Growth & Development - Toddlers

Developmental categories
1. Growth
2. Motor
3. Language
4. Psychosocial/Cognitive
Impact of development
1. Patient interactions
2. Common issues
  1. Patient safety
  2. Patient education

Nursing Points

General

1-3 years old
Growth slows compared to infancy
Language development is rapid

Assessment

Growth
1. Gains 4-6 pounds a year
2. Grows 3 inches a year
3. Head circumference equal to chest circumference by 1-2 years
4. Anterior fontanelle closes 9-18 mo
Motor Development
1. Builds tower of 8 blocks high
2. Can copy a circle on paper
3. Rides tricycle around 3 yrs
4. Jumps by 2 yrs
Language Development
1. 300 words by 2 yrs
2. Links words together by 2 yrs
Psychosocial/Cognitive
1. Autonomy vs Shame and Doubt
2. Positive outcomes are self-control and willpower
3. Parallel play
4. Symbolic play
5. Toilet training – dry by day

Therapeutic Management

Patient Interactions
1. Be cautious when giving choices
2. Avoid yes or no questions
Safety & Patient Education
1. The Terrible Two’s
  1. Positive parenting
  2. Boundary setting
2. Toilet training
  1. Assessing for readiness
  2. Positive reinforcement
  3. See patient education below
3. Injury – burns, poisoning, drowning, falls
  1. Lock poisons and meds away
  2. Stair gates
  3. Never leave unsupervised in bathtub
4. Picky eaters
  1. Nutrition
    
    Full fat milk until 2 yrs
  2. Iron-deficiency anemia is common

Nursing Concepts

Human Development
Patient Centered Care
Health Promotion

Patient Education

Educating caregivers about toilet training
1. Control of sphincters occurs around 18-24 mo
2. Assessing readiness
  1. Waking from naps dry
  2. Verbalizing need to go
  3. Dry for at least 2 hours during the day
  4. Nighttime dryness may not occur until 4-5 yrs
3. Planning
  1. Caregivers able to invest time
  2. Appropriate toilet
    
    Feet on floor or stool
  3. Limit time on toilet to 5-8 min
  4. Stay with child
  5. Teach hand hygiene
Education parents about nutrition for toddlers
1. Full fat milk until 2 yrs
2. Avoid food battles
  1. May restrict food to 4 or 5 main foods to avoid anything new
3. Avoid using food as reward
4. Offer iron-rich foods
  1. Iron -fortified cereal
  2. Red meats
  3. Leafy greens
  4. Fish
  5. Dried fruit
  6. Beans

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Transcript

Hey Guys! I’m glad you are joining me for these lessons on growth and development. Let’s get started and talk through what to expect for Toddlers.

Our toddler patients are ages 1-3. Pretty much what’s happening during this phase is refining all of basic skills. In the next phase- preschoolers, you see them get close to perfecting these basic skills but for toddlers there’s still a lot of struggle. Which is part of the reason we get the lovely phase called terrible twos. They want to do everything on their own but really can’t. So there are a lot of opportunities for injury and frustration.

Growth slows a lot compared to infancy. And because of this caloric needs are a lot less than they were for infants which is a relief for parents who are struggling with picky eaters. On average they gain 4-6 lbs a year and grow 3 inches a year. Heads are still large compared to body size.

Motor skills really come on during this phase- but again a lot of it is still pretty clumsy. They learn to run but can’t stop very easily. They can go up and down stairs but do it two feet at a time.

Fine motor skills develop from stacking blocks to holding a pen and being able to copy a circle.

Language development is probably the most exciting thing happening for toddlers. Their comprehension really explodes and they begin to be able to express themselves and ask for things they need. For milestones you are looking for them to know and use 300 words by the age of 2 and they should also be able link words together.

From a nursing point of view- keep in mind that they understand a lot more than they may let on so it’s important to be kinda careful about what you say in front of the child. So sometimes this means telling a parent about the procedure away from the child.

Remember, toddlers want to do everything on their own. Erikson describes this as Autonomy vs Shame and Doubt. Basically, they need to be able to try things on their own and then be helped and encouraged to succeed. It’s this drive for autonomy that gives us the “terrible twos”. Eating, dressing and toilet training are the 3 most obvious tasks they want to accomplish and they can become battle zones for parents.

Toddlers engage in parallel play. Where they play alongside other children but don’t really interact. And they love symbolic play where they mimic everyday actions they see around the house like talking on the phone or serving dinner.

My biggest piece of advice for working with toddlers is to avoid giving them the opportunity to say “No”! We all know they love that word! And if you walk in their room and say “Can I take your temperature?” they are 100% going to say “No!” and then you are stuck. So instead, try “I need to see how warm you are and to put this little red light on your finger. Which one should I do first?”. They may still run away and yell “No!”, but at least you tried!

Okay so- toddlers have kind of a bad reputation right? But this is for a reason. The little quiet baby has grown into an opinionated, fast moving little person who can’t quite communicate how they are feeling. So, like I mentioned earlier frustrations can be high. Because of this there are a lot of opportunities to educate parents about parenting. And honestly, this can feel super awkward. There are a million ways to parent so how can we possible give advice? Well there are some basic tips that are always a safe bet to recommend and they are all about positive parenting, boundary setting and minimizing opportunities for misbehavior. I’ve simplified them and they are outlined in the patient education section of this lesson!

Other topics that nurses may be asked to provide education on are toilet training, injury prevention and picky eating and you’ll find more detailed information about these topics in the outline as well.

A couple of things I want to highlight though- For toilet training, during the toddler years we only expect children to be dry by day. Nighttime dryness may not occur until 5 years of age. Also, with the change in routines toddlers are at increased risk for becoming constipated.

For nutrition during toddler years – it’s not uncommon for toddlers to have diets that are pretty poor in nutrients. Vitamins help, but don’t fix everything. One very common deficiency is iron which can result in tired, pale and anemic toddlers who need a supplement.

Again check out the outline and notes for more on all of this!

Your priority nursing concepts for this content are human development, patient centered care and health promotion.

Okay guys – that’s it for our very busy and fiesty toddlers! They are at a slightly lower risk that our infants because growth has slowed down and they are less dependent, but they still have a lot going on! Your three key points to take away from this lesson are 1) Toddlers want autonomy. Self-care, nutrition, toilet training – they want to do it all themselves and most of your education points stem from this. Number 2) Their language development is exciting and by far the most rapid area of development for toddlers. Number 3) Safety is still a big concern. So make sure you can educate parents on preventing falls, drowning, poisoning and burns.

That’s it for our lesson on growth and development during toddlerhood. Make sure you checkout all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!

Growth & Development – Toddlers

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Outline

Overview

Nursing Points

General

Assessment

Therapeutic Management

Nursing Concepts

Patient Education

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Transcript

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