Toddler Life Stage

The Toddler Life Stage
Fall 2018
Jacey Mitchell, RDH, MS
Copyright © 2018, Elsevier Inc. All Rights Reserved.

Biology and Genetics
 12-18 months 3 years of age→
 Overview of developmental/physical changes
 2-4 inches height/year; 4-6 lb weight/year
 Continue to measure head circumference
 May measure length (recumbent) or height (standing)
2Copyright © 2018, Elsevier Inc. All Rights Reserved.

Physical Characteristics by System
Kidneys ● Specific gravity similar to adults
● 500-600 mL urine at 2 years old
● Begin voluntary control
Gastrointestinal ● Functional maturity
● Needs more frequent meals/snacks
● Control of internal/external anal sphincters
Respiratory ● Lung capacity increases
● Respiratory rate decreases
● Smaller upper tract diameter (airway
obstruction potential)

EENT ● Similar to infant
● Continued risk for otitis media
Endocrine ● Become functional (exception: reproductive)
Circulatory ● Blood pressure increases
● Heart rate decreases
● More effective thermoregulation
Immunity ● Active immunity/immunizations by 18
months
● Exposure to new/different organisms—
begin to build immunity

Teeth ● All 20 primary teeth erupt by end
of toddlerhood
● At risk of choking because of immature
swallowing pattern
Musculoskeletal ● Increased size/strength of muscle fibers
● Myelination of corticospinal tract sufficient
for most movement
● Voluntary motor movements often with
involuntary movement on other side of
body
● Does not show hand dominance

Gordon’s Functional Health Patterns
 Health perception–health management pattern
 Nutritional-metabolic pattern
 Elimination pattern
 Activity-exercise pattern
 Sleep-rest pattern
 Cognitive-perceptual pattern
 Self-perception–self-concept pattern
 Roles-relationships pattern
 Sexuality-reproductive pattern
 Coping–stress tolerance pattern
 Values-beliefs pattern

Health Perception–
Health Management Pattern
 Little understanding of health
 Depend on caregivers for health management
 Health behaviors (e.g., brushing teeth) part of taught rituals
 Identify with behavior modeled by caregivers
 Nutrition
 Exercise

Nutritional-Metabolic Pattern
Nutrition Principles
 Ensure adequate iron intake
 Moderate amount of milk (low in Fe)
 Prevent dental caries: bedtime bottle only water
 Juice overconsumption
 Appetite decreased—assess intake over several days
 Mealtime
 Opportunity to offer healthy, age-appropriate choices
 Avoid overattention/punishment re food behavior

Elimination Pattern
Toilet Training
 Major parental concern
 Emotional/physical readiness—usually 18 months of age or older
 Nurse provides anticipatory guidance to parents on:
 Developmental readiness of child
 Parental attitudes and process of toilet training

Activity-Exercise Pattern
 Always busy and exploring
 Most waking hours at play
 Exploring, imitating, creating rituals
 Risk for injury
 Parallel play: side-by-side, but independent play
 Anticipatory guidance
 Appropriate toys, opportunities for learning and social encounters, limit TV
time

Sleep-Rest Pattern
 Need: 12 hours a day; one to two naps
 Schedules are helpful to avoid overfatigue
 Rituals help develop a sense of security
 Night terrors
 Normal, less frequent as child develops
 Not fully awake
 Instruct parent to speak soothingly, do not try to wake child

Cognitive-Perceptual Pattern
 Sensorimotor—preoperational
 Egocentrism—world as relates to them
 Object permanence
 Play imperative—learn by repetition
 Hearing—critical for language/speech
 Hearing loss assessed at birth, can be tested during toddler, preschool years
 Otitis media: leading cause of hearing loss in toddlers
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Cognitive-Perceptual Pattern (Cont.)
 Vision
 Amblyopia—diminished or loss of vision in one eye
 Brain favors normal eye
 Strabismus—deviation in line of vision
 Management focused on making child use eye with reduced vision (lazy eye)
 Be alert to “red flags” of vision problems (next slide)
 Taste and smell
 Begin learning conditioned association between smell/taste; develop food
aversions

Red Flags of Vision Problems
 Rubs eyes excessively
 Shuts one eye, tilts head, sideways gaze
 Difficulty with close vision
 Blinks, frowns, squints on viewing objects
 Holds book close to eyes
 Red, encrusted or swollen eyelids
 Inflamed or watery eyes
 Recurrent styes

Self-Perception–Self-Concept Pattern
 Erikson: autonomy vs doubt/shame
 Relinquish dependence on others
 Need to explore world
 Physically
 Relationships—“NO” and temper tantrums
 Guidance to parents
 Safe environment
 Promoting autonomy
 Preventing and dealing with temper tantrums

Roles-Relationship Pattern
 Roles understood as they relate to child
 Sibling rivalry: ongoing negotiation of roles and relationships
 Imitate others
 Prefer others’ possessions
 Child abuse—Dental Hygienists’ Role
 Need to be aware of potential; s/s abuse
 Report when child abuse suspected

Sexuality-Reproductive Pattern
 Genital exploratory behavior and masturbation
 Normal developmental process
 Opportunity to learn about body
 Parents reaction is variable
 Recommend using correct anatomical terms

Coping–Stress Tolerance Pattern
Temperament
 Individual style of emotional or behavioral response across situations
 Foundation for coping
 Influenced by environmental characteristics
 Influences psychosocial adjustments

Values-Belief Pattern
 Healthy behaviors reflect positive values/beliefs
 Toddler’s environment
 Teach right/wrong
 Contribute to security, belonging, autonomy
 Values/beliefs
 Interactions with parents
 Religious rituals/beliefs
 Development facilitated by consistent behavioral expectations, reinforcing
acceptable behavior

Environmental Processes: Physical Agents
 High risk for accidental injury
 Structural hazards
 “Baby-proof” the environment
 Inspect for hazards in unfamiliar environments
 Appropriate supervision
 Toys
 Inspect toys
 Risk of small removable parts, batteries, toxic paint, sharp edges

Environmental Processes: Physical Agents
 Sports
 Improper storage of guns, heavy equipment
 Wear bike helmets
 Drowning: highest risk ages 1-3
 Can drown in water if covers nose/mouth
 Danger: pools, tubs, toilets, pails of water
 Burns
 Hot liquids, electrical cords, fireplaces
 Lower water heater to 120-125°F

Motor Vehicle–Related Injury
 One of leading causes of death 1-4 years
 Child safety seats
 Correct seat for weight of child
 Proper installation of safety seat
 Rear seat position preferred
 Pedestrian accident potential at home
 Killed/injured in driveway by backing vehicle

Biological Agents and Poisoning
 Biological agents
 Potential of bioterrorism: talk about fears, appropriate precautions/response
 Poisoning—greatest risk ages 1-2
 Toddlers use mouth as way to explore environment
 Medications, household products, plants, cigarettes, alcohol, cosmetics
 Suspected poisoning—contact Poison Control Center
 Lead—teach primary prevention, screening (secondary prevention)

Determinants of Health:
Social Factors and Environment
 Day care—HHS four-step approach
 Interview potential provider and observe setting
 Check references
 Make decision based on specific criteria
 Get and stay involved
 Culture and ethnicity
 Toddlers shaped by family values/beliefs
 Knowledge, respect, negotiation across cultures needed for high-quality health
outcomes

Levels of Policy Making and Health
 Legislation
 Safety and injury prevention
 Abuse and neglect protection
 Assistance for handicapped children 0-3 years
 Economics
 Toddler mortality/morbidity rates increase in poverty
 Medicaid, uninsured, SCHIP program

Toddler Life Stage

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