Early Childhood: (Toddler and preschool

periods)
Assistant.Prof. Ohoud Y. El-Sheikh
Pediatric Nursing
 Normal toddler
Definition: Toddler stage is between 1 to 3 years of age. During this period, growth slows
considerably.

• The beginning of independence or autonomy.

Physical growth

1. Weight

• The toddler's average weight gain is 1.8 to 2.7 kg/year.

• Formula to calculate normal weight of children over 1 year of age is: Age in years 2+8 = ….. kg.

• e.g., The weight of a child aging 4 years = 4 2 + 8 = 16 kg

 2. Height

• It increases about 10 to 12.5 cm/ year.

• 1-2 years increases 1 cm / month.

• Formula to calculate normal height of children over 1 year of age

= Age in years 5 + 80 =…. cm.

• e.g., the length of 2 years old child = 2 5 + 80 = 90 cm

 3. Head and chest circumference

• The brain develops to about 90% of its adult size.

• The head increases 10 cm only from the age of 1 year to adult age.

• Head circumference increase only about 2 cm during the second year.

• During toddler years, chest circumference continues to increase in

size and exceeds head circumference.

• Anterior fontanel closes between 12 – 18 months of age.

 4. Teething
Physiological growth
• By 2 years of age, the toddler
• Pulse: 80–130 beats/min (average 110/min).
has 16 temporary teeth.
• Respiration: 20–30C/min.
• By the age of 30 months (2.5
years), the toddler has 20 teeth Bowel and bladder control

5. Abdomen • bowel control starts from 1- 1.5 year.

• it is protruded and appears “pot- • Daytime control of bladder and bowel

bellied “‫كرش‬:::‫ب‬ control by 24–30 months (2-2.5 years).

• Because of immature abdominal • Night time bladder control by 2.5-3 years.

musculature
• Senses

 binocular vision‫ رؤي ه مجهري ه او دقيقه‬is well developed by 15

month of age, visual acuity of 6/6 is achieved during this
period

 Senses of smell, hearing, touch, and taste becomes

increasingly well developed
Gross motor development

 Walks alone at 15 months

 Runs well at 24 months

 Jump with both feet at 30 months Walk sideways and backward

 Climbs on furniture

 Throws ball over head without falling

 Stands of one foot alone momentarily

 Gross - Motor of toddler

At 15 months, the toddler  At 18 months:

can: • Hold cup with both hands.

• Walk alone. • Transfer objects hand-to hand at will.

• Creep upstairs.  At 24 months:

• Assume standing position • Go up and down stairs alone with two feet on each step.
without falling. • Hold a cup with one hand.

• Hold a cup with all • Remove most of own clothes.

fingers grasped around it. • Drink well from a small glass held in one hand.
At 30 months: the toddler can:

• Jump with both feet.

• Jump from chair or step‫ ا لسلم‬.

• Walk up and downstairs, one foot on a step.

• Drink without assistance
Fine Motor - toddler
Holds cup with both hands at
1 year old: transfer objects from
18 months
hand to hand
Eats with spoon at 18
2-year-old: can hold a crayon and
months.
color vertical strokes ‫ي ستخدم ق لم‬
‫ت لوينعمودي‬ Removes most of own clothes
at 24 months.
• Turn the page of a book
Drinks without assistance at
• Build a tower of six blocks
30 months.
3-year-old: copy a circle and a
cross – build using small blocks
 Language Development
30 months: 150- 300 words
 At 15month = 4-6 words
 Talk constantly (use plurals – Give first and
(mainly names
last name)
 18 months: 10 words or
 Echolalia (repetition of words and phrases
more
without understanding
 At 2 years = 40-50 words
36 ms: 1000 words
 Know body name parts –
 can say name, age, gender
enjoy listening short stories
 Talk about something that happened in the past
 Ask questions (what that?)
 Ask why
 Emotional development
• Stranger anxiety – should dissipate by age 2 ½ to 3 years

• Temper tantrums‫ ن وباتا لغضب‬: occur weekly in 50 to 80% of children – peak

incidence 18 months – most disappear by age 3

• Sibling rivalry‫ ا لتنافسب ينا الشقاء‬: aggressive behavior towards new infant: peak
between 1 to 2 years but may be prolonged indefinitely

• Thumb sucking

• Toilet Training
 Cognitive development
• Up to 2 years, the toddler uses his senses and motor development to different self
from objects.

• The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive

development (2-4 years), where he is still egocentric and cannot take the point of
view of other people

• His thinking is based on concrete perceptions and on actions in his immediate

environment.

.‫• يعتمد تفكيره على تصورات ملموسة وعلى أفعال في بيئته المباشرة‬
 Social development

• The toddler is very social being but still egocentric.

• He imitates parents. e.g. in clothes, in cleaning the house.

• Notice sex differences and know own sex.

• According to Erikson, the development of autonomy during this period is

centered around toddlers increasing abilities to control their bodies, themselves
and their environment i.e., "I can do it myself".

• Negativism: always saying no is a normal part of healthy development

 Sense of autonomy

• I can do it my self

• Increase abilities to control their bodies

• They want to do things for themselves using their newly acquired

motor skills e.g walking, climbing

• If they feel small and, or they forced to be dependent on others

they will develop a sense of doubt and shame
• Toilet training • Toilet training guidelines

 It is the major task of toddlerhood  It should not be initiated during times of

 Toddler not usually ready until 18- (stress as coming a new baby, a move, a

24 months divorce, or a vacation)

 Bowel training occurs first then  Potty size should be appropriate to the

bladder child age

 Night bladder training occur (4-5)  Position should be suitable; the child’s

years old legs reach the floor.

• Signs of readiness are:

 Staying dry for 2 hours

 Regular bowel movements

 Child able to sitting, walking and squatting

 Child able to verbalizing desire to go toilet

 Wanting to please parents and be drying and having a dry diaper

‫الرغبة في إرضاء الوالدين والتجفيف والحصول على حفاضات جافة‬

 Needs of toddlers

 Love and security

Toilet training
 Independence in self-care, so the
parents should:  Toilet training is the most

 Be consistent; set realistic limits important task of the toddler.

 Reinforce desired behaviors  Approach and attitude of

 Be constructive, teach self-control parents play a vital role in
 Punish immediately and toilet training.
appropriately after a bad behavior
 Needs of toddlers

Nutrition

Serve food in small amounts.

Cut food into small pieces.

The child eats very little and eating just one type of food for days or
weeks and then switching to another type. So, child’s food should
include all food groups: milk, meat, fruits, vegetables, cereals, fat
and CHO.
 Needs of toddlers
 The child shouldn’t be forced to eat.

 Nutritious snacks between meals.

 Vitamins and iron supplements

 Accident prevention

 Play (Parallel play)

 Health supervision: physical check-up, immunization, dental health

 B. Preschool stage
• Definition
• Physiological growth
• It is the stage where child is 3 to 6 years of
age. The growth during this period is • Pulse: 80–120 beat/min. (average
relatively slow. 100/min).
• Physical growth
• Respiration: 20–30C/min.
• Weight: The preschooler gains
• Blood Pressure: 100/67+24/25
approximately 1.8kg/year.
mmHg.
• Height: He doubles birth length by 4–5
years of age.
 Motor Development • Fine motor

• Fine Motor – Older Toddler • Buttoning clothing

• 3-year-old: copy a circle and a cross – • Holding a pencil

build using small blocks
• Building with small blocks
• 4-year-old: use scissors, color within
the borders • Using scissors

• 5-year-old: write some letters and • Playing a board game

draw a person with body parts
• Have child draw picture of himself
 Cognitive Development
Preschooler up to 4 years of age is in the pre-conceptual phase

He begins to be able to give reasons for his belief and actions,
but not a true cause- effect relationships. e.g. he may say:” It is
not morning because I didn’t eat breakfast”

 He has concept of time and uses symbols in his play, e.g. a piece
of wood may represent a car. ‫ي ستخدم ا لرموز ف يا لع ابه‬
 Language Development

3rd year
5th year
• Vocabulary of 800- 1000 words.
 Vocabulary of 2100
• Uses 4 words sentences.
words.
• Ask why.
 Asks for the meaning of
4th year
words.
• Vocabulary of 1500 words.
 Repeats sentence of 12 or
• Uses 3 to 7 words sentences.
more syllables.
• Uses “I” in his speech
 Emotional Development of Preschooler
• Fears the dark

• Tends to be impatient‫ ن افذ ا لصبر‬and selfish

• Expresses aggression through physical and verbal behaviors.

‫يعبر عن العدوان من خالل السلوكيات الجسدية واللفظية‬.

• Shows signs of jealousy of siblings.

 Social Development

• More cooperative in play.

• The preschooler is in the stage where he develops a sense of

initiative; where he wants to learn what to do for himself, learn about
the world and other people.

• If he fails to achieve this sense of initiative, he will develop a sense of

guilt, where he will appear anxious and frightened in his contact with
others.
 Social Development

• Egocentric in his thought and behavior, unable to see others’ viewpoints.

• Tolerates short separation from parents by 3 years and separates easily by

5 years of age.

• Less dependent on parents but needs their reassurance and help.

• May have dreams and nightmares‫ ك وابيس‬.

• Demonstrates strong attachment for parent of opposite sex. ‫مينحلل هذا‬

‫ا لكالم‬
 Development of Body Image

• This stage plays a significant role in body image development.

• In this stage, the preschooler increasing comprehension of language

leads to understanding the desirable and undesirable appearance. He is
aware of the meaning of words, as "pretty" or "ugly" and he reflects
the opinions of others regarding his own appearance. ، ‫ف يهذه ا لمرحل ة‬
‫ إن ه‬.‫ي ؤديف ه م ا لطف لا لمتزاي د ل لغ ة إ لىف ه م ا لمظه ر ا لمرغوبوغي ر ا لمرغوبف يه‬
‫ مثل"جميل" أو "ق بيح" ويعكسآراء ا آلخرينف يما ي تعلقب مظهره‬،‫ي درك معنىا لكلمات‬.
 Problems of pre-school

Thumb sucking Bad language.

Enuresis. Hurting others.‫ي ؤذيا الخرين‬

Encopresis.‫ا لتغ وط ا لالرادي‬ Destructiveness‫مدمر‬

Selfishness.
 Needs of the preschool child
• Learning language.
• Safety and accident prevention: Place
• Play: associative play.
locks on cabinets containing toxic
• Need for responsiveness to their questions,
substances
use simple terms because preschooler has
short attention span. • Nutrition: (according to the activity
• Medical supplements level, climate, and health status).
• Dental care 90 Kcal/kg (1800 calories per day),
• Sleep (12 hours at night, infrequent daytime 100 ml/kg daily fluids.
naps)
• Monitoring growth and development