Toddler Growth and Development - Ages 1-3

Growth and Development

• Age span ranges from 1 to 3 years
• Talk to children in this age group with a growing sense of autonomy
• Growth rate begins to decrease
  • Weight gain is approximately 5 to 6 pounds per year
  • Height increases by about 5 inches per year
• Bladder capacity increases
• Baby fat decreases as toddlers transition into leaner, more muscular bodies
• Appetite decreases
• Head circumference increases by about 2 cm.
• Chest circumference should grow to be greater than the head circumference
• Toddlers still typically have a prominent abdomen
• Lordosis is present
• Respiratory rate slows slightly, but breathing continues to be mainly abdominal
• Heart rate is around 90 bpm
• Blood pressure is approximately 99/64 mmHg
• The brain develops to 90% of its adult size
• The respiratory system's lumens of vessels enlarge progressively, lowering the risk of lower respiratory infections
• Stomach secretions become more acidic
• Stomach capacity increases to 3 times per day
• Control of urinary and anal sphincters becomes possible
• Production of Immunoglobulin IgG and IgM antibodies matures around 2 years old
• Passive immunity acquired during intrauterine life is no longer effective
• 8 new teeth, specifically canines and first molars, typically erupt during the second year
• Toddlers typically have 20 deciduous teeth by 3 years old

Gross Motor Development

• At 15 months
  • Walks alone well
  • Can seat self in chair
  • Creeps up stairs
• At 18 months
  • Can run and jump in place
  • Walks up and down stairs while holding onto a hand or railing
  • Places both feet on one step before advancing
• At 24 months
  • Walks up stairs alone
  • Uses both feet on the same step at the same time
• At 30 months
  • Can jump down from chairs

Fine Motor Development

• At 15 months
  • Puts small pellets into bottles
  • Scribbles voluntarily with a pencil or crayons
  • Holds a spoon well, but may still turn it upside down on the way to their mouth
• At 18 months old
  • No longer rotates a spoon to bring it to their mouth
• At 24 months
  • Opens doors by turning doorknobs
  • Unscrews lids
• At 30 months
  • Makes simple lines or strokes for crosses with a pencil

Language Development

• At 15 months
  • Says 4 to 6 words
• At 18 months
  • Says 7 to 20 words
  • Uses jargoning
  • Can name one body part
• At 24 months
  • Says 50 words
  • Uses 2-word sentences with a noun or pronoun and verb
  • Common sentences include "Daddy go," and "Dog talks"
• At 30 months
  • Verbal language increases steadily
  • Knows full name
  • Can name one color
  • Holds up fingers to show age

Play

• At 15 months
  • Can stack 2 blocks
  • Enjoys being read to
  • Drops toys for adults to recover
• At 18 months
  • Imitates household chores, such as dusting
  • Begins parallel play
• At 24 months
  • Engages in parallel play
• At 30 months
  • Spends time playing house
  • Imitates parents' actions
  • Play is "roughhousing" or active

Emotional Development

• Toddlers are resistant to sitting in laps or being cuddled
• At 15 months, they are still enthusiastic about interacting with people
• At 18 months, they imitate the things they see a caregiver doing
• By 2 years old, they become aware of gender differences

Cognitive Development

• Toddlers are "little scientists"
• From 18 to 24 months, they use problem-solving or symbolic thoughts, but they may struggle to see one project as different from another
• Faulty reasoning can cause them to reach wrong conclusions

Nursing Roles in Health Promotion

• Promote Safety:
  • Keep all poisonous products, drugs, and small objects out of reach
  • Exercise caution when children are playing outside
  • Encourage the use of protective gear
  • Toddlers should be placed in a rear-facing car seat until they are at least 2 years old
  • Avoid toys or objects with lead content
• Promote Nutritional Health:
  • Recognize that a decline in food intake is common
  • Provide small amounts of food and allow the toddler to ask for more
  • Involve toddlers when cleaning the plate after eating
  • Allow self-feeding
  • Provide finger foods
  • Let toddlers choose which foods to eat
  • Provide 1,000 to 1,400 kilocalories per day
  • Ensure that protein and carbohydrates requirements are met during the toddler period
  • Avoid diets high in sugar
  • Do not restrict fats before 2 years old
  • Children over 2 should have a fat intake of 30% to 35% of calories from fish, nuts, and vegetable oils
  • Keep trans-fats to a minimum
  • Ensure adequate calcium and phosphorus intake
  • Provide fortified soy milk and tofu in vegetarian diets
• Promote Development in Daily Activities:
  • Encourage independence
  • Provide shoes that are firm enough for walking
  • Educate caregivers about changes in toddlers' sleeping patterns
  • Make bathing enjoyable
  • Keep toddlers safe while bathing
  • Encourage healthy snacks instead of high-carbohydrate foods
  • Prevent putting a child to bed with bottle feeding
  • Continue to drink fluoridated water or take fluoride supplements
  • Brush their teeth with supervision
  • Schedule the first dental visit as early as the 12-month
  • Read stories about dental visits
• Promote Healthy Family Functioning
  • Provide security while promoting independence

Parental Concerns

• Toilet Training:
  • Considered the biggest task of toddlerhood
  • An individualized process for each child
  • Start and complete based on the child's ability to accomplish it
  • Toddlers must have achieved 3 important developmental levels:
    • Control of rectal and urethral sphincters
    • Cognitive understanding of what it means to hold urine and stool until it can be released at a certain place and time
    • Desire to delay immediate gratification for more socially accepted actions
• Ritualistic Behavior:
  • Usually seen during the latter part of toddlerhood
  • Commonly evident in pre-school age
  • Offers comfort and independence
  • Desire for "their" spoon at meal-time or "their" blanket at bedtime
• Negativism:
  • Indicates that the toddler understands they are a separate individual with separate needs
  • The more caregivers try to make a child obey, the more resistant the child is likely to be
  • Verbalize a statement instead of asking questions
  • Let the toddler make choices
• Discipline:
  • Instill a sense of discipline as early as possible
  • Consistency and praising correct behavior are more effective than punishing wrong behavior
  • Use the "time-out" technique
• Separation Anxiety:
  • Begins at 6 months and lasts through the pre-school period
  • Ensure separation is from a primary caregiver
  • Give a firm goodbye while reassuring them that you will return home soon; avoid prolonged goodbyes
  • Sneaking out may strengthen the child's fear of abandonment
• Temper Tantrums:
  • Occur because toddlers are independent enough to know what they want, but lack the ability to express their feelings in a socially acceptable way