Nursing Care of a

Family with a
Toddler Child

Christine M. Fiel, RN MN LPT MAEd

Growth and Development of a Toddler
Physical Growth

Weight Gains 5 to 6 lb(2.5kg) / year

Height 5 in (12 cm) / year

Head Circumference increases only about 2 cm

A. Body Contour
• prominent abdomen
• forward curve of the spine at the sacral area (LORDOSIS)
• waddle or walk with a wide stance
 B. Body Systems
Body systems continue to mature during this time:
• Respirations slow slightly but continue to be mainly abdominal. In the respiratory
system, the lumens of vessels enlarge progressively = lower respiratory
infection becomes less.
• HR : 90 b/m; BP : 99/64 mmHg.
• The brain : 90% of its adult size.
• Stomach secretes more acid; therefore, gastrointestinal infections become less
common.
• Stomach capacity increases = a child can eat three meals a day.
• Control of the urinary and anal sphincters becomes possible with complete
myelination of the spinal cord = toilet training
• IgG and IgM antibody production becomes mature at 2 years of age
= passive immunity non operative
C. Teeth
2 years = Eight new teeth (the canines and the first molars)
2.5 to 3 years = All 20 deciduous teeth (Gonsalves, 2008).
Developmental Milestones

Age(Mos) Fine Motor Gross Motor Language Play

• Puts small pellets into

small bottles.
• Scribbles voluntarily with a • Walks alone • 4–6 words • Can stack 2 blocks;
pencil or crayon. • Can seat self in chai • Enjoys being read to
15
• Holds a spoon well but • Creeps upstairs • Drop toys for adult
may turn it upside down to recover
on the way to the mouth

• Run and Jump in place

• Can walk up and down • 7–20words, uses • Imitates household
• No longer rotates spoon the stairs with something jargoning chores, dusting, etc.
18
to bring to mouth to hold on to. Typically • names 1 body • BEGINS PARALLEL
places both feet on one part PLAY
step before advancing.
Age(Mos) Fine Motor Gross Motor Language Play
• Can open doors turning • Walks on stairs alone but • 50 words, • PARALLEL PLAY
the knob; still using both feet on 2-word EVIDENT
• Unscrews lids same step to advance sentences
24 • (noun-pronoun
and verb)
Ex: “Me go”

• Makes simple lines or • Can jump down from • Verbal language • Spends time playing
strokes for crosses with stairs increases house
pencil • Knows full name • Imitating parent's
• Can name one action
30
color • “Rough-housing” or
• Holds finger to active
show age
Language Development

• “No” = autonomy
• Encourage language development by naming objects as parents play wit
h their child (“ball,” “block,” “music box,” “doll”); Children should not
be made to name an object before they can have it.
• Always answer a child’s question

Note: Because children learn language from imitating what they hear, they will
speak like those around them. If they are spoken to in baby talk, their
enunciation of words can be poor
Emotional Development

A. Autonomy
• Sense of Autonomy VS Shame or doubt (Erik Erickson, 1993)
Autonomy = Independence
Notioned to be negativistic, obstinate (stubborn), and difficult to manage.
B. Socialization
• Once toddlers are walking well, they become resistant to sitting in laps and being
cuddled
15 months - enthusiastic about interacting with people
18 months - imitate the things they see a parent doing, such as “study” or
“sweep,” so they seek out parents to observe and initiate
interactions.
2 or more years - become aware of gender differences and may point to other
children and identify them as “boy” or “girl.”
Play Behavior
• Parallel play – side-by-side play (normal developmental sequence)
• Age appropriate toys: ( toys they can control, giving them a sense of pow
er in manipulation, an expression of autonomy )

 Trucks,
 squeaky frogs,
 Waddling ducks,
 Rocking horses,
 Pegs,
 Blocks,
 Toy telephone
15 months - put-in, take-out stage; stacks of boxes or balls that fit inside each other
18-months - pull toys; Toys should be strong enough to take a great deal of abuse
2 years - imitating adult actions; Imitation is the play
By the end of the toddler period - rough-housing; spend at least part of every day in this
very active, stimulating type of play.
Cognitive Development

• Tertiary Circular Reaction Stage (Between 12 and 18 months)

Fifth and sixth stages of Piaget’s sensorimotor thought ; “a little scientist”

Health Promotion For A Toddler And Family
Promoting Toddler Safety
• Accidental ingestions (poisoning) are the type of accident that occurs most frequently
in toddlers (Dart & Rumack, 2008).
• Aspiration or ingestion of small objects
• Urge parents to childproof their home
• A safety gate on the door of the room is another way to keep a toddler contained and
safe.
• Other accidents that occur frequently in toddlers include motor vehicle accidents,
burns, falls, drowning, and playground injuries.

Note: These accidents happen because toddlers’ motor ability jumps ahead of their
judgment.
 Common Safety measures
Potential accident Prevention measures
• Maintain child in car seat; do not be distracted from safe driving by a child in a car.
• Do not allow child to play outside unsupervised.
• Supervise toddler who is too young to be left alone on a tricycle.
Motor vehicles • Teach safety with pedaling toys (look before crossing driveways; do not cross streets)
*But do not expect that toddler will obey these rules at all times
(in other words, stay close by).
• Never present medication as candy. Buy medications with childproof caps; put away
• immediately after use.
• Never take medication in front of child.
• Place all medication and poisons in locked cabinets or overhead shelves where child
cannot reach them.
• Never leave medication in parents’ purse or pocket, where child can reach it.
Poisoning
• Always store food or substances in their original containers.
• Know the names of house plants and find out if they are poisonous. (Call regional poison
control center for information.)
• Hang plants or set them on high surfaces beyond toddler’s grasp.
• Be certain that small batteries or magnets are out of reach.
• Post telephone number of nearest poison control center by the telephone.
• Inspect toys to be certain they are free of lead-based paint.
Promoting Nutritional Health of a Toddler
Take note during toddler stage:
a. Appetite is decreased
b. Promotion of independence is important
c. They usually do not like food that is “mixed up”
d. They often prefer brightly colored foods to bland colors.

TODDLERS NUTRITION

• Sedentary children ages 1 to 3 years = 1000 kcal daily;

• Active children ages 1 to 3 years = 1400 kcal daily
(U.S. Department of Agriculture [USDA], 2005)
• Protein and carbohydrate
• calcium and phosphorus
• 2 years old = do not restrict fats
• Over 2 years old = fat intake between 30% and 35% of calories; Sources : fish, nuts, and vegetable oils
• Milk should be whole milk until age 2 years
• Trans–fatty acids should be kept to a minimum
• Avoid high sugar foods
Promoting Toddler Development in Daily Activities

A. Dressing
B. Sleep – Need for sleep declines; 8 – 12 hours with naps in between; they naturally fall asleep when
they are tired.
- Other toddlers resist naptime as part of their developing negativism.
- They love a bedtime routine: bath, pajamas, a story, brushing teeth, being tucked into bed, having a
drink of water, choosing a toy to sleep with, and turning out the lights.
- Many toddlers are ready to be moved out of a crib into a youth bed or regular bed with protective
side rails or a chair strategically placed beside it by the end of the toddler period.
C. Bathing - usually enjoy bath time, and parents should make an effort to make it fun by providing a toy, such
as a rubber duck, boat, or plastic fish.
NOTE: DON’T LEAVE THE CHILD UNATTENDED WHEN BATHING
D. Care of Teeth - toddlers need to have a toothbrush they recognize as their own; At the end of the toddler
period, they can begin to do the brushing themselves under supervision
- first visit to a dentist skilled in pediatric dental care at about 12 months of age for
assessment of dentition
Promoting Healthy Family Functioning

Learning self-reliance is the primary goal of a child during the toddler

period

• Help parents to understand their responses towards the attempts of a toddler at b

eing independent which are crucial to the healthy development of their child.
• If parents punish children excessively at each move toward independence, children
will not fight them indefinitely. Instead, they will begin to feel guilty for wanting to
do things independently.
• Caution some parents not to begin to function at the same level as their toddler.
• 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 picke
d up and carried, this is natural.
Parental Concerns Associated With the Toddler Period
A. Toilet Training - one of the biggest tasks a toddler tries to achieve; toilet training
is an individualized task for each child.

Before children can begin toilet training, they must have reached three important dev
elopmental levels, one physiologic and the other two cognitive:
• They must have control of rectal and urethral sphincters, usually achieved at the time they walk
well.
• 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.
• They must have a desire to delay immediate gratification for a more socially accepted action.

NOTE: Some toddlers smear or play with feces, often at about the same time that toilet training is
started. Teach parents to accept this behavior for what it is: enjoyment of the body and of the self
, and the discovery of a new substance. After a child is fully toilet trained, this activity rarely persi
sts.
 How To Toilet Train A Toddler
1. Children are physically ready for toilet training when 7. Do not allow a child to remain on a potty chair for
they walk securely. much longer than 10 minutes (less than that if he is
resistant).
2. Use pull down pants to avoid accidents.
8. If your child is not ready or does not successfully use
3. Purchase either a potty chair that sits on the floor or the potty on a day-to-day basis, have him return to
an infant seat that is placed on the regular toilet diapers for a short period.

4. Place child on the potty chair or toilet at regular 9. When boys have mastered defecation, it is time to
interval. include urination.

5. Praise your child if he does urinate or defecate. 10. Some toddlers have difficulty remaining dry at night
Remind him to wash his hands. until they are 3 to 4 years old. Do not pressure your
child to accomplish nighttime dryness, but assume
6. Be careful not to flush the toilet while the child is that he is doing the best he can do
sitting on it.
11. Do not wake your child during the night and carry
him to the bathroom to void.
B. Ritualistic Behavior
• Although toddlers spend a great deal of time every day investigating new
ways to do things and doing things they have never done before, they als
o enjoy ritualistic patterns.

C. Negativism - As part of establishing their identities as separate individ

uals, toddlers typically go through a period of extreme negativism.
• A positive stage in development
• Toddlers have learned they are separate individuals with separate needs
• A toddler’s “no” can best be eliminated by limiting the number of questio
ns asked of the child.
D. Discipline - means setting rules or road signs so children know what is
expected of them.
Punishment is a consequence that results from a breakdown in dis
cipline, from the child’s disregard of the rules that were learned.
• Remind parents that “discipline” and “punishment” are not interchangeable
terms.
• It is setting safety limits and protecting others or property
• Two general rules to follow are
(a) parents need to be consistent
(b) rules are learned best if correct behavior is praised rather than
wrong behavior punished.
• “Timeout” is a technique to help children learn that actions have conseque
nces.
E. Separation Anxiety - begins at about 6 months of age and
persists throughout the preschool period.

• Most toddlers react best to separation if a regular babysitter is e

mployed or the day care center is one with consistent caregivers
.
• Parents should say goodbye firmly. Prolonged goodbyes only lead
to more crying. Sneaking out prevents crying and may ease th
e parents’ guilt, but it can strengthen fear of abandonment so sho
uld be discouraged.
F. Temper Tantrums
• Temper tantrums occur as a natural consequence of toddlers’ developme
nt (Taylor, 2007); they are independent enough to know what they want,
but they do not have the vocabulary or the wisdom to express their feeli
ngs in a more socially acceptable way.
• A tantrum may be a response to difficulty making choices or decisions or
to pressure from activities such as toilet training.