Understanding Growth and Development
Toddlers
Toddlers are age 12 months to 36 months: Autonomy vs. Shame and Doubt (Erikson)
Basic Principles:
• The primary source of activity is continued until about 18 months of age
and then the toddler transitions into a focus on elimination needs.
• The child learns to control his bowels, but if this process doesn’t happen
an “anal” fixation may develop and can lead to obsessive/perfection or
disorganized behaviors.
• Cognitive development is characterized by EGOCENTRISM
– Curious about their environment
– Leaves parents for extended period of time
– Searches for objects through hiding places
– Imitates words and sounds and adult behavior
– Engages in parallel play
– LOVES ROUTINE!!!
– Uses 2-3 words together
– Possessive of their toys; uses the word MINE
– Follows direction
– Egocentrism is observed in the behaviors and play
• The toddler has entered the world of NO NO NO NO NO!
– Toddlers are aware of their will and control over others but they
are conflicted with exerting autonomy and relinquishing the
much enjoyed independence on others
– Holding on and letting go are evident in how the toddler uses his
hands, mouth, eyes: “No don’t touch”, spitting out food, etc.
– NEGATIVEISM and RITUALISM are typical
– Toddlers learn to behave based on the restrictions that are
placed on their actions
– If the child’s behavior is punished they learn it is bad; if it is
rewarded, it is positive
– By 36 months you may see developmental aspects of a
conscience
Assessment Guidelines
• Important things to focus on when assessing the toddler
– Steady growth in weight and height
– Development of body image; they learn to associate body parts
with meanings
– Gender identity is developed by age 3
– Developing self-image, avoid using negative terms like skinny
legs or chubby legs.
• Play is important so provide enough space for play; encourage
pretend play
• Permit child to help with adult tasks - they want to feel productive
• Provide toys or activities that help with expression of feelings: language
skills aren’t developed enough to express all feelings
• When assessing the child let them hold and touch equipment-this will
greatly reduce their fear.
Developmental Milestones
• Some important developmental milestones to remember:
– Gross motor: walks without help, creeps up stairs, kneels without
support
– Fine motor: builds tower of 2 cubes, holds 2 cubes in one hand,
scribbles, uses cup well but struggles with a spoon
– Language: says 4-5 words, including name, points and ask for
objects, understands simple commands, says 10 or more words,
uses 2-3 phrases, TALKS ALL THE TIME
– Tolerates separation from parents
– TEMPER TANTRUMS are normal
– May develop a dependency on security item – like a special
blanket or stuffed animal
Pain Assessment
• What are signs a toddler maybe in pain?
• Toddlers don’t understand why or what is causing them to have pain so
they express:
– Extreme emotional upset
– Physical resistance
– Excessive activity
– Restlessness
– Loud crying
– Attempts to push stimulus away
Pain Scales
FLACC
• FLACC- used for ages 2 months to 7 years (if unable to communicate
pain level)
• 2 points are scored for each area for a total possible score of 10.
0= no pain, 10=worst pain
– Face
– Legs
– Activity
– Cry
– Consolability
