This document provides information on parenting a toddler, including their physical, emotional, and cognitive development. It discusses safety measures to prevent accidents, recommendations for nutrition, daily activities like dressing/bathing/sleep, and common behavioral issues such as temper tantrums. The role of nurses in caring for healthy or ill toddlers is also outlined, with examples of nursing actions to support the toddler's development and sense of autonomy in various areas such as medication, rest, stimulation, and elimination.

1. PARENTING A
TODDLER
ELECTIVE 1

2.  ASSESSMENT OF GROWTH AND DEVELOPMENT AMONG
TODDLERS
A. Physical Development
 They tend to have a prominent abdomen; abdominal muscles are
not strong enough to support abdominal contents.
 Toddlers waddle when they walk; they also have a wide distance
when walking.
 Heart rate is approximately 90bpm; blood pressure increases to
about 99/64mmHg
 The child is able to eat 3 meals every day due to increase in stomach
capacity. Gastric secretions become more acidic.
 Urinary and anal sphincter control becomes possible with
complete myelination of the spinal cord.
 All 20 deciduous teeth are present by 2 ½ to 3 years of age.

3. B. Emotional Development
 The developmental task during this period is to learn a sense of
autonomy.
 An optimum level of autonomy is achieved when parents are able to
encourage independence while still maintaining sound rules to
promote safety.
 Toddlers are able to differentiate themselves at separate individuals.
 When the child reaches 18 months, toddlers begin to imitate what
they see. By 2 years of age, they become aware of gender differences
and are able to identify themselves as a boy or girl.
 Common behaviors manifested by toddlers include:
 Does not separate easily from parents
 Negativism
 Prefers rituals and routine activities
 Active physical explorer of environment

4.  Begins attempts at self-assertion
 Easily frustrated by limits
 Temper tantrums
 May have favorite “security object”
 Uses “mine” for everything; does not understand concept sharing
C. Cognitive Development
 The toddler enters the fifth stage of sensorimotor though or tertiary
circular reaction stage (between 12 and 18 months). This behavior can
be simply described as extreme curiosity or interest in trying to
discover new ways to handle objects or new results.
 By stage 6 (18 – 24 months), problem solving or symbolic thought
emerges. Children at this stage are also able to remember an action
and imitate it later (deferred imitation).
 At the end of toddler period, children begin to use a process known as
assimilation. They are not able to change their thoughts to fit a situation;
therefore, they have to change the situation to fit their thoughts

5. PLANNING AND IMPLEMENTATION FOR HEALTH
PROMOTION AMONG TODDLERS
A. Safety
POTENTIAL ACCIDENTS PREVENTIVE MEASURES
Motor Vehicles Maintain child in car seat: do not be
distracted from safe driving by a child in
a car.
Do not allow child to play outside
unsupervised. Do not allow child to
operate electronic garage doors.
Supervise toddler who is too young to be
left alone on a tricycle

6. POTENTIAL ACCIDENTS PREVENTIVE MEASURES
Teach safely with pedalling toys (look
before crossing driveways: do not cross
streets) but do not expect that toddler
will obey these rules at all times (in other
words, stay close by).
Falls Keep house windows closed or keep
secure screens in place.
Place gates at top and bottom of stairs.
Supervise at playgrounds.
Do not allow child to walk with sharp
object in hand or mouth.

7. Raise crib rails and check to make sure
they are locked before walking from crib.
Aspiration Examine toys for small parts that could be
aspirated; remove toys that appear
dangerous.
Do not feed toddler with popcorn,
peanuts, etc.; urge children not to eat
while running. Do not leave toddler alone
with a balloon.
Drowning Do not leave toddler alone in a bathtub or
near water (including buckets of cleaning
water and washing machine)

8. Animal Bites Do not allow toddler to approach strange
dogs.
Supervise child’s play with pets.
Burns Buy flame-retardant clothing.
Cook on the back burners of stove if
possible and turn handles of pots toward
back of stove to prevent toddler from
reaching up and pulling them down.
Use cool-mist vaporizer rather than steam
vaporizer or remain in room when
vaporizer is operating so child is not
tempted to play with it.

9. Keep screen in front of fireplace or heater.
Monitor toddlers carefully when they are
near lit candles.
Do not leave toddlers unsupervised near two-
water faucets.
Check temperature setting for hot-water
heater ad turn down thermostat it is over
125ᵒF.
Do not allow toddlers to blow out matches
(teach that fire is not fun); store matches out
of reach.
Keep electric wires and cords out of toddlers
reach; cover electrical outlets with safety
plugs.

10. General Know whereabouts of toddlers at all times.
Toddlers are able to climb on chairs and stools
and could turn door knobs and go outside.
Be aware that the frequency of accidents
increases when the family is under stress and
therefore less attentive to children. Special
precautions must be taken at these times.
Be aware some children are more active,
curious, and impulsive and therefore more
vulnerable to accidents than others.

11. B. Nutrition
 Place a small amount of food on a plate and allow the child to eat.
Cleaning a plate gives the child a feeling of independent functioning.
 Offer finger foods and allow the child to choose between two types of
food to promote independence.
 Avoid giving food that is high in sugar and carbohydrates.
 Adequate calcium and phosphorous intake is important for bone
mineralization.
C. Daily Activities
 Dressing
 By the end of the toddler period, most toddlers are able to put on their
own socks, underpants and shirt.
 Encourage parents to allow their children to dress themselves to
develop a sense of autonomy.
 Sneakers are ideal for toddlers because the soles are hard enough for
rough surfaces and arch support is limited.

12.  Sleep
 If the child finds it hard to sleep at night, shorten or omit his/her
afternoon nap.
 Parents must be sure that older siblings do not point out the toddler all
the exciting things he/she missed while napping.
 Include naptime as part of a routine, not as separate activity.
 Make a bedtime routine such as a warm bath, tooth brushing, bedtime
story, or choosing a toy to sleep with.
 If the toddler is no longer comfortable sleeping in a crib, move him/her
in a grown-up bed.
 Children need to understand that sleeping in a regular bed does not
give them the right to get in and out of bed as they choose because
they cannot roam unsupervised

13.  Bathing
 The time for a toddler’s bath depends on the parents and the child’s
wishes and schedule.
 Advice parents not to leave their child unsupervised in the bath tub.
 Make bath time enjoyable by providing a toy such as rubber duck, toy
boat or plastic fish.
 Oral Care
 Offer fruits (pieces of apple, banana and orange) as snack.
 Avoid giving high-carbohydrate food because this can cause dental
decay.
 Encourage the child to drink fluoridated water and eat food high in
calcium (e.g. Cheese, milk, and yogurt)
 Toddlers can begin brushing their teeth on their own under the
supervision of their parents. After brushing, parents should use dental
floss to clean between the child’s teeth and remove plaque.
 Instruct parents to make an appointment to the dentist when the
child reaches 2 ½ years of age.

14. COMMON BEHAVIOR PROBLEMS
A. Bed Wetting and Toilet Training
 Involuntary urination while asleep after the age at which bladder control
would normally be anticipated.
 The medical term for this condition is “nocturnal enuresis”
 Studies show that parents become frustrated because they want their
children to be toilet trained at an early age. Most girls can stay dry by age
six and most boys stay dry by age seven. By ten years old, 95% of children
are dry at night.
 Toilet training is an individualize task. It should begin depending on the
child’s readiness and ability to accomplish it.
 Before children can begin toilet training, they must reach the following
developmental levels.
 Control of rectal and urethral sphincters.
 Cognitive understanding of what it means to hold urine and stool until
they can release them at a certain place and time.
 Desire to delay immediate gratification.

15. B. Thumb Sucking
 It usually involves placing the thumb into the mouth and rhythmically
repeating sucking contact for a prolonged duration.
 It can also be accomplished with any piece of skin within reach (such as
the big toe) ad is considered to be soothing and therapeutic for the
person.
 At birth, babies will reflexively suck any object placed in its mouth; this is
the sucking reflex responsible for breastfeeding.
 As a child develops the habit, it will usually develop a “favorite” finger to
suck on, in much the same way it develops a favorite hand to write with.
It is not known if the preference for a hand to suck on affects
handedness in any way, or vice versa.
 Gradually stop the toddler from sucking his/her thumb. This behavior
usually stops by pre school years. If behavior persists, evaluate need for
attention, peer play.

16. C. Temper Tantrums
 Occur as a natural consequence of toddler’s development. Toddlers are
independent enough to know what they want; they do not have the
vocabulary or wisdom to express their feelings in a more socially
acceptable way.
 The child may kick, scream, stamp feet, shout, “No, no, no.”, lie on the
floor, flail arms and legs, and bang the head against the floor. Children
may even hold their breath until they become cyanotic and slump to
the floor.
 Tantrums are often the result of kids frustration with the world – they
can’t get something (for example, an object or a parent to do what they
want.
 Toddlers want a sense of independence and control over the
environment – more than they may be capable of handling. This creates
the perfect condition for power struggles as a child thinks “I can do it
myself” or “I want it, give it to me”. When kids discover that they can’t
and can’t have everything they want, the stage is set for a tantrum.

17.  Parents can manage temper tantrum by doing the following:
 Avoid abrupt end to play or making excessive demands.
 Offer only allowable choices.
 Once a decision is verbalized, avoid sudden changes of mind.
 Provide diversion to achieve cooperation.
 Ignore the outburst.
D. Discipline
 Discipline and punishment are not interchangeable terms. Discipline means
setting the rules so children will know what is expected of them.
Punishment is a result or consequence of disregard for the rules.
 Parents need to be consistent when setting the rules.
 Rules are learned best if the child’s right behavior is praised rather than
punishment of wrong behavior.
 Time-out is a technique for discipline. To use it effectively, parents must be
certain that children are aware of the rule that they are trying to enforce. If
they repeat undesired behavior, parent should select an area that is non-
stimulating such as a corner of a room or hallway. This is also called the
“time-out” space. The child must not return from that space until he/she
learns to be calm and quiet.

18. E. Separation Anxiety
 Fear of separation from parents; begins at 6 months and persists
throughout the preschool period.
 Most toddlers react best to separation if a regular babysitter is employed
or a day care center has consistent caregivers.
 When leaving a child, parents must say goodbye firmly, repeat the
explanation that they will be there the next morning.
ROLE OF THE NURSE IN THE CARE OF A FAMILY WITH A
HEALTHY/ILL TODDLER
AREA NURSING ACTIONS
Nutrition A special diet may limit typical finger foods. Use
imagination to offer other foods not usually eaten
this way as finger foods. Allow child to help pour
liquid diet for a tube feeding. Toddlers are frightened
by vomiting because they have no control over it.
Check for possibility of nausea; toddlers have no way
to express this other than by not eating.

19. AREA NURSING ACTIONS
Dressing Changes A child can hold pieces of tape or put tape in
place to maintain sense of control. The child can
remove an old bandage if it is not contaminated.
Allow the child to view his/her incision and watch
dressing changes; explaining each step of a
procedure as you perform, it helps the child
maintain control.
Restrain only those body parts necessary during a
procedure to allow a child sense of control.
Remove all supplies after a procedure, or the
child may “redo” the dressing.

20. AREA NURSING ACTIONS
Medication Do not give the children an option not to take
the medication.
Do not allow a child to choose a “chaser”, such as
milk or juice after oral medicine.
Do not ask a toddler to indicate a choice of site
for an injection or intravenous insertion; this is
too advanced a decision for a toddler to handle.
Rest Locate or create a ritual for bedtime (put child
into bed, tuck him in, say “Goodnight”. Tuck in
bear, say “Goodnight, bear”). Allow a choice of
toy or cover but not a choice of bedtime or
naptime hour.

21. AREA NURSING ACTIONS
Hygiene Let the child choose a toy that he/she can play
with during bath time.
Allow a child to wash face and hands to gain
control of the situation.
Allow the child to put toothpaste on a brush, but
you should brush or “touch up” teeth afterward
to ensure that all plaque has been removed.
Pain Encourage a child to express pain (say, “Ouch”
when I pull off the tape).
Help channel a child’s self expression to what is
acceptable (e.g. The child may shout but may not
kick).

22. AREA NURSING ACTIONS
Stimulation Provide a toddler with a toy that can be
manipulated, such as boxes that fit inside one
another and can be taken out again, tucks that
can be pushed, and pegs that can be pounded.
In a health care setting, items can usually be
found that fit together (boxes from central
supply or plastic vials from the pharmacy).
Another action toy: buy a non-latex balloon and
tie it to the crib side to be used as a punching
bag; another one to tie to the foot of the crib cab
serve as a leg exerciser.

23. AREA NURSING ACTIONS
Elimination A child who is toilet trained needs to be
encouraged to use a potty chair or toilet during
an illness.
Help children with ureter or bowel stomas to
help in changing bags so they are as
independent on bowel function as possible.
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