Chapter 12

Health Promotion of the Toddler and

Family
Edited by: Michael Mooney MSN, RN, CPNP

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imprint of Elsevier Inc.

Promoting Optimum Growth

and Development
2

The terrible twos

Age 12 to 36 months
Intense period of exploration
Temper tantrums and obstinacy occur frequently
Successful mastery of developmental skills depends

on the trust and guidance of parents

Need to explore, home may not accommodate (winter in the

city)

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imprint of Elsevier Inc.

Biologic Development
3

Weight gain slows to 4 to 6 pounds per year

Birth weight should be quadrupled by 2 years
Height increases about 3 inches per year
Growth is steplike rather than linear
Plotted on growth charts
Adult height is 2 times the height at age 2 years
Anterior fontanel closes by 12 months
Should be closed by 18 mos, on later end

Posterior closes at 2-3 months

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Sensory Changes
4

Visual acuity of 20/40 is acceptable

Development of hearing, smell, taste, and touch

increases
Uses all senses to explore the environment
(exporation)

Taste preferences much more specific

More likely to graze than eat full meals

Parent conflict-if forced to sit and eat, may lead to obesity

May need to supplement for calories

Iron deficiency secondary to excess milk intake

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Maturation of Systems
5

Most physiologic systems are relatively mature by the end of

toddlerhood
Inner ear structures are short and straight, tonsils are large and,
therefore, upper respiratory tract infections, otitis media, and
tonsillitis are common

Get sick often

Voluntary control of elimination

Sphincter control at age 18 to 24 months
Parents will irrationally think that they can early
Similar sleep wake cycle
Neurobehavioral organization improves

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Gross and Fine Motor Development

6

Locomotion

Walks by 12 months; runs by 18 months (falls easily)

Climbs stairs by age 2 years

Up & down stairs

Has improved coordination between 2 and 3 years

Signifigant
Fine motor development

Has improved manual dexterity at 12 to 15 months

Throws a ball by 18 months
Draws circles by age 3 years

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Psychosocial Development
7

Begins development of independence and self-control

Toleration of separation, control over bodily function, verbal means of
communication, socially acceptable behavior
Erikson: Autonomy versus shame and doubt

Get the idea that they can fail=shame and doubt

Have to achieve trust vs. mistrust

Negativism

No! or the attempt of them to do it themselves

Parents may be exhausted, may give into it

Ritualization provides a sense of comfort

Id, ego (common sense), and superego (conscience)
Includes socially acceptable behavior
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Cognitive Development
8

Piaget

Sensorimotor phases

Imitation and domestic mimicry are common

Awareness of causal relationships between two events
(problem solving and operations)

Tertiary circular reactions at 13 to 18 months

Utilizing experiments to achieve new goals
Invention of new means through mental combinations at 19 to 24
months

Re investigate each time (light switch turns on light)

Learns spatial relationships

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Preconceptual Phase
9

Begins at about age 2 years and lasts until age 4 years

Transition between self-satisfying behaviors of infancy

and socialized relationships

Understanding communication and roles

Increased use of language

Concern with why and how
Prelogical thinking
Magical thinking is common, explaining somebody died is difficult,
changes need to be slow
Box 12-1
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Spiritual Development
10

Spiritual development often parallels cognitive

development
Assimilates toward family routines

Praying before meals, etc

Spiritual routines can be comforting

Religious teachings and moral development

influence toddler behavior

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Development of Body Image

11

Body image closely parallels cognitive development

and self-awareness
Refers to body parts by name
Avoid negative labels about physical appearance

May last throughout life

Recognizes gender differences by age 2 years

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Development of Sexuality
12

Exploration of genitalia is common

Fondling, freaks parents out, is very normal
What is socially acceptable
Gender roles are understood by a toddler

Based on family values

Gender identity is established by age 3 years

Assimilates toward family gender standards

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imprint of Elsevier Inc.

Social Development
13

Differentiation of self from mother and from

significant others is a major task

Separation-marked by individualization
Individuation

Delayed gratification
Increased understanding and awareness of object

permanence and ability to tolerate frustration

diminished stranger fear

Wont be fearful of other adults, even if parents arent

Transitional objects provide security (blanket/doll)

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Language
14

Increasing level of comprehension

Increasing ability to understand
Look for hearing loss if child is delayed
Unless there is regression
Comprehension of 300 words by age 2 years
At age 2 years, can use two- or three-word phrases
65% of words should be understood
Too much TV can decrease language production
At age 3 years, can use simple sentences and acquires five to six

new words a day

Gestures precede each language milestone up to 30 months of age

Normal, but should decrease by 30 months

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Personal Social Behavior

15

Toddlers develop skills of independence

May vary
Sudden mood swings are common
Skills of independence may result in tyrannical,

strong-willed, volatile behaviors

Skills include feeding, playing, dressing, and
undressing self
Begin to understand others feelings

I will disappoint mom if I hit my brother

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Play
16

Parallel play
Imitation
Little emphasis on gender-stereotyped toys
Everything looks interesting and fun
Increased locomotive skills
Educational toys and books
Tactile play-sand
Appropriate safety in relation to size, shape, risk

for toxins, and sturdiness of toys

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Coping with Concerns Related to Normal

Growth and Development
17

Toilet training

5 markers of readiness

Physical, mental, phychological, parental

Sibling rivalry

Include older children in caregiving of younger child

Temper tantrums

Consistency & developmentally appropriate expectations/rewards

Negativism

Exerting independence & self-control

Open ended questions
Reduce their opportunities to say No

Regressive behavior-cant cope and perfec the skill

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Assessing Readiness for Toilet Training

18

Voluntary sphincter control -18 months

Ability to stay dry for 2 hours
Fine motor skills to remove clothing
Willingness to please parents
Curiosity about adults or siblings toilet habits
Impatience with wet or soiled diapers

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Promoting Optimum Health during

Toddlerhood
19

Nutrition

Phenomenon of physiologic anorexia-not enough calories to

thrive
Grazing is normal
MyPlate recommendations
Drinks an average of 24 to 30 ounces of milk per day and eats
1 cup of fruit per day

Sleep and activity

Sleeps for 11 to 12 hours per day
Has an adult sleep pattern by age 3 years

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Dental Health
20

Parents assist with cleaning with correct size brush

at bedtime
Regular (biannual) dental examinations
Plaque removal
Fluoride treatments or supplements
Limited sugar in the diet

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Injury Prevention
21

Motor vehicle injuries (car seat safety)

Drowning
Burns
Poisoning
Aspiration and suffocation
Bodily damage (falls, being struck, bites or

stings)

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imprint of Elsevier Inc.