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Course: Pediatric Nursing

Topic: Child Growth and Development Toddlers

The Nurses International Community

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Module Goals

Learners will be able to:

Explain normal developmental changes (e.g., physiologic, cognitive, psychosocial) that occur in toddlers
Examine common developmental theories (Erikson, Freud and Piaget) relating to the growth of toddlers
Identify the gross and fine motor milestones in toddlers
Demonstrate understanding of emotional and social development in toddlers
Describe the nutritional requirements of toddlers
Discuss nurses’ role in the development of toddlers

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Toddlers

Medline Plus, 18 February 2022

NorthShore University, 2022

Children ages 1 to 3

It is a time of extensive exploration of the environment.
Physical growth and development slow during the ages of two to four.
It is a challenging time for the parents and child.

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Physical Changes

Paris, Ricardo, & Rymond, 2019

Weight:

At one year, the child has tripled its birth weight.
By age 2, the weight is 4 times that of the birth weight.

Height:

The average height at one year is about 26 to 32 inches.
Toddlers grow about 7.5 cm (3 in) per year.

Brain:

At birth, the brain is about 25 percent of its adult weight.
By age 2, it is at 75 percent of its adult weight.
The proliferation of dendrites occurs during the first two years so that by age 2, a single neuron might have thousands of dendrites.

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Physical Development (continued):

Medline Plus, 18 February 2022

Fine motor skills:

(Use of small muscles in hands and fingers)
Makes a tower of four to six cubes by around 24 months
Scribbles by 15 to 18 months
Can use a spoon by 24 months
Can copy a circle by 24 months

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Social Development

Indicates some needs by pointing at 12 to 15 months.
Looks for help when in trouble by 18 months.
Helps to undress and put things away by 18 to 24 months.
Listens to stories when shown pictures and can tell about recent experiences by 24 months.
Can take part in pretend play and simple games by 24 to 36 months.

Medline Plus, 18 February 2022

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Language Development

Medline Plus, 18 February 2022

Uses 2 to 3 words (other than “mama” or “dada”) at 12 to 15 months.
Understands and follows simple commands (such as "bring to mommy") at 14 to 16 months.
Names pictures of items and animals at 18 to 24 months.
Points to named body parts at 18 to 24 months.
Begins to answer when called by name at 15 months.

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Social Development (continued):

Medline Plus, 18 February 2022

Behaviors:

Independence is paramount
Need limits for appropriate vs. inappropriate behavior
Often use negativism (negative responses) as they begin to express their independence
While trying new activities, they can get frustrated and angry:

Breath-holding
Crying
Temper tantrums

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Emotional Development

Better Health, 2012

Learning about relationships
Can sometimes imagine how other people feel
“No” may be one of their favorite words
Other common behaviors:

Temper tantrums
Can play with others for a short time but aren't yet capable of true sharing
Engages in parallel play
Difficulty waiting and making choices
Difficulty with impulse control
Likes to imitate adults in both appearance and activity

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Psychosocial Development (Erikson's Theory)

Paris, Ricardo, & Rymond, 2019

Autonomy vs. shame and doubt (1 to 3 years)

Learns basic independence
The development of autonomy is centered on the child’s increasing ability to control their bodies, themselves and their environment.
If they do not succeed, they will doubt their own worth and that of others and will have a sense of shyness, doubt and shame.
Good results are self-control and willpower.

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Psychosexual Development (Freud’s Theory)

Paris, Ricardo, & Rymond, 2019

Anal Stage: (1 to 3 years)

The greatest sensual pleasure is obtained from the anal and urethral areas.
This coincides with potty training or learning to manage biological urges.
The ego is beginning to develop in this stage.
Anal fixation may result in a person who is compulsively clean and organized or one who is sloppy and lacks self-control.

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Sensorimotor Stage: (from birth to 2 years)

Children rely on the use of the senses and motor skills.
From birth until about age 2, the infant understands their world by tasting, smelling, touching, hearing, and moving objects around.
This is a “hands-on” type of knowledge.
They’re primarily concerned with learning about physical objects.
They progress from reflex activity through simple repetitive behaviors to imitative behavior objects.

Paris, Ricardo, & Rymond, 2019

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Critical Thinking Question

Toddlers are in which stage according to Erikson’s psychosocial development theory?

Trust vs. Mistrust
Initiative vs. Guilt
Autonomy vs. Shame and Doubt
Industry vs. Inferiority
Identity vs. Role Confusion

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Growth and Developmental Needs

Medline Plus, 18 February 2022

Safety:

Toddler safety is very important.
More accidents occur during the toddler years than at any other stage of childhood.
Falls are a major cause of injury.
Toddlers should not be left alone for even short periods of time.
Install window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features to keep the child safe.

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Growth and Developmental Needs

NorthShore, 2022

Potty/Toilet Training:

Begin toilet training between 22 and 30 months of age; each child may differ.
The child needs to have control of the bladder and bowels before beginning potty training.

Signs of readiness for potty training

Having a dry diaper after naps and for at least two hours at a time.
Bowel movements around the same time each day, not during the night.

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Nutritional Requirements

Bradford. n.d

The growth rate slows down, and a decrease in appetite may make mealtime difficult.
A regular meal pattern of 3 small balanced meals with variety, including 2-3 nutritious snacks, is recommended.
Foods offered should be nutrient dense and meet (but not exceed) energy requirements.

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Nutritional Requirement

American Heart Association, April 16, 2018

Calories/ foods	Age 1 year	Age 2-3 years	Detail
Calories kilocalories per day (kcal/d)	900 kcal/d	1000 kcal/d	Additional calories: by 0-200 kcal/d if moderately physically active, and by 200–400 kcal/d if very physically active
Fat	30-40%	30-35%
Milk / Dairy	2 cups	2 cups	The American Academy of Pediatrics recommends the use of whole milk. Low fat or reduced fat milk should not be started before 2 years of age.
Lean Meat and Beans	1.5 ounces	2 ounces
Fruits	1 cup	1 cup	Serving sizes are 1/4 cup for 1 year of age; 1/3 cup for 2 to 3 years of age
Vegetables	3/4 cup	1 cup	Serving sizes are 1/4 cup for 1 year of age; 1/3 cup for 2 to 3 years of age. A variety of vegetables should be selected from each subgroup over the week.
Grains	2 ounces	3 ounces	Half of all grains should be whole

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Nutrient Requirements (continued):

Breastfeeding:

It should be continued up to at least 24 months of age per the WHO recommendations.

Cow’s Milk:

Provides protein, calcium, and vitamins A and D
Whole milk rather than reduced-fat milk

Daily intake of 100% fruit juice should be limited to 4 oz between one and three years.
Water is the best option for toddlers between meals for hydration and adds no additional calories.

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Nutrient Requirements (continued)

The recommended daily intake of (age one to three):

Vitamin D: 600 IU
Calcium:700 mg
Iron: 7 mg per day

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Critical Thinking Question

How much kcal is required for a child who is one year old?

1000 kcal/ day
900 Kcal/ day
1200 Kcal/ day
1500 Kcal/ day

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Nurses’ Role in the Development of Toddlers

Promote parental role construction:

Education about growth and development
Guide to stimulate development (touching, speaking and playing)
Promote parent-child interaction (emotional and cognitive development)

Guidance and support for the implementation of physical health care:

Early detection and treatment of disorders
Teach parents to identify signs of health problems
Health education: feeding, prevention of infectious diseases, hygiene and comfort care

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, 2019

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Nurses’ Role in the Development of Toddlers (continued):

Guidance for promoting a safe environment:

Provide guidance for a safe family environment
(Smoke detector, tap water temperature, protection on windows and stairs, safe place to sleep)

Application of theories, principles and methods of maternal and child programs:

Conduct home visits
Supervise child development in a structured program

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, 2019

Contact info: info@nursesinternational.org

Anticipatory guidance for Injury Prevention:

Aspiration of foreign objects:

small objects (grapes, coins, colored beads, candy) that can become lodged in the throat should be avoided
Toys with small parts should be kept out of reach
Age-appropriate toys should be provided
Clothing should be checked for safety hazards (loose buttons)
Parents should know emergency procedures for choking

Burns

Bath water temperature should be checked, and hot water should not exceed 49 C (120 F)
Electrical outlets should be covered
Pot handles should be turned toward the back of the stove, so the child doesn't reach for them when attempting to pull up to a standing position
Working smoke detectors should be kept in the home
Toddlers should wear sunscreen when outside

Bodily harm

sharp objects should be kept out of reach
firearms should be kept in locked boxes or cabinets
toddlers should not be left unattended with any animals
toddlers should be taught stranger safety

Drowning

Do not leave unattended in bathtubs
toilet lids should be kept closed
Toddlers should be supervised when around pools or any body of water
Toddlers should be taught to swim

Falls

Doors and windows should be kept locked
Crib mattresses should be kept in the lowest position with the side rails all the way up
safety gates should be used at the top and bottom of stairs

Poisoning

Safety locks should be placed on cabinets that contain cleaners and other chemicals
Medications should be kept in childproof containers and out of reach of toddlers

Suffocation

plastic bags should be avoided
Pillows should be kept out of cribs
Crib slats should be no farther apart than 6 cm (2.375 in)
Crib mattresses should fit tightly

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Poison Prevention

Stay Safe. org, n,d.

Store paint and pesticides in garages and sheds that are locked and on high shelves away from children.
Monitor children and do not leave them unattended.
Label all unmarked containers and do not store products in food containers.
Have the contact information for the poison control center on hand and stored on your mobile phone.

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Drowning Prevention

Gate your pool properly.
Attend to babies or toddlers in the bathtub 100% of the time. Never leave them alone.
Do not leave large open containers of water in the yard or in the house unattended. Examples: cleaning buckets and kiddie pools
Cover hot tubs at all times and secure the covers, so they don’t slip off easily.
Check and replace all drain covers in a pool.

Safehome.org, 2021

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Preventive Measure of Choking

Make sure children chew their food thoroughly.
Cut food into fingertip-sized pieces.
Inspect toys for small pieces that might come oﬀ easily.
Check the ground regularly for small items like bits of toys, hard foods, marbles, and jewelry that children could easily choke on.
Avoid serving peanuts, seeds, popcorn, chewing gum, whole grapes, and hard candy to children younger than 4 years.

SafeHome. Org, 2021

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Nurses’ Role in the Development of Toddlers (continued):

Development of therapeutic relationships:

Trustful relationships with parents and other family members
Respect the decisions of parental figures

Implementation of maternal and child care management:

Intervene in complex personal and social situations of families
Assume the role of manager

Promotion access to support networks:

Provide information about community resources that parental figures can use in childcare

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, (2019)

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Nurses’ Role in the Development of Toddlers (continued)

Guidance for the life course of parental figures:

Help women define their goals and solve problems that may affect the continuity of their education, job search and planning of future pregnancy.

Use of scientific evidence to guide practice:

Interact with families through an organized, dynamic and systematic method of critical thinking about child health and child development.

Reticena, Yabuchi, Gomes, Siqueira, Abreu, & Fracolli, (2019)

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Critical Thinking Question

Create a teaching plan about home safety for parents of toddlers in your community.

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Red Flags

Birth weight is less than expected for age
Failure to thrive
Malnutrition
Failure to meet the expected growth and development of the expected age group
Unsafe environment
Child abuse and neglect

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

(AHRQ, 2020)

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

(AHRQ, 2020)

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References

American Heart Association ( April 16, 2018). Dietary Recommendations for Healthy Children. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/dietary-recommendations-for-healthy-children

Andrews, M. M., Boyle, J. S. & Collins, J. W. (2020). Transcultural concepts in nursing care (8th Ed.). Wolters Kluwer: Philadelphia, PA.

Belagavi, D. (2019). Theories of growth and development in pediatrics: A review. Disease. J PaediatrNursSci ;2(3):63-6. https://www.innovativepublication.com/media/journals/IJPNS-2-3-63-66.pdf

Contact info: info@nursesinternational.org

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References

Better Health. (2012). Child development (6) - two to three years. https://www.betterhealth.vic.gov.au/health/healthyliving/child-development-6-two-to-three-years#social-and-emotional-development

Bradford. (n.d). Every Baby Matters: Guidelines for good nutrition in Bradford and Airedale Nutrition and 1-5 year olds. https://www.bradford.gov.uk/media/1908/7-nutrition-guidelines-1-to-5-years.pdf

MedlinePlus. (18 February 2022). Toddler Development. https://medlineplus.gov/ency/article/002010.htm

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References

NorthShore University. (2022). Toddler ( 2 - 4 years). https://www.northshore.org/pediatrics/ages-and-milestones/toddler--2---4-years/

Paris, J., Ricardo, A. & Rymond, D. (2019). Growth and Development https://docs.google.com/document/d/1wjD-vdmYPhdirIWczCCqEDxqmeMzaA4-/edit

Riley, L. K., Rupert, J. & Boucher, O. (2018). Nutrition in Toddlers. Am Fam Physician.98(4):227-233. https://www.aafp.org/afp/2018/0815/p227.html

Contact info: info@nursesinternational.org

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References

Reticena, K. O., Yabuchi, V., Gomes, M., Siqueira, L. D., Abreu, F., & Fracolli, L. A. (2019). Role of nursing professionals for parenting development in early childhood: a systematic review of scope. Revista latino-americana de enfermagem, 27, e3213. https://doi.org/10.1590/1518-8345.3031.3213

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896803/#:~:text=For%20the%20development%20of%20parenting%20in%20early%20childhood%20care%2C%20the,4

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