Toddler Health Promotion
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Describe the "terrible twos"
- Age 12-36 mo
- Intense period of exploration (risk for injury)
- Temper tantrum, obstinacy occur frequently
- Autonomy v. shame & doubt
What physical changes take place during toddler-hood?
- Anterior fontanel closes by 18mo
- Weight gain slows to 4-6 lb/year
- Birth weight should be 4x by 2.5 yrs
- height increases about 3in/yr
- Head and chest circumference is equal by 1-2 yrs of age
What sensory changes does the toddler experience?
- Visual acuity of 20/40 is acceptable
- Hearing, smell, taste, and touch increase in development
- Uses all senses to explore environment
What gross and fine motor developments does the toddler experience?
- 15 mo: walks without help, creeps up stairs, uses cup well, builds a tower of 2 blocks
- 18 mo: assumes standing position, throws ball overhand, manages spoon, turns pages of book 2-3 at a time
- 2yr: walks up and down stairs by placing both feet on step, builds tower of 6-7 blocks
- 2.5 year: jumps in place with both feet and can stand on one foot momentarily, can draw circles and has good hand-finger coordination
- *safety is key due to locomotion and growing independence
What stage of psychosocial development is the toddler in? How is this manifested? What kind of play is common in the toddler?
- Erikson's Autonomy vs. Shame & Doubt
- Manifested in temper tantrums, negativism
- Ritualization provides a sense of comfort
- Separation Anxiety between 8mo-3yrs and peaks at 10-18mo
- Parallel play is common along with mimic play (playing house)
What cognitive development takes place in the toddler?
- Piaget's Sensorimotor Stage transitions to the preoperational stage around 19-24 mo
- Object permanence is fully developed
- magical Thinking
- Ego-centrism, centration, and inability to see from other's perspective
- Globalization and transductive reasonsing
Describe spiritual development in the toddler
- According to Fowler
- Religious teaching and moral development influence toddler behavior
- Spiritual routines can be comforting
How is body image developing in the toddler?
- Can refer to body parts by name
- Avoid negative labels about body appearance
- Recognize sexual differences by age of 2 years
Describe the development of sexuality in the toddler?
- Going from the Anal stage to the Phallic stage (freud)
- Exploration of genitalia is common
- Gender roles are understood by the toddler
- Commonly play "house"
What important differentiation takes place during social development?
- Can differentiate self from mother and from significant others
How does language develop in the toddler?
- Increase in comprehension and ability to understand
- Recognizes names of people and objects
- Should know first and last name by 3 y/o
- 300 words by 2 yrs
- 1 yr: 1 word sentences (holophrases)
- 2 yr: 2 or 3 word sentences
- 3 yr: several words to create simple sentences following grammatical rules
What kind of "skills of independence" develop in the toddler and what should they be allowed to attempt?
What are some concerns or "growing pains" of toddlerhood?
What are some signs that the toddler is ready to potty train?
- voluntary sphincter control must be established (between 18-24 mo old)
- Ability to stay dry for 2 hrs
- Fine motor skills to remove clothing
- Willingness to please parents
- Curiosity about adults or siblings toileting habits
- Impatience with wet or soiled diapers
Describe the toddler's nutrition
- Toddlers become picky eaters and want to eat to taste
- Physiologic anorexia leads to decrease in appetite and fussy eating
- Meals can be finger foods that encourage autonomy and grazing, but should always be supervised by an adult
- Juice should be limited to 4-6oz per day with 1 full cup of fruits
- Common food allergies include nuts, soy, dairy, and seafood
- Watch for choking hazards such as hot dogs and popcorn
Describe the toddler's sleep and activity cycle
- Average 11-12 hrs of sleep/day including nap (nap may be excluded for older toddlers)
- Resistance to bedtime and fears are common (magical thinking)
- Maintain a regular bedtime routine along with transition items or activities
Describe the toddler's dental health
- regular dental examinations
- flossing and brushing by care giver with increasing supervised autonomy
- Brush teeth after meals and bedtime (only water after bedtime brushing)
- Fluoride may be supplemented (controversial)
- Should not be put to bed with bottle or juice in order to prevent caries
- Low-cariogenic diet
What are the common causes of injury in the toddler? What are some ways to prevent injury?
- Motor vehicle injuries: ensure car seat safety (right size, rear facing until age 2)
- Drowning: close toilet seat, do not leave standing water, watch near bodies of water
- Burns: do not hold coffee and baby, watch hot objects (such as stove) since toddlers can climb
- Poisoning: do not tell kids that medicine is candy. Child proof cabinets and caps, keep poison control number in view
- Aspiration and suffocation: avoid small objects, latex balloons, trouble foods such as hotdogs and popcorn (if it fits through a toilet paper tube, it can be aspirated by a toddler)
What vaccines are given during ages 4-6?
- DTaP- 5th dose
- IPV- 4th dose
- MMR- 2nd dose
- VAR- 2nd dose
- Annual Flu (IIV or LAIV)
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