Child Development: Toddler Ages 1-3 Years

Toddler Ages 1-3 Years: Developmental Changes

• Family experiences changes as child seeks independence and autonomy, a normal part of development
• Nurses guide and assist families through this process

Healthy Development

• Start with a health history, observing behavior, communication, exploration, and comfort-seeking
• Focus on anticipatory guidance, meeting the child at their point in development
• Consider safety, age-appropriate expectations, diet, naps/sleep, toilet training, and play

Physical and Emotional Changes

• Rapid physical and emotional changes occur during this stage
• Focus on agility and normal milestones
• Be realistic about average development

Basic Nursing Care

• Measure weight, height, and head circumference (if not walking) with the child in a supine position
• Weight gain slows, "baby fat" decreases, and a wide gait continues to improve

Milestones and Characteristics

• 20 deciduous teeth, speaking in 2-word sentences, and increased muscle tone
• Lordosis persists until abdomen tone changes at 2 years of age
• Parallel play, recognizing people, and enjoying friends

Vital Signs

• HR: 90-110 bpm
• RR: slows (20s-40s bpm), belly breathing persists
• BP: 99/64 mmHg (difficult to measure)
• Brain grows to 90% of adult size
• Stomach acid increases, tolerating 3 meals/day

Toilet Training

• Started when the child shows interest, stays dry for 2 hours, and is cognitively, physically, and emotionally ready
• Preschools often require potty training
• Review additional guidelines (page 834, BOX 30.5)
• Be cautious with children with Down syndrome, congenital anomalies, or other syndromes

Well-Child Visits

• Purpose: monitor growth, development, and overall health; provide preventative care and education
• Frequency: every 2-3 months until 12 months, then every 3-4 months until 24 months
• Components:
  • Physical examination
  • Measurement of height, weight, and head circumference
  • Developmental assessment
  • Nutrition and feeding guidance
  • Safety and injury prevention counseling
  • Vaccination administration

Vaccination Schedules

• Recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC)
• Vaccines administered during well-child visits:
  • Hepatitis B: birth, 1-2 months, 6-18 months
  • Rotavirus: 2, 4, 6 months
  • Diphtheria, Tetanus, and Pertussis (DTaP): 2, 4, 6, 15-18 months
  • Haemophilus influenzae type b (Hib): 2, 4, 6, 12-15 months
  • Pneumococcal conjugate (PCV): 2, 4, 6, 12-15 months
  • Influenza: annual, starting at 6 months
  • Measles, Mumps, and Rubella (MMR): 12-15 months
  • Varicella (chickenpox): 12-15 months

Growth and Development

• Physical growth:
  • Average weight gain: 1-2 pounds per month
  • Average height gain: 1-2 inches per month
• Developmental milestones:
  • Gross motor: rolling, sitting, crawling, standing, walking
  • Fine motor: grasping, raking, pointing
  • Language: cooing, babbling, saying first words
  • Cognitive: recognizing objects, imitating actions
• Red flags for developmental delays:
  • No smiling or social interaction by 6 months
  • No sitting by 10 months
  • No walking by 18 months

Nutrition and Feeding

• Breast milk or formula: primary source of nutrition until 12 months
• Solid foods:
  • Introduction: around 6 months
  • Single-ingredient, iron-rich foods first (e.g., pureed meats, iron-fortified cereals)
  • Gradually introduce new foods, monitoring for signs of allergy or intolerance
• Snacks and finger foods:
  • Offer around 8-10 months
  • Encourage self-feeding and independence

Common Childhood Illnesses

• Upper respiratory tract infections (URTIs):
  • Symptoms: runny nose, cough, fever
  • Treatment: supportive care (e.g., hydration, rest)
• Otitis media (ear infections):
  • Symptoms: ear pain, fever, pulling on the ear
  • Treatment: antibiotics, pain management
• Gastroenteritis (stomach flu):
  • Symptoms: diarrhea, vomiting, fever
  • Treatment: hydration, electrolyte replacement, rest
• Skin infections:
  • Symptoms: redness, swelling, warmth, pus
  • Treatment: antibiotics, wound care