This document discusses the growth and development of toddlers from 1 to 3 years of age. It covers biological, psychosocial, cognitive, language, emotional and moral development. Key points include proportional physical growth milestones, fine and gross motor skill development, early language acquisition of 10-20 words by 18 months and 2-3 word phrases by 2 years, emergence of autonomy versus shame in psychosocial development, and pre-conventional morality. Common injuries for toddlers such as falls are also mentioned.

2. Growth & development of toddler
Presented by -
Swaraj Suman
Msc Nursing 1st year
AIIMS BBSR

3. Toddler
Toddler is of the developmental age group
from 1 year to 3 years of age.

4. Growth & development of toddler
 Biological development
 Psychosocial development
 Psychosexual development
 Cognitive development
 Moral development
 Spiritual development

5. Contd..
 Emotional development
 Language development

6. Biological development
Proportional changes
 Weight- Average weight gain is 1.8-2.7 kg
(4 -6 pounds) per year.
 Birth weight
-Tripled - 1 year Of age
- Quadrupled – 2 to 2 ½ years of age

7. Contd..
Height- 7.5 cm (3inches) per year
 Height of 2 years old child = 81-85 cm
 Expected height = age in years X 2 + 77
 Length doubles by – 4 to 5 years of age
 Length is recorded for children
• <2 years of age = Infantometer
• > 2 years of age = Stadiometer

9. Contd..
Head circumference
 Total increase in HC in 2 year = 2.5cm (1 inch)
 Then rate of increase slows till 5 yrs. of age.
• 2 cm per month for first 3 months
• 1cm per month between 3 to 6 month
• 0.5 cm per month for the rest of first year of life
• Macrocephaly – defined as occipitofrontal circumference
greater than 2 SD.( above the mean for age and sex).
• Microcephaly – defined as occipitofrontal circumference more
than 3 SD.( below the mean for age, sex, and gestation ).

13. Contd.
Chest circumference
 Continues to increases
 HC=CC?
After 2 years CC > HC

14. Contd.
MUAC
 It is used for the assessment of nutritional
status.
At birth 11 to 12 cm
 1 yr. =12-16cm
 1yr. to 5 yr. = 16-17cm

20. Wheech formula ( expected weight)

21. Calculation of percentages of malnutrition.(weight
for age )
Formula= Acutal weight/ expected weight X 100
Eg:- 2 year of child having weight is 8 kg.
 8/12 X100 = 66 % ( grade II malnutrition)

22. Dentition
Age Type Total no. of
teeth
Temporary teeth
12-15 months First molars 8-12
15-24 months canines 12-16
24-30 months Second
molars
16-20

23. Sensory changes
 Full binocular vision developed.
 Sense of hearing, smell, taste, and touch
become increasingly well developed,
coordinated with each other, & associated with
experiences.
 Development of specific taste preferences.

25. Maturation of systems
Integumentary system
Resistance of skin to infections and ability to
prevent fluid loss increased.
Eccrine sweat glands produce small amounts of
responses to warm temperature.
Fine body hairs begin to grow on the arms and
legs.

26. Contd..
Cardiovascular system
 Pulse , BP increases in toddler period.
 Blood vessels increases in size.
 Regulation of body temperature.

27. Contd..
Respiratory system
 Structures of respiratory tract increases in size
with increase in thoracic volume and hence
decrease in respiration rate.

28. Contd..
Gastrointestinal system
 Salivary glands reached maturity by the end of
the 2 years of age.
 Capacity increases but rapidity of food
passage through GI tract decreases.
 HCL production increases.

29. Contd.
Genitourinary system
 Maturation of kidneys by 2 years of age.
 Myelination of urethral sphincter.

30. Contd..
Immune system
Ig M reaches to adult level = 1st yr. Of later life
Ig G = middle of toddler period.

31. Contd..
Nervous system
 Brain reaches two third of its adult size at 2
years of age & three quarter by 3 years.
 Broca’s area developed.
 Motor control of extremities and sphincter.
 Myelination of spinal cord (able to stand , run,
jump).

32. GROSS MOTOR
• At 15 months
• Assume standing position without help
• Walk without support

33. Contd..
• Creeps up stairs
• Cannot throw ball without falling

34. GROSS MOTOR ( AT 18 MONTHS)
• Child able to run
• Climbs on furniture
• Pull and pushes toys

35. GROSS MOTOR(AT 24 MONTHS)
• Walk backward well
• Walks up & down stairs

36. GROSS MOTOR(30 MONTHS)
• Stand on one foot alone
• Walk up and down stairs

37. Rides a pedal car
Can throw ball overhead

38. GROSS MOTOR
Age Milestones
15 months Walks alone, creeps
upstairs
18 months Runs , explores drawers
2 years Walk up and downstairs
(2feet/ step) , jumps
3 years Rides tricycle , alternate
foot going upstairs

39. FINE MOTOR( AT 15 MONTHS)
• Builds a tower of 2-3 cubes
• Open boxes
• Poking fingers in hole
• Scribble spontaneously

40. FINE MOTOR( 18 MONTHS)
• Builds tower of 3- 4 cubes
• Imitates vertical lines
• Transfer object hand to hand at will

41. Contd…
Walk on tip toe
Jumps well in place
with both feet

42. FINE MOTOR (AT 24 MONTHS)
• Builds a tower of 6-7 cubes
• Imitates horizontal lines
• Turns pages of book one at time

43. FINE MOTOR (30 MONTHS)
• Makes horizontal & vertical lines( not able to join)
• Imitates circular strokes (good hand finger
coordination).
•
•
•
Holds crayon with fingers
Builds tower of 8 cubes

44. FINE MOTOR MILESTONES
Age Milestones
15 months Imitates scribbling, tower of 2
blocks
18 months Scribbles, tower of 3 blocks
2 years Towers of 6 blocks, vertical and
circular strokes
3 years Towers of 9 blocks, copies circle

45.  Towers of Cubes/ blocks= Age X 3
 Eg:-
Eg :-
 2 X 3 =6 (2 year baby can make 6
towers of cubes)
 3 X 3 = 9 ( 3 year baby can make
9 towers of cubes)
age No of blocks
15 m 2cubes
18 m 3 cubes

46. 18 months 24 months ( 2 year)
3 year 4 year
DRAWING SKILL AT VARIOUS AGES

47. At 15 months At 18 months-24 months 30 months
Feeding
skills
Hold with two
hands
• Manage spoon without
rotation
• Frequently spillage
• Remove simple garments
• Ready for bowel and
bladder control
• Verbalize toilet needs
occasional
spillage
Dressing
skills
stick out arm and
legs
Buttons &
unbuttons
one large
front button
Toileting
skills
May complain
when wet
day time
bladder
control but
beginning
night time
bladder
control.

49. LANGUAGE DEVELOPMENT
At 15 months At 18 months At 2 years At 3 years
• Uses
expressive
jargon (4- 6
words)
• Asks objects
by pointing
• Understands
simple
command
• May use
head-shaking
gestures
• Say 10 or
more words
• Form word
combinations
• Approximately
300 words.
• Use two or
three word
phrases.
• Uses I ,you
• Understand
directions
• Asks
question
s.
• Knows
name,
age, sex

50. EMOTIONAL DEVELOPMENT
• Separation anxiety
• fear

51. THEORIES OF DEVELOPMENT
 Psychosexual development
- Anal stages

52. PSYCHOSOCIAL DEVELOPMENT
 Autonomy v/s shame, doubt

53. COGNITIVE DEVELOPMENT
Sensorimotor (Birth to 2 years)
 Substage 5 (12 to 18 months)- tertiary circular
reaction
 Substage 6 ( 18 months to 2 years)- The invention of
new means through mental combinations.
Preoperational stage (2 to 7 years)
- The child begins to represent the world symbolically.

54. MORAL DEVELOPMENT
Pre conventional level-
Stage 0 ( birth to 2 yrs.) – What I like is
good.
Stage 1 ( 2 yrs. to 3 yrs.)
 Punishment-obedience-orientation

55. SPIRITUAL DEVELOPMENT
Intuitive projective faith

56. PLAY
• Parallel play

57. NEED OF THE TODDLER
 Around this age, the children will begin to understand the
cause and effect of doing so.
 They are able to follow simple commands. They have
specific likes and dislikes.
 In this state children need -
• Parental love
• Acceptance
• Proper nutrition
• Play stimulation
• Toilet training
• Immunization
• Safety
• Nutrition

58. COMMON INJURIES AND ACCIDENTS IN TODDLER

60. JOURNAL REVIEW
• Journal of child & adolescent behavior
• Author:- Butchon and liabsuetrakul, year- 2017, 5:1
The development and growth of children aged under 5 years in northeastern thailand: a
cross-sectional study
• Methods: A cross-sectional survey was conducted in the northeast of thailand during april-
september 2014.Seventy thai mothers aged less than 34 years who were admitted to the
postpartum ward of a regional hospital and their first child were included. Developmental delay
among their first children was assessed by the denver II, thai version.
• Results:- Children aged 36-62 months showed a higher delayed development, especially in the
gross motor domain. The prevalence of underweight and stunting were common among children
aged 12-35 months (6.2% and 15.6%, respectively) and wasting was higher among those aged 36-
62 months (5.3%). Hyperactivity and showing anger when displeased were common.
• Conclusion: A high prevalence of suspected delay was found among children aged 36-62 months.
Suboptimal growth was common among those 12-35 months. Early identification of
developmental delay and early interventions may have a substantial impact on financial,
educational, and social costs in the future.
•

61. • Parent report measures of infant and toddler social-emotional development:
a systematic review
• Author:- Maiken Pontoppidan (2017)
• Methods: We conducted a systematic review applying a narrative synthesis approach. We
searched Medline, PsychInfo, Embase for articles published from 2008 through
September 2015 to identify parent-report measures of infant and toddler social-emotional
development. Data on the characteristics of the measures, including psychometric data,
were collected.
• Results: Based on 3310 screened articles, we located 242 measures that were screened for
eligibility. In all 18 measures of infant and toddler social-emotional development were
included. Ten of the measures were developed specifically for measuring social-emotional
development, and eight were measures including subscales of social-emotional
development.
•
• Conclusions: Several measures of infant and toddler social-emotional development have
been developed within the last decade. The majority of psychometric data are available
through manuals, not peer-reviewed journals. Although all measures show acceptable
reliability, the most comprehensive and psychometrically sound measures are the Ages
and Stages Social-Emotional, Infant-Toddler Social and Emotional Assessment, Brief
Infant-Toddler Social and Emotional Assessment and Child Behaviour Checklist .

62. SUMMARY

63. QUIZ TIME

68. REFERENCES
Books:-
Terri Kyle, Susan Carman. Essential of pediatric nursing;
Growth and development of toddler,2nd ed. Wolter’s Kluwer
2013.Pg no-177-211
Wong’s, Essential of pediatric nursing; Developmental &
genetics influences on child health promotion,10th ed. Elsevier
publisher. Pg no-125-139
Marlow’s, Textbook of pediatric Nursing ; Normal toddler
growth ,development and care, south asian ed. Elsevier
publishers,2013 .pg no-583-611

69. OP Ghai , Essential pediatrics,Development,9th ed.
New Delhi, CBS publisher,2019 .pg no-44-49
Journals:-
 Maiken Pontoppidan et al., parent report measures of
infant and toddler;socio economic development, vol 2,
issue 34 , April 1 2017, page no.127-137.
 Butchon and liabsuetrakul, Journal of child and
adolescent behaviour, vol 1,issue 5 ,January 2017 .

70. websites:-
 https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/toddlers.
 https://raisingchildren.net.au/toddlers/development/development-tracker-1-3-
years/2-3-years
 https://www.parentingforbrain.com/parallel-play
 https://www.healthline.com/health/parenting