UPH-Dr. Jose G.

Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

Toddler Developmental Milestones What to Expect..... and when to be concerned! You are your child's first and most important teacher. Every day, your child is learning as you talk, play, and interact together. Development is a combiunation of age, individual growth, and experiences. Your child will progress at his or her own rate; your involvement will promote developmental milestones. How many words does the average 2-year-old know? When do children first play with other children cooperatively? When do you worry if a child is not walking? Is separation anxiety normal? When are children usually ready to be toilet trained? These questions and many more are on the minds of parents as they watch their youngster grow and develop. The following tabled contain items that are appropriate for toddlers 12-24 months of age and should not be applied to children under the age of one. Separation Anxiety As toddlers develop, they become more confident and begin to demonstrate independence. Toddlers 12 to 18 months old exhibit mood swings and volatile behaviors because they are torn between complete dependency and the desire for independence. With independence, they learn the limits of their abilities. However,

they still have a fear of abandonment, which presents as separation anxiety. By the age of 2, children are beginning to build the skills they need to become independent, freethinking persons. They can walk, talk, and make simple choices for themselves. These new skills help them to establish their own identity. But without their parents in close view, toddlers find themselves easily overwhelmed. The trust that has been developed between parent and child allows the 2-year-old to conquer separation anxiety.

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

Motor Development What to Expect............ Fine Motor (12-24 months)

When to be concerned.......... By 18 months.....

builds tower of three small blocks puts four rings on stick places five pegs in pegboard turns pages two or three at a time scribbles turns knobs throws small ball paints with whole arm movement, shifts hands, makes strokes uses a spoon and cup

Your child's limbs seem stiff Your child's muscles seem floppy and loose Your child doesn't walk yet Your child is walking on her toes Your child favors one hand or side of his body Your child seems very clumsy Your child is constantly moving Your child has trouble grasping and manipulating objects Your child drools and has difficulty eating Your child's motor skills are regressing

By 24 months..... Gross Motor (12-24 months)

walks alone walks backwards picks up toys from floor without falling pulls toys, pushes toys seats self in child size chair walks up and down stairs with hand Discuss any suspected developmental delays with your child's pediatrician. held Generally, a parent's instinct that motor moves to music development is delayed is often correct.Remember to correct your child's age for prematurity.

By 24 months doesn't walk confidently By 24 months shows no interest in climbing By 24 months will not push or pull toys

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

Language Development What to Expect............ 18 Months

When to be concerned.......... By 12-18 months, your child does not:

Has vocabulary of 5-20 words Vocabulary made up chiefly of nouns Some echolalia (repeating a word or phrase over and over) Is able to follow simple commands Recognition of pictures of familiar persons, objects'Early 2-word combinations of words emerge; Needs are requested verbally such as "more, up";

24 Months

Can name a number of objects common to his surroundings Combines words into a short sentence Length of sentences is given as one to two words Approximately two-thirds of what child says should be intelligible Vocabulary 150-300 words Can use two pronouns correctly: I, me, you - although me and I are often confused Responds to such commands as "show me your eyes (nose, mouth)" Child understands simple questions and commands; Child will refer to self by name; Start to use the negative "not go";

look upward or turn toward a new sound hear you call from another room enjoy shaking rattles or playing with toys that make sound become scared by a loud voice turn head or eyes toward a sound he can not see change expressions at the sound of a voice or loud noise say single words by 18 months have a vocabulary of at least 10 words by age 24 months will not iminate the speech of others follow simple commands use words or gestures to make his or her wants known

Discuss any suspected speech or language delays with your child's pediatrician. Generally, a parent's instinct that speech development is delayed is often correct. Before a speech and language evaluation is conducted, a hearing screening or test should be considered to rule out a hearing loss.Remember to correct your child's age for prematurity.

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

Social Development What to Expect............ At 12 to 18 months of age, toddlers begin to become interested in the world around them. Still, they view everything in terms of themselves. As they start to discover other people, they learn how to elicit reactions from them. As they continue to grow, they learn to socialize by trial and error Between ages one and two:

When to be concerned.......... By 24 months.....

recognizes self in mirror or picture refers to self by name plays by self; initiates own play imitates adult behaviors in play helps put things away points to some body parts uses familiar objects correctly (cup, key, phone, shoe, ec.) recognizes pictures of familiar objects or people tries to figure out how things work

Your child will not play interactive games, such as "PatA-Cake,:"Peek-a-boo," or "This Little Piggie," etc. Your child's will not play alone for a short period of time Your always seeks you out to play Your always demands your attention Your child does not show any independence Your child does not care if you are in the room or not Your child does not display any emotions (fear, shyness, anger, etc.) Your child does not express caring for others with smiles or hugs Your child never tries to comfort you or others Your chld never says "no" or "mine" Your child does not have temper tantrums

Discuss any suspected problems with your child's pediatrician. Generally, a parent's instinct is often correct.Remember to correct your child's age for prematurity.

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

Supportive Care for Toddlers withSpecial Health Needs

Cynthia Huffman Cynthia Huffman, MSEd, MBA, WHAT WOULD YOU DO IF ONE OF THESE CHILDREN WERE IN YOUR CARE? Infant/toddler teacherseven those with years of training and experienceare often bewildered and even frightened by the challenge of supporting children with chronic illness and health issues and their families. At some time in their career, most early childhood teachers will care for a child whose development is affected by a special health problem. Recent medical advances leading to longer lives and shorter hospital stays, current trends in managed care, more mothers working outside the home, and laws that require inclusion have increased the number of children with chronic illness and special health needs in early care and education programs. We do not know for sure how many infants and toddlers have special health care needs, but here is what we do know: Childrens emotional, physical, and intellectual experiences in the first three years of life are vital in laying the foundation for the future. Every young child should have regular checkups with a medical professional. Approximately 40 percent of children four years and younger have at least one hospital visit each year (National Center for Health Statistics 1999). Research (Vernon et al. 1965; Thompson 1985) repeatedly indicates that older infants and toddlers (six months to three years) are most vulnerable to the effects of hospitalization or a health care crisis. The effects of hospitalization-related stress in young children, such as behavior problems, sleep problems, or regressions in previously learned developmental skills are often seen at home and in early childhood settings. Early childhood staff faces new challenges when a child with special health needs enrolls in or returns to their program. In addition to obtaining accurate current information about health status, treatments, and medications; developing health care and emergency plans; and determining appropriate adaptations to activities and the environment; teachers must be prepared to provide immediate and sensitive support for the special emotional and developmental needs of these children.

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

At some time in their career, most early childhood teachers will care for a child whose development is affected by a special health problem. Beyond the Journal Young Children on the Web July 2006 2 Impact of chronic illness and hospitalization Just as every child is unique, so every chronic illness, health condition, and disability has a unique pattern of symptoms and requires a particular treatment. Yet regardless of their differences in diagnosis, children who are ill and their families face many of the same issues. Toddlers Illness and hospitalization often threaten a toddlers developing autonomy. Some children fight to maintain control, and others relinquish all control. The child may have limited opportunities and ability to pursue developmentally appropriate learning. Hospitalized children may become cautious about seeking new experiences and require more reassurance from caring adults. Toddlers do not understand illness. Their magical and egocentric thinking may lead them to believe they caused their own illness or that their illness is punishment for bad behavior. During hospitalization, being away from parents is the greatest concern even for a toddler who has learned to cope with routine separations. A child might view such separation as abandonment, a sign of lost love, or punishment. Toddlers may be frightened by unfamiliar surroundings and intrusive procedures by strangers. Hospitalization may limit opportunities to socialize or succeed in accomplishing simple tasks. Hospitalized children may show increased intensity in their reactions and behavioral responses to stress as well as changes in their daily habits, such as eating, toileting, and sleeping. Children may regress in any or all areas of development. Regression can be intensified by physical and emotional disruptions in parent support. illness and hospitalization often threaten a toddlers developing autonomy. Beyond the Journal Young Children on the Web July 2006 3 Development for all children is applicable, but some children may need extra help and more time for practice as well as some adaptations to the environment, activities, or materials. Developmental milestones The sequence of developmental milestones is the same for all children with or without chronic illness but chronic illness and its resulting symptoms may slow the rate of development. Keep in mind that some toddlers with chronic illness or who have had frequent or prolonged hospitalizations may not have mastered the developmental tasks of infancy. An 18-month-old may need help developing trust and feeling secure, or a three-year- old may need help learning to feed him (see Teacher Tips for Helping Infants and Toddlers). Progress through play Play is the means through which children learn, socialize, express feelings, and process their concerns and fears. Play promotes childrens progress in all areas of development.

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3

In addition to encouraging developmentally appropriate play for all children in their care, teachers can facilitate medical play that focuses on emotional issues related to health care. Medical play. Recently hospitalized toddlers often act out separation anxiety or medical procedures in dramatic play, which may reveal their fears about what happened or what might happen next. Children can pretend they are health care professionals and the dolls their patients. Through play, children can explore stressful experiences in a safe environment, helping children understand and gain some control over them. A child may reveal how he can be comforted if asked, What can we do to make your doll feel better? Here are some ways teachers can help young children cope with the effects of a health crisis or hospitalization: Be prepared for the need to reestablish trust, no matter how strong a childs prior relationship with you. Respond immediately to an infants expressions of need or discomfort; soothe and comfort the child. Make an extra effort to maintain schedules that are in synch with the babys rhythms, and be alert to the babys cues that he is ready to interact or play, or that he needs a break from activity. Provide appropriate stimulation and freedom for a child to explore and master new experiences. Offer toddlers continual confirmation that they are loved and that trusted adults are there for them. Reassure them that the illness or hospitalization is not their fault and that it is not punishment for bad behavior. Maintain consistent schedules and provide choices to allow the child as much control over the environment as possible. Encourage mastery of self-help skills and socialization, but be patient children often need time to regain previously mastered skills, such as toileting or taking turns. Support childrens reliance on security objects such as a pacifier, blanket, or favorite stuffed animal and other successful self-coping strategies. Promote independence, but remember that all children need age-appropriate guidance and limits. Encourage and validate all suitable expressions of emotions. Helping infants and toddlers cope A young child with special health needs is first and foremost a child. As with all children, developmentally appropriate care requires an ongoing process of evaluating needs, planning and carrying out a course of action, evaluating results, reevaluating needs, and revising plans as necessary

UPH-Dr. Jose G. Tamayo Medical University

College of Nursing Submitted by: Anna Carmela L. Lunas BSN 3A Group 3