Toddler Development Milestones

• Focus is on children aged 1 to 3 years

Learning Objectives

• Understand the physical, cognitive, and psychosocial development of toddlers
• Understand health risks, concerns, and health promotion strategies for this age group

Toddlerhood

• Age range is 12-36 months
• Toddlers develop rapidly in their motor skills
• Toddlers engage in self-care activities such as feeding, dressing, and toileting
• They become aware of their ability to control their environment
• Toddlers get pleasure from accomplishing tasks
• Toddlers can experience frustration and tantrums when restricted
• Nurses should consider developmental milestones to guide care, teaching, and support to toddlers and families
• Patience, consistency, and a non-judgmental approach to toilet training are crucial
• Encourage the child's need for independence, like allowing them to dress or feed themselves
• Minimize separation anxiety and fear in clinical settings
• Reduce physical discomfort and incorporate play into nursing care

Transitions to Early Childhood

• This slide lists major challenges that occur during the toddler stage that can act as transitions into early childhood
• Speech: An 18-month-old may use around 50 words
• Speech: a 24-month-old could have a vocabulary of up to 200 words and start using two-word sentences
• Locomotion: Gross motor skills rapidly advance from unsteady walking to running, jumping, and climbing
• Toddlers require 11-14 hours of sleep per 24 hours, including naps
• Toilet training requires the toddler to have the physical and cognitive ability to recognize the urge to urinate and defecate
• Toddlers exhibit temper tantrums and negativity as they assert their independence and struggle with limitations
• Toddlers may start attending daycare or play school, which introduces new social interactions and independence
• "The terrible twos" highlights the challenging but normal period of testing boundaries and asserting independence
• Toddlers are naturally curious and explore their environment

Physical Development

• Growth slows compared to infancy
• Toddlers gain about 4-6 pounds per year
• Height increases approximately 3 inches per year
• The skeletal system continues to develop
• Birth weight is typically quadrupled by 30 months
• Anterior fontanel closes between 12 and 18 months
• Myelination of the spinal cord is completed by 2 years old, critical for bowel and bladder control
• Breathing shifts from primarily abdominal to more thoracic
• The eustachian tube is shorter and straighter than in adults, making toddlers more susceptible to ear infections
• The full set of primary teeth is usually complete by 2.5 years of age
• Teeth brushing and oral care are important for oral hygiene

Gross Motor Development

• Locomotion skills develop, toddlers are constantly moving and exploring
• Gait changes from a wide, unstable gait to running, climbing stairs, and riding tricycles by age 3
• By age 2, toddlers can often stand on one foot, walk on tiptoe, and jump with both feet

Fine Motor Development

• Manual dexterity increases
• Toddlers gain more control over hands and fingers
• Progression from spontaneous scribbling to drawing simple shapes and stick figures
• Toddlers begin feeding themselves with a spoon, gradually gaining accuracy
• Stacking blocks improves; 18-month-olds stack 3-4 blocks, 24-month-olds stack 6-7 blocks, and 30-month-olds stack 8 or more blocks
• Casting/throwing objects is common, especially around 15 months

Sensory Changes

• Visual acuity of 20/40 vision is acceptable
• Vision and ability to focus are still developing
• Depth perception is immature
• Eye-hand coordination improves
• Toddlers reach for attractive objects around 15 months
• Toddlers look at picture books and identify forms around 12-18months
• Hearing, smell, taste, and touch develop along with other skills and are used to explore the environment

Cognitive Development According to Piaget

• Toddlers complete the sensorimotor stage around 24 months, then move to the preoperational stage
• Toddlers primarily see things from their own point of view (Egocentrism)
• Toddlers use symbols to represent objects, people, and places
• Toddlers become aware of the relationships between events (Causal relationships)
• Toddlers socialize with siblings and other significant individuals
• Toddlers learn about spatial relationships
• Toddlers understand that objects continue to exist even when they are not visible (Object permanence)
• Toddlers imitate actions they have seen others perform

Language Development

• 18 months: About 50 words
• 24 months: About 200 words
• Toddlers understand more words than they can use themselves (Higher comprehension)
• Start combining words to form simple sentences of 2-3 words
• Toddlers can learn more than one language
• Toddlers respond to the tone of voice and facial expressions
• Showing empathy for a toddler trying to communicate minimizes frustration

Moral Development

• Toddlers do not understand the concepts of right and wrong
• Toddlers behave to avoid unpleasant experiences and seek pleasant experiences

Psychosocial Development According to Erikson

• Main psychosocial conflict is developing a sense of autonomy versus feeling doubt and shame
• Toddlers develop a sense of independence and want to do things for themselves
• Toddlers want to make choices about their environment
• Saying "no" is a common way for toddlers to assert their independence (Negativism)
• Toddlers display strong will and often exhibit temper tantrums when frustrated
• Rituals provide toddlers with a sense of comfort
• Toddlers begin to play alongside others Moves from solitary to parallel play
• Toddlers remain strongly attached to their parents and fear separation

Health Risks

• Increased mobility, independence, and curiosity lead to a higher risk of injury
• Childproofing the environment is crucial
• Toddlers put objects and substances in their mouths
• Lack of awareness makes drowning a significant risk
• Adults should closely supervise toddlers and set safety limits
• Complete dependence on parents to keep them safe
• Car seats are essential for automobile safety
• Rear-facing car seats are recommended for all children under 2 years old

Health Risk Prevention

• Always use car seats appropriately and supervise children near traffic (Motor vehicle safety)
• Supervise closely near water, fence pools, and keep toilet lids closed (Drowning prevention)
• Keep hot items and appliances out of reach, use guards on heat sources, and check bathwater temperature (Burn prevention)
• Store potentially toxic agents in a locked cabinet and out of reach (Poisoning prevention)
• Secure windows, use gates on stairs, and remove scatter rugs (Fall prevention)
• Avoid giving small, hard foods, and use toys that do not have small parts (Choking and suffocation prevention)
• Avoid giving sharp or pointed objects to toddlers, especially when they are walking or running (Bodily harm prevention)
• Teach personal safety and supervise interactions with animals

Nutrition

• Toddlers usually stop drinking breast milk or formula
• Excessive milk intake can lead to decreased appetite for solid foods and iron deficiency
• More solid foods and cow's milk are needed
• Limit milk intake to 500-750 mL (2-3 servings) per day
• Children should not drink low-fat or skim milk until 2 years of age. Whole milk is needed for physical and intellectual growth
• A balanced diet includes grains, vegetables, fruits, proteins, and dairy products
• A well-nourished toddler should have a steady, proportional gain in height and weight
• Toddlers prefer chopped or finger foods for self-feeding
• A variety of foods ensures a balanced diet
• Young children can have small appetites
• Encourage a variety of healthy food options
• Offer small meals and snacks at regular intervals
• Allow children to decide how much they want to eat

Other Nutritional Tips

• It's normal for children to eat more at some meals and less at others
• A child's activity level can impact their appetite
• Growth spurts may result in more hunger
• Emotions such as excitement or sadness can affect appetite
• Review and use Canada's Food Guide for healthy eating recommendations

Additional Resources

• Safety in the Home & Community is available for parents with infants and toddlers
• The Centre of for Disease Control and Prevention (CDC) website
• Ontario Poison Centre provides resources about Household Hazards
• "Candy or Pill" game educates parents and children about potential hazards

Safe Toys

• Toys that engage movement, language and exploration are best for 1 year olds
• Good ones are board books, recordings with songs, stories, creative materials like markers, crayons, paper, pretend play items, building blocks
• Toys that support problem-solving, pretending, creativity, and physical activity are best for 2 year olds
• Include puzzles, blocks, transportation toys, construction sets, child-sized furniture, dress-up clothes, art supplies, picture books, music players, and toys for large motor skills

Nursing Care: Goals

• Minimize separation anxiety related to separation from parents
• Build a trusting relationship with the child
• Reduce the child's fear of medical procedures
• Ensure the child is as comfortable as possible during procedures
• Support the child's growth and development
• Include play in their care

Nursing Care: Techniques

• Squat or sit to be at the child's eye level
• Use a soft voice, especially if a child is crying
• Use play to establish a safe, non-threatening environment
• Communicate with words they can understand (e.g., 'boo boo' or 'ouch')
• Avoid using frightening words like “shot,” “fix,” or “take your vital signs"
• Toddlers learn through exploration and making good choices
• Allow the toddler to sit on the parent's lap during the exam
• Offer simple choices to give toddlers some control
• Calmly state what area you will examine next
• Use distraction such as having a parent read or blow bubbles
• Prepare a toddler no more than one day ahead of time for a procedure
• Ask the child to point to a body part you will examine
• Show the child the equipment
• Praise the child for cooperation and use their first name
• Allow dressing self, using a potty chair, and self-feeding to encourage autonomy
• Name objects using simple explanations
• Perform treatments in a separate room rather than the child's bedroom
• Give the toddler a choice after the procedure and to decrease resistance
• Comfort the toddler after a painful procedure by rocking, singing, offering a snack, or holding them

Explore key toddler development milestones including physical growth, motor skills, and autonomy. Learn about spinal cord maturation, common challenges like limit testing, and health aspects such as ear infection susceptibility. Understand the advancements in fine motor skills and the closure of fontanelles.