This document discusses development in toddlers aged 1 to 3 years. It covers physical, cognitive, speech, and psychosocial development. Key topics include rapid growth and development; achieving independence; toilet training; injury prevention; and appropriate toys, play, and guidance techniques. The goals are to support the toddler's autonomy and social skills while maintaining safety.

1. Chapter 17Chapter 17
The ToddlerThe Toddler

2. ObjectivesObjectives
• Describe the physical, psychosocial, and
cognitive development of children from 1 to 3
years of age, listing age-specific events and
guidance when appropriate.
• Discuss speech development in the toddler.
• Describe the task to be mastered by the
toddler according to Erikson’s stages of
growth and development.
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3. ObjectivesObjectives (cont.)(cont.)
• List two developmental tasks of the toddler
period.
• Discuss the principles of guidance and
discipline for a toddler.
• Discuss how adults can assist small children
in combating their fears.
• Identify the principles of toilet training (bowel
and bladder) that will assist in guiding parents’
effort to provide toilet independence.
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4. ObjectivesObjectives (cont.)(cont.)
• Describe the nutritional needs and self-
feeding abilities of a toddler.
• List two methods of preventing the following;
automobile accidents, burns, falls, suffocation
and choking, poisoning, drowning, electric
shock, and animal bites.
• Describe the characteristic play and
appropriate toys for a toddler.
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5. General CharacteristicsGeneral Characteristics
• A toddler is between 1 to 3 years of age
• No longer completely dependent on others
• Rapid growth and development during
infancy slows down
• Erikson’s stage of autonomy versus shame
and doubt
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6. General CharacteristicsGeneral Characteristics (cont.)(cont.)
• Major parental responsibility
– Maintaining safety for the toddler while
allowing the opportunity for social and physical
independence
– Maintain positive self-image and body image
in child
• Negativism can be countered by offering
limited choices and the use of distraction in
handling toddlers whose favorite word is “no”
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7. General CharacteristicsGeneral Characteristics (cont.)(cont.)
• Developing self-control and socially
acceptable outlets for aggression and anger
are important in the formation of personality
and behavior
• Rituals increase the toddler’s sense of
security by making compulsive routines of
simple tasks
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8. Physical DevelopmentPhysical Development
• Birthweight quadruples by 2.5 years of age
• Rate of brain growth slows
• Body proportions change
– Head and trunk grow more slowly
• Musculoskeletal system grows and bones begin to
ossify
• Protuberant abdomen flattens when muscle fibers
increase in size and strength
• Myelination of spinal cord nearly complete by 2
years
• Bowel and bladder control usually complete by 2.5
to 3 years of age
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9. Physical DevelopmentPhysical Development (cont.)(cont.)
• Respirations still mainly abdominal but shift to
thoracic as child reaches school-age
• Capable of maintaining stable body temperature
• Eruption of deciduous teeth complete by 2.5
years
• Defense mechanisms of the skin and blood are
more effective
• Digestive processes and stomach capacity
increase to allow three-meal-a-day schedule
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10. Sensorimotor and CognitiveSensorimotor and Cognitive
DevelopmentDevelopment
• Sensory and motor abilities do not function
independently
• Memory strengthens
• Is able to assimilate information through trial,
error, and repetition
• Piaget’s sensorimotor and preconceptual
phase of development emerges rapidly in this
age group
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11. Sensorimotor and CognitiveSensorimotor and Cognitive
DevelopmentDevelopment (cont.)(cont.)
• Able to tolerate longer periods of separation
from parents to explore environment
• Aware of cause and effect
• Concept of spatial relationships develops
• Begins to internalize standards of behavior
• Copies words and roles of the models seen in
the home
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12. Sensorimotor and CognitiveSensorimotor and Cognitive
DevelopmentDevelopment (cont.)(cont.)
• May confuse essential with nonessential
body parts/functions
• Expelling feces and urine and then flushing it
down the toilet may be upsetting as the
toddler may see it as flushing a part of
themselves away
• Nurse should teach parents skills that will
enable the toddler to feel loved even if
behavior is not acceptable
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13. Speech DevelopmentSpeech Development
• Parallels cognitive growth
• Expressive and receptive language continue
to develop
• Respond to tone of voice and facial
expressions of those around them
• Showing empathy toward the toddler who is
trying to communicate verbally will help
minimize frustrations
13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

14. Screening for Signs of AutismScreening for Signs of Autism
• Preliminary symptoms may include
– No pointing, gesturing (e.g., bye-bye) by 12 months
– No single words by 16 months
– No spontaneous two-word phrases by 24 months
– Loss of achieved language or social skills
• Important to rule out lead poisoning, hearing
deficit, neurological disorders,
musculoskeletal diseases and inborn errors
of metabolism.
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15. Guidance and DisciplineGuidance and Discipline
• Goal is to teach, not punish
• Discipline involves guidance
• Parent responses to temper tantrums can
either reinforce the desirability of or the risks
involved in such behavior
• Expectations must be in line with the child’s
physical and cognitive abilities
– Limit-setting
– Time-outs
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16. Guidance and DisciplineGuidance and Discipline (cont.)(cont.)
• Child seeks approval
– Use positive approach whenever possible
– Approval increases self-confidence
• Use of fear or physical aggression with a
toddler does not foster self-control
– Can lead to physical and emotional abuse
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17. Guidance and DisciplineGuidance and Discipline (cont.)(cont.)
• Fear-provoking event affects extent of
toddler’s reaction
– If alone, fear may be greater
– Once fear has been learned, it is more difficult
to eliminate
• Stress increases fear of separation
– Self-consoling behaviors include favorite
possession or repetitive rituals
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18. Daily CareDaily Care
• Adults should be at eye level when talking to
toddler
– Seems less overwhelming
• Flexible schedule organized around needs of
entire household is best
• Clothing should be easily put on and
removed
• Sunburn protection
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19. Daily CareDaily Care (cont.)(cont.)
• Shoes should fit shape of foot and be ½ inch
longer and ¼ inch wider than the foot
• Important for toddler to wear their regular
shoes to the clinic as it shows the health care
provider how the body is being used
• Posture is greatly influenced by that of other
family members
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20. Toilet IndependenceToilet Independence
• Much depends on
temperament of the
toddler and the
person guiding toilet
training
• Voluntary control of
anal and urethral
sphincters begins
around 18 to 24
months of age
20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

21. Toilet IndependenceToilet Independence (cont.)(cont.)
• Use potty chair or place the child on the toilet
facing the tank
• Bowel training usually attempted first
• Do not leave toddler on toilet for more than a few
minutes at a time
• Bladder training can begin when toddler stays
dry for about 2 hours
• If toddler has special words for defecation or
urination, be sure to tell other health care
providers and document in care plan for toddler
21Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

22. Nutrition CounselingNutrition Counseling
• Caloric needs decline to about 100
calories/kg/day
• Limit milk intake to no more than 24 ounces
(720 mL) per day
• Serving size is 1 tablespoon of solid food per
year of age
• Food is chopped into fine pieces
• Various foods are offered
• A 2-year-old likes finger foods
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23. Day CareDay Care
• Must meet families’
– Personal preferences
– Cultural perspectives
– Financial and special needs
• Should be state-approved
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24. Day CareDay Care (cont.)(cont.)
• Differs for toddlers because
– Shorter attention span
– Tendency to engage in parallel play rather
than group play
– Need closer supervision to maintain safety
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25. Nursing TipNursing Tip
• A major task for parents is to “let go” and
allow the toddler to interact with influences
outside the family in day care centers or
preschools
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26. Injury PreventionInjury Prevention
• Best prevention is knowledge of age-
appropriate risk and anticipatory guidelines
• Parents need to understand their child’s
activities at certain ages in order to prevent
injuries by taking appropriate precautions
• Toddlers are curious and mobile
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27. Injury PreventionInjury Prevention (cont.)(cont.)
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28. Toys and PlayToys and Play
• Parents must be
taught to inspect
toys and to buy toys
suitable to the age,
skills, and abilities of
their child
• Play is the work of
toddlers
• Through play they
learn how to
– Manipulate and
understand their
environment
– Socialize
– Explore their world
28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

29. Toys and PlayToys and Play (cont.)(cont.)
• Social development takes form
• Egocentric thinking
• Parallel play gradually leads to cooperative
play
• Protect the child from sunburn, mosquitoes,
and other vectors
• Childproofing the home is also important
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30. Question for ReviewQuestion for Review
• What are the three stages of separation
anxiety?
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31. ReviewReview
• Objectives
• Key Terms
• Key Points
• Online Resources
• Critical Thinking Question
• Review Question
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