Hockenberry: Wongs Essentials of Pediatric Nursing, 9th Edition

Chapter 12: Health Promotion of the Toddler and Family

Key Point Summaries

The toddler stage, extending from 12 to 36 months, is a period of intense exploration of

the environment.
Biologic development during the toddler years is characterized by the acquisition of fine
and gross motor skills that allow children to master a wide variety of activities. In general,
adult height is about twice the childs height at 2 years of age. Accurate measurement of
height and weight during the toddler years should reveal a steady growth curve that is
steplike rather than linear (straight), which is characteristic of the growth spurts during the
early childhood years.
Although most of the physiologic systems are mature by the end of toddlerhood,
development of certain areas of the brain is still occurring, allowing for greater intellectual
capacity.
Locomotion is the major gross motor skill acquired during toddlerhood, followed by
increased eye-hand coordination. By 12 to 13 months of age, toddlers walk alone. They are
able to jump using both feet and climb stairs by age 2 to 2 years.
Specific tasks in the psychosocial development of a toddler include differentiating self
from others, tolerating separation from parent, coping with delayed gratification, controlling
bodily functions, acquiring socially acceptable behavior, communicating verbally, and
interacting with others in a less egocentric manner. Achievement of toilet training is a major
developmental milestone for the toddler.
According to Erikson, the major developmental task of toddlerhood is acquiring a sense
of autonomy while overcoming a sense of doubt and shame. Several characteristics,
especially negativism and ritualism, are typical of toddlers in their quest for autonomy.
The misuse or overuse of vitamins as a part of complementary and alternative
medicine (CAM) places some children at risk for health problems. Herbs known to have
adverse effects in children include ephedra, comfrey, and pennyroyal; some herbs may not be
harmful taken alone but may counteract or potentiate prescription medications when taken
concurrently. Health care workers need to be knowledgeable about the benefits or potential
harm in herbs so that they can appropriately counsel parents and address their concerns.
In Piagets sensorimotor and preoperational phases of development, the toddler
experiments by incorporating the old learning of secondary circular reactions with new skills
and applies this knowledge to new situations. There is the beginning of rational judgment,
an understanding of causal relationships, and discovery of objects as objects. Preoperational
thought is characterized by egocentrism, centration, global organization of thought
processes, animism, and irreversibility.
Transitional objects, such as a favorite blanket or toy, provide security for toddlers,
especially when they are separated from parents, dealing with a new stress, or just fatigued.

All Elsevier items and derived items 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.
Key Point Summaries 12-2
Language is the major cognitive achievement in toddlerhood. Although the number of
words acquired is notablefrom about four at 1 year of age to approximately 300 at age 2
years the ability to comprehend and understand speech is much greater than the number of
words the child can say.
Development of body image occurs with increasing motor ability, at which point toddlers
recognize the importance and capacity of body parts. A sense of maleness or femaleness
gender identityis formed by age 3 years.
The two phases of differentiation of self from significant others are separation and
individuation.
The solitary play of infancy progresses to parallel playthe toddler plays alongside, not
with, other children.
Parental concerns during the toddler years include toilet training, coping with sibling
rivalry, limit setting and discipline, dealing with temper tantrums, negativism, and regression.
Temper tantrums are nearly universal during toddlerhood as independence is established
and more complex tasks are attempted that may overwhelm the child emotionally. Toddlers
may assert their independence by violently objecting to discipline.
Negativism is not an expression of being stubborn or insolent, but a necessary assertion
of self-control.
Effective discipline techniques for toddlers include reward, ignoring or extinction, and
time-out.
One of the major tasks of toddlerhood is toilet training. The child must be able to
recognize the urge to let go and hold on and be able to communicate this sensation to the
parent. Five markers signal a childs readiness to toilet train: bladder readiness, bowel
readiness, cognitive readiness, motor readiness, and psychological readiness. According to
some experts, physiologic and psychological readiness is not complete until ages 22 to 30
months.
Nutrition is important at this stage because eating habits established in toddlerhood tend
to have lasting effects in subsequent years. At approximately 18 months of age, most toddlers
manifest a decreased nutritional need with a decreased appetite, a phenomenon known as
physiologic anorexia. The amount of food consumed by the toddler is not as important as
the quality of the food consumed because growth is considerably less than in infancy.
Conditions such as obesity and cardiovascular disease can be prevented by encouraging
healthy eating habits in toddlers and their families.
Regular dental examinations, fluoride supplementation, removal of plaque, and provision
of a low-cariogenic diet promote optimum dental health.
Toddlers require parental supervision and assistance with toothbrushing and flossing.
Because of increased locomotion, toddlers are at high risk for sustaining injuries. Fatal
injuries are primarily a result of motor vehicle accidents, drownings, and burns. Many of the
deaths are caused by injuries within the car when restraints have not been used or have been
used improperly. Unrestrained children riding in the vehicles front seat are at highest risk for
injury.

All Elsevier items and derived items 2013, 2009, Mosby, Inc., an imprint of Elsevier Inc.