Microsoft PowerPoint - MuddToddler.pptx

GROWTH ANDDEVELOPMENT OF THETODDLER AGES 1 TO 3Infant: birth to 12 months of age1THEORISTS RELATED TO TODDLER*Erikson Autonomy vs Shame and DoubtPiaget sensory motor stageErikson . Trust vs. mistrust depends on his needs fulfillment. If the needs such as food, diaper change etc is nto done by the caregiver ( parents) then mistrust may develop

2THREE FUNDAMENTAL DOMAINSPhysicalCognitive Psychological/SocialGROWTH OF THE TODDLERContinues to be rapidDecreased velocity from infancyToddlers generally reach half of their adult height by age 2MEASURING GROWTHHeight, 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 chartMOTOR DEVELOPMENTCNS maturation during toddler years allows for improved control and coordination of both gross and fine motor skillsMOTOR MILESTONESAge of attainment varies but sequence is generallyconsistent

AgeGross motorFine motor12-15 monthsWalks forwardfeeds self fingerfoods24 monthsRunsright or left handedness18 monthsWalks up stepsreaches, removeswith assistanceshoes/socks36 monthsClimbs wellundresses selfPedals a tricycleholds pencil,turns book pageat a timeCOGNITIVE DOMAIN-LANGUAGE DEVELOPMENTInfluenced by social interactions and exposuresReceptive language is far more developed than expressive language developmentBy 2 years of age, should speak about 50 wordsLANGUAGE DEVELOPMENT IN TODDLERS1112 months2 words other than "mama/dada15 months15-18 monthsBabbles; repeats words Begins to point to body parts24 months2-word phrases & sentences50 word vocabulary, 2/3 of speech understandableTalks mostly in sentences Understood half the time; can3 yearssay name, gender, ageVISION IN TODDLERVisual acuity is 20/50 by two years (20/40 by 3)Concerns if:rubs eyes excessively, squint, have photophobiahave difficulty reaching or picking up small objectsengages in head tiltingholds objects close to facePLAY IS THE WORK OFCHILDRENToddlers are on-lookers with curious watching of other children playing Parallel playbecomes the predominantstyle of play with toddlers engaged in similar play activity with minimal interaction.EMOTIONAL DEVELOPMENTfocused on self- EgocentrismPower strugglesIndependence versus dependenceGENDER DEVELOPMENTTwo year old can distinguish gender and will identify themselves as boy or girlAge three beginning to show sex-typed preferencesLearning many thingsControlling their tempers is not one of thNo! Mine! I do it myself!

Anticipatory guidance for parents:Provide routineDirect them to something elseGive them small choices on mattersProvide quiet, calm, hug themComfort objects

How can these be applied to the hospitalized child??

Adapted from: http://www.childwelfare.gov/pubs/res_packet_2008/ch_three_tantrums.pdfTANTRUMSem!!TODDLER PARENTING ANDDISCIPLINEUse limit setting and time-out for inappropriate behavior (one minute for each year of age)Praise good behaviorEmphasize consistency, especially between parentsSpend time with child daily, especially readingBe a role modelAssign chores appropriate for age putting toys awayBegin socialization with other childrenLimit television, correlation with aggressive play, watch with child, appropriate content (may affectparents viewing habits)Your toddler is smarter than you thinkPROMOTING GROWTH AND DEVELOPMENTOF THE TODDLER

Age appropriate toysRead to the child everydayTalk and singingUnderstanding developmental norms so parents have realistic expectationsSOCIAL FACTORS DEMOGRAPHIC CHANGES INFAMILYIncreasing rate of divorce and remarriageDelays and declines in childbearingRise in female workforceIncreasing incidence of single parent familiesChildhood poverty, unemploymentHomelessness, foster familiesIncarceration of parentComposition of family changing extended family members provide care, same sex parentsFAMILY FUNCTIONINGFamily functioning is more directly related to healthy growth and development than is family structureComponents of family functioning include provision of a stable and safe physical environment, financial and emotional resources necessary to provide supportive andnurturing care with appropriate supervisionand guidanceDEVELOPMENTAL SCREENING ANDASSESSMENT TOOLS USED IN PRIMARYCAREAges and Stages Questionnaire (ASQ) parent completed child monitoring system for children 4 to 48 monthsDenver II screens personal, social, fine motor- adaptive, language and gross motor domains in children birth to 6 yearsM- CHAT Checklist for Autism in ToddlersASSESSMENT OF RISK PREVENTION FORTODDLER RELATED TO GROWTH ANDDEVELOPMENT

Smoke, radon and carbon monoxide detectorHot water heater setting, water safetyUse of toddler car seat properly installedChildproofing home (and childcare center/provider) appropriate to agePet safety, gun safetyUse of sunscreen SPF 15 or higherSCREENING CONTINUEDBody mass index beginning age 24 monthsVision screen ages 3 (cover/uncover test)Hearing screen- gross evaluationLead screening based on risk factors and medicaid patients between ages one and two (lead level)Anemia screeningRISK FACTORS FOR LEAD SCREENINGChild lives in or cared for in house built before 1950 or before 1978 that has undergone renovationHas a sibling or playmate followed for elevated lead levelsLives with a person whose jobs or hobbies involve lead exposure pottery, car, paintLive near industrial siteNUTRITION IN THE TODDLERBig changes!Nutrition primarily from breastmilk/formula in infancy, now source is foodWeaning from the bottle should occur between 12-15 monthsShould use cup, or cups without valvesShould move to cows milk around 12 monthsLow in ironWhat problem can this cause?Limit milk intake to 16-24 ounces a dayLimit juice to 4-6 oz/dayWater okTODDLER NUTRITIONBUT HE WONT EAT ANYTHINGToddlers dont require as many calories per size than they did in infancyPhysiologic anorexiaFood jagsOffer 3 meals and 2 snacks daily of adult portion sizes

Anticipatory guidance for parentsFamily mealsDont battle!Continue to offer varietiesTODDLER ELIMINATIONMost toddlers are psychologicallyand physiologically ready to toilet train between 18 and 30 monthsMajority of children achieve daytime bowel and bladder training simultaneously with an average age of 28 monthsNighttime control generally occurs about 1 year after daytime control is achievedTODDLER ELIMINATIONToilet 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 SLEEPOne to 3 year olds usually sleep 10 to 12 hours anight and take 1 to 2 napsMove 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 objectsblankets, special toyIf child wakens, quietly reassure child and let them fall asleep in their own bedORAL HEALTHDental care brushing teeth in am and bed.*smear of fluoridated toothpaste until age 2, then pea sized amountFirst dental visit by 1 year of ageCan take child along to your dental appointment if appropriate.before*source-aap.orgTODDLER AND HEALTHY ACTIVITYAvoid 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 ageTODDLER SAFETYApply recommendations given for infant plus;Emphasize street safety- begin teaching basic rules of pedestrian and traffic safetyAvoid 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 facingHelmets with any type of bicycle (as passenger)Enroll in swimming lessons and supervise around waterSupervise around playground equipmentPHYSICAL EXAMINATION OF TODDLER RELATED TO GROWTH AND DEVELOPMENTDevelopmental considerationsstages of autonomy vs shame and doubt striving for independencenegativism and temper tantrums commonbeginning of magical thinkingmajor fears separation from parents, intrusion of body orifices, loss of control, painAPPROACHES TO PHYSICAL EXAMINATION FOR TODDLER BASED ON DEVELOPMENTUse of distraction helpfulAllow child to touch and hold equipment before examinationDemonstrate examination on doll, toy or parent before conductingGive child choices when possibleConduct as much of examination on parents lap as possibleConduct using a noninvasive to invasive sequencePAIN ASSESSMENT OF THE TODDLERToddlers (and preschoolers) may not understand quantitative ratingsFear of being asked questions by strangersWill often give you an answer even if they dont understand the questionWill often use extremes of scales

What pain scales might you use?Copyright 2012 Wo lters Kluwer Health I Lippincott Williams & Wilkins