Toddlers typically go through a period of extreme negativism. Their reply to every request is a very definite "no". This change indicates that the toddler has learned he or she is a separate individual with separate needs. The more parents try to make children obey them; the more children are likely to resist.

Remind parents that "discipline" and "punishment" are not interchangeable terms. Discipline means setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline. Two general rules to follow are (1) parents need to be consistent, and (2) rules are learned best if correct behavior is praised rather than wrong behavior is punished. "Timeout" is a technique of helping children learns that actions have consequences.

Separation Anxiety
Toddlers have difficulty accepting being separated from their primary caregiver. It helps if parents say goodbye firmly, repeat the explanation that they will be there when the child wakes in the morning, and then leave. Prolonged goodbyes only lead to more crying.

Temper Tantrums
Almost every toddler has a temper tantrum at one time or another. Probably the best approach is for parents to tell the child simply that they disapprove of the tantrum and then ignore it. Children who are left alone in the kitchen will usually not continue a tantrum but will stop after 1 or 2 minutes and rejoin their parents. Parents should then accept the child warmly and proceed as if the tantrum had not occurred.

Physically Challenged or Chronically Ill Toddler
  • lt is important for these children to develop a strong sense of autonomy as possible.
  • A toddler with a long-term illness or who is physically challenged can be expected to exhibit normal toddler behaviors.
  • Remind the parents that the behavior is more often an indication of age and development rather than of illness so they can respond firmly.
  • Promoting autonomy calls for creative planning because there may be many tasks that must be done for the child.

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