Average achievements of a toddler 18 months


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Average achievements of a toddler 18 months

  1. 1. PHYSICALAnterior fontanel closed - may be closed as early as 12monthsAbdomen protrudesPhysiological anorexia due to decreased growthHas sphincter controlMOTORWalks-seldom falls-sideways and backwardCan walk upstairs holding with one handCan attempt jumping4/25/2013 St.Phn MBARUKU SAID
  2. 2.  Sits self in small chair Climbs on furniture Gets into everything, explores drawers evenwaste baskets Pushes light furniture around room Throws ball overhead without falling Scribbles vigorously Turns pages in a book Can put things into a hole4/25/2013 St.Phn MBARUKU SAID
  3. 3.  SELF CARE Holds cup with both hands and can hand it tocare giver, put it down or drops it. Eats with spoon and turns spoon in mouth Spills frequently May play with food Negativism and high activity level May interfere with eating4/25/2013 St.Phn MBARUKU SAID
  4. 4.  Removes and unzips simple garments Complains when wet May indicate need to toilet Increased readiness for bowel and bladdercontrol May control bowel movement May smear feces4/25/2013 St.Phn MBARUKU SAID
  5. 5.  SENSORY Intense interest in pictures Identifies various shapes PSYCHOSOCIAL Sense of autonomy (a feeling of independence) Egocentric Autonomous behavior increasing Negativism and dawdling predominant Have temper tantrums Aware of strangers4/25/2013 St.Phn MBARUKU SAID
  6. 6.  Seeks help when in trouble May resist to sleep for sometime Bed rituals begins Imitates parents behavior Possessiveness begins Gender identity begins INTELLECTUAL Is comfortable when hearing parents voice Short attention span Begins sense of time and anticipation of events Begins to think Beginning traces of memory Experiments actively to achieve goals4/25/2013 St.Phn MBARUKU SAID
  7. 7.  LANGUAGE Speaks an average of 10 real words Name pictures Uses words than gestures to express desire About 25% of vocalization is intelligible PLAY STIMULATION Enjoys solitary play or watching activities ofothers Has a favorite toy4/25/2013 St.Phn MBARUKU SAID
  8. 8.  Provide: For motor play Large hollow wooden blocks Balls Pull toys Low swing with arms and back Low slide Rocking chair or horse Low wheeled toys to ride Small chair and table Running and chasing games4/25/2013 St.Phn MBARUKU SAID
  9. 9.  For creative play Container with openings into which blocks ofdifferent shapes can be placed Blocks, bowls, tumblers Finger paints Large crayon Clay Bells around wrist or ankle Sand toys (shovels, pail) Stuffed animals and dolls to drug, sit upon or hug Imitates parental actions in play4/25/2013 St.Phn MBARUKU SAID
  10. 10.  PHYSICAL Weight approximately 11.8-12.7 kg Height approximately 82.5 -85 cm Gained 10 -12 cm in second year Adult height is about twice height at 2 years Chest circumference exceeds head circumference Anterior posterior diameter less than lateraldiameter Head circumference 49-50 cm Pulse 110 + 20 –average 100 beats/minute4/25/2013 St.Phn MBARUKU SAID
  11. 11.  Respiration 26-28/minute Blood pressure 99/64 + 26/24 Landau reflex completely disappeared Approximately has 16 temporary teeth Physiologic function is mature exceptendocrine and reproductive Abdomen protrudes less than in 18 months May control daytime bowel and bladder4/25/2013 St.Phn MBARUKU SAID
  12. 12.  MOTOR Can walk with heel toe gait Walks backwards in imitation Runs more quickly with few falls Jumps Kicks large ball Builds tower of 6-7 cubes Makes cubes into a train Turns pages of a book one at a time Opens door by turning knob May run away Unscrews lid or jar Folds paper once (imitating)4/25/2013 St.Phn MBARUKU SAID
  13. 13.  SELF CARE Drinks well from a small glass held in one hand Puts spoon in mouth occasionally with one hand Plays with food Can use a straw May request certain foods Pulls on own simple garments Removes most of own clothing Verbalizes toilet needs4/25/2013 St.Phn MBARUKU SAID
  14. 14.  Usually bowel trained with occasional accidents Usually urinates when taken to toilet Toilet trained in day time May still smear stool May brush teeth with help Attempts to wash self in tub or shower SENSORY Accommodation well developed Inserts square objects into its appropriate place orhole May develop strabismus (squint)4/25/2013 St.Phn MBARUKU SAID
  15. 15.  PSYCHOSOCIAL Sense: Has sense of autonomy Still egocentric in both thought and behavior Separation anxiety continues Shows early signs of individuality Independent from care giver Is possessive (mine not yours) Does want to share possessions May push other children as if they are objects outof his way May want to make friends but doesn’t know how4/25/2013 St.Phn MBARUKU SAID
  16. 16.  Pulls other persons to show them something Does not want to sleep so has many demandsbefore bed time Upset by changes in routine Thumb sucking decreased Focuses on own wishes Violent temper tantrums decreasing PSYCHOSEXUAL Anal stage4/25/2013 St.Phn MBARUKU SAID
  17. 17.  INTELLECTUAL OR COGNITIVE Attention span is longer Memory increases Starts to understand past present and future Increased sense of time- can anticipate eventsand can wait for them. Can pretend4/25/2013 St.Phn MBARUKU SAID
  18. 18.  LANGUAGE Understands more complex sentences Can obey 2 commands given at the same time Enjoys stories with pictures No longer use jargon Knows about 300 words Refers to self by first name Uses pronouns I, me, mine Asks what’s, who’s that Tells about immediate experiences Identifies familiar objects Verbalizes need for drink, food and toileting May use the word now meaningfully About 66% of vocalization are intelligible4/25/2013 St.Phn MBARUKU SAID
  19. 19.  PLAY AND STIMULATION Little social interaction with other children Begins to learn to replace toys in their proper place Frequently idle (dawdles) Pulls wagon Manipulates play materials such as clay, finger paints,brush paints Sings songs Needs large puzzles and toys to take apart Enjoys hearing stories with pictures4/25/2013 St.Phn MBARUKU SAID
  20. 20.  Takes favorite toys to bed Mimic domestic activities of parents Enjoys playing with dolls4/25/2013 St.Phn MBARUKU SAID
  21. 21.  PHYSICAL Weight –gains about 5kg between 1 and 3 years Weight is quadrupled Height increases about 6-8 cm during the thirdyear Has a full set of 20 temporary teeth Daytime bowel and bladder control possiblyestablished4/25/2013 St.Phn MBARUKU SAID
  22. 22.  MOTOR Can stand on one foot momentarily Walks on tiptoe for few steps upon request Walks up and down stairs one foot on a stepalternating feet Jumps well in place with both feet off the floor Jumps fro step or low chair Can throw a large ball 4-5 feet Can ride a walker or pedal car4/25/2013 St.Phn MBARUKU SAID
  23. 23.  Builds a tower of 8 cubes Adds chimney to train or cubes Imitates circular strokes Holds crayon with fingers instead of entire hand Good hand-finger coordination SELF CARE Can feed himself with occasional spilling Pours from a jug often spilling Gets a drink without assistance4/25/2013 St.Phn MBARUKU SAID
  24. 24.  Distinguishes between finger and spoon food Chews with mouth closed DRESSING Puts arm through large arm hole Buttons a large front button Unbuttons large front buttons Helps to put things away TOILET AND GROOMING Mastery of daytime bowel and bladder control May go to the toilet himself4/25/2013 St.Phn MBARUKU SAID
  25. 25.  Control bowel at 26 months -Controls urination 30 months Needs assistance with wiping Attempts to wash hands adequately Can partially dry hands upon reminder SENSORY Recalls visual images4/25/2013 St.Phn MBARUKU SAID
  26. 26.  PSYCHOSOCIAL Sense of autonomy (1-3 years) Theoretically autonomy is achieved at the end oftoddler period. If it is not achieved a sense ofshame and doubt predominates Still egocentric Learns to cope with separation anxiety Independent behavior increases Achieves some self control based on self esteemrather than fear4/25/2013 St.Phn MBARUKU SAID
  27. 27.  Reluctant to go to bed Negativism and dawdling continue Temper tantrums may or may not decrease Imitates sex role behavior of adults Knows own sex PSYCHOSEXUAL Anal stage (1-3 years)4/25/2013 St.Phn MBARUKU SAID
  28. 28.  INTELLECTUAL Concept of time still limited Begins causal thinking Problem solving through trial and error LANGUAGE Identifies five body parts when named Gives full name (first and last) if asked Uses appropriate pronoun when referring to self “I” Uses plurals and past tense of verbs Talks constantly4/25/2013 St.Phn MBARUKU SAID
  29. 29.  Asks why Uses 4-5 word sentences About 75 % of vocalizations are intelligible PLAY STIMULATION Helps to put things away Pretends in play Motor play Pushes and steers toys well4/25/2013 St.Phn MBARUKU SAID
  30. 30.  Needs Large cars Trucks Cardboard boxes Block trains that interlock Carries breakable objects4/25/2013 St.Phn MBARUKU SAID
  31. 31.  CREATIVE PLAY They need: Clay Finger paints Large crayons Large wooden puzzles Sand box toys String to string beads or lace large shoes Bright colored construction Paper to fold or cut with blunt scissors4/25/2013 St.Phn MBARUKU SAID
  32. 32.  Quiet play Cloth or cardboard books Toys for water play DRAMATIC PLAY Baby doll and doll equipment Toys for house keeping such as small broom and dust cloth Play telephone The toddler’s curiosity may lead the child into danger forexample: Motor vehicle accidents Bath tub drowning Hot fluid scalding4/25/2013 St.Phn MBARUKU SAID
  33. 33.  Electric shock leading to death Poisonous substances can kill the toddler Drugs can also kill or overdose Kerosene can kill Try as much as possible that all these are out ofreach of children4/25/2013 St.Phn MBARUKU SAID
  34. 34.  The basic needs of a toddler are: Love and security Discipline leading to self control Progression to independence Achievement of control of bodily functions Nutrition Accident prevention4/25/2013 St.Phn MBARUKU SAID
  35. 35.  Love and security Parental love should be constant, unconditionaland openly expressed even when the child ismisbehaving This type of love enables the toddler to growand to reach out for more mature goals sincethe child feels loved and secure, thefrustrations everyone endures in the process ofmaturation can be handled4/25/2013 St.Phn MBARUKU SAID
  36. 36.  Both boys and girls give their first love to their primarycaregiver usually the mother, when the father gives thesame care as the mother the toddler generally feelsattached to and secure with both parents Toddlers may develop separation anxiety if theprimary caregiver leaves them alone for example in anursery school or hospital This is evidenced by: Restlessness Hyperactivity Depression manifested by crying and withdrawal4/25/2013 St.Phn MBARUKU SAID
  37. 37.  Regression to earlier modes of behavior (Regression is returning to an earlier or formerstate or type of behavior) The parents should understand that suchbehaviors are normal Toddlers who are attempting to achieve autonomymay become overwhelmed by separation anxietywhen the parents attention is diverted from themto a new sibling or when they enter nursery schoolor are admitted to a hospital thus they regress4/25/2013 St.Phn MBARUKU SAID
  38. 38.  They may return to earlier behaviors such asdemanding to drink from a nursery bottle,refusing to cooperate in toilet training andloosing the various skills that they tried so hardto achieve The best way to handle a child’s regression issimply to ignore it.4/25/2013 St.Phn MBARUKU SAID
  39. 39.  Discipline leading to self control Proverbs 22:6 “Teach a child to choose the right path and when he is olderhe will remain upon it.” Discipline means establishing and adhering to standards ofbehavior for the toddler with the goal of self control It includes Setting of limits (rules and guidelines) These must be set on the daily behavior of children if theyfeel secure4/25/2013 St.Phn MBARUKU SAID
  40. 40.  Reinforcement of approved behavior by deepening this trustingbond between parents and child is preferred over materialrewards. Constructive discipline helps the child to better behaved andhappier Qualities of constructive discipline Consistency Clarity Firmness- parents must mean what they say and say what theymean Immediacy Encouragement of independence4/25/2013 St.Phn MBARUKU SAID
  41. 41.  Disciplinary action A loving reward is more consistently effectivein disciplining a child than punitive actionsBUT: Punishment is a useful tool if used withdiscretion Punishment should be given privately andwith respect4/25/2013 St.Phn MBARUKU SAID
  42. 42.  Examples of punishment Physical punishment Explaining or reprimanding Disregarding or ignoring- This should be avoided if there isdanger of physical harm to the child Taking time out- this means that the child is removed fromany positive reinforcement when misbehavior occurs Instead of the parents giving a scolding or spanking forunwanted behavior the child is placed in a boring situationfor a specified period of time. No playing is permitted This will be perceived as a punishment4/25/2013 St.Phn MBARUKU SAID
  43. 43.  The toddler ultimately gives up the misbehavior in order to returnto the family group Outcomes of discipline Parents must define reality for their children and throughguidance and discipline, help them in their striving for maturity Types of parents who fail in this period Those that are over demanding and insist upon perfection inbehavior This causes intense anxiety and guilt in their children Those who set no limits or over permissive These fail to provide security and help to their children to learn tolive harmoniously in society4/25/2013 St.Phn MBARUKU SAID
  44. 44.  Those who provide inconsistent discipline These make their children to find difficulties to developstable behavioral control and values Among the procedures for discipline the safest is the use oftime out or isolation Disciplinary action may sometimes be necessary butremember children still need compassion, understandingand respect for their developing independence DEPENDENCE PROGRESSING TO INDEPENDENCE INSELF CARE By the time children reach 3 years of age they are beginningtheir journey to independence in self care4/25/2013 St.Phn MBARUKU SAID
  45. 45.  Children learn to care for themselves initiallyby attempting to imitate the actions of theirparents and siblings The achievements in self care includes Feeding Dressing Toilet Grooming4/25/2013 St.Phn MBARUKU SAID
  46. 46.  ACHIEVING CONTROL OF BODILY FUNCTIONS Achieving control of bodily functions of defecation andurination is one of the major tasks of the toddler period The relative importance of this achievement dependson the culture and the socioeconomic status of thechild’s family. In some groups, toddlers do not wear nappies or pantsand are permitted to move through the home andenvironment excreting at will. In these families toilettraining is not emphasized so the children in effectmust train themselves4/25/2013 St.Phn MBARUKU SAID
  47. 47.  Process of toilet training The parents record the times the child eliminates forseveral days This record provides the toddlers own schedule fortraining that is when it is appropriate to place the childon a comfortable child sized toilet sit or potty chair The potty chair should be used only in the toilet roomor bathroom so that the act of excretion is associatedwith this one location The parents take the child to the bathroom and calmlyexplain in simple language what is to be done.4/25/2013 St.Phn MBARUKU SAID
  48. 48.  Specific words that are widely understood toindicate the acts of defecation and urination areused The parents stay with the toddler during the entireprocess. Do not allow the child to play at this time The accidents that occur during the process oftoilet training should be ignored A two year old toddler is generally toilet trained inthe day time4/25/2013 St.Phn MBARUKU SAID
  49. 49.  The 21/2 years old may have begun to master nighttime bladder control however accidents are common Night time bladder control may not be complete untilthe child is 4-5 years of age Fecal smearing This behavior occur between the ages 15-18 months The desire to smear may be sublimated by providingclay, damp sand and mud4/25/2013 St.Phn MBARUKU SAID
  50. 50.  The 21/2 years old may have begun to master nighttime bladder control however accidents are common Night time bladder control may not be complete untilthe child is 4-5 years of age Fecal smearing This behavior occur between the ages 15-18 months The desire to smear may be sublimated by providingclay, damp sand and mud4/25/2013 St.Phn MBARUKU SAID
  51. 51.  Therefore avoid shaming and ridicule A young child who is categorized as being“good” or “bad” usually lives up to theappropriate expectation. The child’s own effort also promotes or reducesself esteem Patience and persistence are necessary inhelping children develop self esteem as theybecome able to cope with life in their world4/25/2013 St.Phn MBARUKU SAID
  52. 52.  PLAY AND STIMULATION Functions of play: Play during the toddler period stimulates all areas ofgrowth and development The social importance of play increases as the childgrows Active play encourages gross and fine muscledevelopment-surplus energy is worked off When playing besides and watching others they seemto want to be friendly but at this time their social skillsare inadequate so adult supervision is necessary4/25/2013 St.Phn MBARUKU SAID
  53. 53.  Play assist the toddler to fully develop the concept of objectpermanence They develop very early understanding of moral values They learn differentiate between right and wrong when theyare taught not to hurt others in play They develop language and speech when they talk to toys,pets, others parents Reading and singing to child helps Negative feelings and tensions can be released in anapproved way for example an angry child can find relief bypounding soft balls or begs through holes in a board ortossing bean bags4/25/2013 St.Phn MBARUKU SAID
  54. 54.  PLAY RESPONSES In early toddler period play is free andspontaneous They are in most cases destructive They normally claim their own toys by saying“mine, mine” They learn sharing later Do not encourage them to give up their toy untillater on.4/25/2013 St.Phn MBARUKU SAID
  55. 55.  PLAY RESPONSES In early toddler period play is free and spontaneous They are in most cases destructive They normally claim their own toys by saying “mine, mine” They learn sharing later Do not encourage them to give up their toy until later on. NUTRITION Nutritional intake include the essential nutrients in theamount necessary for maintenance, replacement and growthof tissue and for energy4/25/2013 St.Phn MBARUKU SAID
  56. 56.  They are usually 3 well spaced small meals with inbetween nutritious snacks each day. Toddlers need less food per unit of body weight duringthe second year of life than infants because the growthrate is less rapid. At about 18 months toddlers develop what is known asphysiological anorexia If inadequate amounts of vitamins and mineralsespecially iron are not obtained in the diet because ofthe anorexia supplements can be prescribed Children may prefer playing than eating, so take careof the meal times4/25/2013 St.Phn MBARUKU SAID
  57. 57.  ACCIDENT PREVENTION Accidents are the largest single cause of mortality anddisability between the ages of 1-4 years Accidents include Motor vehicle accidents Drowning Burns Suffocation Falls Poisoning Other injuries e.g. cuts4/25/2013 St.Phn MBARUKU SAID
  58. 58.  When parents understand their child’s level ofgrowth and development they can predict thehazardous situations that may result in anaccident then judge how much responsibilitythe child can assume for self protection If the child is injured accidentally point to thechild the cause of the accident and it will be alesson to the child.4/25/2013 St.Phn MBARUKU SAID