ثب صثwefe wef wefwefdzfzfsdfsddddddddsdf sdfewe weewwww weff s

1. Growth and development for
school age

2.  Middle childhood, ages 6 to 12 years, is probably one of the
healthiest periods of life.
 Slow, steady physical growth and rapid cognitive and social
development characterize this time.
 During these 6 years, the child’s world expands from the tight
circle of the family to include children and adults at school, at
a workship community, and in the community at large.
 The child becomes increasingly independent.
 Peers become more important as the child starts school and
gradually moves away from the security of home.

3.  The school-age child develops a sense of industry and learns
the basic skills needed to function in society.
 The child develops an appreciation‫تقدير‬ of rules and
conscience.‫الضمير‬ Cognitively, the child grows from the
egocentrism of early childhood to more mature thinking.

4.  The school-age years are characterized by slow and steady growth.
 The physical changes that occur during this period are gradual and subtle.
‫دقيق‬
 The average annual weight gain for a school-age child is approximately 3
to 5 lb (1.3 to2.2 kg); the increase in height is 1 to 2 in. (2.5 to 5 cm).
 School-age children appear thinner and more graceful ‫رش‬
‫ا‬
‫قة‬ than
preschoolers do.
 Children who did not lose a lordosis and knock-kneed appearance during
the preschool period lose this now.‫المرحلة‬ ‫هذه‬ ‫في‬ ‫ذألك‬ ‫فقدان‬ ‫يمكن‬
 Musculoskeletal growth leads to greater coordination and strength. The
muscles are still immature, however, and can be injured from overuse.

5.  By 10 years of age, brain growth is complete, so fine motor
coordination becomes refined.
 An adult vision level is achieved.
 The eruption of permanent teeth and growth of the jaw do not
correlate with final head growth, malocclusion with teeth
malalignment may be present.
‫سوء‬ ‫هناك‬ ‫يكون‬ ‫وقد‬ ،‫للرأس‬ ‫النهائي‬ ‫بالنمو‬ ‫الفك‬ ‫ونمو‬ ‫الدائمة‬ ‫األسنان‬ ‫ظهور‬ ‫يرتبط‬ ‫ال‬
‫األسنان‬ ‫اصطفاف‬ ‫سوء‬ ‫مع‬ ‫إطباق‬
 The immune globulins IgG and IgA each reach adult levels,
and lymphatic tissue continues to grow in size until about age
9 years.
 Frontal sinuses develop at about 6 years, so sinus headaches
become a possibility.

6.  The left ventricle of the heart enlarges to be strong enough to
pump blood to the growing body.
 Cleared heart murmurs may become apparent due to this extra
blood crossing heart valves.
 The pulse rate decreases to 70 to 80 beats/min.
 Blood pressure rises to about 112/60 mmHg.
 Maturation of the respiratory system leads to increase oxygen–
carbon dioxide exchange.

7. Sexual development
 The age at onset of puberty varies widely, and puberty is
occurring at an earlier age than previously .
‫الس‬ ‫عن‬ ‫مبكرة‬ ‫سن‬ ‫في‬ ‫البلوغ‬ ‫ويحدث‬ ،‫كبير‬ ‫بشكل‬ ‫البلوغ‬ ‫بداية‬ ‫عند‬ ‫العمر‬ ‫يختلف‬
‫ابق‬
 Onset of puberty is no longer unusual in girls who are 8 or 9
years old. On the average, African-American girls begin
puberty 1 year earlier than white girls and by age 8 years,
42.9% of African-American girls, as compared to 18.3% of
white girls, demonstrate‫يوضح‬ initial signs of pubertal
development.
 Menarche, the onset of menstruation, occurs, on average,
during the 12th year, however, with the decrease in the age of
puberty onset, the age at menarche is also likely to decrease.
‫مع‬ ،‫ذلك‬ ‫ومع‬ ،‫عشرة‬ ‫الثانية‬ ‫السنة‬ ‫خالل‬ ،‫المتوسط‬ ‫في‬ ،‫الحيض‬ ‫بداية‬ ،‫الحيض‬ ‫يحدث‬
‫الحيض‬ ‫​سن‬​​​ ‫ينخفض‬ ‫أن‬ ‫ا‬ً‫ض‬‫أي‬ ‫المحتمل‬ ‫من‬ ،‫البلوغ‬ ‫بداية‬ ‫سن‬ ‫انخفاض‬

8.  The brain become mature so , the hypothalamus transmits an
enzyme to the anterior pituitary gland to begin production of
gonadotropic hormones, ‫هرمونات‬
‫ا‬
‫التناسلية‬ ‫لغدد‬ which then activate
changes in the testes and ovaries to cause puberty.
 Timing of the onset of puberty varies widely, between 8 and 14
years of age partly due to genetic and cultural differences, and
is rated according to Tanner stages .
 Sexual maturation in girls usually occurs between the years of
12 and 18; in boys, between 14 and 20 years.
 This change in the onset of puberty is important because it
means, for sex education to be effective, parents or schools
must introduce this material as early as when their children are
in grade school. Precocious ‫النضوج‬ ‫مبكر‬ puberty is an abnormal
onset of puberty

9. Age in years Boys Girls
9—11yers  Prepubertal weight gain occurs.  Breasts: elevation of papilla with
breast bud formation; areolar diameter
enlarges. ‫الثدي‬ ‫برعم‬ ‫تكوين‬ ‫مع‬ ‫الحليمة‬ ‫ارتفاع‬
.
‫الهالة‬ ‫قطر‬ ‫يتضخم‬
11–12  Sparse‫متناثر‬ growth of straight,
downy, slightly pigmented hair at
base of penis.
 Scrotum becomes textured;
growth of penis and testes
begins.
 Sebaceous gland secretion
increases.
 Perspiration‫عرق‬ increases.
 Straight hair along the labia; vaginal
epithelium becomes cornified.
 pH of vaginal secretions become acidic;
slight mucous vaginal discharge is
present.
 Sebaceous gland secretion increases.
 Perspiration increases.
 Dramatic growth spurt.
12–13  Pubic hair present across pubis.
 Penis lengthens.
 Dramatic linear growth spurt.
‫دراماتيكية‬ ‫خطية‬ ‫نمو‬ ‫طفرة‬
 Breast enlargement may occur.
 Pubic hair grows darker; spreads over
entire pubis.
 Breasts enlarge, still no protrusion of
nipples.
 Axillary hair present.

10. • Epidermal keratinocytes undergo a unique
form of terminal differentiation and
programmed cell death known as
cornification. Cornification leads to the
formation of the outermost skin barrier, i.e.
the cornified layer, as well as to the formation
of hair and nails

11.  Concerns of Girls.
‫البنات‬ ‫اهتمامات‬
 Prepubertal girls are usually taller by about 2 in. (5 cm) or more than
preadolescent boys because their typical growth spurt begins earlier.
 A girl notices the change in her pelvic contour and her hips are
becoming broader.
 Early preparation for menstruation is an important preparation for
future childbearing ‫اإلنجاب‬and for a girl’s concept of herself as a
woman.
 A girl who is told menstruation is a normal function that occurs
every month in all healthy women has a different attitude toward her
body than a girl who wakes up one morning to find blood on her
pajamas and is told bluntly.‫بصراحة‬
 The girl may feel her body is out of control. she can accept and
enjoy growing up if it involves something so unpredictable?

12.  Should explain the reason for menstrual flow, girls need an
explanation of proper hygiene and reassurance they can bathe,
shower when their periods.
 Girls also need to know that vaginal secretions will begin to be
present. If this is not explained, a girl may fear unnecessarily she has
contracted an infection.
 Explain that any secretions that cause vulvar irritation ‫الفرج‬ ‫تهيج‬
should be evaluated by a healthcare provider because this does
suggest infection.
 Most girls have some menstrual irregularity during the first year or
two after menarche (the start of menstruation). This occurs primarily
because a girl’s cycles are at first anovulatory‫إباضة‬ With added
maturity and the onset of ovulation, cycles become more regular

13.  A girl may fear that irregular periods indicate a hormone imbalance.
She may worry about her future ability to conceive‫اإلنجاب‬ , or she
may be ill informed about how conception occurs and may fear
irregularity of her periods means that she is pregnant.
 Both malnourishment and obesity possibly influence menstrual
regularity.
 Emotions can also affect consistent‫ثابت‬ cycles..
 If irregularity continues beyond the first year, a careful history of the
girl’s nutrition; overall health; and school, social, and home
adjustment ‫المنزل‬ ‫تعديل‬should be taken.
 Dysmenorrhea, or painful menstruation should be discussed and how
to deal with this period to relive pain

14.  Concerns of Boys:
 Boys who are not prepared for the physical changes of puberty
worry about them in the same way as girls.
 Boys become aware of increasing genital size .
 If they do not know testicular development precedes‫يسبق‬ penis
growth, they can worry that their growth will be inadequate.
 Hypertrophy of breast tissue (gynecomastia) can occur in
prepubescent boys,‫البلوغ‬ ‫قبل‬ ‫األوالد‬ most often in those who are
obese. A youth with this condition may be concerned‫قلقان‬ a breast
tumor is present or may feel embarrassed about his growing
breasts.
 He can be assured that this is a transitory phenomenon and,
although it makes him self-conscious, will fade‫يختفي‬ as soon as
his male hormones become more mature and active.

15.  You can assure them that pubic hair normally appears first
and that chest and facial hair may not grow until several years
later.
 As increased seminal fluid begins to be produced, boys begin
to notice ejaculation‫القذف‬ during sleep, termed nocturnal
emissions.‫االحتالم‬
 Preadolescent boys may believe the old myth that loss of
seminal fluid is debilitating; also, boys may have heard the
term “premature ejaculation” and worry this is a forewarning
of a problem in years to come. Both are myths.
‫السائ‬ ‫فقدان‬ ‫بأن‬ ‫القائلة‬ ‫القديمة‬ ‫األسطورة‬ ‫المراهقة‬ ‫قبل‬ ‫ما‬ ‫مرحلة‬ ‫في‬ ‫األوالد‬ ‫يصدق‬ ‫قد‬
‫ل‬
‫مصطلح‬ ‫األوالد‬ ‫سمع‬ ‫ربما‬ ،‫ا‬ً‫ض‬‫أي‬ ‫منهك؛‬ ‫أمر‬ ‫المنوي‬
"
‫القذف‬ ‫سرعة‬
"
‫ويشعرون‬
‫القادمة‬ ‫السنوات‬ ‫في‬ ‫مشكلة‬ ‫من‬ ‫مسبق‬ ‫تحذير‬ ‫بمثابة‬ ‫هذا‬ ‫يكون‬ ‫أن‬ ‫من‬ ‫بالقلق‬
.
‫كالهما‬
‫أساطير‬

16. Components of Sex Education
 Basic anatomy and physiology.
 Body functions.
 Expected changes related to puberty.
 Menstruation, nocturnal emissions.‫واالحتالم‬ ‫الشهرية‬ ‫الدورة‬
 Reproduction.
 Teenage pregnancy.‫المبكر‬ ‫الحمل‬
 Human immunodeficiency virus (HIV) infection prevention.
 Sexually transmissible disease prevention.

17. Dental
 During this school-age years.
 All 20 primary (deciduous) teeth are lost and are replaced by
28 of the 32 permanent teeth.
 All permanent teeth, except the third molars, erupt‫تندلع‬ during
the school-age period.
‫المدرسة‬ ‫سن‬ ‫فترة‬ ‫خالل‬ ،‫الثالثة‬ ‫األضراس‬ ‫باستثناء‬ ،‫الدائمة‬ ‫األسنان‬ ‫جميع‬ ‫تظهر‬
 Most first-graders are characterized by a snaggle-tooth
appearance.
‫المتعرجة‬ ‫األسنان‬ ‫بمظهر‬ ‫األول‬ ‫الصف‬ ‫طالب‬ ‫معظم‬ ‫يتميز‬

18. A snaggle-tooth appearance.
Early school-age children typically have a missing upper
incisor as deciduous teeth are replaced by permanent teeth.
‫المتعرجة‬ ‫األسنان‬ ‫مظهر‬
.
‫المبكرة‬ ‫المدرسة‬ ‫سن‬ ‫في‬ ‫األطفال‬ ‫لدى‬ ‫يكون‬ ‫ما‬ ‫عادة‬
‫الدائمة‬ ‫باألسنان‬ ‫اللبنية‬ ‫األسنان‬ ‫استبدال‬ ‫يتم‬ ‫حيث‬ ‫مفقودة‬ ‫علوية‬ ‫قاطعة‬

19. Developmental milestones
 Motor Development:
 During the school years, coordination improves.
 A development sense of balance and rhythm allows children
to ride a two-wheeled bicycle, dance, skip, jump rope, and
participate in a variety of sports.

20. Age in
year
Physical development Psychosocial and cognitive
development
6years  year of constant motion; skipping‫تخطي‬
is a new skill; first molars‫ضروس‬ erupt.
First-grade teacher becomes authority
figure; adjustment to all-day school
may be difficult and may lead to
nervous manifestations of fingernail
biting, etc. Defines words by their use
(e.g., a key is to unlock a door, not a
metal object).
‫قد‬ ‫سلطة؛‬ ‫ذات‬ ‫شخصية‬ ‫األول‬ ‫الصف‬ ‫معلم‬ ‫يصبح‬
ً‫ب‬‫صع‬ ‫ا‬ ً‫أمر‬ ‫اليوم‬ ‫طوال‬ ‫المدرسة‬ ‫مع‬ ‫التكيف‬ ‫يكون‬
‫ا‬
،‫األظافر‬ ‫قضم‬ ‫مثل‬ ‫عصبية‬ ‫مظاهر‬ ‫إلى‬ ‫يؤدي‬ ‫وقد‬
‫ذلك‬ ‫إلى‬ ‫وما‬
7 years  Central incisors erupt;‫المركزية‬ ‫القواطع‬
difference between sexes becomes
apparent in play (e.g., video games vs.
dolls); spends time in quiet play.
 .Learns conservation (e.g., water
poured from tall container to a
wide, flat one is the same amount
of water); can tell time; can make
simple change.
‫الحفظ‬ ‫يتعلم‬
(
‫م‬ ‫المسكوب‬ ‫الماء‬ ،‫المثال‬ ‫سبيل‬ ‫على‬
‫ن‬
‫نفس‬ ‫هو‬ ‫ومسطح‬ ‫واسع‬ ‫وعاء‬ ‫إلى‬ ‫طويل‬ ‫وعاء‬
‫الماء‬ ‫كمية‬
)
‫أن‬ ‫يمكن‬ ‫الوقت؛‬ ‫معرفة‬ ‫يستطيع‬ ‫؛‬

21. Ages in year Physical development Psychosocial and cognitive
development
9 years  All activities done with friends  Friend or club age; a 9-year-old club
is formed to spite someone, has
secret codes, is all boy or all girl;
clubs disband and reform quickly.
10years  Coordination‫تناسق‬ improves  Ready for camp away from home;
collecting age; likes rules; ready for
competitive games.‫تنافسية‬ ‫ألعاب‬
11years  Active, but awkward and ungainly
‫المراس‬ ‫وصعب‬ ‫محرجا‬ ‫ولكن‬ ،‫نشط‬
 Insecure with members of opposite
sex; repeats off-color jokes.
12 years  Coordination improves.  A sense of humor ‫الدعابة‬ ‫حس‬ is
present; is social and cooperative.

22. Importance of Active Play
 Coordination and motor skills improve as the child is given an
opportunity to practice.
 Children should be encouraged to engage in physical activities.
 During the school-age years, children learn physical fitness
skills that contribute to their health for the rest of their lives.
 Team sports, such as soccer and baseball, provide
opportunities not only for exercise and improvement of motor
skills.
 Obesity has became a major problem in children in the United
States.

23.  By 7 years of age, children require more props ‫الدعائم‬for play
than when they were younger. To be a police officer. a 7-year-
old may need a badge and gun.
 Around 7 years of age, children also develop an interest in
collecting items such as baseball cards, dolls, rocks, or marbles
‫أو‬ ‫الصخور‬ ‫أو‬ ‫الدمى‬ ‫أو‬ ‫البيسبول‬ ‫بطاقات‬
‫الرخا‬
‫م‬
 Most girls and boys of this age also enjoy helping in the kitchen
with jobs such as making cookies and salads or frosting cakes.
 Many schools begin music lessons for children at about 9 years
of age.

24.  Nine years of age is also a time when children use social media.
 Many 10-year-olds spend most of their time playing screen
games. Boys and girls play separately at age 10 years, although
interest in the opposite sex is apparent.
 During their 10th year, children become very interested in rules
and fairness.‫اإلنصاف‬
 Club activities become structured, with a president, a secretary,
and rules of order
‫النظام‬ ‫وقواعد‬ ،‫وسكرتير‬ ،‫رئيس‬ ‫مع‬ ،‫منظمة‬ ‫النادي‬ ‫أنشطة‬ ‫تصبح‬
 Children age 11 and 12 years enjoy dancing and playing table
games

25.  Preventing fatigue and dehydration during long hours of play.
 Parent should know signs of fatique.irritability,and to encourage
rest period , increase fluid during day

26. Development of fine motor
 Balanced and hand eye coordination improve with maturity
and practice.
 Children take pride in activities that require skilled and fine
motor skills …..model building, playing musical instrument,
and drawing.
 Six-year-olds can easily tie their shoelaces. They can cut and
paste well and draw a person with good detail.

27. Fine motor development
 By 8 years of age, children’s eyes are developed enough so
they can read regular size type. This can make reading a
greater pleasure and school more enjoyable .
 Eight-year-olds are able to write script‫النصي‬ in addition to
print.
 They enjoy showing off this new skill in cards, letters, or
projects.
 By age 9 years, their writing begins to look mature and less
awkward. ‫محرج‬
 Reading and writing are fun. These are activities that can help
a child pass the hours during an illness.

28.  Older school-age children begin to evaluate their teachers’
ability and may perform at varying levels depending on each
teacher’s expectations.
 The middle school curriculum involves more challenging
science and mathematics courses than previously and includes
good literature.
 This may be a child’s first exposure to reading as a fulfilling
and worthwhile experience rather than just as an assignment
and may be the time a child is “turned on” to reading.
‫باالهتمام‬ ‫وجديرة‬ ‫رضية‬ُ‫م‬ ‫تجربة‬ ‫باعتبارها‬ ‫للقراءة‬ ‫للطفل‬ ‫تعرض‬ ‫أول‬ ‫هذا‬ ‫يكون‬ ‫قد‬
‫الذي‬ ‫الوقت‬ ‫هو‬ ‫يكون‬ ‫وقد‬ ،‫مهمة‬ ‫مجرد‬ ‫وليس‬
"
‫فيه‬ ‫يتحول‬
"
‫القراءة‬ ‫إلى‬ ‫الطفل‬

29. EMOTIONAL DEVELOPMENT
 Ideally, children enter the school-age period with the ability to
trust others and with a sense of respect for their own worth.
‫الث‬ ‫على‬ ‫بالقدرة‬ ‫يتمتعون‬ ‫وهم‬ ‫المدرسة‬ ‫سن‬ ‫فترة‬ ‫األطفال‬ ‫يدخل‬ ،‫المثالية‬ ‫الناحية‬ ‫ومن‬
‫قة‬
‫لقيمتهم‬ ‫باالحترام‬ ‫شعور‬ ‫ومع‬ ‫باآلخرين‬

30. Developmental Task: Industry Versus Inferiority
‫الدونية‬ ‫مقابل‬ ‫الصناعة‬
 learning a sense of industry or accomplishment.‫إنجاز‬
 If children are prevented from achieving a sense of industry or do
not receive rewards for accomplishment, they can develop a
feeling of inferiority‫الدونية‬ or become influenced‫تأثر‬ they cannot do
things they actually can do.
 These children can have difficulty tackling ‫معالجة‬ new situations
later in life (e.g., new job, new school, new responsibility).
because they cannot envision‫تصور‬ how they will be successful in
handling them. This can result in frustration‫إحباط‬ in school or work
activities

31. Cognitive development
 Intuitive thinking includes animism‫الروحانية‬ ‫يشمل‬ ‫الحدسي‬ ‫التفكير‬
 Centration.
 Egocentrism.‫األنانية‬
 Concrete operation stage.includs flexibility of thinking.
Problem solving .
 Attention span increase.
 Reversibility.5+3=8 8-5=3

32. Characteristic of preoperational thinking (to remember)
– Egocentrism ;-‫االنانية‬ views everything in relation to
self is unable to consider another point of view.
‫الذات‬ ‫حول‬ ‫التمركز‬
:
-
‫وجهة‬ ‫في‬ ‫النظر‬ ‫يستطيع‬ ‫وال‬ ‫بذاته‬ ‫يتعلق‬ ‫ما‬ ‫كل‬ ‫يرى‬
‫أخرى‬ ‫نظر‬
– Animism :- believes that inert objects are alive
and have wills of their own .
‫الروحانية‬
:
-
‫بها‬ ‫خاصة‬ ‫إرادات‬ ‫ولها‬ ‫حية‬ ‫كائنات‬ ‫الخاملة‬ ‫األجسام‬ ‫بأن‬ ‫تؤمن‬
– Irreversibility :- cannot see a process in reverse
order
– Magical thought :- believes that magical thought is
the cause of event.
– Centration :- tend to focus on only aspect of an
experience ignoring other possible alternatives.
‫الممكنة‬ ‫األخرى‬ ‫البدائل‬ ‫متجاهلة‬ ‫التجربة‬ ‫من‬ ‫الوحيد‬ ‫الجانب‬ ‫على‬ ‫التركيز‬ ‫إلى‬ ‫تميل‬

33.  The child move from the intuitive thinking ‫البديهي‬ ‫التفكير‬of the
preschool year to the logical operation of the school age years,
child gains new knowledge and develops more efficient
problem solving ability and greater flexibility of thinking.
 By age 8 years, the child moves into the stage of concrete
operational,‫الملموس‬ ‫التشغيل‬ ‫مرحلة‬ followed by the stage of
formal operational at around 12 years

34.  Cognitive development :
 The age from 5 to 11 years is a transitional stage where children
undergo a shift from the preoperational thought they used as
preschoolers to concrete operational thought or the ability to reason
through any problem they can actually visualize during school age .
 Children can use concrete operational thought because they learn
several new concepts during school age, such as:
Accommodation, the ability to adapt thought processes to fit what is
perceived such as understanding that there can be more than one reason
for other people’s actions.
 A preschooler might expect to see the same nurse in the morning who
was there the evening before, whereas a school-age child will
understand that different nurses work different shifts.

35.  Conservation,‫على‬ ‫الحفاظ‬ the ability to appreciate‫ِّر‬‫د‬َ‫ق‬ُ‫ي‬ that a change
in shape does not necessarily mean a change in size. If you pour
30 ml of cough medicine from a thin glass to a wide one.
 Example: the preschooler will say that one glass holds more than
the other; a school-age child will know that both glasses hold an
equal amount.
 Class inclusion, the ability to understand that objects can belong to
more than one classification.
 Example :A preschooler is able to categorize items in only one
way, for example, stones and shells ‫اصداف‬are found at the beach; a
school-age child can categorize them in many ways such as by
different materials or by a difference in sizes and shapes, not just
that they are found at the beach.

36.  These cognitive developments lead to some of the typical
changes ‫النموذجية‬ ‫التغييرات‬ and characteristics of the school-age
period.
 The ability to classify objects leads to the collecting activities
of the school-age period.
 Class inclusion is also necessary for learning mathematics and
reading, systems that categorize numbers and words.

37.  They can mentally retrace process ‫استرجاع‬ ‫عملية‬ a skill necessary
for understanding mathematical problem.
 Children can understand and use clock time at around age 8 years
and understand calendar time and memorize dates at age 9 years .
 An understanding of conservation of weight develop at 9 to 10
year, and an understanding of volume is present at 11 to 12 years.
‫عمر‬ ‫في‬ ‫الوزن‬ ‫على‬ ‫الحفاظ‬ ‫فهم‬ ‫يتطور‬
9
‫إلى‬
10
‫عمر‬ ‫في‬ ‫الحجم‬ ‫فهم‬ ‫ويتطور‬ ،‫سنوات‬
11
‫إلى‬
12
‫ا‬ً‫م‬‫عا‬
.

38. Concrete operations stage :- (7 or 8 year )
 Problem solving becomes more efficient and reliable as the
child learns how to form hypotheses , the use of symbolism
becomes more sophisticated, and children now can manipulate
symbols for thing in the way that they once manipulated the
things themselves.
‫الف‬ ‫تكوين‬ ‫كيفية‬ ‫الطفل‬ ‫يتعلم‬ ‫عندما‬ ‫وموثوقية‬ ‫كفاءة‬ ‫أكثر‬ ‫المشكالت‬ ‫حل‬ ‫يصبح‬
،‫رضيات‬
‫األشي‬ ‫برموز‬ ‫التالعب‬ ‫اآلن‬ ‫لألطفال‬ ‫ويمكن‬ ،‫ًا‬‫د‬‫تعقي‬ ‫أكثر‬ ‫الرمزية‬ ‫استخدام‬ ‫ويصبح‬
‫اء‬
‫بأنفسهم‬ ‫باألشياء‬ ‫قبل‬ ‫من‬ ‫بها‬ ‫يتالعبون‬ ‫كانوا‬ ‫التي‬ ‫الطريقة‬ ‫بنفس‬
 The child learn the alphabet and how to read, attention span
increase as the child grows older facilitating classroom
learning.

39. Classification and logic
 Older school age children are able to classify objects according
to characteristics they share to place things in a logical order
and to recall similarities and differences .
 Children love to collect and classify stamps, sticker, sports
cards, shells ‫الصدف‬, dolls, rocks, or anything imaginable,
school age children understand relationship such as larger and
smaller, lighter and darker.
 School age children move away from magical thinking as they
discover that there are logical physical explanation for most
phenomena.

40.  Conservation ‫المحافظة‬ .certain prosperities of object don’t
change simply because their order, form or appearance has
changed.eg…..amount of clay‫طين‬ .
‫الحفظ‬
:
‫مظهرها‬ ‫أو‬ ‫شكلها‬ ‫أو‬ ‫ترتيبها‬ ‫تغير‬ ‫لمجرد‬ ‫تتغير‬ ‫ال‬ ‫األشياء‬ ‫خصائص‬ ‫بعض‬
.
‫المثال‬ ‫سبيل‬ ‫على‬
…
..
‫الطين‬ ‫كمية‬
 Understanding of weight developed at 9 or 10 years.
 Volume is present at 11 or 12.

41.  Classification of logic:
 Older school children classify object according to
characteristics they share.
 Child love to collect and classify stumps ,stickers, sport cards
,dolls.
 Class inclusion …the concept that object can belong to more
than one classification.
 Sense of humor.‫مزاح‬

42. Spiritual and Moral Development
‫واألخالقية‬ ‫الروحية‬ ‫التنمية‬
 Piaget:
 Young school-age children obey rules because powerful, all-
knowing adults hand them down.
‫يعرف‬ ‫الذين‬ ‫األقوياء‬ ‫البالغين‬ ‫ألن‬ ‫بالقواعد‬ ‫المدرسة‬ ‫سن‬ ‫في‬ ‫الصغار‬ ‫األطفال‬ ‫يلتزم‬
‫ون‬
‫لهم‬ ‫يسلمونها‬ ‫شيء‬ ‫كل‬
.
 During this stage, children know the rules but not the reasons
behind them.
 Rules are interpreted in a literal way, and the child is unable to
adjust rules to fit differing circumstances‫الظروف‬ .
‫لتناسب‬ ‫القواعد‬ ‫تعديل‬ ‫من‬ ‫الطفل‬ ‫يتمكن‬ ‫وال‬ ،‫حرفية‬ ‫بطريقة‬ ‫القواعد‬ ‫تفسير‬ ‫يتم‬
‫المختلفة‬ ‫الظروف‬

43. Jean Piaget's theory of cognitive development
• Jean Piaget's theory of cognitive development
suggests that children move through four different
stages of learning. His theory focuses not only on
understanding how children acquire knowledge, but
also on understanding the nature of intelligence.
Piaget's stages are:
• Sensorimotor stage: Birth to 2 years
• Preoperational stage: Ages 2 to 7
• Concrete operational stage: Ages 7 to 11
• Formal operational stage: Ages 12 and up

44. Fostering Self-Esteem ‫الذات‬ ‫احترام‬ ‫تعزيز‬
 Give children household responsibilities according to their
developmental level and capabilities.
 Set reasonable rules, and expect the child to follow them.
 Allow your child to solve problems and make responsible
choices.
 Give praise ‫مدح‬ for what is praise worthy. Do not be afraid to
encourage your child to do better.

45. Sensory development
 Eyes fully developed by age 6.
 Growth spurt result in myopia .‫النظر‬ ‫قصر‬ ‫إلى‬ ‫تؤدي‬ ‫النمو‬ ‫طفرة‬
 Behaviors that parent notice squinting ‫العينين‬ ‫أحول‬ by:
 1- closing to T.V.
 2- complaint of frequent headache.
 Vision screening yearly should be done.

46. Hearing
 Annual audiometric screening tests are important to detect
hearing loss before unrecognized deficits lead to learning
problems.

47.  The concept of friendship changes as the child matures.
 At 6 and 7 years old, children form friendships merely‫د‬‫ر‬َ‫ج‬ُ‫م‬ on
the basis of who lives nearby or who has toys that they enjoy.
 By the time children are 9 or 10 years old, friendships are
based more on emotional bonds, warm feelings, and trust-
building experiences.

48. Kohlberg
Definition: Lawrence Kohlberg's Theory or Moral Development is a
sequential developmental theory in which the notions of adult experience
and moral development converge. Moral growth begins early in life and
continues in stages throughout adulthood until death
‫نظرية‬
‫كولبرج‬
‫الب‬ ‫تجربة‬ ‫مفاهيم‬ ‫فيها‬ ‫تتالقى‬ ‫متسلسلة‬ ‫تطورية‬ ‫نظرية‬ ‫هي‬ ‫األخالقي‬ ‫التطور‬ ‫أو‬
‫الغين‬
‫األخالقي‬ ‫والتطور‬
.
‫طوال‬ ‫مراحل‬ ‫على‬ ‫ويستمر‬ ‫الحياة‬ ‫من‬ ‫مبكر‬ ‫وقت‬ ‫في‬ ‫األخالقي‬ ‫النمو‬ ‫يبدأ‬
‫الموت‬ ‫حتى‬ ‫البلوغ‬ ‫مرحلة‬
 Kohlberg describes children between ages 7 and 12 years as being in
stage 3 of the conventional level .‫التقليدي‬ ‫المستوى‬
What is the conventional stage?
At the conventional level, conformity to social rules remains important to
the individual. However, the emphasis shifts from self-interest to
relationships with other people and social systems.
 A “good-boy” or “good-girl” or orientation characterizes this stage, in
which the child conforms to rules to please others and avoid
disapproval.‫الرفض‬

49. Family Influence‫تأثير‬
 Children manifest antisocial behaviors during middle
childhood. Behaviors such as cheating, ‫الغش‬lying, and stealing
are not uncommon.
 Parents and teachers profoundly influence moral development.
‫األخالقي‬ ‫التطور‬ ‫على‬ ‫عميق‬ ‫بشكل‬ ‫والمعلمون‬ ‫اآلباء‬ ‫يؤثر‬
 Parents can teach children the difference between right and
wrong most effectively by living according to their values.

50. Spirituality and Religion
 Spiritually, school-age children become acquainted with the
basic content of their faith.
‫األساسي‬ ‫المحتوى‬ ‫على‬ ‫المدرسة‬ ‫سن‬ ‫في‬ ‫األطفال‬ ‫يتعرف‬ ،‫الروحية‬ ‫الناحية‬ ‫ومن‬
‫إليمانهم‬
.
 Children reared within a religious tradition feel a part of their
religion.
‫الذين‬ ‫األطفال‬ ‫يشعر‬
‫ينشأون‬
‫دينهم‬ ‫من‬ ‫جزء‬ ‫بأنهم‬ ‫الدينية‬ ‫التقاليد‬ ‫ضمن‬
.

51. Nutritional Requirements
 Growth continues at a slow, regular pace,‫منتظمة‬ ‫وتيرة‬ but the
school-age child begins to have an increased appetite.
 Energy needs increase during the later school-age years.
 Children in this age-group tend to have few eating
idiosyncrasies ‫الخصوصيات‬ and generally enjoy eating to satisfy
appetite and as a social function.

52.  Dietary recommendations for school-age children include
2 ½ cups of variety of vegetables;
 1 ½ cups of variety of fruits; ‫الفواكه‬ ‫من‬ ‫متنوعة‬ ‫مجموعة‬
.
 5 ounces of grains ‫الحبوب‬ ‫من‬ ‫أوقية‬ (half of which should be
whole grain);
 5 ounces of protein (lean meat, poultry‫دواجن‬, fish, beans);
and 3 cups of fortified nonfat milk or dairy products.

53. A Vegetarian Diet
 School-age children who are vegetarians or vegans‫نباتيين‬ need to
learn how to obtain essential nutrients whether they pack their lunch
or purchase ‫شراء‬ it at school.
 The consumption of adequate protein and calcium is important for
muscle, bone, and dental development.
 Foods highest in calcium are green leafy‫الورقية‬ vegetables such as
spinach and turnip‫اللفت‬ greens, enriched bread, and cereals.
Soybeans,‫الصويا‬ ‫فول‬ legumes,‫البقوليات‬ grains‫بقوليات‬, and immature
seeds such as green beans, lima beans‫الفاصوليا‬, and corn are relatively
high in protein.
 Encourage outside activities for sun exposure to increase vitamin D.

54.  Dental Care
 Malocclusion: Good occlusion, or alignment, of the teeth is
important for tooth formation, speech development, and physical
appearance.
 Many school-age children need orthodontic braces
‫التقويمية‬ ‫األقواس‬to correct malocclusion, a condition in which is the
teeth are crowded,, crooked‫ملتوية‬ or out of alignment.
 Factors such as
 Heredity.
 Cleft palate.
 Premature loss of primary teeth, and mouth breathing lead to
malocclusion.
 Thumb sucking is not believed to cause malocclusion unless in
persists past age 5 or 6 years.

55. • Preventing Dental Injuries.
• Dental Health Education.

56.  PROMOTING DEVELOPMENT OF A SCHOOL-AGE
CHILD INDAILY ACTIVITIES.
 Dress:
 Although school-age children can fully dress themselves, they
are not skilled at taking care of their clothes until late in the
school-age years.
 School-age children have definite opinions about clothing
styles, often based on the likes of their friends, a popular sport,
or a popular musician ‫موسيقي‬ rather than the preferences of
their parents.

57.  Sleep and Rest:
 The number of hours spent sleeping decreases as the child
grows older.
 Children ages 6 and 7 years need about 12 hours of sleep per
night. Some children also continue to need an afternoon quiet
time or nap to restore energy levels.
 Occasionally, school-age children have sleep problems, most
commonly sleepwalking and sleep terrors ‫الرعب‬ (night terrors).
Both conditions occur during deep sleep.
 Most 6-year-olds are too old for naps but do require a quiet time
after school to get them through the remainder of the day.
 Nighttime terrors may continue during the early school years
and may actually increase during the first-grade year as a child
reacts to the stress of beginning school.

58. Discipline: ‫تأديب‬
 Firm, consistent limits increase children’s sense of security
and reinforce ‫تعزز‬ the message that an adult cares about them.
‫التي‬ ‫الرسالة‬ ‫وتعزز‬ ‫باألمان‬ ‫األطفال‬ ‫شعور‬ ‫من‬ ‫تزيد‬ ‫والمتسقة‬ ‫الصارمة‬ ‫الحدود‬ ‫إن‬
‫بهم‬ ‫يهتم‬ ‫البالغ‬ ‫الشخص‬ ‫أن‬ ‫مفادها‬

59.  Safety.
 Car safety.
 Fire and burn safety.
 Bicycle , in-line skating scooter, ‫التزلج‬ ‫سكوتر‬ and Skateboard‫تزلج‬ ‫لوح‬
Safety.
 Pedestrian ‫مشاة‬ Safety. ‫المشاة‬ ‫ممر‬
 Water Safety.
 Patient –Centered Teaching

60.  Parent should help adjust the belts so that the lap belt fits snugly
over the bony pelvis and the shoulder harness is positioned
across the chest.
 Fire Safety Rules:
 1- Know two specific escape routes from each area in the home .
 2- Know how to access number.
 3- Have a predetermined meeting area outside the house .
 4- Never return to a burning house.
 5- Practice fire drills.‫الحرائق‬ ‫على‬ ‫التدريبات‬ ‫ممارسة‬
 6- Parent need to invest the time to teach their children how to
use tools and appliances ‫األجهزة‬ properly and must establish
guidelines to avoid burn injuries as a result of the child
inexperience.

61.  Bicycle safety practices actually begin when the child learns to
ride a tricycle and progressively build as the child becomes more
skilled and begins to ride a bicycle , a helmet ‫خوذة‬ and other
safety accessories are essential for protection .
 Helmet and protective pads covering knee and elbows help to
protect the most vulnerable area of the child body from serious
injury .

62. Pedestrian safety ‫المشاة‬ ‫سالمة‬
 Between the ages of 5, and 9 years at the greatest risk for auto
pedestrian injuries. ‫السير‬ ‫حوادث‬
 Children are commonly struck ‫أصابت‬when they dart into traffic ,
especially where parked cars obscure the drivers view of the
child e .g crossing the street in front of a school bus playing near
cars in driveways or yards.

63.  Children in this age group have the misconception that if they
can see the car the driver must be able to see them and will be
able to stop instantly.
 Children learn traffic safety by watching and doing exposure
to traffic increase as the child begins to walk to and from
school and friends house

64.  Water Safety
 To swim well enough to keep their head above water for a
short time at about 8 years old.
 Advise parents to teach children to wade ‫الخوض‬ into shallow
water or to jump feet first into water of unknown depth to
prevent neck injuries .
 Safety near the water includes never running pushing or
jumping on other who are in the water.

65.  Selected Issue related to school-age.
 Peer influence. ‫األقران‬ ‫تأثير‬
.
 Influence of teachers.
 Parent’s Role.
 School refusal.
 Helping a child overcome school refusal.
‫المدرسة‬ ‫رفض‬ ‫على‬ ‫التغلب‬ ‫على‬ ‫الطفل‬ ‫مساعدة‬

66. Adjustment to school ‫المدرسة‬ ‫مع‬ ‫التكيف‬
 Most children are ready to start school particularly if they
have older sibling, children starting school may be a
frightening experience , even children who have attended
preschool have some anxiety about beginning first grade.
 Adjustment to school depends on a variety of factors
including the child physical and emotional
 Maturity, the child experiences, and the parents ability to
support the child accept the separation
 From peers children learn how to cooperate, compete,‫المنافسة‬
bargain, ‫مساو‬
‫ا‬
‫ة‬ and follow rules.
 Peer approval is of major importance as children look to their
friends for recognition ‫ف‬ ُّ‫تعر‬and support.

67.  An effective teacher makes learning fun and capitalizes on the
child interests and talent .‫المواهب‬
 Teacher guide the child learning by rewarding ‫مجزي‬ success
and helping the child learn from and deal with failures.
 The teacher plays an important role in preventing feeling of
inferiority ‫الدونية‬ in the child .
 By structuring the learning environment so that the child
experiences success the teacher bolsters ‫يعزز‬ feelings of
industry.
 The child must create and adhere to a schedule for completing
large assignments to prevent last minute panic.‫ذعر‬

68.  The television should be turned off during study time and
distractions kept to a minimum, adequate sleep is
important for school performance.
 School Refusal
 School refusal is a descriptive term for behavior that may
indicate the presence of a specific phobia separation
anxiety truancy ‫المدرسة‬ ‫عن‬ ‫التغيب‬ or social phobia.
 School phobia need to be defined both symptomatically
and operationally to determine if its cause is related to
anxiety .

69.  Some school refusing children show specific fears of school or
school related situation ( tests, Bullies, ‫المتنمرون‬ teacher
reprimands,‫التوبيخ‬ undressing for gym ‫رياضي‬ ‫)نادي‬ .
 Children may go to school unwillingly ‫مضض‬ ‫على‬or may refuse
and have temper tantrum‫غضب‬ ‫نوبة‬ if the parent insist on taking
the child to school , younger children may complain of
 stomachaches.
 Headache.
 nausea, and vomiting .
 Other children may complain of
 palpitation .
 feeling faint, these symptoms typically resolve when the child
returns home

70.  Self-care children:
 Children who take care for themselves like dressing ,cleaning
.eating ,and bathing after school while left alone .
 The number of children who let themselves into their home
after school and are left alone to continue to grow as the
number of dual ‫مزدوج‬ income and single parent families
increase. Potential positive outcome are learning to be
independent and responsible.
 Nurse help families by offering support and education to
parent to reduce the risks for self-care children.

71.  Obesity:
 can be a precursor ‫نذير‬ of hyperlipidemia, sleep apnea,
orthopedic problems hypertension and diabetes.
 Risk factors:
 Cultural
 genetic
 behavioral environmental socioeconomic factors are linked to
obesity.
 Assessing the scope of the problem: caused by increased
calories intake, decreased physical activity.
 Prevention: Regular exercise healthy eating habit .

72.  How to prevent and manage Obesity:
 1- Do not use food as a reward.‫مكافأة‬
 2- Establish consistent times for meals and snacks and discourage
in-between eating.
 3- Offer only healthy food options (ask the child to chose between
an apple or popcorn,‫الفشار‬ not an apple or a cookie ‫بسكويت‬.
 4- Avoid keeping unhealthy food in the house and minimize trips
‫رحالت‬ to fast-food restaurants.
 5- Be a role model by improving your own eating habits and levels
of activity.

73.  Stress:
 Source of Stress in children:
 1- School pressure.
 2- Physical threats.
 3- Competitive sports. ‫التنافسية‬ ‫الرياضات‬
.
 4- Tight schedules and adaptation overload.
 5-Family pressure.
 6- Media influence.‫اإلعالمي‬ ‫التأثير‬
 7- Peer Victimization.‫األقران‬ ‫إيذاء‬

74.  Peer victimization
 Often called bullying‫تنمر‬ is a problem for school age children.
 Strategy to deal with it:
 ( speak up.
 walk away.‫بعيدا‬ ‫امش‬
 tell someone, don’t react ‫ال‬ ،‫أحدا‬ ‫أخبر‬
‫تهتم‬ ).

75. Growth And Development
During Early Childhood

76. Growth And Development During
Early Childhood( Toddler)

78.  The toddler years are characterized by struggle‫كفاح‬ for autonomy
as the child developed a sense of self separation from the parent ,
toddler explore the environment and master new skills .
 Toddler egocentric and demanding behavior , often marked by
temper tantrums and negativism, have given this age the label the
terrible twos. ‫الغضب‬ ‫بنوبات‬ ‫يتسم‬ ‫ما‬ ‫ا‬ً‫ب‬‫غال‬ ،‫والمتطلب‬ ‫األناني‬ ‫الطفل‬ ‫سلوك‬
‫الع‬ ‫هذا‬ ‫أعطى‬ ،‫والسلبية‬
‫م‬
‫الرهيبة‬ ‫الثنائيات‬ ‫تسمية‬ ‫ر‬
 Parental guidance is needed to handle the negativism, temper
tantrums,،‫الغضب‬ ‫نوبات‬ and sibling rivalry ‫األشقاء‬ ‫تنافس‬ that are
characteristic of this age group.
 The preschooler becomes increase independent mastering many
self care and motor skills And developing greater social and
emotional maturity , imagination , creative. ‫مبدع‬

79. Physical Growth and Development
• The Toddler:-
• Weight gain is 2.5 kg /year .
• Body mass index (BMI) screening is completed at 24 months
to identify toddlers who are overweight or underweight.
• A child birth weight has quadrupled by age 2 to 3 years .
• Height (12 cm) a year during the toddler period
• Height average 7.5 cm /years .
• Head circumference increase 2 cm during the toddler years
,compared with the growth of 12 cm in the first 12 month .
• , chest circumference should have grown greater than that of
the head.

80. • Body contour:
• Immature abdominal musculature give the toddler a
potbellied appearance ‫بطن‬ ‫مظهر‬. Toddlers tend to have a
prominent abdomen.
• With an exaggerated lumber curve the child short legs
appear slightly bowed, and the feet seem flat because of
a plantar fat pad that disappears around the age of 2
years .
• They also have a forward curve of the spine at the sacral
area (lordosis). As they become more experienced at
walking, this will correct itself naturally.

81. Toddler a potbellied appearance . Toddlers tend to have a
prominent abdomen because their abdominal muscles are not yet
strong enough to support abdominal contents as well as they will
be able to do later

82. Bowes legs in toddler

83. Lordosis in toddler (have a forward curve of the
spine at the sacral area (lordosis).

84. • Body Systems:
• Body systems continue to mature during this time.
 • Respirations slow slightly but continue to be mainly
abdominal.
 • Heart rate slows from 110 to 90 beats/min.
 • Blood pressure increases to about 99/64 mmHg.
 • The brain develops to about 90% of its adult size.
 • In the respiratory system, the lumens of vessels
enlarge progressively so the threat of lower respiratory
infection lessens.

85.  • Stomach secretions become more acid; therefore,
gastrointestinal infections also become less common.
 • Stomach capacity increases to the point a child can eat
three meals a day.
 • Control of the urinary and anal sphincters becomes
possible with complete.
 myelination of the spinal cord so toilet training is
possible.
 • Immune globulin (Ig)G and IgM antibody production
becomes mature at 2 years of age.
 The passive immunity obtained during intrauterine life is
no longer operative.

86.  Teeth:
 Eight new teeth (the canines and the first molars) erupt during the
second year. ‫جديدة‬ ‫أسنان‬ ‫ثمانية‬ ‫تظهر‬
(
‫األولى‬ ‫واألضراس‬ ‫األنياب‬
)
‫الثانية‬ ‫السنة‬ ‫خالل‬
 All 20 deciduous ‫المتساقطة‬ teeth are generally present by 2.5 to 3 years
of age.
 Deciduous teeth play an important role in the growth and
development of the jaws and face and in speech development ,
premature loss of the deciduous teeth complicated eruption of the
permanent teeth. ‫الدائمة‬ ‫االسنان‬

87. All 20 deciduous teeth are generally present
by 2.5 to 3 years of age.

88.  Growth spurts ‫طفرات‬ are short periods of time when the child
experiences quick physical growth in height and weight.
 Growth spurts are a normal part of child's development and
occur at different stages of their childhood until they reach
physical maturity.

89. Acceleration : ‫تسارع‬

90.  Developmental milestones: are a set of functional skills or age-
specific tasks that most children can do at a certain age range.
 Some children achieve their developmental milestones earlier
and some later than other children. Some are able to speak earlier
than others, but walk later.
 Most developmental delays in children are not serious, and
children eventuallyً‫ا‬‫مؤخر‬ catch up with their peers. However, if a
more serious delay or a disability is present, providing help early
is important in helping the child reach his full potential.‫محتمل‬


91.  Knowing the developmental milestones for different ages
helps parents, teachers, and healthcare professionals
understand normal child development and also aids in
identifying potential problems with delayed development.
 Developmental delays :exist when a child does not reach
his/her milestones at about the same time as other children the
same age.

92. • The developmental milestones of the toddler years are
less numerous but no less dramatic than those of the
infant year because this is a period of slow and
steady, not sudden, growth.
‫أ‬ ‫ليست‬ ‫ولكنها‬ ً‫ا‬‫عدد‬ ‫أقل‬ ‫الصغار‬ ‫األطفال‬ ‫سنوات‬ ‫في‬ ‫التنموية‬ ‫المعالم‬ ‫إن‬
‫قل‬
‫بطيء‬ ‫نمو‬ ‫فترة‬ ‫هذه‬ ‫ألن‬ ‫الرضيع‬ ‫بسنوات‬ ‫الخاصة‬ ‫تلك‬ ‫من‬ ‫دراماتيكية‬
‫ا‬ً‫ئ‬‫مفاج‬ ‫وليس‬ ،‫وثابت‬
• Toddler development is influenced to some extent by
the amount of social contact and the number of
opportunities children have to explore and experience
new degrees of independence

93. DEVELOPMENTAL MILESTONES for toddler
• 15 months Fine Motor:
• Puts small pellets‫الكريات‬ into small bottles.
• Scribbles voluntarily with a pencil or crayon.‫تلوين‬ ‫قلم‬ ‫أو‬ ‫رصاص‬ ‫بقلم‬ ‫طواعية‬ ‫الشخبطة‬
• Holds a spoon well but may still turn it upside down on the way to mouth.
• Binocular vision is well established by age 15 months. Visual acuity is
about 20/40 by 2 years of age.
• Gross Motor:
• Walks alone well;
• can seat self in chair; can creep up stairs .
• Learning to walk well is the crowing‫صياح‬ achievement of the toddler, take a
few steps, fall, and repeat the process over and over oblivious‫غافل‬ to bumps
and bruises.‫كدمات‬
• Language :
• 4-5 words.
• Play.
• Can stack two blocks; enjoys being read to; drops toys for adult to recover
(exploring sense of permanence
• ‫كتلتين‬ ‫تكديس‬ ‫يمكن‬
.
‫للتعافي‬ ‫للكبار‬ ‫ألعاب‬ ‫إسقاط‬ ‫له؛‬ ‫بالقراءة‬ ‫يستمتع‬
(
‫بالديمو‬ ‫الشعور‬ ‫استكشاف‬
‫مة‬

94. Puts small pellets into small bottles.

95. Can stack two blocks

96. Scribbles voluntarily with a pencil or crayon.

97.  18months fine motor :
 No longer rotates a spoon to bring it to mouth .
 Gross motor :
 Can run and jump in place.
 can walk up and down stairs holding onto a person’s hand or
railing; typically places both feet on one step before
advancing.‫دربزين‬

99. • Language development :
• 7–20 words; uses jargoning ‫;المصطلحات‬ names one body
part.
• Urge parents to encourage language development by
naming objects (e.g., ball, block,‫حاجز‬ music box, doll) as
they play with their child or when they give the toddler
something (“Here is your drink of water,” “Let’s put on
these pajamas,
• Play:
• Imitates household chores such as dusting; begins
parallel play (playing beside, not with, another child)
‫المتوازي‬ ‫اللعب‬ ‫يبدأ‬ ‫الغبار؛‬ ‫إزالة‬ ‫مثل‬ ‫المنزلية‬ ‫األعمال‬ ‫يقلد‬
(
‫معه‬ ‫وليس‬ ‫آخر‬ ‫طفل‬ ‫بجانب‬ ‫اللعب‬
)

100. parallel play (playing beside, not with, another
child)

101.  24months fine motor:
 Can open doors by turning doorknobs; unscrew lids . ‫األغطية‬ ‫فك‬
.
 Gross motor :
 Walks up stairs alone, still using both feet on same step at same time.
 By 24 months can put on simple items of clothing but cannot differentiate front to
back, also can zip large zippers ‫الكبيرة‬ ‫السوستة‬ put on shoes ,and wash and dry their
hands.
 Two years old brush their teeth but need help in adequately removing plaque.
 Feeding, dressing and play provide opportunities for the child to development
autonomy.
 Language:
 50 words; two word sentences (noun or pronoun and verb), such as “Daddy
go,” “Dog talks” .
 Play:
 Parallel play evident
‫واضح‬ ‫الموازي‬ ‫اللعب‬

102. Can open doors by turning doorknobs;
unscrew lids .

103. Child proof door

104.  30 months:Fine motor :
 Makes simple lines or strokes for crosses with a pencil.
‫رصاص‬ ‫قلم‬ ‫باستخدام‬ ‫للصلبان‬ ‫بسيطة‬ ‫ضربات‬ ‫أو‬ ‫ا‬ً‫ط‬‫خطو‬ ‫يرسم‬
 Gross motor:
 Can jump down from chairs
 Language:
 Verbal language increasing steadily; knows full name; can name one color
and holds up fingers to show age
 Play:
 Spends time playing house, imitating parents’ actions; play is
“roughhousing” or active
‫اللعب‬ ‫الوالدين؛‬ ‫تصرفات‬ ‫وتقليد‬ ،‫بالمنزل‬ ‫اللعب‬ ‫في‬ ‫ا‬ً‫ت‬‫وق‬ ‫يقضي‬
"
‫خشن‬
"
‫نشط‬ ‫أو‬

105. Jump from chairs

106. Emotional Development
• 1-Autonomy: Erikson.
• The developmental task of the toddler years according to Erikson
is the development of a sense of autonomy versus shame or
doubt. ‫الشك‬ ‫أو‬ ‫الخجل‬ ‫مقابل‬ ‫باالستقاللية‬ ‫الشعور‬
• Children who have learned to trust themselves and others during
the infant year are better prepared to do this than those who have
not learned to trust themselves or others.
• To develop a sense of autonomy is to develop a sense of
independence.
• A healthy level of autonomy is achieved when parents are able to
balance independence with consistently sound rules for safety..
• The senses and motor abilities of the toddler do not function
independently of one another
‫البعض‬ ‫بعضها‬ ‫عن‬ ‫مستقل‬ ‫بشكل‬ ‫الطفل‬ ‫لدى‬ ‫الحركية‬ ‫والقدرات‬ ‫الحواس‬ ‫تعمل‬ ‫ال‬
• Tow year-old toddlers reach, grasp,‫يمسك‬ inspect, smell, taste, and
study objects with their eyes.

107. • Socialization:
 Once toddlers are walking well, they become resistant to sitting
in laps ‫حضن‬and being cuddled.‫يحتضن‬ This is not lack of a
desire for socialization but a function of being independent
 At 15 months, children are still excited ‫متحمس‬about interacting
with people, providing those people are willing to follow them
where they want to go.
‫على‬ ‫األشخاص‬ ‫هؤالء‬ ‫يكون‬ ‫أن‬ ‫بشرط‬ ،‫الناس‬ ‫مع‬ ‫للتفاعل‬ ‫متحمسين‬ ‫األطفال‬ ‫يزال‬ ‫ال‬
‫الذهاب‬ ‫يريدون‬ ‫حيث‬ ‫لمتابعتهم‬ ‫استعداد‬
 By 18 months, toddlers imitate ‫التقليد‬the things they see a parent
doing, such as “study” or “sweep,”‫تمشيط‬ so they seek out
parents to observe and imitate.
 . By 2 or more years of age, children become aware of gender
differences and may point to other children and identify them
as “boy” or “girl

108.  3-Play Behavior:
 Play is the work of a toddler. Through play, toddlers learn how
to manipulate and understand their environment, socialize, and
explore their world.
 All during the toddler period, children play beside other
children, not with them. This side-by-side play (parallel play)
is not unfriendly but is a normal developmental sequence that
occurs during the toddler period.
 Toddlers prefer pots and pans from the kitchen, supervised
water play, dancing to music, and crayons or finger paint and
paper.

109. • The toys toddlers enjoy most are those they can play with by
themselves and that require action. Trucks they can make
go, rocking horses they can ride, ‫وخيول‬ ،‫تشغيلها‬ ‫يمكنهم‬ ‫شاحنات‬
،‫ركوبها‬ ‫يمكنهم‬ ‫هزازة‬
• These are all toys children can control, giving them a sense
of power in manipulation,‫بارعة‬ ‫معالجة‬ which is an expression
of autonomy

110. The best play pots‫األواني‬ and pans ‫المقالي‬from the
kitchen

111.  At 15 months of age, children are still continue to enjoy stacks
of boxes that fit inside each other. They enjoy throwing toys
out of a playpen or from a high chair tray as long as someone
will pick them up and return them again and again.
 By age 2 years, when toddlers begin to spend time imitating
adult actions in their play such as wrapping a doll‫دمية‬ ‫تغليف‬
and putting it to bed or “driving the car,” they begin to use fewer
toys than before.
 By the end of the toddler period, both boys and girls begin to
like roughhousing and spend at least part of every day in this
very active, stimulating type of play Encouraging parents to
schedule this type of play outdoors,
‫الخشن‬ ‫اللعب‬ ‫حب‬ ‫في‬ ‫والبنات‬ ‫األوالد‬ ‫من‬ ‫كل‬ ‫يبدأ‬ ،‫الصغير‬ ‫الطفل‬ ‫فترة‬ ‫نهاية‬ ‫بحلول‬
‫للغاية‬ ‫والمحفز‬ ‫النشط‬ ‫اللعب‬ ‫من‬ ‫النوع‬ ‫هذا‬ ‫في‬ ‫يوم‬ ‫كل‬ ‫من‬ ‫األقل‬ ‫على‬ ‫ا‬ً‫ء‬‫جز‬ ‫ويقضون‬
.
،‫الطلق‬ ‫الهواء‬ ‫في‬ ‫اللعب‬ ‫من‬ ‫النوع‬ ‫هذا‬ ‫جدولة‬ ‫على‬ ‫اآلباء‬ ‫تشجيع‬

112. Imitating adult actions

113. Psychosexual development
 At18 months toddler enter Freud's anal stage , that as children
focus on mastery of bowel and bladder function , also directed
to the genital area .
 By 2year child aware gender .
 By 3year can correctly identify anatomic pictures of boys and
girls .
 Encouraging parent to make traditional gender typed toys
available to both boys and girls .
 In most cultures boys and girls are treated differently and thus
are taught male and female behaviors .
 Sex play and masturbation ‫االستمناء‬ are common in toddler .

114.  Nursing can reassure parent that self exploration or exploration
of another toddler body is normal behavior during early
childhood.
 When parent discover children involved in sex play casually
telling them to dress and directing them to another activity can
limit sex play without producing feeling of sham or anxiety
‫إخبارهم‬ ‫فإن‬ ،‫الجنس‬ ‫يمارسون‬ ‫أطفالهم‬ ‫أن‬ ‫األهل‬ ‫يكتشف‬ ‫عندما‬
‫يمكن‬ ‫آخر‬ ‫نشاط‬ ‫إلى‬ ‫وتوجيههم‬ ‫مالبسهم‬ ‫بارتداء‬ ‫عرضي‬ ‫بشكل‬
‫القلق‬ ‫أو‬ ‫بالخجل‬ ‫الشعور‬ ‫دون‬ ‫الجنسي‬ ‫اللعب‬ ‫من‬ ‫يحد‬ ‫أن‬

115. Cognitive Development
 As a toddler, a child enters the final stages of Piaget’s sensorimotor thought
and the beginning of the preoperative period at approximately 12 months
 Toddlers are described as “little scientists” because of their interest in trying to
discover new ways to handle objects or new results that different actions can
achieve. , toddlers need supervision for these types of scientific investigations
because they can lead to errors or injury.
 Learning in this stage occurs mainly by the trial and error.
 Most of day is busy to see what will happen as they dump fill ‫ا‬ ‫ملء‬
‫ل‬
‫فر‬
‫ا‬
‫غ‬ , empty
and explore every accessible area of their environment
 Object permanence is firmly establish by this age
‫الع‬ ‫هذا‬ ‫في‬ ‫بقوة‬ ‫الكائن‬ ‫ديمومة‬ ‫تأسيس‬ ‫يتم‬
‫م‬
‫ر‬
 Object permanence describes a child's ability to know that objects
continue to exist even though they can no longer be seen or heard.
‫رؤيتها‬ ‫الممكن‬ ‫من‬ ‫يعد‬ ‫لم‬ ‫لو‬ ‫حتى‬ ‫موجودة‬ ‫تزال‬ ‫ال‬ ‫األشياء‬ ‫أن‬ ‫معرفة‬ ‫على‬ ‫الطفل‬ ‫قدرة‬ ‫األشياء‬ ‫بقاء‬ ‫يصف‬
‫سماعها‬ ‫أو‬
.
Example. if you place a toy under a blanket, the child who has achieved
object permanence knows it is there and can actively seek it.

116. Characteristic of preoperational thinking
– Egocentrism ;-‫االنانية‬ views everything in relation to
self is unable to consider another point of view.
‫الذات‬ ‫حول‬ ‫التمركز‬
:
-
‫وجهة‬ ‫في‬ ‫النظر‬ ‫يستطيع‬ ‫وال‬ ‫بذاته‬ ‫يتعلق‬ ‫ما‬ ‫كل‬ ‫يرى‬
‫أخرى‬ ‫نظر‬
– Animism :- believes that inert objects are alive
and have wills of their own .
‫الروحانية‬
:
-
‫بها‬ ‫خاصة‬ ‫إرادات‬ ‫ولها‬ ‫حية‬ ‫كائنات‬ ‫الخاملة‬ ‫األجسام‬ ‫بأن‬ ‫تؤمن‬
– Irreversibility :- cannot see a process in reverse
order
– Magical thought :- believes that magical thought is
the cause of event.
– Centration :- tend to focus on only aspect of an
experience ignoring other possible alternatives.
‫الممكنة‬ ‫األخرى‬ ‫البدائل‬ ‫متجاهلة‬ ‫التجربة‬ ‫من‬ ‫الوحيد‬ ‫الجانب‬ ‫على‬ ‫التركيز‬ ‫إلى‬ ‫تميل‬

117. Egocentrism example
• if you wake up late and go to school in a stained sweater,
you may think that everyone noticed. This occurs primarily
due to the egocentric bias: we are so focused on ourselves
that we forget others are also occupied with themselves or
whatever they are doing

118. Animism example
• include water sprites, vegetation deities, and tree spirits,
among others. Animism may further attribute a life force
to abstract concepts such as words, true names, or
metaphors in mythology.
‫وغيرها‬ ‫األشجار‬ ‫وأرواح‬ ‫النباتات‬ ‫وآلهة‬ ‫المائية‬ ‫العفاريت‬ ‫تشمل‬
.
‫األرواح‬ ‫تنسب‬ ‫قد‬
‫االستعارات‬ ‫أو‬ ‫الحقيقية‬ ‫األسماء‬ ‫أو‬ ‫الكلمات‬ ‫مثل‬ ‫مجردة‬ ‫مفاهيم‬ ‫إلى‬ ‫الحياة‬ ‫قوة‬ ‫ا‬ً‫ض‬‫أي‬
‫األساطير‬ ‫في‬

122.  Children at this stage have a type of faulty reasoning (prelogical
reasoning) that can lead them to wrong conclusions and faulty
judgment
 At the end of the toddler period, children enter a second major
period of cognitive development termed preoperational thought
and begin to use a process termed assimilation.‫االستيعاب‬
 Piaget believed that there are two basic ways that we can adapt
to new experiences and information: assimilation and
accommodation.
 Assimilation is the easiest method because it does not require a
great deal of adjustment‫تعديل‬. Through this process, we add new
information to our existing knowledge base, sometimes
reinterpreting these new experiences so that they will fit in with
previously existing information.

123. Language Development
 The Toddler :-
 Between 15 and 24 months language ability develops rapidly
 Toddler understand many more words then they can say
because receptive language.
 Sometime after 18 months many children experience a sudden
spurt ‫سرعة‬ in speech production and comprehension , resulting
in a vocabulary of 300 or more words at 24 months.
 By 2 year roughly 60% to 70% of toddlers speech should be
understandable .

124.  Parent can promote language development by talking to their
child and incorporating ‫دمج‬ teaching into daily routines .
 Feeding, bathing, dressing, and going on outing to both new
and family placed offer opportunities for verbal interaction and
the practice of growing language skills.
 The child should be encouraged to express needs rather than
the parent anticipating ‫توقع‬ and providing what the child wants
before the child asks for it

125. PROMOTING TODDLER SAFETY
 Accidents (unintentional injuries) are the major cause of death in
infants through late adolescents in the United States (CDC, 2012a).
 Unintentional ingestions (poisoning) and auto accidents are the types
of unintentional injuries that occur most frequently in toddlers.
 poisoning can involve medicine such as acetaminophen ,.
 Aspiration or ingestion of small objects such as watch or hearing aid
batteries, pencil erasers, or parts of crayons ‫تلوين‬ ‫أقالم‬ is also a major
danger for children of this age .
 Urge parents to childproof their home ‫من‬ ‫منزلهم‬ ‫حماية‬ ‫على‬ ‫الوالدين‬ ‫حث‬
‫األطف‬
‫ال‬ by putting all poisonous products, drugs, and small objects out
of reach by the time their infant is crawling, and certainly by the time
their infant is walking, to avoid these problems.

126.  Other unintentional injuries that occur frequently in toddlers
include
 motor vehicle accidents,.
 burns,.
 Falls.
 drowning, and playground injuries.
 These occur because toddlers’ motor ability jumps ahead of
their judgment. To prevent serious injury, teach parents to be
alert as to what their toddler is doing at all times.
 For safety in automobiles, parents should keep their toddlers in
rear-facing seats until age 2 years, or until the child reaches the
maximum height and weight for their particular seat.

127. Falling safety from stairs

129. Should be prevent toddler from falling

130. Should be prevented from aspiration

131. Toy safety for toddler should be large to
prevent aspiration

132. Motor vehicle safety

133. Bathroom hazards should be kept in closed
cupboard

134. Buckets ;‫دلو‬

135. Drowning safety for toddler its family
responsibility

136.  children need to ride in a car seat with a five-point restraint
Car seats should be placed in the back seat so the child is not
struck by the passenger seat airbag.
 Remind parents that it is unsafe to leave a toddler alone in a
car.
 One way for a parent to be reminded that the child is in the
back seat is to always place a purse ‫مقعد‬ or briefcase in the
back seat alongside the child’s car seat.
 Toddlers need to wear a helmet as soon as they begin riding a
tricycle.
 UNINTENTIONAL INJURY PREVENTION MEASURES
FOR TODDLERS chapter (box) 30 page 1791

137.  Lead Screening:
 The CDC has set as a goal the elimination of elevated blood lead levels in
children.
 All children between the ages of 6 months and 6 years who live in
communities with buildings built before 1950 and immigrant children who
might have been exposed to sources of lead in another country should be
tested for the presence of lead in their body (lead poisoning).
 ‫عام‬ ‫قبل‬
1950
‫بلد‬ ‫في‬ ‫الرصاص‬ ‫لمصادر‬ ‫تعرضوا‬ ‫ربما‬ ‫الذين‬ ‫المهاجرين‬ ‫األطفال‬ ‫اختبار‬ ‫ويجب‬ ،
‫أجسادهم‬ ‫في‬ ‫الرصاص‬ ‫وجود‬ ‫من‬ ‫للتأكد‬ ‫آخر‬
(
‫بالرصاص‬ ‫التسمم‬
)
 Because lead is toxic to body tissue, ingestion of it leads to
 1-serious damage to the brain and nervous system, kidneys, and red blood
cells.
 2- Levels as low as 5 μg/dl can cause learning and behavioral problems.
 3-High levels may result in seizures, cognitive challenges, coma, and even
death.
 The CDC (2012b) recommends screening for all children between the ages
of 9 and 12 months at least once and again at 18 or 24 months of age. A

138. Toddler Nutrition Requirements
 Parents may become frustrated ‫محبط‬when trying to provide
adequate nutrition for their toddler because of a toddler’s
varying and unpredictable appetite and food preferences.
 Sedentary (inactive ) children ages 1 to 3 years should
consume 1,000 kcal daily; active children in this age group
may need up to 1,400 kcal daily.
 Adequate calcium and phosphorus intake is important for bone
mineralization. Milk should be whole milk until age 2 years.
 Calories are best supplied by a variety of foods spaced into
three meals a day.
 fat coming from sources of polyunsaturated and
monounsaturated fatty acids, such as fish, nuts ,‫المكسرات‬ and
vegetable oils, the same as adults.

139.  By age 1 year most children are eating the same food as the
rest of the family , toddler should be offered three meals and
two health snacks ‫خفيفة‬ ‫وجبات‬ each day , most 2 year old's can
drink from a cup and use a spoon well if given the opportunity
to practice.
• After 2 year, low- fat (2%) milk may be given , milk intake
should be limited to 2 or 3 cups /day, yogurt‫زبادي‬ and cheese
are other milk group sources , .
• poultry, fish, and lean meat are good sources of iron , low
sugar breakfast cereals are sources of iron and vitamins.
• snacks of fruits and vegetables assist in meeting the child
nutritional requirements.
• Food jags :
• The volume of food the child eats may vary from day to day ,
the child may want the same food at every meal for several
days and then suddenly reject the food completely, they may
not like mixing food , many children prefer juices to milk and
water.

140. PROMOTING TODDLER DEVELOPMENT IN DAILY
ACTIVITIES
 A toddler’s new independence and developing abilities in self-
care, such as dressing, eating, and to a limited extent hygiene,
present special challenges for parents.
 Learning how to promote autonomy yet maintain a safe,
healthful environment should be a major goal for the family.
 1- Dressing :
 By the end of the toddler period, most children can put on their
own socks and underpants .
 Some may also be able to pull on trousers, pullover shirts (the
sleeves of a shirt often confuse a toddler), or simple dresses.

141.  By 24 month can put on simple items of clothing but cannot
differentiate front to back, also can zip large zippers, ‫سحاب‬ ‫يمكن‬
‫الكبيرة‬ ‫السوستة‬ put on shoes ,and wash and dry their hands. they
habitually put shoes on the wrong feet.
 If they feel they must change the child’s clothes, urge them to begin
with a positive statement, such as “You did a good job,” before
making the switch.

142.  2- Sleep:
 The amount of sleep children need gradually decrease as they
grow older.
 They may begin the toddler period napping twice a day and
sleeping 12-14hours each night and end it with one to two nap
.
 If a child has difficulty falling asleep at night, it may be time to
omit or shorten an afternoon nap.
 Some toddlers begin having night terrors or awake crying from
a bad dream and so may receive little sleep because they are
reluctant ‫متكاسل‬ to fall back asleep.

143.  Other toddlers resist naptime as part of their developing
negativism.
 The parent can state simply, “It’s naptime now,” and then give
a secondary choice: “Do you want to sleep with your teddy
bear or your rag doll.‫بك‬ ‫الخاص‬ ‫خرقة‬ ‫دمية‬ ‫أو‬ ‫بك‬ ‫الخاص‬ ‫دب‬ ‫دمية‬ ‫مع‬
 Toddler often resist going to bed , using dawdling or even
temper tantrums to postpone separation from loved ones and
the exciting events of the day.
‫حتى‬ ‫أو‬ ‫تباطؤهم‬ ‫مستخدمين‬ ،‫السرير‬ ‫إلى‬ ‫الذهاب‬ ‫الصغار‬ ‫األطفال‬ ‫يقاوم‬ ‫ما‬ ‫ا‬ً‫ب‬‫غال‬
‫اليوم‬ ‫في‬ ‫المثيرة‬ ‫واألحداث‬ ‫أحبائهم‬ ‫عن‬ ‫االنفصال‬ ‫لتأجيل‬ ‫الغضب‬ ‫نوبات‬
.
 Children of this age often have trouble relaxing and falling
asleep, warm bath before bed time promotes relaxation.

144.  a toddler loves a bedtime routine: bath, pajamas, a story,
toothbrushing, being tucked ‫مطوي‬into bed, having a drink of
water, choosing a toy to sleep with, and turning out the lights.
 toddlers like to see parents as firm, consistent people.
‫ومتسقين‬ ‫حازمين‬ ‫كأشخاص‬ ‫والديهم‬ ‫رؤية‬ ‫الصغار‬ ‫األطفال‬ ‫يحب‬
 Remind parents to stress that sleeping in a regular bed does not
give children the right to get in and out of bed as they choose.
 This arrangement gives them a feeling of independence but
still keeps them safe.
 Put side rails for crib to prevent sleeping on floor or Dressing
the child in warm pajamas or putting a blanket on the floor to
protect child be solutions to help parents accept this.

145. Tips for dealing with a toddler who's
resisting bedtime:
 Promote relaxation. Before bed, consider a warm bath or
quiet reading. .
 Set a routine. Performing the same steps every night
helps your child to get used to a sleep routine. ...
 Keep him active during the day.
 Cuddle child .
 Read story
 Emphasize time together. ..
 Transition object, such as a favorite blanket or stuffed
animal, are often an important part of child bed time
routine.

146.  3-Bathing:
 The time for a toddler’s bath should depend on the parents’
and the child’s wishes and schedule.
 Toddlers usually enjoy bath time, and parents should make an
effort to make it fun by providing a toy, such as a rubber duck
or plastic fish.
 Bath time is usually so enjoyable for toddlers that parents can
use it as a recreational activity.
 Remind parents toddlers can sit well in a bathtub, it is still not
safe to leave them unsupervised.
 Parents shouldn’t add bubble bath to the water because its use
is associated with vulvovaginitis and possibly urinary tract
infections, especially in girls

148. Parallel play is important for toddler development

149. Dental care for toddler (pediatric dentist )

150.  4- Dental Care:
 Toddlers often need between-meal snacks. To help prevent
dental caries from frequent snacking.‫خفيفة‬ ‫وجبات‬ ‫تناول‬
 encourage parents to offer fruit (e.g., bananas, pieces of apple,
orange slices) or protein foods (e.g., cheese, pieces of chicken)
for snacks rather than high carbohydrate items such as cookies
to limit exposure of the child’s teeth to carbohydrate.
 Calcium (found in large amounts in milk, cheese, and yogurt)
is especially important for the development of strong teeth and
so are other good snack foods.

151.  Remind parents not to put a child to bed with a bottle of milk
or juice to help prevent the development of caries.
 Toward the end of the toddler period, they can begin to do the
brushing themselves under supervision. Because toddler like to
imitate, watching parent brush their teeth can be motivating,
small soft, nylon bristle brush works best.
‫أسنانه‬ ‫ينظفون‬ ‫وهم‬ ‫الوالدين‬ ‫مشاهدة‬ ‫فإن‬ ،‫التقليد‬ ‫يحبون‬ ‫الصغار‬ ‫األطفال‬ ‫ألن‬ ‫ا‬ ً‫نظر‬
‫م‬
‫النايلون‬ ‫من‬ ‫المصنوعة‬ ‫الخشن‬ ‫الشعر‬ ‫ذات‬ ‫الصغيرة‬ ‫فالفرشاة‬ ،‫ا‬ ً‫محفز‬ ‫يكون‬ ‫أن‬ ‫يمكن‬
‫أفضل‬ ‫بشكل‬ ‫تعمل‬
 Fluoride makes tooth enamel ‫المينا‬resistant to acid attack
preventing decay.
 A diet that is low in sweets and high in nutritious food
promotes dental health.
 Remind parents that it is better for a child to brush thoroughly
once a day, probably at bedtime.

152.  Urge parents to schedule a first dental visit with a dentist
skilled in pediatric dental care by 12 months of age.
 Screenings and assessment of dentition can begin as early as 6
months of age but should occur no later than 24 months of age

153. Tooth decay may be due to wrong practices
during infant period

154.  PROMOTING HEALTHY FAMILY FUNCTIONING:
 Because learning self-confidence is the primary goal of a child
during the toddler period,
 Help parents to understand their responses to these attempts‫محاوالت‬
at independence are crucial ‫مهم‬ to the healthy development of their
child.
 Although the child still needs firm limits to feel secure, a child
must be given room to make independent decisions in areas the
parents feel they do not need to control.
 At bedtime, naptime, or anytime they are tired, toddlers may
become much more like their old selves, wanting to sit on a
parent’s lap and be rocked or picked up and carried. This does not
signal babyish behavior or regression in a toddler; it is a natural
state between infant and preschool ages.

155. PARENTAL CONCERNS ‫مخاوف‬ ASSOCIATED WITH THE
TODDLER PERIOD
• 1-Toilet Training:
• Toilet training is one of the biggest tasks a toddler tries to
achieve.
• You can explain to parents that toilet training is an
individualized task for each child.
• It should begin and be completed according to a child’s ability
to accomplish it, not according to a set schedule .
• Toilet training need not start this early, however, because
cognitively and socially, many children do not understand
what is being asked of them until they are 2 or even 3 years
old.

156. • Before children can begin toilet training, they must have
reached three important developmental levels, one physiologic
and the other two cognitive:
• 1- They must have control of rectal and urethral sphincters,
usually achieved by the time they walk well.
• 2-They must have a cognitive understanding of what it means
to hold urine and stools until they can release them at a certain
place and time.
• 3-They must have a desire to delay immediate enjoyment for a
more socially accepted action.

157.  Myelinization of the spinal cord which usually occurs
between 12 to 18 months.
 The average toddler is ready for toilet training to begin until 18
to 24 mo.
 If the child resist it is helpful to stop training and wait 30 to 60
day and begin .
 Bowel control is usually achieved before bladder control .
 Daytime bladder control occurs before nighttime bladder
control.
 Punishment and coercive ‫قهري‬ techniques cause feeling of
shame and lead to power struggles ‫صراعات‬.
 Many children cannot remain completely dry until the age of 3
year .

158. Sign redness for toilet training

161.  The markers of readiness for toilet training :
 children are ready for toilet training when they begin to be
uncomfortable in wet diapers.
 They demonstrate this by pulling or tugging‫سحب‬ at soiled
diapers,
 or they may bring a parent a clean diaper after they have soiled
so they can be changed of autonomy.
child can remove own clothing
child is willing to let go of a toy when asked
‫ذلك‬ ‫منه‬ ‫طلب‬ُ‫ي‬ ‫عندما‬ ‫لعبة‬ ‫عن‬ ‫للتخلي‬ ‫استعداد‬ ‫على‬ ‫الطفل‬ ‫يكون‬
child is able to sit , squat ‫يتقرفص‬ and walk well

162. Ritualism ‫طقوس‬ And The Importance Of
Routine
 Ritualism help the child venture ‫يغامر‬ out and away from the
safety of the parents by ensuring uniformity and security .
 they also enjoy ritualistic ‫طقوس‬ patterns. They will use only
“their” spoon at mealtime or only “their” blanket at bedtime. .
They will not go outside unless a mother or father locates their
favorite cap.
 Ritualism allow the toddler to have a sense of control, the
child feels more confident with a secure home base.

163. Negativism

164. Negativism :-
 As part of establishing their identities as separate individuals,
toddlers typically go through a period of extreme negativism.
 One of the most dramatic expressions of independence is show
in a variety of way the toddler favorite word seems to be no.
‫من‬ ‫متنوعة‬ ‫مجموعة‬ ‫إظهار‬ ‫هو‬ ‫االستقالل‬ ‫عن‬ ‫دراماتيكية‬ ‫األكثر‬ ‫التعبيرات‬ ‫أحد‬
‫هي‬ ‫الصغار‬ ‫األطفال‬ ‫لدى‬ ‫المفضلة‬ ‫الكلمة‬ ‫بها‬ ‫تبدو‬ ‫التي‬ ‫الطرق‬
"
‫ال‬
"
 The toddler seems to feel that saying yes .
 Negativism may result in screaming , kicking , hitting, biting,
or breath holding .
 The nursing should given support and encourage the parent to
deal with the toddler trying behavior with patience and a sense
of humor,‫مزاح‬ to much pressure and forceful method of
control often lead to defiance tantrum ‫غضب‬ ‫نوبة‬ and prolonged
negative

166.  How to deal with negativism:
 1-A toddler’s “no” can best be reduced by limiting the number
of questions asked of the child. A father does not really mean,
for example, “Are you ready for dinner?” He means, “Come to
the table. It’s dinnertime.
 2- A toddler needs experience in making choices, It’s bath time
now” but then says, “Do you want to take your duck ‫بطة‬ or
your toy boat into the tub with you?” Other example is “It’s
lunchtime. Do you want to use a big or little plate ‫”?صحن‬.

168.  Discipline:‫تأديب‬
 Discipline means setting rules or road signs so children know
what is expected of them.
 Punishment is a consequence ‫عاقبة‬that results from a
breakdown in discipline ‫تأديب‬or the child’s disregard of the
rules that were learned.
 Discipline ‫تأديب‬for the toddler should be designed to teach
rather than punish.
 Two general rules to follow include:
 1. Parents need to be consistent.‫متسقين‬ ‫يكونوا‬ ‫أن‬ ‫اآلباء‬ ‫على‬ ‫يجب‬
 2. Rules are learned best if correct behavior is praised rather
than wrong behavior punished.

169.  One goal of discipline‫تأديب‬ and limit setting is to teach self-
control .
 Toddler need and want discipline to feel secure ,they have little
control over their behavior and need limits to learn how to
behave and how to follow the rules and expectation of society.
 Effective discipline techniques for children of this age include
a time out , diversion, and positive reinforcement, physical
punishment, such as spanking , is one of the least effective
discipline techniques.
،‫المهلة‬ ‫العمر‬ ‫هذا‬ ‫في‬ ‫لألطفال‬ ‫الفعالة‬ ‫االنضباط‬ ‫تقنيات‬ ‫تشمل‬
‫الضرب‬ ‫مثل‬ ،‫الجسدي‬ ‫والعقاب‬ ،‫اإليجابي‬ ‫والتعزيز‬ ،‫والتحويل‬
،
‫فعالية‬ ‫األقل‬ ‫االنضباط‬ ‫تقنيات‬ ‫أحد‬ ‫هو‬

170. Separation Anxiety
 Separation anxiety is a fear of being separated from parents
begins at about 6 months of age and persists throughout the
preschool period.
 Toddlers who have separation anxiety have difficulty
accepting being separated from their primary caregiver to
spend the day at a day care center or if they or their primary
caregiver is hospitalized
 Separation Anxiety peaks`‫ذروة‬ again in the toddler period .
 Children at this stage have difficulty differentiating their own
feeling from those of their parents , although the children
experience a strong desire to be independent and leave their
mother.
 Leave taking and brief separation are acceptable to a toddler if
they are the toddler idea .

171.  Games such as hide and seek ‫الغميضة‬ ‫مثل‬ ‫ألعاب‬ help the child
master fears of separation child can control.
 Toddler should be told honestly and clearly about a separation
shortly before it occurs.
 Transition objects such as favorite blanket or toy provide
comfort to the toddler .
 Affection and attention are needed to help the toddler cope
with the stress of separation.

172. Temper tantrum for toddler

173.  TEMPER TANTRUMS:‫الغضب‬ ‫نوبات‬
 (uncontrolled anger reactions)
 Almost every toddler has a temper tantrum at one time or another.
The child may kick; scream; stomp feet; shout, “No, no, no”; flail
arms and legs; bite; or bang his or her head against the floor.
 Temper tantrums occur as a natural consequence of toddlers’
development.
 temper tantrums occur most often when children are tired, just
before naptime or bedtime, or during a long shopping trip or visit.
 parental practices such as inconsistency, permissiveness excessive
strictness a over protectiveness increase the probability of
tantrums.
‫المفرطة‬ ‫والحماية‬ ،‫المفرطة‬ ‫والصرامة‬ ،‫والتسامح‬ ،‫االتساق‬ ‫عدم‬ ‫مثل‬ ‫األبوية‬ ‫الممارسات‬
‫الغضب‬ ‫نوبات‬ ‫احتمالية‬ ‫من‬ ‫تزيد‬
 Some children hold their breath as part of a temper tantrum until
they become cyanotic.

174.  suggestions for managing temper tantrums.:‫الغضب‬ ‫نوبات‬
1-Do assessment to determine the reason for tantrum
2-The best approach is for parents to simply tell a child that they
disapprove of the tantrum and then ignore it.
‫ثم‬ ‫الغضب‬ ‫نوبة‬ ‫على‬ ‫يوافق‬ ‫ال‬ ‫أنه‬ ‫ببساطة‬ ‫الطفل‬ ‫الوالدان‬ ‫يخبر‬ ‫أن‬ ‫هو‬ ‫أسلوب‬ ‫أفضل‬
‫يتجاهالنها‬
3-Safety isolate and ignore the child.
4-The child should learn that nothing is gained from a
tantrum not even attention.

176. Sibling riveraly ‫األشقاء‬ ‫تنافس‬
 Parent love and attention difficult for most toddler .
‫الصغار‬ ‫األطفال‬ ‫لمعظم‬ ‫بالنسبة‬ ‫صعب‬ ‫أمر‬ ‫واهتمامهم‬ ‫الوالدين‬ ‫حب‬
 Toddler egocentrism ‫األنانية‬ makes it difficult for them to
understand that a parent can love more than one child..
 The toddler has limited resources to cope with such stress and
may react by treating the baby roughly damaging property or
harming pets .
‫معاملة‬ ‫خالل‬ ‫من‬ ‫يتفاعل‬ ‫وقد‬ ‫الضغط‬ ‫هذا‬ ‫مثل‬ ‫مع‬ ‫للتعامل‬ ‫محدودة‬ ‫موارد‬ ‫الطفل‬ ‫لدى‬
‫قاس‬ ‫بشكل‬ ‫األليفة‬ ‫الحيوانات‬ ‫إيذاء‬ ‫أو‬ ‫الممتلكات‬ ‫بإتالف‬ ‫الطفل‬

177. Sibling rivalry

178.  Strategies to Decrease Sibling Rivalry
 - Including the toddler in preparation for the new baby .
 - Explaining to the toddler what new babies are like .
 - Letting the child feel the fetus move .
 - Reading picture books about new sibling .
 - Talking about changes that the newborn might create.
 - Referring to the baby as ours.

179. How to deal with sibling rivalry keep under
supervision of parents

180. Characteristics of Preoperational
Thinking
– Egocentrism ;-‫االنانية‬views everything in relation to
self is unable to consider another point of view.
– Animism :- believes that inert objects are alive
and have wills of their own .
– Irreversibility :- cannot see a process in reverse
order
– Magical thought :- believes that magical thought is
the cause of event.
– Centration :- tend to focus on only aspect of an
experience ignoring other possible alternatives.

181. Play :-
 Four year tend to be more argumentative and less generous
with playmates, and feel more secure in a group and are testing
their roles and communication skills.
‫زمالء‬ ‫مع‬ ً‫ء‬‫سخا‬ ‫وأقل‬ ً‫ال‬‫جد‬ ‫أكثر‬ ‫يكونوا‬ ‫أن‬ ‫إلى‬ ‫سنوات‬ ‫األربع‬ ‫ذوو‬ ‫األطفال‬ ‫يميل‬
‫ومهارات‬ ‫أدوارهم‬ ‫ويختبرون‬ ‫المجموعة‬ ‫في‬ ‫األمان‬ ‫من‬ ‫بمزيد‬ ‫ويشعرون‬ ،‫اللعب‬
‫بهم‬ ‫الخاصة‬ ‫التواصل‬
.
 The 5 year enjoys playing with other children .
 Children between the age of 3 to 5 year enjoy parallel and
associative.‫وترابطية‬ ‫موازية‬
 During play preschooler learn simple games and rules ,
language concepts, and social roles.
 Preschooler enjoy dress-up clothes , housekeeping, toys, doll
houses, and other toys that encourage pretending , tricycles
and climbing toys help to develop muscles and coordination.
preschooler also enjoy materials for cutting, pasting, and
painting.

182. Physiologic Anorexia:-
• Teach parent appropriate ways to approach the
child who is experiencing physiologic anorexia.
• Parent not to allow their child to fill up with
snacks, milk, and juices, small portion should be
offered so that the child does not feel
overwhelmed ‫ثقل‬ُ‫م‬by the amount of food , meal
time should be pleasant and not time to discuss
discipline ‫تأديب‬problems , children should not be
made to sit at the table after the rest of the
family has left.

183. Preventing Poisoning :-
 Children younger than 5 year are the most common victims of
poisoning and children 1 to 3 year are at the highest risk.
 Small children who are thirsty or hungry will ingest poisons
that look or smell inviting .
 Medication should never be called candy ‫حلويات‬ and because
young children often mimic their parent, adults should be
discouraged from taking medicine in the child's presence.

184. Preschooler Safety
 car safety
 Fire and Burn Safety
 firearm safety :- many guns are kept in the home loaded and
readily accessible to young children
 personal safety basic guideline that a child need to know
about personal safety include saying no, getting away and
telling an adult.
 Children need to know how to access emergency help if they
need it
 Children learn to identify safety officials ‫المسؤولين‬ and how to
dial emergency numbers.

185. • Sexual Abuse
• Preventing sexual abuse begins with teaching
children the normal
healthy boundaries of their bodies and what
constitutes inappropriate Behavior .
• If some one is touching their body in an
inappropriate way , they should Always tell an adult.

186. • Physical readiness

187. • Selected Issues Related to the Preschooler
Stuttering
‫تأتأة‬ ‫المدرسة‬ ‫قبل‬ ‫ما‬ ‫بمرحلة‬ ‫تتعلق‬ ‫مختارة‬ ‫قضايا‬
• Is a disturbance in the flow and time patterning of
speech. This may include repeating words or
phrases
• Dysfluency ‫الطالقة‬ ‫خلل‬tend to be more common during
time of excitement ‫اإلثارة‬ .reaction to stuttering can
increase the dysfluency.‫الطالقة‬ ‫خلل‬
• Child is expressing not on the way the child is
speaking, parent should not complete their child
sentences or draw attention to their child speech.

188. What are the different types of stuttering?‫تأتأة‬
• Developmental stuttering
As their speech and language processes are developing,
they may not be able to meet verbal demands.
• Neurogenic stuttering
Neurogenic stuttering is also a common disorder that
occurs from signal problems between the brain and
nerves and muscles.
• Psychogenic stuttering
This type of stuttering may occur in people with a mental
illness, or those who have experienced excessive mental
stress or anguish.‫معاناة‬ Although stuttering may cause
emotional problems, it is not believed to be the result of
emotional problems.

189. • How to Help the Child Who Stutters
• listen closely when your child soeaks.‫يتحدث‬
• Speak slowly
• Provide opportunities for the child to talk
without distraction
• Reduce pressure to communicate by limiting
the number of question.
• Do not ask a second question before the first
question is answered.
• Repeat or rephrase what your child says to
verify that you have understood it.

190. • Preparing the Child for school
• Child physical health and strong .
• Child attends to own toileting need and washes hand
independently .
• Child can separate from parent
• Child attention span is long
• Child can listen to and follow tow or three part instruction
• Child can restrict talking to appropriate time
• Child is able to tolerate the frustration‫إحباط‬ of not receiving
immediate attention from the teacher.
• Child can hold a pencil properly and turn pages one at a time
• Child counts 10
• Child recognizes the colors of the rainbow.‫قزح‬ ‫قوس‬