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Transcript of The Toddler
Skills Development 12-36 months About the way the toddler will grow... Did You Know? The Terrible Two's! Have you heard? through this presentation... Take a journey... Here are some examples... Injury Prevention
Aspiration and Suffocation Safety Concerns -The anterior fontanel or that “soft spot” on your little one’s head will close between 12 and 18 months old.
-The birth weight is quadrupled by 2 ½ yrs.
-And the average weight gain is 4-6 pounds (lb) yearly.
-The height will grow about 3 inches or 7.5 cm yearly and mostly in the legs.
-By 1-2 years of age chest circumference will equal head circumference, then exceed it and the abdomen. The terrible twos is just a saying that the little ones growing before our eyes are such scientists!
These little Einsteins have to experiment with everything! Because by now their senses are increasingly well developed and coordinated, toddlers really put things to the test! They will hypothesize in their own nature,
they will observe, taste, feel , smell, hear, and even throw stuff! They might even test the nerves of themselves and their caregivers! Whether it’s having a temper
tantrum or being sensationally sweet
and kind or being absolutely messy
and daring or observant and
listening; this journey will help give
you insight of what to expect for
development through the toddler years. A lot of changes can be noticed
every day & through almost all
activities whether it’s big or small. The Gross or the "Big" motor Skills The toddler can walk
any help but
a wide stance -Slowly going up stairs
-Kneeling without support
-Trying to run and falling a lot
-Losing balance when stopping suddenly, coming around corners, or throwing a ball Still running and falling
Walking up stairs with one hand held
Sitting self on chair
Pulls and pushes toy
Throwing without falling Jumps with both feet
Jumps from a step or chair
Stands on one foot quickly
Tip-toeing a few steps 2 1/2
yrs Stands on one foot
Walking tiptoe longer
with alternate footing 12-13mo 15 months 18 months 24 months Walking up and down the stairs alone with two feet on each step and not falling down and losing balance as easily while kicking a ball, running, and picking up an object 3 yrs 2 The fine or "small" motor skills Can grasp or pick up
a small object but
cannot let go at will Builds tower of 3-4 cubes
Reaching, holding, and letting go of objects are well developed,
Turns 2-3 pages in a book at a time,
Use a spoon without rotation
Imitates strokes in a drawing 15 mo -Builds tower of 6-7 cubes
-Makes 2 or more cubes like a train
-Turns pages in a book one at a time 24 mo -Builds tower of 8 cubes
-Adding chimney to train of cubes
-Imitates vertical & horizontal strokes in drawing and can make 2+ strokes for cross 2 1/2
yrs 12 mo -Can drop or release a small object at will
-Can drop a pellet in a narrow-necked bottle -Not yet catch and throw, but loves to play throw and get/chase.
-Can hold two cubes in one hand and build a tower out of it.
- Scribbles spontaneously!
-Uses a cup well
-Rotates spoon before it reaches the mouth 18 months Drawing with vertical
or circular strokes by copy
Unscrews lids. &
-Holds crayon with fingers
rather than fist
-Moves fingers independently Nutrition From 12-18 months, the growth rate slows.
So the toddler won’t need as many calories, protein, and fluids.
But protein should stay at 13 grams a day and energy
requirements are still high for the muscle growth and energy levels.
The estimated energy requirements (EER) for toddlers vary by age,
gender, and feeding method. For example: 18 month old boy that
weighs 25.8 lb may have an EER of 961 kcal/day where a 24.2 lb
18 month girl would need an EER of 899 kcal/day. By 12 months most toddlers eat what the rest of the family eats. Toddlers need from 1000-1800 calories daily. -6 ounces (oz) of grains, at least half the portion (3 oz) whole grain
-2 ½ cups (20 oz) of vegetables
-1 ½ cups (12 oz) of fruits
-3 cups of milk until 2 years of age, then 2 cups (16 oz) of milk
-5 ounces of meat and beans A helpful hint: -1 tablespoon (T or tbsp) of solid food per year of age or ¼-1/3 of the adult portion size.
-Use the tablespoon guide for easily measured foods like rice or vegetables
-Use the Fraction guide for bread or milk. Milk is not a good source of iron and intake should be no more than 2-3 servings (16-24 oz) a day. Also, the appetite for solid food may be decreased or pushed away if given more milk to the child. After 2 years old, kids can be given low-fat milk Adequate intake of calcium is 500 mg/day No more than 6 oz of
fruit juice is recommended Nutritional Recommendations: Adequate intake of Vitamin D is 400 International units or (IU). This will help prevent rickets, which can soften or weaken bones and can cause pain and abnormal growth development. With good nutrition comes the potential of a
good growing body and especially a good growing
mind! Erikson’s Psychosocial Stage of Development The developmental stage recognized by Erikson during toddlerhood is acquiring a sense of autonomy (independence/freedom) while overcoming a sense of doubt and shame. Erik Erikson was a psychoanalyst who developed a theory on psychosocial development. Healthy individuals will pass through 8 stages during their lifetime. If not met with success the individual may have to deal with the conflict again later in life. Autonomy vs. Shame and Doubt Napping once a day is still needed for most toddlers and usually stops after 2-3 years of age. 2 year old: Sleep is still almost the same as previously and generally averages 12 hours a day. Sleeping 3 year old: Children will reach the sleep pattern as an adult. Cognitive
Development Sensorimotor Phase Preoperational
Development Language Play Personal-Social Behavior Injury
Prevention Burns Aspiration and Suffocation Safety Concerns Poisoning Drowning Falls References: 1.Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D.. (2010). Maternal Child Nursing Care. 4th ed. Ch. 37; 42;49 Pp. 1017-1042; 1198-1200;1493-1494. Elsevier Mosby. Maryland Heights, Missouri. By: Yasmin A., Mary E., Tho N., Toni H., Whitley M., Sarai L., Brenda B., Krystal M., Elizabeth B., Ruthann H. -Include your child at family mealtimes
-Encourage your child to feed themselves at the beginning of a meal when they are hungry, but help if they tire later in the meal.
-Continue to provide 3 to 4 meals a day. Additional nutritious snacks may be offered
1-2 times a day They will also be able to hold a cup with 2 hands, but will probably spill some contents. 18 months. Hooray! At this stage of life, they will become more picky about the foods they eat, or not eat them at all They are learning to eat independently, first with their hands, then with utensils From 12-18 months.... -Pick up & eat finger foods
-Grasps spoon with whole hand
-Holds cup with 2 hands
-Reject unfamiliar foods
-Have a decreased appetite from the previous year Kids are discovering more new foods, tastes, and textures Picks up and eats finger foods &
Grasps spoon with whole hand Developmental characteristics: Developmental Characteristics:
-Compared with the first year of life, a
decreased appetite is common
-Unfamiliar foods are often rejected the
first time But watch out for what's in those cups! -Whole cow's milk, and not skim milk should be given before 2 years of age and replaces formula at 12 months. (but cannot quite use a spoon too well until 18mo.) -Soy formula can still be given until 2 years if your little one cannot tolerate dairy products well Help your child's mind and body grow! Developmental characteristics:
-Displays curiosity, wants to be independent, especially when feeding self!
-Food likes and dislikes become prominent
-Tends to go on food jags (refusal of all but 4 or 5 favorite foods over an extended period)
-In non-controlling, non-coercive conditions, healthy children have the ability to self-regulate the amount of food and energy consumed
It is important that kids
get Small, nutritious, frequent and energy-dense feedings to meet nutrient
and energy needs! Keep in mind: Most toddlers will show their
decreased nutritional need with a
decrease in appetite, a phenomenon
known as physiologic anorexia. From 18-24 months... Don't worry, this doesn't mean that your child will suffer from anorexia nervosa, a disorder involving food restriction and a particular body image depiction! Anorexia just means a decreased appetite. However, toddlers are at risk for not getting the essential nutrients they will need such as iron or calcium and phosphorus for the bones because of their characteristic food habits, especially strong taste preferences! Iron is a part of all cells. It is part of the protein hemoglobin in a red blood cell and carries oxygen from our lungs throughout our bodies. Having too little hemoglobin is called anemia. Iron also helps our muscles store and use oxygen. Without enough iron in the diet, a common condition seen in childhood is iron-deficiency anemia. If not prevented or treated, iron-deficiency anemia can cause cognitive, motor, and behavioral impairment. Parents are encouraged to provide good sources of iron that include those with heme and non-heme iron sources: red meats, poultry, fish, green leafy vegetables, dried fruit, and beans. Toddlers are more in tune to others; they may pick up habits of others. If a family member refuses to eat something, a toddler is more likely to imitate that response. If a plate is full or overfilled, it may look and be overwhelming to the toddler. Ritualism is important: same cup, food, utensils. If food is served on a different plate, the toddler may refuse to eat it. Feeding can be very stressful during this time! Nonetheless, it is important to not force foods. Mealtimes should be pleasurable, not a time for discipline or family arguments. Grazing-nibbling and snacking- is also a good way to ensure proper nutrition, as long as appropriate foods are offered. -By 2 years of age,
eats with a utensil
with little spilling
-By 30 months of age,
lifts & drinks from
a cup & replaces it on
the table It is normal for children
to lose interest in mealtimes.
When hungry, they will
focus on eating. When satisfied,
their attention turns elsewhere Food preferences increase
with frequency of exposure.
It may take 5 to 15 exposures
to a new food before a
child learns to like it From 2-3 Years Old..... -By 2 years of age,
eats most foods
without coughing and choking.
However, it's still important to
Cut food into small, bite-sized
pieces so that the child can
easily eat their food! - Using food as a reward can cause overeating.
- Do not force foods on the child. The child will not see the enjoyment in mealtimes You should know: And remember:
- Mealtimes should be pleasant for
the child. Encourage them to
try new things and praise them
when they do! They are just kids! The amount of food eaten will vary day to day depending on the child's appetite, activity level, whether they are experiencing a growth spurt, or if they are excited or overly tired. To achieve 1800 quality calories a day according to MyPyramid for kids that's... High intake of juice can contribute to diarrhea, over-nutrition or under-nutrition, and the development of caries. Water is highly recommended. Exposure to sunlight is another source of Vitamin D. As infants gain trust in the predictability and reliability of their parents, environment, and interaction with others, they’ll begin to discover that their behavior is their own and that it has a predictable and reliable effect on others. Although sometimes their independence can lead to negative consequences, it's important to let the toddler exert their will to reach autonomy. Why? Because a toddler that is expected to listen all the time or is dependent for a very long time creates a sense of doubt regarding their potential capacity
to control their actions. This doubt is joined by fear and shame when there's a feeling to go against others' desires. On the other end, several characteristics, especially negativism and ritualism are typical characteristics of a toddler in their quest for autonomy. Negativism: The persistent negative response to request “no!!”, “me do!!”, “mine!!”. Emotions are strong & usually with rapid mood swings. If they are unable to do something such as opening a toy or are scolded for their attitude, they may have a temper tantrum and may seek comfort. If not dealt with constructively, the child will have trouble with socialization in the future.
Ritualism: The need to maintain sameness and reliability such as regular routines are needed for reasons such as feeling secure. Without the comfort of rituals, there is little opportunity to exert autonomy and regression and dependency occurs. zzzz........... 1 sheep, 2 sheep, 3 sheep, 4 sheep, 5 sheep, 6 sheep, 7 sheep, 8 sheep, 9 Sleep Problems are common -Related to factors such as fear of separation or falling asleep.
-Bed-time rituals (bath, snack, read, same time) are helpful - Transitional objects (stuffed animal, blanket) help ease
insecurity. The trial and error experimentation 13-18 months: Awareness of objects and
spatial relationships. Can place objects into objects, such as small box into large box. And your little one can stretch, stand on a low stool, or pull a string to reach an object. Beginning of rational judgment &
intellectual reasoning Further differentiation from one's self and objects-ability to tolerate separation from parent longer
Awareness of causal relationship between 2 events is apparent , ex: flipping a light switch and aware of reciprocal response (light on/off) but cannot transfer knowledge to new situations. So toddler may keep on reinvestigating an object or that same light switch. Object permanence has advanced: The child cannot find an object that he/she did not see removed, but does realize there are objects behind closed cabinets, doors, on top of counter tops, and under tables. 19-24 months: -Advancement of object permanence: children can look for hidden objects in several places.
-Inferring a cause when only experiencing the effect. Children can infer an object can be hidden anywhere even after they only saw the original hiding place.
-Developed sense of timing, but is exaggerated: 1 minute can feel like an hour There is great symbolization to imitation!
-Imitation displays deeper meaning & understanding. The toddler is acutely aware of others' actions and attempts to copy them. -Domestic mimicry (imitating household activities) and gender-role behavior become increasingly common during this stage. Children do not yet understand concrete logic & can't mentally manipulate information. Children’s increase in playing & pretending takes place. Children during this stage are concerned with the "why" and "how" of things. Characteristics of Preoperational thought: Egocentrism: Can only see their own perspective/point of view and not others
Magical thinking: Believing their thoughts are powerful and can cause events
Centration- focusing on one aspect rather than other alternatives
Animism-Attributing lifelike qualities to inanimate objects Ex: child scolding stairs for making the child fall down
Irreversibility-Inability to undo/reverse actions initiated physically Ex: Child cannot think of positive activity when told to stop talking
Transductive reasoning: Reasoning from the particular to particular Ex: Refusing to eat food because something eaten before wasn't good
Global organization: reasoning that changing any one part of the whole changes the entire whole. Ex: Child refuses to sleep in room because location of bed is changed. 2 years + Each toddler progresses at his or her own pace and girls are known to start talking before boys. The ability to comprehend and understand speech is much greater than the number of words (from 4 at 1yr & possibly up to 300 at 2 yrs). The child uses one-word sentences or holophrases: "Up" can mean "look up" or "pick me up."
They are 25% understandable
Points to objects/gestures- cup to mouth when empty At 1 year old: By 2 yrs-30 mo 3o months: Child puts words into simple sentences, begins to master grammatical rules, and acquires 5-6 new words daily. By 18mo: 10+ words and forms word/gesture combinations Language Development Strings 2-3 words together, such as the phrases "mama go bye-bye" or "all gone" 65% understandable "I" "Me" "You" Pronouns Gives first name Understands directional commands Verbalizes need for toileting, food, or drink By 3 years: Gives first and last name Refers to self by appropriate pronoun Uses plurals Names one color Gestures may accompany language milestones up to 30 months and phase out once language is sufficiently mastered and pace of word learning increases. Refers to self by name Toddlers are developing skills of independence and these are evident in all areas of behavior (feeding, dressing, and toileting). They also begin to develop concerns for the feelings of others and understand adult expectations apply for behavior specific situations. Interaction with people becomes increasingly important. The toddler engages in parallel play- plays alongside, not with, other children Imitation is strong There is less emphasis with gender-stereotyped toys Specific range of toys and types of play/activities include: -Push-pull toys
-Rocking horses - Finger paints & thick crayons
- Blackboard and chalk
-Puzzles with large and simple pieces
-Water toys and rubber ducks
-Stacking rings/nesting toys
-Ride-on toys and tricycles
-Props for make-believe play (kitchen)
-Large play vehicles -Talking (talking dolls and animals, toy telephone, cassette tape recorders)
-Blocks/Interlocking blocks/construction toys that snap together
-Appropriate television programs (no more than 1-2hrs/day)
-Reading stories from a picture book or imitating animal sounds
-Sandbox w/ shovel and pail
-Balls of various sizes
-Small gym and slide
-Simple, sturdy musical instruments
-Hammering toys (pegs or balls through holes) Toddlers curiosity, increased ability to perform activities such as turning a knob, and ability to climb, stretch, and reach objects over their heads places them at an increased potential for burns. Burns rank 2nd among girls and 3rd among boys for accidental death. Tips to prevent the tots from the hot: Keep small stoves, heaters and other hot objects like cigarettes, candles, coffee pot, pot handles, placed out of reach from where a child can tip it or grab it
-Do not cook, eat hot foods or drink hot liquids with a child standing nearby or with a child sitting on your lap
-Check that all appliances like an iron, is turned off and disconnected and placed where it cannot be used
-Always check the bath temperature, keep a hot water heater set a 48.6 degrees C or lower if possible. Don't allow the child to play with the faucets and supervise
-Keep guards in front or around all heating appliances such as a fire place or a furnace
-Cover electrical outlets w/ protective devices & Keep electrical wires hidden or out of reach
-Do not allow the child to play with electrical appliances, including: wires, lighters, and hair-styling appliances
-Stress the danger of open flames
-Explain what "hot" means
-Apply sunscreen with (SPF) 15+ when the child will be exposed to the sun Toddlers are at the highest risk for poisoning. Mouthing activities continues to be prevalent after 1 year of age, and exploring objects by tasting them is part of children's curious investigation. By trial-and-error they are able to unscrew and open most lids/containers, even those child-resistant. They are also able to access many tight-security places. The major reasoning for poisoning is improper storage. 800-222-1222(Poison Control Center)
should be listed and ready to act on Tips for the tot: -Keep all potential toxic agents in a locked cabinet or out of reach
-Replace medications and poisons immediately in a safe place out of child's reach; replace child-resistant caps properly
-Do not refer to medications as candy
-Keep cosmetics away from a child's reach (children often find them in a purse)
-Teach the child not to play with the trash
-Never remove labels from containers of toxic substances Although gross and fine motor skills are better developed, falls are still a hazard. The climbing and running of the toddler are complicated by the child's total neglect for and lack of appreciation of danger. Proper teaching, restraint, & adequate supervision are essential. To prevent the tot from tipping: -Teach safety at play areas such as no horseplay on high slides or jungle gyms, sitting on swings, & staying away from moving swings. -Check playground equipment before use -Place gates at both end of stairs -Guard windows with rails -Lock doors leading to stairwell -Crib rails in highest position, mattresses lowest -Check beds, especially bunk beds for sturdiness -Double-knot shoelaces -Buckle in chairs properly -Good fit clothing Drowning ranks third as cause of accidental death among children 1-4 yrs old. Their intense drive for exploration and investigation, combined with an unawareness of the danger of water and their helplessness in water, makes drowning a viable threat. Death can result in minutes. Tot tips: -Keep the bathroom door closed and the toilet lid down
-If you have a swimming pool, have a fence be placed around it, keep it locked and ensure that the child cannot open it (including inflatable pools)
-Always be alert when the child is near any source of water; adult supervision is essential
-Teach the child how to swim Foreign body aspiration (presents when object goes down the wrong site towards the lungs) is most common during the second year of life. Suffocation can happen because of a toddler's curiosity or play by climbing into large appliances such as old refrigerators, ovens, or dryers, and even toy chests-and accidentally having the door closed behind them. Tips for the toddler:
-Avoid giving the child fruits that have pits (cherries, plums, peaches, mangoes, apricots and dates)
-Avoid giving dried beans, hard candy, chewing gum, popcorn, grapes, and marshmallows
-Allow the child to only play with toys that do not have a sharp edge or any removable parts to them
-Inspect toys and cloths such as for batteries, buttons
-Choose toy boxes or chests that do not have heavy hinges
-Keep automatic garage door opener in a hidden place out of the child's reach
-Removing all doors before discarding or
storing appliances Motor Vehicle Injuries Motor vehicle injuries cause more accidental deaths in all pediatric groups after age 1 year than any other type of injury or disease and are responsible for almost half of all accidental deaths of children 1-4 years. Many of which restraints were used improperly. Other factors are children climbing into car trunks when opening and closing it, riding in the open back of a truck, being hit by an automobile, and overheating in a car. Toddler safety tips: Use federally approved car restraint Supervise child while playing outside Do not allow child to play behind a parked car or on a curb Do not permit child to play in pile of leaves, snow, or large cardboard container in trafficked areas Supervise tricycle riding Lock fences and doors if not directly supervising child Teach child to obey pedestrian safety rules:
Look left, right, & left again before crossing street Stand back a step from the curb Obey traffic signals Use sidewalk, if none, walk facing traffic Buckle up! If unsure, ask your local fire dept for proper restraint
methods. 6.Hockenberry, Marilyn J and David Wilson. (2012).Wong's Clinical Manual of Pediatric Nursing. 8th ed. Pp. 167-169. St. Louis, MO: Elsevier 2.New York State Department of Health. (2010). Pediatric Dietary Needs: General Guidelines. Retrieved from: http://www.health.ny.gov/facilities/hospital/emergency_preparedness/guideline_for_hospitals/nutrition.htm 3.Centers for Disease Control and Prevention. (2011). Iron and Iron Deficiency. Retrieved from: http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 1 3 1 2 1 2 1 1 1 1 2 2 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 6 6 1 6 1 1 1 1 1 Adults sometimes forget the fascination of feeling slippery cream, mud, catching bubbles, and reshaping clay. These type of activities are important and allows children freedom of expression. If there are any doubts about the progress and development of the toddler in your life, it's helpful to contact a healthcare provider. Toddlers do not put an emphasis on gender toys. Play objects such as dolls, dollhouses, kitchen, dress-up, balls , and trucks are suitable for both genders. The toddler will inspect toys, talk to it, test it's strength & durability, & may even make new uses for it. Parallel Play Parallel play (or parallel activity) is when children play with toys like those the children around them are using but are absorbed in their own activity and usually play beside rather than with one another. Children in this stage may comment on what they are doing or imitate what another child does, but they rarely cooperate in a task or engage in dramatic play or formal games with others. This type of play appears to serve as a bridge to more complex cooperative activities. 1 1 5 5. Collard, R. (2013). Parallel Play. J-rank Article: Social Issues Reference: Child Development Reference, Volume 6. Retrieved from:
http://social.jrank.org/pages/452/Parallel-Play.html Current Health Issue: Autism Spectrum Disorders (ASDS) is considered the fastest growing developmental disability in the United States. ASDS are complex neurodevelopmental disorders of brain function accompanied by intellectual and social behavior deficits. It is typically noticed during early childhood, primarily from 24 to 48 months of age.
Children with ASD demonstrate several peculiar and often seemingly bizarre characteristics primarily in social interactions, communication and behavior. One hallmark characteristic is the inability to maintain eye contact with another person. Children with autism do not always have the same manifestations; cases vary from mild forms requiring minimal supervision, to severe forms in which self-abusive behavior is common. Speech and language delays are also common in ASD children. Any toddler who does not display such language skills as babbling or gesturing by 12 months, single words by 16 months, and two –word phrases by 24 months is recommended for immediate hearing and language evaluation.
Early recognition, referral, diagnosis, and intensive early intervention tend to improve outcomes for children with ASD. Unfortunately diagnosis is often not made until 2 to 3 years of age after symptoms are first recognized. Autism For further details: Autism is the most common autism spectrum disorder. People with autism have differences in the development of their thinking, language, behavior and social skills. The differences appear before age three, and can be diagnosed by 18 months. For a diagnosis of autism, a child must have a specified number of symptoms in these areas:
-communication (including language delay)
-restricted range of behaviors, activities and interests (often called stereotypic behaviors) http://journals.lww.com/ajnonline/Fulltext/2008/11000/Eye_Contact_and_Autism.16.aspx 7. University of Michigan Health System. (2008). Autism, Autistic Spectrum Disorders (ASD) and Pervasive Developmental Disorders (PDD). Retrieved from: http://www.med.umich.edu/yourchild/topics/autism.htm 7 1 1 6 Eye Contact and Autism Abstract: Study links reduced eye contact with social disability in autistic children. http://onlinelibrary.wiley.com/doi/10.1111/j.1744-6155.2009.00200.x/abstract Defining Autism Spectrum Disorders Abstract: To have a better understanding/insight into understanding Autism Spectrum disorder and the closely related neurobiological disorders including Autistic disorder, Asperger's Disorder, and Pervasive Developmental Disorder within. The importance of Iron Iron rich or fortified foods is recommended in children over 6 months. Click below: "Bye-Bye" "Bye" Points to common objects 15 mo: Says no when meaning yes or okay "Asks for objects by pointing" Understands simple commands 4-6 words Talks a lot or incessantly Says at least 50 words at 2 yrs The child says at least 1 word 4 4 4 5-6 word sentences 6 4. American Academy of Pediatrics. (2013). Ages and Stages: Toddler. Retrieved from:
http://www.healthychildren.org/English/ages-stages/toddler/Pages/default.aspx 4 At least 200 words