Early childhood
Just the factsIn this chapter, you’ll learn:
physical, psychological, and cognitive development of toddlers and preschoolers
developmental theories in the toddler and preschool years
common concerns of parents of toddlers and preschoolers
injury prevention for toddlers and preschoolers
health problems of toddlers and preschoolers.
Toddlerhood
Toddlerhood, from ages 1 to 3 years, is the stage in which children start displaying independence and pride in their accomplishments. They intensely explore their environment, trying to figure out how things work. It’s also the time when they begin to display negativism and have temper tantrums.
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Physical development
During the toddler stage, physical growth is characterized by:
growth rate that slows during the second year of life
possible limited food intake, which may concern parents, so they need to be reassured this is normal
steady growth on a growth curve that’s more steplike than linear, demonstrating growth “spurts.”
Height, weight, and head circumference
From ages 1 to 2:
Toddlers grow approximately 3½″ to 5″ (9 to 12.5 cm) per year (with growth mostly in the legs, rather than in the trunk, like infants).
Toddlers gain about 8 oz (227 g) per month.
Head circumference increases about 1″ (2.5 cm) per year.
Anterior fontanel usually closes (between 12 and 18 months).
Two’s take off
By age 2:
Birth weight has usually quadrupled; average weight is 27 lb (12.3 kg).
Head circumference is usually equal to chest circumference.
The child is about half of adult height, with an average height of 34″ (86.4 cm).
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Three’s relax
From ages 2 to 3, toddlers:
grow 2″ to 2½″ (5 to 6.5 cm)
gain about 3 to 5 lb (1.5 to 2.5 kg)
show slowed increases in head circumference (less than ½″ [1.3 cm] per year).
Teeth
By approximately 33 months, all deciduous teeth have erupted and the child has about 20 teeth. The child should already be brushing with a small, soft-bristled toothbrush (with parental supervision) and may use a scant amount of fluoride toothpaste or, if needed, fluoride supplements.
Gross motor development
Gross motor activity develops rapidly in toddlers. One-year-olds can:
walk alone using a wide stance
begin to run but fall easily. By age 2, the toddler can:
run without falling most of the time
throw a ball overhand without losing his balance
jump with both feet
walk up and down stairs
use push and pull toys.
Fine motor development
Fine motor development begins slowly; however, by age 2, the toddler has generally mastered some fairly complex fine motor skills. A 1-year-old can:
grasp a very small object.
A 2-year-old can:
build a tower of four blocks
scribble on paper
drop a small pellet into a small, narrow container
use a spoon well and drink well from a covered cup
undress himself.
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Psychological development
A child develops a more elaborate vocabulary, a sense of autonomy, and socially acceptable play skills during the toddler stage.
Language development and socialization
As the toddler learns to understand and, ultimately, communicate with the spoken word, he develops the social skills that will allow him to interact more effectively with others.
Language
During toddlerhood, the ability to understand speech is much more developed than the ability to speak.
Now we’re talking
By age 1:
The child uses one-word sentences or holophrases (real words that are meant to represent entire phrases or ideas).
The toddler has learned about four words.
Twenty-five percent of the 1-year-old’s vocalization is understandable.
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Talk about progress!
By age 2:
The number of words learned has increased from about four (at age 1) to approximately 300.
The child uses multiword (two- to three-word) sentences.
Sixty-five percent of speech is understandable.
Frequent, repetitive naming of objects helps toddlers to learn appropriate words for objects.
Socialization
During toddlerhood, children develop social skills that determine the way they interact with others. As the toddler develops psychologically, he can:
differentiate himself from others
tolerate being separated from a parent
withstand delayed gratification
control his bodily functions
acquire socially acceptable behaviors
communicate verbally
become less egocentric.
Erikson’s developmental theory
As discussed in chapter 2, Erikson believed that each developmental stage is characterized by a particular psychosocial crisis (positive versus negative) that must be resolved before the child can master the task at hand.
Growing painsToddler development
At the toddler stage, children begin to master:
individuation (differentiation of self from others)
separation from parents
control of body functions
communication with words
acquisition of socially acceptable behaviors
lesser egocentricity when interacting with others.
Putting the “no” in autonomous
According to Erikson’s developmental theory, autonomy versus doubt and. shame is the developmental task of toddlerhood. In this context, Erickson maintains that:
Toddlers are in the final stages of developing a sense of trust (the task from infancy) and are ready to start asserting some control, independence, and autonomy.
Negativism is displayed in the toddler’s quest for autonomy.
Ritualism, a need to maintain sameness and reliability, gives the toddler a sense of comfort.
The child’s significant other is the “paternal” person in his (or her) life.
Development of the ego creates a conflict for the child, specifically, how to deal with the impulses of the id (which requires immediate gratification), while learning socially acceptable ways to interact with the environment.
Development of the superego, or conscience, begins with the incorporation of the morals of society. (See Toddler development.)
Play
Play is the work of children. It’s through play that the child learns about his own capabilities and develops the skills needed to interact with others and his environment.
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New rules, new game
During the toddler stage:
Play changes considerably as the toddler’s motor skills develop; he uses his physical skills to push and pull objects; to climb up, down, in, and out; and to run or ride on toys.
A short attention span requires frequent changes in toys and play media.
Toddlers increase their cognitive abilities by manipulating objects and learning about their qualities, which makes tactile play (with water, sand, finger paints, clay) important. (See Toddler toys.)
Many play activities involve imitating behaviors the child sees at home, which helps them learn new actions and skills.
Play becomes more social but not necessarily interactive.
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Parallel play
During the toddler stage, children commonly play with others without actually interacting. In this type of parallel play, children play side by side, commonly with similar objects. Interaction is limited to the occasional comment or trading of toys. This form of play helps the toddler develop the social skills needed to move into more interactive play.
Cognitive development
According to Piaget’s developmental theory, a child moves from the sensorimotor stage of infancy and early toddlerhood (birth to age 2) to the longer, preoperational stage (ages 2 to 7). Piaget made several observations about this transitional time in the young child’s life.
Tertiary circular reactions refers to the 13- to 18-monthold child’s use of active experimentation (trial and error); he uses newly acquired skills and knowledge to reach previously unattainable goals and discover new objects and areas.
Toddler toys
Safe toys that promote a toddler’s exploration include:
play dough and modeling clay
building blocks
plastic, pretend housekeeping toys, such as pots, pans, and play food
stackable rings and blocks of varying sizes
toy telephone
wooden puzzles with big pieces
textured or cloth books
plastic musical instruments and noisemakers
toys that roll, such as cars and trains
tricycle or riding car
fat crayons and coloring books
stuffed animals with painted faces (button eyes can pose a choking hazard).
Familiar at home, foreign at the store
The toddler may be aware of the relationship between two events (cause and effect) but may not be able to transfer that knowledge to a new situation. (For example, a toddler might need to reinvestigate the function of a familiar object or the identity of a familiar person over and over again when he encounters that object or person in a new, out-of-context setting.)
That’s using my head
From about ages 18 to 24 months, the toddler will look for new ways to accomplish tasks through mental calculations.
Object permanence advances as toddlers are more aware of the existence of objects that are out of sight, such as behind closed doors, in drawers, and under tables.
Toddlers begin to use language and are able to think about objects or people when they aren’t present.
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Sincerest form of flattery
Imitation displays deeper meaning and understanding of the toddler’s role in the family as the child observes and helps with household activities and identifies with the same-sex parent.
Toddlers begin to use preoperational thought, with increasing use of words as symbols.
Problem solving, creative thinking, and some understanding of cause and effect begin during the toddler years.
Keys to health
Guidelines for nutrition, sleep and rest, and dental hygiene should be followed to maintain a toddler’s good health.
Nutrition
Nutrition guidelines for toddlers include:
a decrease in protein requirements from infancy (to 1.2 g/kg/day)
caloric requirement of approximately 100 kcal/kg/day
considerable need for vitamins and minerals, such as iron, calcium, and phosphorus.
Developing healthy eating habits
The eating habits learned during the toddler years can set the stage for many years to come. Positive experiences with food and family meals are likely to set a foundation for a healthy, pleasurable “relationship” with food. On the other hand, negative experiences—power struggles, unpleasantness, food given or withheld to control behavior—may predispose the toddler to future food-related problems, such as overeating, extremely picky eating, and even an increased risk for eating disorders.
You eat what you are
A toddler’s developing eating habits are influenced by a range of factors, including:
physiologic anorexia, which occurs at approximately age 18 months (when growth slows), and results in decreased appetite and a picky, fussy eater with strong taste preferences
need to imitate family members (toddlers may refuse to eat a particular food that parents or siblings choose not to eat)
being easily overwhelmed by large portions
inability to sit through a long meal without becoming fidgety or disruptive at times
food used as a reward or sign of approval (which may encourage overeating for nonnutritive reasons)
food that’s forced or mealtimes that are consistently unpleasant (which may keep the child from developing the sense of pleasure usually associated with eating).
Food preparation
Most toddlers eat the same food that’s prepared for the rest of the family. Here are a few “toddler truisms” to help make mealtime enjoyable:
Serving size should be approximately 1 T of solid food per year of age (or one-fourth to one-third the adult portion size) so as not to overwhelm the child with larger portions.
Frequent, nutritious snacks are more likely to promote proper nutrition than are three large meals per day.
Most toddlers prefer to feed themselves; they’re skillful at handling finger foods but are still messy with soft foods as they’re learning to use a spoon.
Sleep and rest
Parents are usually pleased to hear that most toddlers sleep through the night without awakening. A consistent routine, such as a set bedtime, a light snack, reading, and a security object, helps toddlers prepare for sleep.
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Good night, sleepyhead
Sleep requirements change slightly as a toddler grows and approaches the preschool stage.
From ages 1 to 2, a toddler needs 10 to 15 hours of sleep every 24 hours.
The 2- to 3-year-old needs 10 to 12 hours of sleep per night.
During toddlerhood, naps gradually decrease to one per day; at age 3, toddlers usually don’t need a nap.
Dental hygiene
When teeth begin to break through the gumline, a child should begin brushing his teeth with a small, soft-bristled toothbrush (with parental assistance). Fluoride toothpaste should be avoided until the child is 2 years old. When used earlier, before the child can spit out toothpaste, ingested fluoride leads to fluorosis, which can discolor teeth.
Fluoride
Fluoride is a mineral that reduces the incidence of tooth decay. It’s found naturally in water, certain foods, and drinks made with fluoridated water.
Unless the water supply has adequate fluoride (more than 0.6 ppm), children age 2 and older may need to receive a daily fluoride supplement. Before recommending fluoride supplements, consider other potential fluoridated water sources such as the child care center or a relative’s house that the child frequents. When administering supplements or teaching the caregiver to do so, keep in mind that:
The supplement should be taken on an empty stomach and the child shouldn’t eat or drink for 30 minutes afterward.
The supplement should remain in the child’s mouth for 30 seconds before swallowing (if possible).
Use of fluoride products can lead to accidental poisoning; fluoride-containing toothpastes, supplements, and rinses must be stored out of the reach of young children.
Low-cariogenic diet
A low-cariogenic diet is important for developing strong, healthy teeth because caries need fermentable sugars, especially sucrose, to develop. The following information will help parents identify and minimize high-cariogenic foods in their child’s diet:
Sticky or hard foods are more cariogenic than others because they remain in the mouth longer.
Refined table sugar, honey, molasses, corn syrup, and dried fruits such as raisins are highly cariogenic.
It’s more important to limit the frequency of sugar consumption than the total amount consumed.
Timing is everything
Sweets that are consumed immediately after a meal are less damaging than sweets that are eaten as snacks.
“Early childhood caries” (ECC) may occur when a child is routinely given a bottle of milk or juice at naptime or bedtime or uses the bottle as a pacifier while awake (a bottle of water may be used if needed). Breast-feeding has also been associated with ECC when the child frequently falls asleep at the breast.
Coping with concerns
A toddler is prone to developing troubling behaviors relating to toilet training, temper tantrums, and discipline. Negativism and periods of separation anxiety may manifest through physical behaviors such as temper tantrums.
Toilet training
For toilet training to be successful, the child must display three signs of toilet training readiness:
First, the child must have control of the rectal and urethral sphincters.
Second, the child must have a cognitive understanding of what it means to hold his stool and urine until he can go to a certain place at a certain time.
Third, the child must have a desire to delay his immediate reward for a more socially accepted action.It’s in his head, too
Physical readiness for toilet training occurs at ages 18 to 24 months when myelinization of pyramidal tracts and conditioned reflex sphincter control are intact. Despite physical readiness, however, many children aren’t cognitively ready to begin toilet training until they’re between ages 36 and 42 months.
Ready, set, go potty!
When physically and cognitively ready, the child can start toilet training. The process can take 2 weeks to 2 months to complete successfully. It’s important to remember that there’s considerable variability from one child to another. Other signs of readiness for toilet training include:
periods of dryness for 2 hours or more, indicating bladder control
child’s ability to walk well and remove clothing
cognitive ability to understand the task
facial expression or words suggesting that the child knows when he’s about to defecate.
Step by step
Steps to toilet training include:
teaching words for voiding and defecating
teaching the purpose of the toilet or potty chair
changing the toddler’s diapers frequently to give him the experience of feeling dry and clean
helping the toddler make the connection between dry pants and the toilet or potty chair
placing the child on the potty chair or toilet for a few moments at regular intervals and rewarding successes
helping the toddler understand the physiologic signals by pointing out behaviors they display when they need to void or defecate
rewarding successes but not punishing failures.
Temper tantrums
As they assert their independence, toddlers demonstrate “temper tantrums” or violent objections to rules or demands. These tantrums include such behaviors as lying on the floor and kicking his feet, screaming, and holding his breath.
Hush little baby, don’t throw a fit
Tantrums can occur at any time of the day but commonly occur before bedtime. The active toddler may have trouble slowing down and, when placed in bed, resists staying there.
Assessment of temper tantrums in a toddler should include the following questions:
How often do tantrums occur?
What circumstances provoke tantrums?
How does the child behave during tantrums?
How does the child behave between tantrums?
Are expectations of the parent consistent with the child’s developmental age?
Have there been any recent changes in the home?
Does the child have other behavior problems?
Dealing with tantrums
Dealing with a child’s temper tantrums can be a challenge for parents who may be frustrated, embarrassed, and exhausted by their child’s behavior. If tantrums occur in public places, parents may feel as if they’re being judged by others and viewed as inept at parenting and unable to control their child’s behavior.
Annoying but normal
The nurse should reassure parents that temper tantrums are a normal occurrence in toddlers and that the child will outgrow them as he learns to express himself in more productive ways. This type of reassurance should be accompanied by some concrete suggestions for dealing effectively with temper tantrums:
Provide a safe and childproof environment.
Hold the child to keep him safe if his behavior is out of control.
Give the toddler frequent opportunities to make developmentally appropriate choices.
Give the child advance warning of a request to help prevent tantrums.
Remain calm and be supportive of a child having a tantrum.
Ignore tantrums when the toddler is seeking attention or trying to get something he wants.
Help the toddler find acceptable ways to vent his anger and frustration.
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When to get help
Parents should be advised to seek help from a health care provider when problematic tantrums:
persist beyond age 5
occur more than five times per day
occur with a persistent negative mood
cause property destruction
cause harm to the child or others.
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Negativism
Negativism refers to persistent negative responses to requests and is typical of toddlers as they strive for autonomy. “No” and “Me do” become the responses to almost everything, and the toddler’s emotions are very strongly expressed with rapid mood swings.
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