Growth and Development toddler Child Health Nursing Pediatric Nursing Pathophysiology

1. Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing(Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.
GROWTH AND DEVELOPMENT OF
TODDLER
1

2. INTRODUCTION
• The word is derived from “to toddle”, which means to
walk unsteadily, like a child of this age. The toddler
period extends from age 1 year to approximately 3 years
of age. The toddler who learned to trust the parents
during infancy now can use this trust in exploration and
investigation of a world beyond the parent’s arms. The
toddler years are a time of great cognitive, emotional
and social development.
2

3. PHYSIOLOGICAL DEVELOPMENT
The physiological functioning of the body is mature by the end
of the toddler period, with the exception of the endocrine and
reproductive systems.
INTEGUMENTARY SYSTEM • Fine body hair begins to
grow on the arms and legs. The hair on the head becomes
coarser and darkens as it gradually approaches the eventual
mature color.
CARDIOVASCULAR SYSTEM • The pulse rate decreases
and the blood pressure increases during the toddler period. The
heart and blood vessels increase in size as the child grows.
RESPIRATORY SYSTEM • The structures of the respiratory
tract increase in size, with an accompanying increase in
thoracic volume, leading to decreased respiratory rate. 3

4. PHYSIOLOGICAL DEVELOPMENT
GASTROINTESTINAL SYSTEM • The salivary
glands have reached functional maturity by the end of the
second year. The toddler can chew food and keep it in the
mouth so that the salivary enzymes can begin to act upon it.
• The capacity of the stomach also increases, and the rapidity
with which food passes through the gastrointestinal tract
decreases, so that the toddler can be satisfied with less
frequent feedings than were necessary during infancy.
• With continued growth, hydrochloric acid secretion in
stomach increases, providing protection against various types
of organisms. The incidence of infectious diarrhea, so
common during infancy, is decreased.
4

5. PHYSIOLOGICAL DEVELOPMENT
GENITOURINARY SYSTEM • With continuing maturation of the
kidneys, by 2 years of age the toddler is physiologically able to conserve
water and to concentrate urine on a level similar to that of the adult.
NERVOUS SYSTEM • The number of brain cells is complete by the
beginning of the toddler period.
• They continue to grow until the brain has reached two thirds of
its adult size at 2 years of age.
• Rapid development of the brain leads to increasing control of
behavior but initially results in some disorganization in young
toddlers, manifested by a very short attention span.
• Myelination of the spinal cord is achieved gradually as toddlers show
increasing ability to exert control over posture and coordinated
movements. 5

6. CHARACTERISTICS OF TOODLER
Physical and
physiological
Characteristics
of toddler
Potbelly
Abdomen
Physiological
anorexia
Bowed Legs
6

7. CHARACTERISTIC BEHAVIOURS OF
TOODLER
Recognize themselves in pictures or a mirror;
Imitate the behavior of others, especially
adults and older children.
Beginning of reading and writing.
Short attention span.
Negativistic attitude and Independence.
Ritualistic behavior.
Temper tantrums.
Regression
Egocentric
7

8. CHARACTERISTIC BEHAVIOURS OF
TOODLER
 Curious and more energetic.
 Babbling; beginning to develop language.
 Judgment based on perception, rather than logic.
 Recognizes parents and special people, attaches to
special toys, objects.
 Expresses feelings through crying, facial
expressions, body language, sounds.
 Understands words; communicates via sounds,
gesture.
 Show greater independence; begin to show
defiant behavior; 8

9. Love and security
Nutrition
Hygienic Measures especially Dental care
Toilet Training according to the readiness of the toddler
Immunization and Play facilities
Consistency in discipline and control of temper tantrums.
Prevention of accidents and safety measures.
NEEDS OF TODDLERS
9

10. GROWTH AND
DEVELOPMENTOF
FIFTEENTH MONTH TODDLER
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing(Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.
10

11. PHYSICAL OR BIOLOGICAL
DEVELOPMENT
Legs
Appear
Bowed
11

12. Assumes standing
position without help
GROSS MOTOR DEVELOPMENT
Walk without support at 13
months, wide-based gait
12

13. Loses balance when
walking around corners or
stopping suddenly
GROSS MOTOR DEVELOPMENT
Kneels without
support
Cannot throw
ball without
falling
13

14. Creeps up stairs
GROSS MOTOR DEVELOPMENT
Throws small objects repeatedly
and pick them up again, but may
fall (shows ability to release object
from grasp)
14

15. Builds a tower of 2 – 3 cubes
FINE MOTOR DEVELOPMENT
Opens boxes
15

16. Pokes finger in hole
FINE MOTOR DEVELOPMENT
Scribbles
spontaneously
Makes line
with crayon
16

17. Pats pictures in books and
begins to turn pages
FINE MOTOR DEVELOPMENT
Inserts pellet in narrow –
neck bottle
17

18. May give up bottle
SELF CARE
Hold a cup with all
fingers grasped about it.
FEEDING
SKILL
Enjoys finger
feeding
18

19. Grasps a spoon
and inserts it in to
dish. Cannot fill
the spoon well;
spoon is likely to
be turned upside
down before
reaching mouth
SELF CARE FEEDING
SKILL
19

20. Sticks out arm and leg to
help in dressing
SELF CARE
Removes socks
DRESSING
SKILL
20

21. TOILITING AND
GROOMING SKILLS
Indicates when
diaper is wet or
soiled
SELF CARE
21

22. Binocular vision
fully developed
SENSORY DEVELOPMENT
Looks at pictures
intently for prolonged
periods of time
Can identify geometric
forms and place around
object into its
appropriate place or
hole
22

23. PSYCHOSOCIAL DEVELOPMENT
Sense of autonomy versus doubt and
shame
Egocentric
Separation anxiety
23

24. PSYCHOSOCIAL DEVELOPMENT
Sense of autonomy versus doubt and
shame
Hugs and kisses
parents
Kisses pictures in
book
24

25. PSYCHOSEXUAL DEVELOPMENT
Anal stage (1 to 3)
SPIRITUAL DEVELOPMENT
Intuitive – Projective faith
Preconventional Morality
MORAL DEVELOPMENT
25

26. INTELLECTUAL DEVELOPMENT
SENSORIMOTOR STAGE
Tertiary circular reaction
26

27. LANGUAGE DEVELOPMENT
RECEPTIVE LANGUAGE
Recognizes names of various
parts of body.
Responds to familiar simple
commands
27

28. LANGUAGE DEVELOPMENT
EXPRESSIVE LANGUAGE
Continues use of
expressive jargons
Says 6 to 8 words
Name familiar pictures
or objects such as ball
Shake head to
communicate NO
28

29. PLAY STIMULATION
EXPRESSIVE LANGUAGE
Walking becomes a form of
play
Carries a toy when walking
Provide Balls, Stuffed
animals, Dolls, Musical
toys, Picture books,
Stacking discs or blocks
29

30. THANK U
30

31. GROWTH AND
DVELOPMENT OF
AN EIGHTEENTH
MONTH
TODDLER
Mrs. D. Melba Sahaya
Sweety RN,RM
PhD Nursing , MSc
Nursing(Pediatric
Nursing), BSc Nursing
Associate Professor
Department of Pediatric
Nursing
Enam Nursing College,
Savar,
Bangladesh.

32. Anterior fontanel closed
(May be closed as early as
12 months)
PHYSICAL OR
BIOLOGIC
DEVELOPMENT

33. PHYSICAL OR
BIOLOGIC
DEVELOPMENT
Abdomen protrudes

34. PHYSICAL OR BIOLOGIC
DEVELOPMENT
Physiologic anorexia due
to decreased growth

35. PHYSICAL OR
BIOLOGIC
DEVELOPMENT
Has Sphincter control

36. GROSS MOTOR
DEVELOPMENT
Walk with some what wide stance, but
increasingly more like adult gait

37. GROSS MOTOR
DEVELOPMENT
Walk sideways and backward

38. GROSS MOTOR
DEVELOPMENT
Walk upstairs with one hand held

39. GROSS MOTOR
DEVELOPMENT
Runs stiffly, often falls
Throws ball overhand without falling

40. GROSS MOTOR
DEVELOPMENT
Move quickly from place to place.
Jumping attempted using both feet. May fall in initial
attempts since the body is propelled forward

41. GROSS MOTOR
DEVELOPMENT
Seat self in small chair
Climbs on furniture

42. GROSS MOTOR
DEVELOPMENT
Pulls and pushes toy,
Pushes light furniture around room

43. FINE MOTOR
DEVELOPMENT
Builds tower of
3-4 Cubes,
Scribbles
Vigorously

44. FINE MOTOR
DEVELOPMENT
Imitates a vertical
stroke with
crayon

45. FINE MOTOR
DEVELOPMENT
Turn pages in a
book two or three
at a time

46. FINE MOTOR
DEVELOPMENT
Dumps Pellet
From Bottle ,
Puts block in to
hole

47. FINE MOTOR
DEVELOPMENT
Transfer objects
hand to hand at
will

48. SELF CARE
( FEEDING
SKILL)
Holds cup with
both hands.
Hands it to
care giver, puts
it down, or
drops it on
floor

49. SELF CARE
( FEEDING
SKILL)
Eats with
spoon ; turn
spoon in
mouth. Spills
frequently

50. SELF CARE (
FEEDING
SKILL)
May play
with food,
Finger feeds
Proficiently

51. SELF CARE
( DRESSING
SKILL)
Removes
Simple
garments
( mittens,
shoes) and
unzips
garments

52. SELF CARE (
TOILETING &
GROOMING
SKILL)
May complain
When wet or
soiled or give
indication of
need to toilet

53. SELF CARE
( TOILETING &
GROOMING SKILL)
•Increased
readiness for
bowel and
bladder control.
•Possibly early
control of
bowel
movements

54. SENSORY
DEVELOPMENT
Can see
better, thus
has intense
interest in
picture
54

55. SENSORY
DEVELOPMENT
Identifies various
shapes
55

56. PSYCHOSOCIAL
DEVELOPMENT
Negativism and dawdling
predominant
SENSE OF AUTONOMY
VERSES DOUBT AND
SHAME
56

57. PSYCHOSOCIAL
DEVELOPMENT
Autonomous behaviour
increasing and autonomy
is tested with “NO”
SENSE OF AUTONOMY
VERSES DOUBT AND
SHAME
57

58. PSYCHOSOCIAL
DEVELOPMENT
Begins to have temper
tantrums if things go
wrong
SENSE OF
AUTONOMY VERSES
DOUBT AND SHAME
58

59. PSYCHOSOCIAL
DEVELOPMENT
Imitates parent’s
domestic activities
(sweeping,
Dusting)
SENSE OF
AUTONOMY VERSES
DOUBT AND SHAME
59

60. PSYCHOSEXUAL DEVELOPMENT
Anal Stage (1 to 3 Years)
SPIRITUAL DEVELOPMENT
Intuitive – projective faith
INTELLECTUAL DEVELOPMENT
Sensorimotor stage :Substage IV ( Invention of new mean
through Mental combination)
MORAL DEVELOPMENT
Pre conventional morality

61. RECEPTIVE
LANGUAGE
Identifies picture
of familiar
objects when
named
Identifies on or
more parts of
body when
named 61

62. EXPRESSIVE
LANGUAGE
Speaks 10 real words
(average) besides
jargons
Uses words more
than gestures to
express desires
62

63. EXPRESSIVE
LANGUAGE
Name Pictures
About 25% of
vocalizations are
intelligible
63

64. PLAY
STIMULATION
Wooden blocks, pull toys, clay, large
crayons, stuffed toys, sand toys,

65. PLAY
STIMULATION
Enjoy Solitary play, Imitates parental
action Enjoy playing with balls

66. THANK
You………………….

67. GROWTH AND
DVELOPMENT OF A
2 YEAR TODDLER
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing(Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.

68. PHYSICAL OR BIOLOGICAL DEVELOPMENT
• WEIGHT :- Approximately 11.8 to 12.7kg ; Has gained
1.8 to 2.7 kg during second year
• HEIGHT :- Approximately 82.5 to 85.0 cm ; gained 10
to 12.5 cm in second year
• CHEST CIRCUMFERENCE :- Exceed head
circumference
• HEAD CIRCUMFRENCE :- 49 to 50 cm
• PULSE :- 110 + or – 20 (average 100 beets per
minute) 68

69. PHYSICAL OR BIOLOGICAL DEVELOPMENT
•RESPIRATION :- 26-28 breath per minute
•BLOOD PRESSURE :- 99/64 + or – 26/24
•DENTITION :- Approximately 16 Temporary
teeth
•REFLEX :- Landau reflex completely disappear
•Abdomen protrudes, Probably beginning of
daytime control of bowel and bladder
• 69

70. More grown up,
steady gait
Can walk with
heel-to gait
70

71. Walk backward
well in imitation
Runs more quickly in more
controlled way; has fewer falls
71

72. Walks up and down stairs;
both feet on one step at a time,
holding onto a railing or the
wall
Kicks large ball
without falling
72

73. Jumps crudely with
both feet in place
Picks up object from
floor without losing
balance
73

74. Makes cubes
into a train,
one behind
the other
Build a tower
of 6-7 Cubes
74

75. Open door
by turning
door knob ;
may run
away
Scribbles in
more controlled
way than in 18
months
75

76. Unscrews
lid of jar
Turn pages
of book one
at a time
76

77. Imitates circular
stroke
Imitates horizontal
stroke
77

78. FEEDING SKIL
Drinks well from a
small glass held in
one hand

79. FEEDING SKILL
Plays with
food

80. FEEDING SKILL
Can Use
straw

81. FEEDING SKILL
, May Request
certain foods

82. FEEDING SKILL
Imitates
eating habits
of other

83. DRESSING SKILLS
Pulls on Own,
simple
garments-
coat, elastic
pant,
shoes(laces
untied) 83

84. DRESSING SKILLS
Removes
most of on
clothing
(hat, pant)
84

85. •Usually urinates when
taken to toilet,
•May brush teeth with help
•Verbalizes toilet needs
TOILITING AND
GROOMING SKILL
85

86. •Visual acuity
20/40
•Insert
square object
into its
appropriate
place or hole
•Accommodation
well developed
•May develop
esotropia
( Strabismus )
86

87. PSYCHOSOCIAL
DEVELOPMENT
SENSE OF
AUTONOMY
VERSES DOUBT
AND SHAME
Egocentric
both
thought and
behavior
87

88. PSYCHOSOCIAL
DEVELOPMENT
SENSE OF
AUTONOMY
VERSES DOUBT
AND SHAME
Has great sense
of “mine”, little
of “yours”;
Possessive
88

89. PSYCHOSOCIAL
DEVELOPMENT
SENSE OF
AUTONOMY
VERSES DOUBT
AND SHAME
Behave as though other
children were physically
objects May hug or push
them out of way; would
like to make friends but
does not know how
89

90. PSYCHOSOCIAL
DEVELOPMENT
SENSE OF
AUTONOMY
VERSES DOUBT
AND SHAME
Negativism
and dawdling
continue;
focuses on
own wishes
90

91. PSYCHOSOCIAL
DEVELOPMENT
SENSE OF
AUTONOMY
VERSES DOUBT
AND SHAME
Violent
temper
tantrum
decreasing
91

92. PSYCHOSEXUAL DEVELOPMENT
Anal stage (1 to 3 years)
SPIRITUAL DEVELOPMENT
Intuitive- projective faith
Preoperational stage : Preconceptual phase
(2 to 4 Yrs)
INTELLECTUAL DEVELOPMENT

93. INTELLECTUAL DEVELOPMENT
•Preoccupation with
symbols, in
language, dreams,
and fantasy
•Memory increases
very early
understanding of
past present and
future.
Preoperational stage :
Preconceptual phase
(2 to 4 Yrs)
93

94. Imitation becoming
more symbolic
INTELLECTUAL
DEVELOPMENT
Preoperational stage :
Preconceptual phase
(2 to 4 Yrs)

95. MORAL
DEVELOPMENT
PRECONVENTIONAL
MORALITY
STAGE 1 (2 to 3 Years) if
punished for doing it its wrong;
if not punished it must be right

96. RECEPTIVE
LANGUAGE
Obeys one
directional
preposition (“On”
or “Under”) and
two commands
(Pick up your coat
and put it on the
chair”)
LANGUAGE
DEVELOPMENT
96

97. EXPRESSIVE
LANGUAGE
Knows more than 300
Words
Refers to self by first
name; gives first name
Uses pronouns “I”, “Me”,
“mine”
Tries out in powers of
speech asks “what’s
(who’s) that ?’
LANGUAGE
DEVELOPMENT

98. PLAY
STIMULATION
Enjoys Parallel play
Pulls wagon
Enjoys hearing stories
Manipulates play
materials such as clay
Brush paint, Large
crayons Large crayons

100. GROWTH AND
DEVELOPMENT OF A 30
MONTH TODDLER
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing(Pediatric
Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.
100

101. PHYSICAL OR BIOLOGIC
DEVELOPMENT
• WEIGHT :-
Gains about 5 kg between 1 and 3 years ; Weight
Quadrupled by 2 ½ years
• HEIGHT :-
Grow about 6-8 cm during third year
• DENTITION
Full set of 20 temporary teeth
• Daytime bowel & bladder control
possibly established 101

102. GROSS MOTOR
Stands on one foot
alone momentarily
Walks on tiptoe
for few steps
upon request
Jumps well in place
with both foot on a
step
102

103. GROSS MOTOR
Walks up and down stairs,
one foot on a step alternating
feet
Jumps from step or low
chair
103

104. GROSS MOTOR
Rides a walker or pedal car Can throw a large ball
overhand 4 to 5 feet
104

105. FINE MOTOR
Builds tower of 8 cubes
Adds chimney to train of cubes
Imitates Circular stroke-forms
closed figure
Good hand – finger
coordination
105

106. FINE MOTOR
Hold crayon with finger
instead of entire hand
Makes vertical and horizontal
strokes but may or may not
join them to make a cross
106

107. SELF CARE ( FEEDING
SKILLS)
Self feeding occasional
spilling
Pour from pitcher; often
spills
Chew with mouth closed
Uses fork, but is held
in fist
107

108. SELF CARE ( DRESSING
SKILLS)
Put arm through large
armhole
Buttons one large front button
and unbuttons large front
button
108

109. SELF CARE ( TOIETING AND
GROOMING SKILLS)
Usually has mastered
daytime bladder control ,
Beginning of night time
bladder control
Accidents
common
May go to toilet by self
(for bowel movement 26
months, for urination 30
months) and needs
assistance with wiping
109

110. SENSORY DEVELOPMENT
Visual Acuity 20/30 Recall Visual Images
110

111. PSYCHOSOCIAL
DEVELOPMENT
Egocentrism still Present in
behavior, thought and play
Beginning to learn to cope
with separation Anxiety
Ritualistic behaviour
peaks
111

112. PSYCHOSOCIAL
DEVELOPMENT
Negativism and dawdling continue
Temper tantrums may or may not
decrease
Imitates sex role
behaviour of adults and
Knows own sex
112

113. PSYCHOSEXUAL
DEVELOPMENT
SPIRITUAL DEVELOPMENT
MORAL DEVELOPMENT
113

114. INTELLECTUAL
DEVELOPMENT
Problem Solving through Trial and
Error
Concepts of time improved
114

115. LANGUAGE
DEVELOPMENT
Identifies five body parts when named
115

116. LANGUAGE
DEVELOPMENT
Gives full name if asked and Uses Plurals and
past tense of verb
Asks “ Why”?
Uses 4 – 5 word sentences
* About 75% of vocalization are
intelligible 116

117. PLAY STIMULATION
Parallel play continues Motor Play :- Provide Large
Cars, trucks, pushes and pull
toys
117

118. PLAY STIMULATION
Creative Play:- Provide
clay, finger paint, large
wooden puzzles, large
crayons.
Dramatic Play:-
Provide Baby doll and
doll equipment's, play
telephone, Toys for house
keeping (Small broom,
dust cloth etc...
118

119. 119