Toddler g n d

USEFULL FOR BSC NURSING 3RD YEAR

1. GROWTH AND DEVELOPMENT OF A TODDLER BHARGAV MEHTA Msc Nursing ( ped . Dept )

2. Weight and height: Declines compare to infant At 2years: 12kg (27pounds) At 2 and half years: 4times that at birth Slowing of weight gain leads to a reduced metabolic rate resulting decreased appetite. Gain in height is greater than that in weight during the toddler period. Height increases about 10- 12.5cm (4 to 5inches) per year. BIOLOGIC GROWTH

3. Boys tend to be slightly taller than girls. Decreased head circumference Trunk is long Transverse diameter increases, greater than anterio posterior diameter. Abdomen protrudes "pot bellied” Bowed leg Dentition: at 2years- 16 teeth, 2 and half- 20temporary teeth Contd..

4. Integumentary : resistance to skin infection Cardiovascular: pulse rate decreases, BP increases, heart and blood vessels increases in size. Respiratory: respiratory tract increases in size, increases thoracic volume leading to decreased RR. GI system: salivary gland develops, chew food, stomach capacity increases. Nervous system: increased maturation of brain resulting increased intellectual and cognitive abilities.

5. 15MONTHS

6. Standing position without help Walks without support Loses balance when walking around corners or stopping suddenly Kneels without support Creeps up stairs Throws small object repeatedly and picks them again GROSS MOTOR

7. Builds a tower of 2- 3cubes Open boxes Pokes fingers in hole Scribbles spontaneously Makes line with crayon Begins to turn pages FINE MOTOR

8. Holds a cup with all the fingers and grasp. Grasp a spoon and inserts it into dish Enjoy finger feeding FEEDING SKILLS

9. Sticks out arms and led to help in dressing Removes soaks Toileting and grooming skills Indicates when diaper is wet or soiled. DRESSING SKILLS

10. Sounds localization indicating by head movement Binocular fixation fully developed Looks at pictures for prolong period of time Place round object into its appropriate place or hole. SENSORY

11. Sense of autonomy Negative counterpart: shame and doubt Separation anxiety, tolerates some separation Less fearful of strangers Hugs and kisses parents Kisses pictures in books Imitates household activities. PSYCHOSOCIAL

12. Psychosexual: Anal stage Spiritual: Intuitive- projective Intellectual: Sensorimotor stage Moral: Preconventional morality

13. RECEPTIVE Recognizes names of various parts of body Responds to familiar, simple commands EXPRESSIVE Continues use of expressive jargon with gestures Says 2 to 6words Names familiar pictures or objects like “ball” Shakes head to communicate “no” LANGUAGE

14. Walking becomes a form of play Carries a toy when walking Balls, dolls, musical toys Pictures books Blocks PLAY STIMULATION

15. 18 MONTHS

16. Anterior fontanel closed Abdomen protruded Sphincter control BIOLOGIC GROWTH

17. Walks with somewhat wide stance, but falls seldomly Walks sideways and backward Walks upstairs with one hand held Runs and falls Climbs on furniture Explores drawers, closets etc Pulls and pushes toys GROSS MOTOR

18. Builds tower of 3- 4 cubes Scribbles Imitates a vertical strokes with crayon Turn pages Throws ball without falling FINE MOTORS

19. Can see better Interest in pictures Identifies various shapes SENSORY

20. Sense of autonomy Egocentric Autonomous behavior increases Temper tantrums Awareness of strangers Bedtime ritual begins Thumb sucking Imitates parents PSYCHOSOCIAL

21. Sensorimotor stage Object permanence fully developed Shift attention rapidly from one thing to another Begins to “think” Beginning traces of memory INTELLECTUAL

22. RECEPTIVE Identifies pictures of familiar objects when named Identifies one or more parts of body when named EXPRESSIVE Speaks 10 real words Names pictures Uses words more than gestures Sentence length LANGUAGE

23. E njoys solitary play or watching activities of others Has a favorite toy Motor play Pull toys, balls, rocking chair, small chair and table Creative play: containers with openings into which blocks can be placed, finger paints, clay, large crayon Dramatic play : imitates parental actions PLAY STILULATION

24. 24 MONTHS

25. Weight: 11.8 to 12.7kg Height: 82.5 to 85cm CC> HC HC: 49 TO 50 cm Pulse:110 beats/min Respiration: 26- 28 breaths/per BP: 99/ 64 PHYSICAL GROWTH

26. Steady gait Can walk with heel- toe gait Walks backward well in imitation Runs more quickly Jumps with both feet in place Kicks large balls without falling Picks object from floor GROSS MOTOR

27. Builds a tower of 6- 7 cubes Makes cubes into a train Imitates a circular stroke, horizontal stroke Opens door by turning door knobs Unscrews lid of jar Folds paper once imitatively FINE MOTOR

28. Feeding skills: drinks well from a small glass, put spoon into mouth with one hand, can use straw, imitates eating habits of others Dressing skills: pulls on own simple garments- coat, elastic pants, shoe laces, removes cloths Toileting and grooming skills: verbalizes toilet needs, usually urinates when taken to toilet, may brush teeth with help, attempts to wash self in tub or shower.

29. Visual acuity: 20/40 well accommodation SENSORY

30. Sense of autonomy Egocentric in both thought and behavior Separation anxiety is high Signs of independence Great sense of “mine”, less “yours” Demands before bedtime Violent temper tantrums PSYCHOSOCIAL

31. Preoperational stage Preoccupation with symbols in language, dreams and fantasy Attention span longer Memory increases Symbolic thoughts begins Imitation become more symbolic INTELLECTUAL

32. Preconventional morality Stage 1 (2- 3years): if punished for doing it, it’s wrong; it not punished it must be right. MORAL

33. RECEPTIVE Understands more complex sentences Obeys prepositions “on”, “under” and two commands “pick up your coat and put it on the chair” Enjoys stories with pictures EXPRESSIVE Knows about 300words Uses pronouns “I”, “me”, “mine”. LANGUAGE

34. Enjoys parallel play- social interaction Motor play: pulls wagon, places beads in box and dumps them Creative play: clay materials, finger-paints, brush paints, large crayon, puzzles Quiet play: hearing stories Dramatic: domestic mimicry, enjoys with dolls . PLAY STIMULATION

35. 30 MONTHS

36. Weight: gains about 5kg Height: gains 6- 8cm Dentition: full sets of 20 temporary teeth Daytime bowel and bladder control BIOLOGIC GROWTH

37. Stands on one foot alone Walks on tip toes for few steps Walks up and down stairs Jumps well in place with both feet off floor Jumps from low chair Can throw a large ball Rides a walker or pedal car GROSS MOTOR

38. Build tower of 8cubes Makes vertical and horizontal strokes Imitates circular strokes Holds crayon with fingers instead of entire hands Good hand- finger coordination: moves fingers. FINE MOTOR

39. Feeding skills: self feeding with spilling, drinks without assistance distinguishes between finger and spoon food Chews with mouth closed Uses fork but it is held in fist Dressing skills: Puts arm through large armhole Buttons and unbuttons one large front button.

40. Toileting and grooming skills: Control daytime bladder Accidents common Go to toilet by self for urination, needs assistance for wiping Adequate attempt to wash hands, partially dries hands. Contd..

41. Visual acuity: 20/ 30 SENSORY

42. Sense of autonomy Cope with separation anxiety Independent behavior increases Reluctant to go to bed Temper tantrums may or may not be decreased Imitates sex role behavior of adults Knows owns sex PSYCHOSOCIAL

43. Preoperational stage Begins “causal” thinking Problem solving through trial and error INTELLECTUAL

44. RECEPTIVE Identifies five body parts when named EXPRESSIVE Gives full name if asked Use “I” when referring self Talks constantly Asks" why” Uses 4- 5 words sentences LANGUAGE

45. Parallel play continues Motor play: Pushes and steers toys well Large cars, trucks Block trains that interlock Creative play: clay, finger paints, large crayons, wooden puzzles, cut with blunt scissors Dramatic: baby doll, housekeeping toys, play telephone. PLAY STIMULATION

46. NEEDS OF TODDLERS

47. LOVE AND SECURITY Seperation anxiety R egression