2ND BLK MATERNAL & CHILD NURSING LECTURE

MODULE 7
 respiration slows slightly but
TODDLER: GROWTH AND DEVELOPMENT remains to be abdominal
toddler's physical growth and development slow  the lumen of the tract increase
during the ages of two to four, motor skills, progressively so that the threat of
cognitive development, and language take lower respiratory infection is less
huge strides  CARDIOVASCULAR SYSTEM
 Heart slows from 110 to 90 bpm
Health Promotion For The Toddler  Blood pressure increases to about
99/64 mmHg
TODDLER  NERVOUS SYSTEM
The age from 1-3 years old  brain develops to about 90% of
enormous changes take place in the child and in adult size.
the family .  complete myelination of spinal
the largely immobile and preverbal child now cord causes urinary and anal
becomes a walking, talking child with a sense sphincter control.
of independence.  GI SYSTEM
The term terrible twos has often been used to  stomach capacity increases to
describe the toddler years. the point that the child can eat
It is a time of intense exploration of the 3 meals a day
environment as children attempt to find out how  stomach secretions become
things work; more acid → GI infections are
what the word “no” means; less common
the power of temper tantrums, negativism, and  IMMUNE SYSTEM
obstinacy.
 IgG and IgM antibody
“Getting into things” is their way of learning about
production becomes mature
their world, especially relationships.
@ 2 years of age
Successful mastery of the tasks requires a
 the passive immunity effects
strong foundation of trust during infancy and
from intrauterine life are no
frequently necessitates guidance from others
longer operative
when parent and toddler face the struggles of
 DEFINITION
toilet training, limit setting, and sibling rivalry
 8 new teeth
Growth And Development  the canines and the first
A. PHYSICAL GROWTH molars erupt during the 2nd
 Physical growth actually begins to slow year
through the toddler makes great strides  all 20 deciduous teeth are
through the toddler makes great strides generally present by 2 1/2 to
developmentally 3 years at age
12 MONTHS To 3 YEARS
a. WEIGHT  Caloric requirement is approximately 100 100
 gains only about 5-6 lbs. (2.5 kg) calories/kg/day calories/kg/da
 quadrupled his birth weight  Increased need for calcium, iron, and
 decreased weight gain due to Phosphorus
increased activity.  Needs 16 - 24 oz milk/day
b. HEIGHT  Appetite decreases
 gains on 5 inches (12cm) a year during  Able to feed self
toddler period  Negativism may interfere with eating
 subcutaneous fat ("baby fat") begins to  Initial dental examination at 3 years
disappear
 estimate adult height: multiplying by 2 B. PSYCHOSEXUAL DEVELOPMENT
at 2 years Freud’s Psychosexual Stages
c. HEAD Stage Age Nursing Implication
 HC = CC at 6 months to 1 year Anal stage Toddler Help children achieve
 CC > HC at 2 years - Child learns to bowel and bladder
 head circumference increases only control urination control without undue
about 2 cm during the 2nd year and defecation emphasis on its
compared to about 12 cm during the 1st importance.
year anterior fontanel (bregma) closes
at 12-18 months  As infants gain trust in the predictability and
d. BODY CONTOUR reliability of their parents, environment, and
 prominent abdomen (LORDOSIS) interaction with others
 waddle or walk with wide-stance  they begin to discover that their behavior is their
e. BODY SYSTEM own and that it has a predictable, reliable effect
 RESPERATORY SYSTEM on others.
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 However, although they are aware of their will  Has beginning awareness of ownership (my,
and control over others, they are confronted with mine) at 18 months; shows proper use of
the conflict of exerting autonomy and pronouns (I, me, you) by 3 years
relinquishing the much enjoyed dependence on  Moves from hoarding and possessiveness at 18
others. months to sharing with peers by 3 years
 TOILET TRAINING USING COMPLETED BY 3
C. PSYCHOSOCIAL DEVELOPMENT YEARS.
 Exerting their will has definite negative  18 months: bowel control
consequences, whereas retaining dependent,  2 - 3 years: daytime bladder control
submissive behavior is generally rewarded with  3 - 4 years: night time bladder control
affection and approval.  Differentiation of self from others, particularly the
 Continued dependency creates a sense of doubt mother or primary caregiver
regarding their potential capacity to control their  Toleration of separation from parents
actions compounded by a sense of shame for  Ability to withstand delayed gratification
feeling this urge to revolt against others' will and  Control over bodily functions
a fear that they will exceed their own capacity for  Acquisition of socially acceptable behavior
manipulating the environment  Verbal means of communication
 The latter fear is a basis for instituting limit  Ability to interact with others in a less egocentric
setting and consistent discipline at limit setting manner
and consistent discipline at this age. this age.
 Without appropriate limits on what is Without D. COGNITIVE DEVELOPMENT
appropriate limits on what is acceptable versus  Main cognitive achievement of early childhood:
unacceptable acceptable versus unacceptable acquisition of acquisition of language, language,
behavior, children have no guidelines behavior, which represents mental symbolism.
children have no guidelines for establishing the  Inappropriate to expect toddlers to Inappropriate
end points of their for establishing the end points to expect toddlers to judge which receptacles are
of their ability to control. permissible to explore and which are not.
 Understanding love for the child is shown by:  Forbidden objects, such as the garbage pail,
A. giving him all the freedom he can safely use should be placed out of reach.
B. giving him all the love and help he needs to
keep him safe in an environment beyond his
SENSORIMOTOR
control
STAGE COGNITIVE BEHAVIOR
C. giving him guidance in avoiding hazards in the
& DEVELOPMENT
changing social situation in which he feels
AGE
himself to be the focal point
Tertiary Active > Insatiable
 Has the newly gained modality of holding on and
circular experimentation to curiosity about
letting go. and letting go.
reactions achieve environment
 Holding on and letting go are evident Holding on (13-18 previously > Uses all sensory
and letting go are evident (toddler uses the mo) unattainable goals cues for
hands, mouth, eyes, and, eventually, sphincters exploration
when toilet training is begun.)
Increased concept Ventures away
 Constantly express these social modalities in of object from parent for
play activities such as casting or throwing permanence longer
objects; taking objects out of boxes, drawers, or periods
cabinets; holding on tighter when someone says, Differentiation of Uses physical
"No, don't tighter when someone says, "No, don't oneself from skills to achieve
touch"; and spitting out food as taste touch"; and objects particular
spitting out food as taste preferences become goal
strong.
Early traces of Can find hidden
memory objects, but only in
PSYCHOSOCIAL TASK
first
 Increases independence;; location
 better able to tolerate separation from better
Beginning Able to insert
able to tolerate separation from primary
awareness of round object into
caregiver.
spatial, causal, and hole
 Less likely to fear strangers temporal Fits smaller
 Able to help with dressing/undressing at 18 relationships objects into each
months; other (nesting)
 dresses self at 24 months. Gestures “up” and
 Has sustained attention span “down”
 May have temper tantrums during this period; Able to enter into an > Puts objects into
should decrease by 21/2 years. action at any container and
 Vocabulary increases from about 10 - 20 words point without takes them out
to over 900 words by 3 years.
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reproducing entire > Realizes that  Achieves object permanence; is aware that objects
sequence “out of sight” is not exist even if not in view
out of reach;  Uses “magical” thinking; believes own feelings affect
opens doors and events (e.g., anger causes rain)
drawers to find  Uses ritualistic behavior; repeats skills to master
objects them and to decrease anxiety
> Gains comfort  May develop dependency on “transitional object”
from parent's such as blanket or stuffed animal
voice even if
parent is not Characteristics of Preoperational Thought
visible TRANSDUCTIVE
Causal relationship After flipping a  Reasoning from particular to particular
between two light switch, GLOBAL ORGANIZATION
events is apparent toddlers are aware  Belief that changes from any part of the whole
which that a reciprocal Belief that changes from any part of the whole
demonstrates the response occurs CENTRATION
beginning of but are not  Focusing on one aspect rather than
categorizing data able to transfer considering all possible alternatives.
into distinct that knowledge to ANIMISM
classes, new  Attributing lifelike qualities to inanimate
subclasses, and so situations. objects
on Therefore every IRREVERSIBILITY
time they see what  Inability to undo or reverse the actions
appears to be a initiated physically
light switch, they MAGICAL THINKING
must  Believing that thoughts are all-powerful and
reinvestigate its cause events
function.) INABILITY TO CONSERVE
Classification of e.g. If the child's  Inability to understand the idea that a mass can
objects is still toys are stored in be changed in size, shape, volume, or length
rudimentary, the a paper bag or without losing or adding to the original mass
appearance of large container, he (instead children judge what they see by the
an object denotes or she does not immediate perceptual clues
its function. perceive a given to them)
difference
between that toy
receptacle and the  Concept of time is still embryonic, their sense
garbage pail or of timing is exaggerated-a minute can last an
laundry hour.
basket. If allowed  limited attention spans also indicate
to turn over the toy their sense of immediacy and concern
receptacle, the for the present
child will just as  Egocentrism, or the inability to envision
quickly do the situations from perspectives other than one's
same to other own (e.g. A toddler who takes a toy away from
similar objects another child. The toddler is concerned only with
because, in the playing with the toy and is unable to
child's mind, there conceptualize that taking the toy away will make
is no difference.) the other child unhappy).
Aware of space and They will stretch,
the relationship of stand on a low E. MORAL DEVELOPMENT
their body to stair or stool, and PRECONVENTIONAL PHASE
dimensions such as pull a string to  Involves punishment and obedience
height reach an object.)  Young children behave in accordance
with the freedom or restriction that is
COGNITIVE TASK placed on actions
 Follows simple directions by 2 years.  whether an action is good or bad
 Begins to use short sentences at 18 months to 2 depends on whether it results in reward
years. or punishment
 Can remember and repeat 3 numbers by 3 years.  If children are punished for it, the action
 Knows own name by 12 months; refers to self, gives is bad
first name by 24 months; gives full name by 3 years.  If they are not punished, the action is
 Able to identify geometric forms by 18 months. good, regardless of the meaning of the
act
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F. SPIRITUAL DEVELOPMENT SENSORY AND MOTOR DEVELOPMENT
 Toddlers learn about God through the Improving motor skills make your child more mobile
words and the actions of those closest by age two. The toddler years are a time when your
to them child will likely be in constant motion. Toddlers will
 Have only a vague idea of God and quickly master walking and move on to running,
religious teachings because of their jumping and climbing. Around age two, most toddlers
immature cognitive processes; will be able to navigate stairs, kick or throw a ball and
however, if adults speak about God draw simple lines. During this time, children may still
with reverence, young children stumble frequently and be accident prone. By age
associate God with something special five, better control of fine motor skills allows children
 Begin to assimilate behaviors to dress and undress themselves (a necessity
associated with the divine (folding for toilet training) and write some letters.
hands in prayer)
 Routines such as saying prayers before SOCIALIZATION AND PLAY
meals or at bedtime can be important Play
and comforting  the toddler's "work"; language of the child
 PARALLEL PLAY- children play among other
TODDLER: DEVELOPMENTAL MILESTONES children, often with the same types of toys
PHYSICAL DEVELOPMENT  children use their toys to play out what they want
While children tend to gain about three to five pounds and how they want things to be
and grow three to five inches between ages one and  play among others in an independent fashion
two, this rapid growth tends to slow down between  Games: likes throwing and retrieving games;
ages two and five. During this time, your child will selfish, possessive of toys
develop increased strength and coordination.  (lack of interest in toys: DANGER SIGN)

COGNITIVE DEVELOPMENT  Predominantly- “parallel play” period

After beginning to recognize familiar people and  Provide toys appropriate for increased
objects, between the age of one and two, your toddler locomotive skills: push toys, rocking horse, riding
will be better able to recall recent events. During this toys or tricycles; swings and slide
age your child will imitate others and will become  Give toys to provide outlet for aggressive
much more imaginative, especially during playtime. feelings: work bench, toy hammer and nails,
From two to five, the ability to think and understand drums, pots, pans
grows greatly as children learn letters, numbers,  Provide toys to help develop fine motor skills,
symbols, and colors. problem-solving abilities: puzzles, blocks; finger
paints, crayons
EMOTIONAL AND SOCIAL DEVELOPMENT
The competing emotions that develop during this age Purposes of Play
are often behind the “terrible twos” label. From 12 to  physical development
24 months, children continue to develop strong  social development
bonds with their loved ones, while at the same time  therapeutic value
wanting to be more independent. Between ages two  educational
and four, your child will likely begin to like to “do it  moral values formation
myself” and will want to make more choices on his or
her own. Characteristics Of Play
From age two to five, children learn more about their  free, spontaneous, active, no rules
feelings and begin developing friendships with other  constructive
children their age. Children begin to understand the
difference between right and wrong at this age. They Selection Of Play Materials
will look to their parents for limits and rules and will
 based on likes/dislikes
also often test these limits. Often, when children this
 no sharp edges
age do something wrong, they will begin to feel guilty
about it.
Toys
LANGUAGE DEVELOPMENT  Cars and trucks
Understanding progresses faster than speech in  Balls
a toddler’s language development. Between 15  Building blocks
to 18 months, most toddlers know 10 times more  Stuff toys and dolls (security objects)
words than they can verbally communicate. By  Play telephone (this is a stage of training)
the age of two, however, vocabularies can span  Play hammer, drums, pots and pans (an outlet of
between 50 and 100 words and children begin aggressive behavior)
using two or more words in combination. By the  Push and pull toys
age of five, children can use thousands of words  Wood simple puzzles
to communicate and will speak in sentences.  Large crayons (can draw a circle at 3 years)
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TODDLER: SPECIAL NEEDS , HEALTH PROMOTION, age tend to be fully trained by 38 months, while
AND APPLICATION OF THE NURSING PROCESS girls who start training at the same time are
Safety usually fully trained by 36 months, according to
Accidental injuries are the leading cause of death in a study in the Official Journal of the American
children ages two to four. Many of these injuries are Academy of Pediatrics.
preventable. As your child grows more mobile, make  However, being fully trained does not mean that
sure to be aware of and correct any safety your child will not still need help at times It is
issues inside and outside of your home. common for children to need help wiping after a
bowel movement, until age four or five, and to
Children of this age are prone to injuries from: need adult supervision while using public
 Falls – Playgrounds, stairs, bikes and windows restrooms, until age five or six.
are just a few fall hazards. Be aware of
potentially dangerous situations that could lead
to falling and injury.
 Burns – Hot appliances, foods and liquids are HEALTH PROMOTION FOR THE TODDLER
potential dangers for children this age. Keep Special Needs of A Toddler
children away from appliances (irons, heaters, 1. Specific Areas of Guidance
grills) and remember that these often stay hot  Graded Independence/Negativism
long after they are turned off. Make sure to keep  gives the child opportunity to make choices.
hot food or drink pushed back from the edge of  independence may be denied for possible
the table or counter and out of reach of your painful experience which may hinder a child to
child. try new skills because of fear.
 Poisoning – All potential hazards should be in  regulating the toddler's activities which is an
locked cabinets or out of the child’s reach. Keep important part of his training is a challenge to the
the poison control phone number readily adult.
available in your home.  providing safe environment for a gradually
 Car Safety – Your child should be restrained in expanding area of growth.
appropriate car seat at all times while the car is  avoiding use of pain and ridicule as a means of
in motion. Practice awareness and safety when punishment or of prevention of forbidden
your child is walking or riding a bike near vehicle activities.
traffic. Children should not ride or walk in the  allowing the child to have certain amount of
street. defiance which is normal
 Love and Security
Potty Training  Love enables the toddler to grow up and reach
 Most children are ready to begin toilet out for more mature goals because he feels
training between 22 and 30 months of secure.
age. Remember that with potty training, like with  Love for the mother decreases; attachment to a
all other development, every child is different. loving father increases.
 Wait to start potty training until your child is ready  "Security object" (e.g. diaper, blanket, toy, etc.)
both physically and emotionally. Starting too
early can cause a great amount of frustration for Toilet Training
both parents and children. It is important to try  the child must begin accepting the "reality
to keep the experience a positive one. principle" (giving up an immediate pleasure in
 Before beginning potty training, your child needs order to gain another pleasure later).
to have control of his or her bladder and bowels.  Toddler must give up the pleasure of excreting
Signs of this control include having a dry diaper where and when he desires
after naps and for at least two hours at a time.
Your child also should be having bowel Requisites for Toilet Training
movements around the same time each day, not Physiologic Readiness
during the night. In order for potty training to be  Sphincter control - myelination of nerve tract
successful, your son or daughter must be able to occurs at around 15 - 18 months of age
use a potty seat or potty chair on his or her own,  (MOST IMPORTANT REQUIREMENT)
which includes being able to climb up onto the Recognizes the urge and with ability to stand and
seat, talk to a parent or caregiver and remove his walk to the bathroom and manage clothing
or her own clothing. Psychologic Readiness
 If your child is emotionally ready, he or she  Understands the act of elimination Requisites for
should be willing to cooperate and might even Toilet Training.
talk about being a “big girl” or “big boy.” If your  Ability to verbally communicate need to defecate
child resists, it’s better to stop for a while and or urinate.
then re-start potty training again at a different  Mother or caretaker must be able to recognize
time. verbal behaviors
 Boys and girls are slightly different when it Desire to please the mother
comes to potty training. Boys who start the toilet
training process between 22 and 30 months of
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Principle Of Toilet Training of defiance
 Bowel training should be started before bladder which is normal
training. Temper -occur when a 1. Remove him
 Bladder training is done 1 or more months after Tantrums child cannot from immediate
a fairly well established bowel training. integrate his cause of
 Training should not be accomplished during interval impulses tantrum with the
illness and the demands adult whom he
 Consistency - observe usual time for defecation. of reality. knows loves
him.
2. Delayed Speech - The child is
 A normal child will begin to speak by 15th months frustrated and 2. Be calm and
of age reacts in the only be patient. Do
way he knows by not force
Health Definition/Etiology Intervention violent body attention upon
Problem activity and crying. him, now he
Ritualistic -common between 1. Adults should indicates he is
Behavior ages of 2-4 years
recognize these Causes: ready for the
rituals in such 1. In the hospital comfort of
-done to master phases as: fear of the knowing he is
skills unknown loved.
a. Bathing - use 2. Adult refuses to 3. He should not
of a face towel grant a request. be given extra
b. Eating - use 3. When the child attention but
of bib, own is tired, before should be
utensils bedtime or observed from
c. Sleeping - naptime or during self-injury or
taking a favorite a tiring trip or visit. anything in the
toy or blanket to 4. When mother environment
bed with him says, “No!” too which may be a
frequently with source of injury
2. Show other regards to getting to him.
ways of doing dirty, using a 4. Avoid
things. spoon, running, restraining the
Negativism -persistent a. Reduce etc. child.
negative response opportunities for 5. As a response
to every request. - a “no" answer to difficulty in Prevention:
not an expression making choices or 1. The mother
of being stubborn b. regulating the decisions. 6. should try to
or disrespectful, toddler's When the child is show him better
but a necessary activities which under pressure ways of solving
assertion of is an important such as toilet his problems
control. part of his training. and provide
training is a more socially
-gives the child challenge to the acceptable
opportunity to adult. outlet for his
make choices anger and
c. providing safe frustration.
- independence environment for
may be denied for a gradually 2. He should be
possible painful expanding area helped to
experience which of growth release his
may hinder a child tension in a
to try new skills d. avoiding use socially
because of fear. of pain and approved way
ridicule as a such as physical
means of exercise going
punishment or outdoors,
of prevention of gardening, etc.
forbidden Dawdling -refers to the -good time to
activities. natural jealousy start talking
and resentment of about the new
e. allowing the children to a new baby is when
child to have child in the family. toddlers
certain amount become aware
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-typically involves of the newly learned
the arrival of a new pregnancy and motor, language,
infant but may be the changes social, and
associated with occurring in the cognitive skills.
anyone who joins home in
the family. anticipation of
the new FEARS: SEPERATION ANXIETY
-toddlers do not member  Learning to tolerate and master brief periods of
hate or resent the separation is important developmental task.
infant but do -Toddlers need  Increasing understanding of object permanence
resent the to have a helps toddler overcome this fear.
changes that this realistic idea of  Potential patterns of response to separation.
additional sibling what the
brings, especially newborn will be Protest
the separation like  screams and cries when mother leaves;
from the mother attempts to call her back
during the birth -Providing a doll Despair
on which  whimpers, clutches transitional object, curls up
-usual routine is toddlers can in bed, decreased activity, rocking.
disrupted imitate parental Denial
behaviors is  resumes normal activity but does not form
another psychosocial relationships; when mother
excellent returns, child ignores her
strategy
Sibling -most pronounced Basic Needs of the Toddler
Rivalry in the firstborn, 1. Bathing
who experiences  Time depends on the mother and the child's
"dethronement" wishes.
(loss of sole  May be given before and evening meal, at
parental attention bed time because it relaxes child and helps
Regression -a retreat from a -best approach him to sleep.
present pattern of is to ignore it  Toddlers enjoy bath time so the mother
functioning to past while praising must proved toy during the bath.
levels of behavior existing 2. Clothing
patterns of  Toddlers need clothing that can be changed
-usually occurs in appropriate quickly because they can't stand still for
instances of behavior long.
stress, when one Criteria for clothing:
attempts to cope -advisable not to o light or bright in color
by reverting to introduce new o large and easily managed buttons
patterns of areas of
and snaps placed within easy
behavior that were learning when
reach of the child.
successful in an additional
earlier stages of crisis is present o warm but not too bulky
development or expected, o shoes: the inside with broad toes
such as and relatively narrow heels; low
Causes: beginning toilet heels; ½ inch longer and ¼ inch
-Any threat to their training shortly higher than foot
autonomy, such as before a sibling 3. Dental Care
illness, is born or during  Brush and floss daily (with parents' help) -
hospitalization, a brief twice daily
separation, or hospitalization  Proper oral hygiene and adequate diet are
adjustment to a essential for tooth decay prevention.
sibling, represents  2 ½ - 3 years: as soon as all the deciduous
a need to revert to teeth are out, he can have his FIRST
earlier forms of DENTAL VISIT.
behavior, such as  If water is. not fluoridated, give
increased supplements: 0.25 to 0.5 mg per day
dependency;  Limit concentrated sweets
refusal to use the  Do not allow the child to carry a bottle of milk
potty chair; temper or juice to bed
tantrums; demand  3 years: instruct to brush teeth after eating
for the bottle or and at bedtime
crib; and loss of
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4. Sleep and Exercise o Have swimming pool fence and gates
 Depends on age, health, emotional tension, with childproof locks
and activity during the day.  CUTS AND STABS
 12-14 hrs at night and 1-2 hrs of o Keep knives out of reach
daytime/afternoon nap. o Teach safety with sharp objects
 Usually outgrows bedtime rituals by 3 years o Lock up guns and powder tools
old. o Keep scissors away
5. Nutrition
 caloric requirement: 1,300 calories per day;
100 cal/kg/day
 “Physiologic anorexia”
 Eating Behavior of a Toddler
o The child may develop food
preference.
o He may even refuse food for a
short time.
o Maybe demanding in what he
wants to eat and dishes he uses
and way food is served.
o He is slow and clumsy but he
enjoys feeding himself.
o He may wander away from the
table.

SPECIFIC SUGGESTION FOR FEEDING

 At 1 ½ to 2 years, child can eat table food and
meals a day
 Serve food in small portions
 Chop or cut food in small pieces
 The diet each day should be well-balanced.
(About 16 oz of milk should be given daily).
 Satisfy the child’s appetite with nutritious foods
 Avoid sweets
 Give vitamins
 Do not force him to eat

6. Accident Prevention
 Accidents are the leading cause of deaths
1- 5 years of age.
 Poisoning is a leading cause of morbidity.
 FALLS
o Use stair guards; crib rails always up
o Windows and door always screened
o Supervise at playgrounds
o Keep clothes properly cared for and
fitted
o Avoid slippery floors
 POISONING
o Make sure you don't give medications
as "candies."
o Keep medications out of reach
 BURNS
o Cover electrical outlets
o Turn pot handles toward back of stove
o Do not leave unattended in bathtub,
near stoves
o Keep electrical wires out of reach.
o Teach child what "hot" means
o Check bath water temperature
 DROWNING
o Teach swimming pool and water safety
o Do not leave child unsupervised near
water or bathtub