NOTES

• In the respiratory system, the lumens of

●​ age span from 1 to 3 years, vessels enlarge progressively so the threat
●​ growing sense of autonomy (independence) of lower respiratory infection lessen.

• Stomach secretions become more acid;

therefore, gastrointestinal infections also
●​ WEIGHT AND HEIGHT become less common.
-​ A child gains only about 5 to 6 lb
(2.5 kg) and 5 in. (12 cm) a year Stomach capacity increases to the point a
during the toddler period, much less child can eat three meals a day.
than the rate of growth during the
infant year. • Control of the urinary and anal sphincters
-​ As subcutaneous tissue, or baby fat, becomes possible with complete
begins to disappear toward the end momyelination of the spinal cord so toilet
of the second year, the child training is possible.
changes from a plump baby into a
leaner, more muscular little girl or • Immune globulin (Ig)G and IgM antibody
boy. production becomes mature at 2 years of
●​ Head circumference increases only about 2 age. The passive immunity obtained during
cm during the second year compared to intrauterine life is no longer operative.
about 12 cm during the first year.
●​ Head circumference equals chest TEETH
circumference at 6 months to 1 year of age.
By 2 years, chest circumference should ●​ Eight new teeth (the canines and the first
have grown greater than that of the head. molars) erupt during the second year. All
●​ Body Contour 20 deciduous teeth are generally present by
2.5 to 3 years of age.
​ Toddlers tend to have a prominent ●​ less numerous but no less dramatic than
abdomen because, although they are those of the infant year, because this is a
period of slow and steady, not sudden,
walking well, their abdominal muscles are growth
not yet strong enough to support abdominal
content.
●​ Language Development
​ They also have a forward curve of -​ A word that is used frequently by
the spine at the sacral area (lordosis). toddlers and that is a manifestation of
their developing autonomy is “no.”
●​ Body systems continue to mature during -​ Toddlers may use the word to mean
this time. they are refusing a task that they do
not understand.
• Respirations slow slightly but continue to
-​ To learn other words, children need
be mainly abdominal.
exposure to conversation and need to
• Heart rate slows from 110 to 90 beats/min. be read to often. Language de-
-​ velops quickest if parents respect
• Blood pressure increases to about 99/64 what toddlers have to say so children
mmHg. grasp the use and purpose of
language.
• The brain develops to about 90% of its -​ Children who are very active may use
adult size. fewer words than children who are
less active

J.B.
 NOTES
●​ By stage 6 of cognitive development (between
●​ Autonomy 18 and 24 months of age), toddlers are able
-​ The developmental task of the toddler to try out various actions mentally rather than
having to actually perform them—the
years according to Erikson (1993) is
beginning of problem solving or symbolic
the development of a sense of thought.
autonomy versus shame or doubt. ●​ Children at this stage are also able to
-​ Children who have learned to trust remember an action and imitate it later
themselves and others during the (deferred imitation) ; they can do such things
infant year are better prepared to do as pretend to drive a car.
this than those who have not learned ●​ At the end of the toddler period, children enter
a second major period of cognitive
to trust themselves or others.
development termed preoperational thought
-​ To develop a sense of autonomy is to and begin to use a process termed
develop a sense of independence. assimilation. Because they are not able to
●​ Socialization change their thoughts to fit a situation, they
-​ Once toddlers are walking well, they learn to change the situation (or how they
become resistant to sitting in laps and perceive it).
being cuddled. This is not a lack of a
desire for socialization but a function
●​ Toddlers tend to develop many upper
of being independent.
respiratory and ear infections but otherwise
-​ At 15 months, providing those people
come to health care facilities most often for
are willing to follow them where they
health maintenance visits (recommended at
want to go.
15, 18, and 24 months of age)
-​ By 18 months, toddlers imitate the
things they see a parent doing, such
as “study” or “sweep,”.
●​ Accidents (unintentional injuries) are the
-​ By 2 or more years of age, children major cause of death in infants through
become aware of gender dif-ferences young adults in the United States.
and may point to other children and ●​ Unintentional ingestions (poisoning) and
identify them as “boy” or “girl.” auto accidents are the types of unintentional
●​ Play Behavior. injuries that occur most frequently in
-​ children play beside other children, toddlers.
not with them. This side-by-side play ●​ Aspiration or ingestion of small objects such
(parallel play) is not unfriendly but as watch or hearing aid batteries, pencil
is a normal developmental sequence
erasers, or parts of crayons is also a major
danger for children of this age.
that occurs during the toddler period.
●​ Other unintentional injuries that occur
-​ The toys toddlers enjoy most are frequently in toddlers include motor vehicle
those they can play with by accidents, burns, falls, drowning, and
themselves and that require action. playground injuries.
Trucks they can make go, squeaky
frogs they can squeeze. Lead Screening

-​ The CDC has set as a goal the elimination

●​ a child enters the fifth and sixth stages of of elevated blood lead levels in children
Piaget’s sensorimotor thought (Piaget 1952). (CDC, 2012b).
In these stages, toddlers are described as -​ Elevated lead levels are caused by eating,
“little scientists” because of their interest in chewing, or sucking on objects that are
trying to discover new ways to handle objects covered with lead-based paint.
or new results that different actions can
achieve.

J.B.
 NOTES
-​ • Toys manufactured in countries where should be whole milk until age 2 years, after
restrictions on lead are not enforced or cribs which 2% milk can be introduced.
that were painted with lead-based paint .
●​ vegetarian diet can be easily designed for a
• Soil around the exterior of the house and toddler who prefers finger foods because
contaminated food grown there many vegetables, fruits, and grains such as
pieces of oranges, peaches, raisins,
• Dust or fumes created by home renovation chickpeas, and crackers are easily eaten
this way
• Pottery made with lead glazes or jewelry
made from lead or lead alloys ●​ Dressing
-​ most children can put on their own
• Colored print in newspapers or older socks and underpants
lead-based water pipes -​ Some may also be able to pull on
slacks, pullover shirts (the sleeves of
• Lead dust brought home on the clothing of a shirt often confuse a toddler), or
parents who work with lead products such simple dresses
as batteries. -​ When toddlers dress themselves,
they invariably put shoes on the
•Beginning symptoms of lead poisoning wrong feet and shirts and pants on
include irritability, headache, fatigue, and backwards. Encourage parents to
abdominal pain. Often, however, there are give up perfection for the benefit of
no symptoms before damage occurs, which the child’s developing sense of
is why blood screening is essential. autonomy.
●​ Sleep
-​ The amount of sleep children need
gradually decreases as they grow
older
●​ Because growth slows abruptly after the -​ They may begin the toddler period
first year of life, a toddler’s appetite is napping twice a day and sleeping 12
usually less than an infant’s. hours each night, and end it with
●​ Allowing self-feeding is a major way to both one nap a day and only 8 hours of
strengthen independence in a toddler and sleep at night.
improve the amount of food consumed. ●​ Bathing
Offering finger foods such as pieces of -​ Toddlers usually enjoy bath time,
chicken, slices of banana, pieces of cheese, and parents should make an effort to
and crackers, and allowing a choice make it fun by providing a toy, such
between two types of food helps promote as a rubber duck or plastic fish.
independence while exposing children to -​ Bath time is usually so enjoyable for
varied food. toddlers that parents can use it as a
recreational activity or something to
do on a rainy day when they can find
●​ Sedentary children ages 1 to 3 years should nothing else to interest their child.
consume 1,000 kcal daily; active children in ●​ Dental care
this age group may need up to 1,400 kcal -​ To help prevent dental caries from
daily frequent snacking, encourage
●​ Protein and carbohydrate needs are often parents to offer fruit or protein foods
those most easily met during the toddler for snacks rather than
period; diets high in sugar should be high-carbohydrate items such as
avoided to help prevent toddler obesity. cookies to limit exposure of the
●​ Adequate calcium and phosphorus intake is child’s teeth to carbohydrate
important for bone mineralization. Milk

J.B.
 NOTES
-​ Calcium is especially important for you want to take your duck or your
the development of strong teeth and toy boat into the tub with you?”
so are other good snack foods. ●​ Discipline
-​ In addition, children should continue -​ Discipline means setting rules or
to drink fluoridated water or, if not road signs so children know what is
available, receive fluoride expected of them.
supplements so all new teeth form -​ Punishment is a consequence that
with cavity-resistant enamel. results from a breakdown in
discipline or the child’s disregard of
the rules that were learned.
●​ Toilet Training -​ Parents should begin to instill some
-​ Before children can begin toilet sense of discipline early in life
training, they must have reached because part of it involves setting
three important developmental safety limits and protecting others or
levels, one physiologic and the other property.
two cognitive: -​ Two general rules to follow include:
• They must have control of rectal 1. Parents need to be consistent.
and urethral sphincters, usually 2. Rules are learned best if correct
achieved by the time they walk well. behavior is praised rather than
• They must have a cognitive wrong behavior punished.
understanding of what it means to -​ A “time-out” is a technique to help
hold urine and stools until they can children learn that actions have
release them at a certain place and consequences. To use a time-out
time. effectively, parents first need to be
• They must have a desire to delay certain their child understands the
immediate gratification for a more rule they are trying to enforce.
socially accepted action. ●​ Separation Anxiety
• Because physiologic development is -​ fear of being separated from parents
cephalocaudal, the rectal and urethral sphincters begins at about 6 months of age and
are not mature enough for control in most children persists throughout the preschool
until at least the end of the first year, period. This universal fear in this
when tracts of the spinal cord are myelinated to the age group is known as separation
anal level. anxiety. Toddlers who have
●​ Negativism separation anxiety have difficulty
-​ As part of establishing their identities accepting being separated from their
as separate individuals, toddlers primary caregiver to spend the day
typically go through a period of at a daycare.
extreme negativism. ●​ Temper Tantrums
-​ They do not want to do anything a -​ Almost every toddler has a temper
parent wants them to do. Their reply tantrum at one time or another. The
to every request is a very definite child may kick; scream; stomp feet;
“no. shout, “No, no, no”; flail arms and
-​ A toddler’s “no” can best be legs; bite; or bang his or her head
eliminated by limiting the number of against the floor. Temper tantrums
questions asked of the child. occur as a natural consequence of
-​ A toddler needs experience in toddlers’ development.
making choices, however. -​ They occur because toddlers are
-​ To provide the opportunity to do this, independent enough to know what
a parent could give a secondary they want, but they do not have the
choice. “No” is not allowed for the vocabulary or the wisdom to express
major task, so the parent states, “It’s their feelings in a more socially
bath time now” but then says, “Do acceptable way.
-​

J.B.
 NOTES
2.​ Toddlers learn a great deal about oral
●​ Erikson’s developmental task for the toddler communication in the course of their
period is to form a sense of autonomy or development. Which of the following
independence versus shame or doubt. statements should you expect Jason, a
●​ Toddlers make great strides forward in 2-year-old, to have mastered?
development, but their physical growth a. “Red tomatoes.”
slows. b. “Daddy come.”
●​ A critical milestone of toddler development c. “Old MacDonald.”
is being able to form two-word sentences (a d. “Please, please.”
noun and a verb) by 2 years of age.
●​ Toddlers are capable of preoperational 3.​ As television sets become larger and
thought, or are able to deal much more thinner, viewing becomes easier. To
constructively with symbols than they could investigate if television sets can also be a
as infants. threat to young children, researchers
●​ Important aspects of toddler care are reviewed a Canadian trauma database over
promoting safety, toddler development, and a 15-year period as to how many
healthy family functioning because all three emergency room visits were caused by a
of these facets help in planning nursing care television set falling onto a young child.
that not only meets QSEN competencies They identified a total of 179 injuries (20 to
but that also best meets a family’s total 24 per year). Toddlers were the most
needs. frequently injured age group, and head and
●​ Toddler appetites decrease from those of neck injuries were the most common
the infant, so children eat proportionally less consequences of a television pulled down
than they did as infants. onto a young child (Mills, Grushka, &
●​ Common concerns of parents during the Butterworth, 2012).Based on the study and
toddler period are toilet training, ritualistic the AAP recommendations on television
behavior, negativism, temper tantrums, viewing, how would you advise Jason’s
discipline, and separation anxiety. parents?
●​ Promoting autonomy in the child who is a. Encourage Jason to watch television in
physically challenged or chronically ill calls his room where the television set is smaller.
for creative planning because there may be b. Teach Jason to always watch television
many tasks that must be done for the child from a distance of no less than 12 feet.
to be certain they are done safely. c. Teach Jason to use the remote control so
he can watch television safely by himself.
d. Allow Jason to watch television only
when a parent is free to supervise his
actions.
1.​ The father of Jason, the 2-year-old, has
asked if it is normal for his son to spread his
feet wide apart when he walks. After
providing health education to Jason’s father,
which of his statements suggests that he 4.​ Jason’s grandmother often visits the family.
received accurate teaching? When she does, she brings a number of
a. “Jason may be all right, but toddlers with medications with her. What precautions
dislocated hips also walk that way.” about unintentional poisoning would you like
b. “A wide spaced gait is a common to see the family following?
characteristic of toddlers.” a. Advise the grandmother to keep her
c. “Most toddlers walk with feet close medicine in her purse and stress that no
together to better stabilize themselves.” one should open her purse but her.
d. “His shoes may not have a good arch b. Show Jason his grandmother’s pills and
and this could be causing him to walk emphasize that he is not permitted to touch
unsteadily.” them.

J.B.
 NOTES
c. Assure the grandmother that as long as
her vials of medicine have childproof caps,
there is no danger.
d. Buy the grandmother a medicine case
that locks and place it on a high shelf when
she visits.
5.​ Jason’s mother would prefer to use a
time-out for punishment. What should you
teach Jason’s mother or his day care setting
caregivers about the use of this technique?
a. The child should sit still for as many
minutes as his age.
b. The child should sit still for as many
minutes as he misbehaved.
c. Time-out activities can include quiet play
or reading books.
d. Children are not ready for time-outs until
school age.
6.​ Jason answers every request of his mother
by saying, “No!” His mother admits that she
is exasperated and embarrassed by this
and she states that she is desperate to
change this behavior. How can you best
meet her expressed learning needs?
a. Have her tell Jason she doesn’t want him
to say no anymore.
b. Instruct her to answer all Jason’s
questions by saying, “No!”
c. Encourage her to reduce the number of
questions she asks Jason.
d. Tell her to explain he is not using good
communication skills.

J.B.