GROWTH AND

DEVELOPMENT OF THE
TODDLER
AGES 1 TO 3

THEORISTS RELATED TO TODDLER

*Erikson Autonomy vs Shame and
Doubt
Piaget sensory motor stage

THREE FUNDAMENTAL DOMAINS

Physical
Cognitive
Psychological/Social

GROWTH OF THE TODDLER

Continues to be rapid

Decreased velocity from infancy

Toddlers generally reach half of their adult

height by age 2

MEASURING GROWTH

Height, weight, head circumference from age one

to three obtained at each well child visit and
plotted on appropriate growth chart to age 3
-If HC has been appropriate until age 2, need not
have further measurements
- Recumbent length is plotted on birth to age 3
chart, upright height is plotted on ages 2 thru 18
chart

MOTOR DEVELOPMENT
CNS maturation during toddler years allows for
improved control and coordination of both gross
and fine motor skills

MOTOR MILESTONES
Age of attainment varies but sequence is
generally consistent
Age
motor

Gross motor

Fine

12-15 months

Walks forward

18 months

Walks up steps
with assistance

feeds self finger

foods
reaches, removes
shoes/socks

24 months

Runs

right or left
handedness

36 months

Climbs well
Pedals a tricycle

undresses self
holds pencil,
turns book page
at a time

COGNITIVE DOMAINLANGUAGE DEVELOPMENT

Influenced

by social interactions and

exposures
Receptive language is far more developed
than expressive language development
By 2 years of age, should speak about 50
words

LANGUAGE DEVELOPMENT IN TODDLERS

1112 months
15 months
15-18 months
24 months

3 years

2 words other than "mama/dada

Babbles; repeats words
Begins to point to body parts
2-word phrases & sentences
50 word vocabulary, 2/3 of
speech understandable
Talks mostly in sentences
Understood half the time; can
say name, gender, age

VISION IN TODDLER
Visual acuity is 20/50 by two years (20/40 by
3)
Concerns if:
- rubs eyes excessively, squint, have
photophobia
- have difficulty reaching or picking
up small objects
- engages in head tilting
- holds objects close to face

PLAY IS THE WORK OF

CHILDREN
Toddlers are on-lookers with curious
watching of other children playing
Parallel play becomes the predominant
style of play with toddlers engaged in
similar play activity with minimal
interaction.

EMOTIONAL DEVELOPMENT

focused on self- Egocentrism

Power

struggles
Independence versus dependence

GENDER DEVELOPMENT
Two year old can distinguish gender and will
identify themselves as boy or girl
Age three beginning to show sex-typed
preferences

TANTRUMS

Learning many things

Controlling their tempers is not one of th em!!

No! Mine! I do it myself!

Anticipatory guidance for parents:

Provide routine
Direct them to something else
Give them small choices on matters
Provide quiet, calm, hug them
Comfort objects

How can these be applied to the hospitalized child??

Adapted from: http://www.childwelfare.gov/pu

bs/res_packet_2008/ch_three_tantrums.pdf

TODDLER PARENTING AND

DISCIPLINE
Use limit setting and time-out for inappropriate
behavior (one minute for each year of age)
Praise good behavior
Emphasize consistency, especially between
parents
Spend time with child daily, especially reading
Be a role model
Assign chores appropriate for age putting toys
away
Begin socialization with other children
Limit television, correlation with aggressive play,
watch with child, appropriate content (may affect
parents viewing habits)

Your toddler is smarter than you think

PROMOTING GROWTH AND DEVELOPMENT

OF THE TODDLER

Age appropriate toys

Read to the child everyday
Talk and singing
Understanding developmental norms so parents
have realistic expectations

SOCIAL FACTORS
DEMOGRAPHIC CHANGES IN
FAMILY
Increasing rate of divorce and remarriage
Delays and declines in childbearing
Rise in female workforce
Increasing incidence of single parent families
Childhood poverty, unemployment
Homelessness, foster families
Incarceration of parent
Composition of family changing extended
family members provide care, same sex parents

FAMILY FUNCTIONING
Family functioning is more directly related to
healthy growth and development than is family
structure
Components of family functioning include
provision of a stable and safe physical
environment, financial and emotional resources
necessary to provide supportive and
nurturing care with
appropriate
supervision
and
guidance

DEVELOPMENTAL SCREENING AND

ASSESSMENT TOOLS USED IN PRIMARY
CARE
Ages and Stages Questionnaire (ASQ) parent
completed child monitoring system for children 4
to 48 months
Denver II screens personal, social, fine motoradaptive, language and gross motor domains in
children birth to 6 years
M- CHAT Checklist for Autism in Toddlers

ASSESSMENT OF RISK PREVENTION FOR

TODDLER RELATED TO GROWTH AND
DEVELOPMENT
Smoke, radon and carbon monoxide detector
Hot water heater setting, water safety
Use of toddler car seat properly installed
Childproofing home (and childcare center/provider)
appropriate to age
Pet safety, gun safety
Use of sunscreen SPF 15 or higher

SCREENING CONTINUED

Body mass index beginning age 24 months

Vision screen ages 3 (cover/uncover
test)
Hearing screen- gross evaluation
Lead screening based on risk factors and
medicaid patients between ages one and
two (lead level)
Anemia screening

RISK FACTORS FOR LEAD SCREENING

Child lives in or cared for in house built before
1950 or before 1978 that has undergone renovation
Has a sibling or playmate followed for elevated
lead levels
Lives with a person whose jobs or hobbies involve
lead exposure pottery, car, paint
Live near industrial site

NUTRITION IN THE TODDLER

Big changes!

Nutrition primarily from breastmilk/formula in

infancy, now source is food
Weaning from the bottle should occur between 12-15
months

Should use cup, or cups without valves

Should move to cows milk around 12 months

Low in iron
What problem can this cause?
Limit milk intake to 16-24 ounces a day
Limit juice to 4-6 oz/day
Water ok

TODDLER NUTRITION
BUT HE WONT EAT ANYTHING

Toddlers dont require as many calories per size

than they did in infancy
Physiologic anorexia
Food jags

Offer 3 meals and 2 snacks daily

of adult portion sizes

Anticipatory guidance for parents

Family meals
Dont battle!
Continue to offer varieties

TODDLER ELIMINATION
Most toddlers are psychologically
and physiologically ready to toilet train between 18
and 30 months
Majority of children achieve daytime bowel and
bladder training simultaneously with an average
age of 28 months
Nighttime control generally occurs about 1 year
after daytime control is achieved

TODDLER ELIMINATION
Toilet training should not be started when family
is stressed (new baby, moving, holidays, divorce)
Suggestions for parents praise all efforts, expect
accidents to happen, dont punish, if child is
resistant, try again in a few weeks, follow usual
pattern of elimination, limit time on potty to 5 to
10 minutes.

TODDLER SLEEP
One to 3 year olds usually sleep 10 to 12 hours a
night and take 1 to 2 naps
Move to youth bed when crib is unsafe due to possible
ability to climb out, usually around age 2 to 3.
Toddlers need rituals and consistency at bedtime as
well as security objects
blankets, special toy

If child wakens, quietly reassure child and let

them fall asleep in their own bed

ORAL HEALTH

Dental care brushing teeth in am and before

bed.

*smear of fluoridated toothpaste until age 2, then

pea sized amount
First dental visit by 1 year of age

Can take child along to your dental appointment

if appropriate.

*source-aap.org

TODDLER AND HEALTHY ACTIVITY

Avoid

television - AAP does not recommend

TV for children 2 years or younger.
Physical activity - choose family activities
that encourage physical activity (walking,
tag, short hikes, etc.). Take stairs over
escalators.

Toys should stimulate

achievement of skills and
appropriate for age

TODDLER SAFETY
Apply recommendations given for infant plus;
Emphasize street safety- begin teaching basic
rules of pedestrian and traffic safety
Avoid strangers teach child methods to avoid
encounters with strangers that can be harmful
(teaching what is inappropriate behavior)
rear facing in car seat as long as possible
(manufacturer recs), then forward facing
Helmets with any type of bicycle (as
passenger)
Enroll in swimming lessons
and supervise around water

Supervise around
playground equipment

PHYSICAL EXAMINATION OF TODDLER

RELATED TO GROWTH AND DEVELOPMENT
Developmental

considerations
- stages of autonomy vs shame and doubt
striving for independence
-negativism and temper tantrums
common
- beginning of magical thinking
-major fears separation from parents,
intrusion of body orifices, loss of control,
pain

APPROACHES TO PHYSICAL EXAMINATION

FOR TODDLER BASED ON DEVELOPMENT
Use of distraction helpful
Allow child to touch and hold equipment before
examination
Demonstrate examination on doll, toy or parent
before conducting
Give child choices when possible
Conduct as much of examination on parents lap
as possible
Conduct using a noninvasive to invasive
sequence

PAIN ASSESSMENT OF THE TODDLER

Toddlers (and preschoolers) may not understand

quantitative ratings
Fear of being asked questions by strangers
Will often give you an answer even if they dont
understand the question

Will often use extremes of scales

What pain scales might you use?

Copyright 2012 Wo lters Kluwer Health I Lippincott W illiam s &

Wilkins