INTRODUCTION

Play is universal for all children. It is work for them and ways of their living. It is pleasurable
and enjoyable aspect of child’s life and essential to promote growth and development. Play
is the activity that has no serious motive and from which there is no material gain. Play is a
child’s way of living, or daily “work.” It can satisfied needs in the child for physical,
emotional, social and mental development. It is an activity where child shows the ability for
exploration, imagination and decision making.
DEFINITION
Hughes (2003) states three criteria of defining play-.

 Freedom of choice
 Personal enjoyment
 Focus is on activity itself rather than its outcomes.
These three criteria are fundamental of the play process and in connecting children’s
development with their characteristic changes through the different stages of development.
IMPORTANCE OF PLAY
Play is essential to development because it contributes to the cognitive, physical, social and
emotional well-being of a children and youth.
 PHYSICAL DEVELOPMENT:
 Play stimulates the brain through the formation of connection between nerve cells.
This process helps with the development of the fine and gross motor skills.
 Active play help in muscle development and physical growth.
 Play increase range of motion, coordination, balance, flexibility, and fine and gross
motor skills by jumping, dancing, riding cycles.
 Sensory development occur through tactile, visual, auditory and kinesthetic
stimulation derived from playing with different toys.
 EMOTIONAL DEVELOPMENT
 Play reduces fear, anxiety, stress, irritability.
 Creates joy, intimacy, self-esteem and mastery.
 Improves emotional flexibility and openness.
 Increases calmness, resilience and adaptability and ability to deal with surprise and
change.
 Play can heal emotional pain.
 Develops confidence through experiencing success in play.
 Helps to control emotion and reduce impulsive behavior.

 SOCIAL DEVELOPMENT
 Helps in realization of self and others.
 Increases empathy, compression and sharing.

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 Creates options and choices.
 Models relationship based on inclusive rather than exclusive.
 Improves non-verbal skills.
 Increase attention and attachment.
 Helps learning negotiation skills.
 Makes believe play allows child to understand different roles.

 INTELLECTUAL DEVELOPMENT
 Learns colors, shapes, sizes, through playing with various objects.
 Identifies letters, common words, symbols, signs with their meaning by solving
puzzles.
 Increases listening and speaking ability by storytelling activity.
 Improves writing skills through scribbling, painting and drawing activity.
 Books and videos increase vocabulary.
 Learns problem solving skills through games and puzzles.

 MORAL DEVELOPMENT
 Learns. Which behaviors are acceptable and which are not.
 Understands importance of taking turns and honesty.
 Recognizes importance of teamwork.

 CREATIVITY
 Express their imagination power through various play activity.
 Exercise their creative ideas by playing with paper, play dough and raw material etc.
 Pretend play increases their creativity.
 Creative thinking occurs in group activity.

 THERAPEUTIC VALUE
 Play can relieve stress and anxiety.
 It divert pain in a sick child.
 Play helps in explain various concepts, procedures to child like demonstrating
injection to a doll.
 Through various play activity, parents can understand their child’s need, fear, area of
low confidence etc.
CLASSIFICATION OF PLAY
Children’s play range from simple physical play with objects such as baby rattles to move
complex cognitive play in games with many rules such as cards or chess.
Play can be classified according to the social participation in play, cognitive involvement
and combination of both social and cognitive characteristics.

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 TYPES OF PLAY ACCORDING TO THE LEVEL OF SOCIAL PARTICIPATION
Parten (1932) observed children’s behavior during play and developed a continuum
showing level of children’s participation in social play, which includes types of play
according to social participation.
 UNOCCUPIED PLAY: From birth to 3 month, the child is busy in unoccupied play.
Children seems to be making random movements with no clear purpose, but this is
the initial form of playing with least social involvement.
 SOLITARY PLAY: From 3-8 month babies spend much of their time playing on their
own. During solitary play, children are very busy in playing with own toys and they
may not seem to notice other children sitting or playing nearby.
 ONLOOKER PLAY: onlooker play happens most often during toddlers years. This is
were the child watches other children play. Children are learning how to relate to
others and learning language. Although children may ask questions to other children,
there is no effort to join the play.
 PARALLEL PLAY: From the age of 18- 2 year, children being to play alongside other
children without any interaction. This is called parallel play.
 ASSOCIATIVE PLAY: Preschooler become more interested in other children than the
toys. Child starts to socialized other children. This play is sometimes referred to as “
loosely organized play.” As associative play helps the preschooler the do’s and don’ts
of getting along with others. Associative play teaches the art of sharing, encourages
language development, problem solving skills and cooperation.
 COOPERATION PLAY: It is common in preschool and school age children. As their
social and emotional development matures, children plays cooperatively with others.
They play an organized structure and children will communicate with each other as
they work together towards a common goal. They have division of labour, team
formation with various roles. In this stage, children respect for others properly,
realize they may need permission to use other toys and are more willing to share
their toys.
 TYPES OF PLAY ACCORDING TO THE COGNITIVE INVOLVEMENT
Smilansky (1968) builds on piaget’s stages, defining characteristic of 4 stages of
cognitive play.
 FUNCTIONAL PRACTICE PLAY: When children run, jump, and play games such as hide
and seek and tag they engage in physical play. Physical play offers a chance of
children to exercise and develop muscle strength. This play teaches various physical
and social skills. The child will learn to take turns and accept winning or loosing.
 CONSTRUCTIVE PLAY: In this type of play children create things. Constructive play
starts in infancy and become more complex as the child grows. This type of play
starts with the baby putting things in his/her mouth to see how they feel and taste.
As a toddler, children begin building with blocks, playing in sand, and drawing.
Constructive play allows children to explore object and discover patterns to find
what works and what does not work. Children gain pride when accomplishing a task
during constructive play.
 DRAMATIC/ PRETEND PLAY: Children learn to try new roles and situation
experiment with languages and emotions with pretend play. Children learn to think
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 and create beyond their world. They assume adult role and learn to think in abstract
methods. Children stretch their imaginations and use new words and numbers to
express concepts, dreams and history thus improving language, vocabulary, and
memory abilities.
 GAMES WITH RULES: When children move from a self-centered world to
understanding the importance of social contracts and rules, they begins to play
games with rules. It is usually played by more than one person and not common
before 4 years of age.

 TYPES OF PLAY ACCORDING TO COMBINATION OF BOTH COGNITIVE AND SOCIAL

CHARACTER

 SOCIO-DRAMATIC PLAY: Socio-Dramatic Play is most typical of 3, 4 and 5 year old

children. In this type of play, children represent their growing understanding of the
world through their body language, spontaneous oral language and vivid
imagination. Socio-Dramatic Play relates strongly to children’s cognitive and social
abilities. It offers rich opportunities for children to:
- Develops abstract thinking.
- Refine their understandings about the world.
- Solve problems in a safe context.
- Have a sense of control over what they experience or are doing.
- Learn how to relate to their peers in a positive way.

 GROWTH AND DEVELOPMENT AND PLAY STIMUALTION OF 1-3 YEAR (TODDLER)

CHILD
The toddler period extends from 1 year to approximately 3 years of age. During this
time, the individual emerges from the total dependency of infancy to beginning of
independence or autonomy. The toddler who learned to trust the parents during
infancy now use this trust in exploration and investigation of a world beyond the
parents’ arm.
 PHYSICAL GROWTH AND DEVELOPMENT: The three areas under this section include
biologic growth, motor development and sensory development.
BIOLOGICAL GROWTH:
 WEIGHT AND HIGHT: The toddler gains weight about 1.8 to 2.7 kg (4-6 pounds) a
year, this gains occurs in steps or short spurts rather than being uniform over the
months. The average weight at 2yesrs of age is 12kg (27 pounds). At 2 ½ years of age
the child’s weight is about four times that at birth.
The gain in height Is greater than that in weight during the toddler period. height
increase about 10-12.5 cm (4-5 inches) per year and is largely a result of growth in
the length of legs the height at 2 years of age about 85 cm ( 34 inches). Boys tend to
be slightly taller than girls.

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 The young toddler has relatively large head in comparison with the size of the rest of
the body. The rate of increase in head circumference slows somewhat by the end of
infancy, and the head circumference is usually equal to chest circumference by 1 to 2
years of age. The usual total increase in head circumference during the second year
is 2.5 cm (1inch). Then the rate of increase until at age 5 years, the increase is less
than 1.25cm (0.5 inch) per year.
The trunk is long in relation to the legs. As the circumference of the chest increases,
the transverse diameter also increases and becomes greater than the
anteroposterior diameter.
- The abdomen protrudes, making the child appear” pot-bellied” because of
immature abdominal musculature. The legs relatively short, but they grow rapidly
because of growth and their epiphyseal centers. The legs may appear slightly bowed
during the second year because of the weight of the rest of the body.
 DENTITION
The deciduous (temporary) teeth develop. At two years, the toddler has about 16
teeth and at 2 ½ years the full set of 20 temporary teeth has erupted.
 PHYSIOLOGIC DEVELOPMENT: The physiologic functioning mature by the end of the
toddler period, with the exception of the endocrine and reproductive system.
- INTEGUMENTARY SYSTEM: The resistance of the skin to infection and its ability to
prevent fluid loss is increased during early childhood as the epidermis and dermis
become more tightly connected to each other The eccrine glands produce small
amount of perspiration in response to warm temperature, but sebum production is
inadequate, leading to dry skin.
 CARDIOVASCULAR SYSTEM: The pulse rate decreases and the blood pressure
increases during the toddler period. The heart and blood vessel s increase in size as
the child grows. With the growth, the capillaries increasingly constrict in response to
increased environmental warmth. Regulation of own body temperature is more
effective than infancy. Parents and eventually the child, help regulate body
temperature further by putting on or removing outside clothing when necessary.
 BLOOD VALUES: The child’s ability to fight infection has increased and although the
number of white blood cells has decreased, their effectiveness has been improved.
 RESPIRATORY SYSTEM: The structures of the respiratory tract infection increase in
size, with an accompanying increase in thoracic volume, leading to decreased
respiratory rate. The anatomic position of the structure remain much the same as
during infancy. Because of short straight Eustachian tubes through which infection
can reach the ears from nasopharynx , the toddlers continues to develop otitis media
as a complication of nasopharyngitis.
 GASTROINTESTINAL SYSTEM: The salivary glands have reached functional maturity
by the end of second year the toddler can chew food and keep it in the mouth so
that the salivary enzymes can being to act upon it. The capacity of stomach is also
increases, and the rapidity with which food passes through the gastrointestinal tract
decreases, so that the toddler can be satisfied with less frequent feeding than were
necessary during infancy. With continue growth hydrochloric acid secretion in

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 stomach increase. Providing protection against various types of organism. the
incidence of infectious diarrhoea is common during infancy is decreased.
 GENITOURINARY SYSTEM: With the continuing maturation of the kidneys, by 2nd
years of age the toddler is able physiologically to conserve water and concentrate
urine on a level similar to that of adult. This fact together with the myelination of
nerves of the urethral sphincter and increase ability of bladder to hold urine, makes
it possible of a child to control elimination. As the urine become more concentrated
and the bladder capacity increases with bodily growth, the child can gradually learn
to control the urethral sphincter so that toilet training can be achieved.
 IMMUNE SYSTEM: Because passive immunity from the mother decreases during
infancy, immunization is essential for protection of the child. The production of
immunoglobulin M(Ig M), which respond to such immunization, reaches adult levels
during the latter part of first year of life. Adult levels of immunoglobulin G (Ig G) are
reached by the middle of the toddler period adult level of immunoglobulins A, D and
E are not achieved until later in childhood. Although antibodies are produced, the
toddler is still susceptible to infection when exposed to new antigens from other
children in nursery school or community.
NERVOUS SYSTEM

 The number of brain cells is complete by the meaning of toddler period. They
continue to grow until the brain has reached two third of its adult size at 2 years of
age and three quarters of other size 3years of age. Is the child pictures specific areas
of the brain develop, such as broca's area of speech. Other areas of cerebral cortex
develop as a child achieves motor control of the extremities and sphincters. Rapid
development of the brain leads to increasing control of behavior but initially results
in some disorganization in young toddlers, manifested by a very short attention
span. The Nervous System can handle only one incoming stimulus at a time
therefore if another stimulus is introduced the response to the first will be
prolonged. For example is the current scores by young toddler for grasping a
breakable object, the child may not be able to respond immediately if a second
admonition is also given. This lake of immediate response is caused by physiologic
functioning and not buy in attention or the lake of desire to carry out a request. Is
increased voluntary control is developed by 2 to 3 years of age, the child's attention
can we help for longer periods of time and cooperation can be obtained sooner.
 Myelination of spinal cord is achieved gradually as toddlers show increasing ability to
exit control over question and coordination movement. As a result, the child is able
to stand alone before being able to walk and to before achieving the skills of running
and jumping. After 2 years of age comma slows down to reach completion during
puberty.
 AT 15 MONTH OF AGE
 Biologic: legs appear bowed.
GROSS MOTOR DEVELOPMENT:

 Resume standing position without help.

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 Rocks without supported 13 month, wide-based gait.
 Loses balance when walking around corners or stopping suddenly.
 Kneels without support.
 Creeps up stairs.
 Throws small objects repeatedly and fix them up again, but may fall ( shows ability to
release object from grasp)
 Cannot throw ball without falling.

FINE MOTOR DEVELOPMENT:

 Builds a tower of 2-3 cubes.

 Opens boxes.
 Pokes finger in hole.
 Scribbles spontaneously.
 Makes line with crayon.
 Pats pictures in books and begins to turn pages.
 Inserts pellet in narrow-necked bottle.

SELF-CARE
Feeding skills:

 May give up bottle.

 Holds a cup with all finger grasped about it.
 Grasp a spoon and inserts it into dish. Cannot fill the spoon well, spoon is likely to be
turned upside down before reaching mouth. Assist child by feeding with a second
spoon.
 Enjoy finger feeding.
 Leaves dish on tray when fed.
Dressing skill:

 Sticks out arm and leg to help in dressing removes socks.

 Removes socks.
Toileting and grooming skills.

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  Indicating when diaper is wet or soiled.
SENSORY DEVELOPMENT

 Sound localization indicated by head movements in all planes.

 Binocular vision fully developed.
 Looks at picture intently for prolonged periods of time.
 Can identify geometric forms and place round object into appropriate place or hole.
PSYCHOSOCIAL

 Sense of autonomy (1-3year).

 Negative counterpart: Shame and doubt.
 Egocentric
 Separation anxiety: coping depends on primary caregiver presence but can tolerate
some separation. Coping decreased in unfamiliar environment.
 Less fearful of strangers.
 Hugs and kisses parents.
 Being to imitate parents doing housekeeping chores (dusting, folding clothes).
 Very early temper tantrums.
PSYCHOSEXUAL: Anal stage (1-3 years).
SPIRITUAL:

 Intuitive- projective.
INTELLECTUAL OR COGNITIVE:

 Sensorimotor stage: V, Tertiary circular reaction (12-18 month) Experiences only the
present.
MORAL:

 Preconventional morality stage (0-2 years) – The good is what I like and want.
LANGUAGE, SPEECH DEVELOPMENT
RECEPTIVE LANGUAGE:

 Comprehends more than can communicate.

 Recognizes names of various parts of body.
 Responds to familiar, simple commands.
EXPRESSIVE LANGUAGE:

 Continue use of expressive jargon.

 Says 2to 6 words.
 Names familiar pictures such as “ball”.
 Vocalizes wants and points to desired object.
 Shakes head to communicate “no”.

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  Communicates “no” even when following a request.
PLAY STIMULATION: (VISUAL, AUDITORY, TACTILE AND KINETIC)

 Walking become a form of play, carries a toy when walking.

 Balls
 Stuffed animals
 Dolls
 Musical toys
 Picture books
 Stacking discs or blocks.
18 MONTH (1 ½ YEARS)
PHYSICAL OR BIOLOGIC

 Anterior fontanel closed (may be closed as early as 12 months).

 Abdomen protrudes.
 Has sphincter control.
GROSS MOTOR

 Walks with somewhat wide stance, but increasingly more like adult gait. seldom falls.
 Walks sideways and backward.
 Walks upstairs with one hand held.
 Runs stiffly, often falls.
 Seats self in small chair.
 Climbs on furniture.
 Gets into everything- explores, drawers, closets and wastebaskets.
 Pull and pushes toy.
 Pushes light furniture around room.
 Throws ball overhand without falling.

FINE MOTOR

 Builds tower of 3-4 cubes.

 Scribbles vigorously.
 Imitate a vertical stroke with crayon.
 Turns pages in a book 2-3 at a time.
 Dumps pellet from bottle.
 Puts block into hole.
 Transfer objects hand to hand at will.

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SELF CARE
Feeding skills
 Holds cup with both hands.
 Finger feeds proficiently.
 Eats with spoon, turns spoon into mouth. Spills frequently.
 May play with food.
Dressing skills
 Removes simple garments (mitten, shoes) and unzips garments.
Toileting and grooming skills
 May complain when wet or soiled or give indication of need to toilet.
 Increased readiness for bowel and bladder control. Possible early control of bowel
movements.
 May smear faeces.
SENSORY DEVELOPMENT

 Can see better, thus has intense interest in pictures.

 Identifies various shapes.
 Convergence well established
 Some depth perception.
PSYCHOSOCIAL

 Sense of autonomy
 Beings to have temper tantrums if things go wrong.
 Has awareness of strangers but may be less fearful of them.
 Seeks help from others when in trouble.
 Bedtime rituals begins.
 Thumb sucking may peak specially before or during sleep for comfort.
 Kisses parents with pucker, imitate parents’ behaviour, imitates parents’ domestic
activities.
 Beginning awareness of ownership; possessiveness begins.
PSYCHOSEXUAL

 Anal stage

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 SPIRITUAL

 Intuitive- projective
INTELLECTUAL OR COGNITIVE:

 Sensorimotor stage.
 Sub stage : VI, invention of new means through metal combinations ( 18-24 months)
 Concept of object permanence fully developed, is comforted when hearing parents’
voice even if parent cannot be seen.
 Beginning sense of time and anticipation of events.
 Begins to ‘think’.
 Beginning trace of memory.
 Experiments actively to achieve goal.
MORAL

 Preconventional morality
LANGUAGE, SPEECH DEVELOPMENT
RECEPTIVE LANGUAGE

 Identifies pictures of familiar of objects when named.

 Identifies one or more parts of body when named.
EXPRESSIVE LANGUAGE
Vocabulary
 Speaks 10 real words (average) bedside jargon.
 Names pictures.
 Uses words more than gestures to express desires.
 One words used to communicate.
Sentence length
 Uses phrases composed of adjective and nouns.
 About 25% of vocalizations are intelligible.
PLAY STIMULATION: (VISUAL, AUDITORY, TACTILE AND KINETIC)

 Enjoy solitary play or watching activities of others.

 Has a favorite toys or transitional (security) object such as a blanket.
MOTOR PLAY

 Large, hollow wooden blocks.

 Balls
 Pull toys
 Low swing with arms and back.
 Low slide
 Rocking chair or horse.

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  Low wheeled toys to ride.
 Small chair and table.
 Running and chasing games.
CREATIVE PLAY

 Containers with openings into which blocks of different shapes can be placed.
 Finger paints
 Clay
 Large crayons
QUITET PLAY

 Sand toys (shovel, send).

 Stuffed animals and dolls to drag, sit upon or hug.
DRAMATIC PLAY

 Imitates parental actions in play.

AT 24 MONTHS (2 YEARS)
PHYSICAL OR BIOLOGIC

 WEIGH – Approximately 11.8 to 12.7 (26-28lb).

 HIGHT – Approximately 82.5- 85.0 cm ..( 4 to 5inch) in second year. Height is about
twice at two years of age.
 Chest circumference exceeds head circumference.
 Head circumference 49 to 50 cm.
 Pulse 110 ± 20 (average 100bpm).
 Respirations 26-28/ min.
 Blood pressure 99/66 ± 26/24
 Reflex – landau reflex completely disappeared.
 Dentition- approximately 16 temporary teeth.
Physiologic functioning, with the exception of reproductive and endocrine is mature.
Probably ready for beginning daytime control of bowel and bladder.

GROSS MOTOR

 More grown up, steady gait.

 Can walk with heel-toe gait.
 Walk backward well in imitation.
 Runs more quickly in more controlled way, has a fewer falls.
 Walks up and down stairs, both feet on one step at a time, holding onto a falling.
 Picks up object from floor without losing balance.
FINE MOTOR
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  Builds a tower of 6-7 cubes.
 Makes cubes into a train, one behind the other.
 Scribbles in more controlled way than at 18 months.
 Imitates a circular stroke.
 Turns page of a book one at a time.
 Opens door by turning door knob, may run away.
 Unscrew lid a jar
 Folds paper of once imitatively.
 Is proud of accomplishment of motor skills.

SELF CARE
Feeding skills
 Drinks well from a small glass held in one hand puts spoon into mouth occasionally
with one hand, but without turning it. Spills moderately.
 Plays with food.
 Can use straw.
 Imitates eating habits of others.
 May request certain foods.
Dressing skills

 Pulls on one simple garments- coat, elastic pants (with help over hips), shoes.
 Removes most of own clothing (hat, pants).
Toileting and grooming skills
 Verbalizes toilet needs.
 Usually bowel-trained with occasional accident.
 Usually urinates when taken to toilet.
 Toilet- trained in daytime generally.
 May brush teeth with help.
 Attempts to wash self in tub or shower.
SENSORY

 Visual acuity 20/40

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  Accommodation well developed.
 Insert a square object into its appropriate place or hole.
 May develop esotropia (strabismus).
PSYCHOSOCIAL DEVELOPMENT

 Sense of autonomy
 Egocentric in both thought and behaviour.
 Separation anxiety from primary caregiver is at height, fears parents leaving.
 Beginning to show early sign of individually and independence from primary
caregivers.
 Behave as a though other children were physical objects. May hug or push them out
of way; would like to make friends but does not know, how?
 Pulls other person to show them something.
 Does not readily ask for help.
 Sleep resisted overtly; has many demands before bedtime, bedtime rituals continue.
 Upset by changes in routine.
 Thumb sucking decreases.
 Violent temper tantrum decreasing.
PSYCHOSEXUAL DEVELOPMENT: Anal stage

 SPIRITUAL DEVELOPMENT: Intuitive- projective.

INTELLECTUAL OR COGNITIVE

 Preoperational stage
 Preconceptual phase(2-4 years)
 Preoccupation with symbols in language, dreams and fantasy.
 Shifts attention less rapidly than chid of 18 months; attention span longer.
 Increase sense of time; can anticipate events and can wait for them.
 Symbolic thought begins, can ‘pretend’
 Imitation becoming more symbolic.
MORAL DEVELOPMENT

 Preconventional morality stage 1 (2-3years). If punished for doing it, it’s wrong; if not
punished it must be right.
LANGUAGE DEVELOPMENT
RECEPTIVE LANGUAGE
 Understands more complex sentences.
 Obeys one directional preposition (‘on’ or ‘under’) and two commands (“pick up your
coat and put it on the chair”).
 Enjoys stories with pictures identifies four body parts when named.
EXPRESSIVE LANGUAGE

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 Vocabulary
 No longer uses jargon.
 Knows about 300 words.
 Refers to self by first name; gives first name.
 Uses pronouns “me” ‘mine”.
 Tries out new powers of speech. Asks “what’s” (who’s) that?
 Verbalizes need for drink, food or toileting.
 Sentence length
 Two to three words (subject, object, verb).
 About 66% of vocalization are intelligible.
PLAY STIMULATION (VISUAL, AUDITORY, TACTILE AND KINETIC)

 Enjoys parallel play- little social interaction with other children even though their
activity is the same. Interaction that does occur may consist of watching and
imitating each other’s activity.
 Beginning to learn to replace toys in their proper place.
MOTOR PLAY

 Pulls wagon
 Place beads in box and dumps them.
CREATIVE PLAY

 Manipulate play material such as clay and play-Doh.

 Finger paints
 Brush paints
 Large crayons
 Record player and records.
 Sings song
 Large puzzles
 Toys to take apart
QUIET PLAY

 Enjoys hearing stories illustrate with pictures.

 Takes favorite toys to bed.
DRAMATIC PLAY

 Mimics domestic activities of parents.

 Enjoys playing with dolls.

AT 30 MONTH
PHYSICAL OR BIOLOGIC

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  Weight gains about 5kg (11Ib) between 1-3 years.
 Height: Grows about 6-8 cm ( 2.4-3.4inch) during third year.
 Dentition: Full set of 20 temporary ( deciduous) teeth.
 Daytime bowel and bladder control possibly established.
GROSS MOTOR DEVELOPMENT

 Stand one foot alone momentarily.

 Walks on a tiptoe for few steps upon request.
 Walks up and down stairs one foot on a step alternating feet.
 Jumps well in place with both feet off floor.
 Jumps from steps or low chair.
 Can through a large ball overhand 4-5 feet.
 Rides a walker or pedal car.
FINE MOTOR DEVELOPMENT

 Builds tower of 8 cubes.

 Add chimney to train of cubes.
 Make vertical or horizontal strokes but may, but may or may not joint holds crayon
with fingers instead of entire hand.
 Imitates circular from stroke – forms closed figure.
 Holds crayon with finger instead of entire hand.
 Good hand to finger coordination; moves finger.

SELF CARE
Feeding skills
 Self-feeding with occasional spilling.
 Pores from pitcher; often spills.
 Gets a drink without assistance.
 Distinguishes between finger and spoon food.
 Chews with mouth closes.
Dressing skills

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  Puts arm through large arm hole.
 Buttons one large front buttons.
 Helps put things away.
Toileting and grooming skills
 Usually has mastered daytime bladder control.
 Beginning night time bladder control.
 May go toilet by self, needs assistance with wiping.
 Adequate attempt to wash hands, partially dries hands, upon reminder.
SENSORY

 Visual acuity: 20/30 convergence smooth recalls visual images.

PSYCHOSOCIAL

 Sense of autonomy.( 1-3 year). Theoretically achieved at the end of toddler period. If
not, sense of shame and doubt predominates.
 Egocentrism still present in behaviour, thought and play.
 Beginning to learn to cope with separation anxiety.
 Independent behaviour increases.
 Achieves some self-control based on self-esteem rather than fear.
 Negativism and dawdling continue.
 Temper tantrums may or may not decrease.
 Imitates sex role behaviour of adults.
 Knows own sex.
PSYCHOSEXUAL
Anal stage (1-3 years)

 SPIRITUAL : Intuitive- projective

INTELLECTUAL

 Preopertional stage: preconceptual phase (2-4 years)

 Concept of time improved but still limited.
 Begins ’casual’ thinking.
 Problem-solving with trial and error.
LANGUAGE
RECEPTIVE LANGUAGE

 Identified five body parts with names.

EXPRESSIVE LANGUAGE
Vocabulary
 Gives full (first and last) name if asked.
 Talks constantly ask “why?”

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 Sentence length
 Use 4-5 word sentences.
 About 75% of vocalizations are intelligible.
PLAY STIMULATION (VISUAL, AUDITORY, TACTILE AND KINETIC)

 Parallel play continues.

 Helps put things away pretends in play.
MOTOR PLAY

 Pushes and steers toys well.

 Large cars, trucks.
 Cardboard, boxes.
 Block trains that interlock.
 Carries breakable objects.
CREATIVE PLAY

 Clay
 Finger paints
 Large crayons
 Large wooden puzzles.
 Sandbox toys
 Brightly colored construction paper to fold or cut with blunt scissors.
QUIET PLAY

 Uses transitional security object.

 Toys for water play.
DRAMATIC PLAY

 Baby doll and doll equipment.

 Toys for housekeeping (small broom, dust cloth).
 Play telephone.

 PLAY DURING HOSPITALIZATION

It is also one of the childhood’s most effective tools for mastering stress. Play is essential
for sick child as for the healthy one. The sick child needs to play fill lonely hours and by
expressing feeling and aggression through it, to reduce the trauma caused by
hospitalization.

 Children can play in area provided for this purpose, if no rooms is available that can
be used for this specific purpose, a toy cart can be designed that can be moved from
bed to bed.

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  Ill child who is who is unable to play actively with toys may enjoys listening to stories
with pictures.
 Other activity children can do are watching golden fish in a tank, watching
supervised television programs.
 Provide variety of art media such as finger paints, brush paints, painting or molding
with clay.
 Children enjoy play with household equipment.
 Handling empty syringe (without sharp needles), IV tubing etc.
 Children enjoy carts, tricycles and wagons through the use of which they develop
their large muscle.

 PLAY SAFTY
 SELECTION OF SAFE AND SUITABLE TOYS:
 CHOOSE AGE APPROPRIATE TOYS: Choose toys according to the interests, needs
and abilities of different stages of child’s development that can be washed and that
are flame- retardant or resistant and contain non-toxic material.
 WATCH FOR TOY DANGERS
 SHARP EDGES AND SHARP POINTS: Avoid toys sharp points or edges that can hurt a
small child. Stuffed toys may have a wire inside that will stick out if the toy comes
apart. Avoid giving toys with metal parts to toddlers and babies.
 SMALL TOYS AND TOYS WITH SMALL PARTS: Check toys regularly for loose parts,
which may be choking dangers. Check stuffed animals for eyes, noses and parts that
can come off. Put the small toys and toys with small parts out of reach, when young
once are around.
 CORDS AND STRINGS: Toys with long cords and strings can be harmful for babies
and young children. They can wrapped around a child’s neck. Never hand toys with
strings, cords or ribbons in cribs or playpens.
 TOYS THAT FLY OR SHOOT OBJECTS: Keep air rockets and other shooting toys that
can cause serious eye injuries away from young children. Arrows used by children
should have soft tips made out of cork or rubber.
 ELECTRIC TOYS: Charge battery-powered toys for toddler. Chargers and adapters
that come with toys can shock or burn. Buy toy come with battery compartment that
are sealed or need to screwdriver to open.
 READ INSTRUCTION: Read the labelling on new toys. ‘Not suitable for children under
the age of 3 means that there are small parts which could be swallowed..
 PLAY SAFE OUTDOORS: Ensure that ride-on toys are appropriate to age of the and
are suitable. Make sure children always were shoes when playing outside and also
play under supervision.
 OTHERS: Anything big enough to go inside must have ventilation holes, including
tents. Never give adult jewellery to children. Adult jewellery can contain high level of
lead.
 STORAGE AND MAINTAINCE OF PLAY MATERIAL

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  STORE TOYS IN A SAFE PLACE: Put all toys away and off the floor when they are not
being used. If using a toy chest, it should have a air holes and be easy to open from
the inside. Preferably used basket or boxes without lids to store.
 CHECK TOYS OFTEN FOR DANGER: Watch for sharps edges on wooden toys. Check
outdoor toys for rust. Check all toys at regular intervals for any removable parts. If a
toy cannot be fixed through it away.
 OTHERS: Through away plastic wrap and other packaging right away. Through away
broken balloons and put away deflated balloons.
 SUPERVISION:
 Provide a safe supervised play environment.
 Supervised young children during play.
 Keep the children away from furniture, high places, staircase, fireplace and water
body while playing.

 POTENTIAL HAZARDS AND ITS PREVENTION

 MOTOR VEHICLE ACCIDENT:
This is the leading cause of accidental death for children of all ages after the first year
of life. Deaths are caused either when children are passengers within a motor vehicle
or are struck by such a vehicle in the street, driveway or parking lot. Many accidents
are due to lack of improper use of a restraining device.
Automobile accident prevention measures include:

 Always use a car safety restraint correctly when transporting a young child in an
automobile, even on short rides. The safest position for the restraint and the child is
in the middle of the back seat.
 Lock all car doors and teach children not to play with door locks and handles.
 Do not operate a motor vehicle unless every passenger is properly restrained, not
only for safety but also to set a good example for children.
 Stop the car immediately if a child remove the harness or climb out of safety seat.
 Keep the child occupied by providing toys or by having appropriate conversation.
 Never leave heavy or sharp objects loose in a car. The sudden stop or could turn
them into lethal weapons.
 Do not permit a child to suck on candy (lollipops) or ice cream on a stick while riding.
Sudden swerve or jar could jam the stick into child’s s throat.
 DROWNING :
Drowning is also a main cause of accidental death in toddlers. The increased ability of
toddlers to be mobile with upright posture, combined with their heightened curiosity
about their environment, leads them into dangerous situations when bodies of water
both large (swimming pools or river) and small( children's pools, bathtubs or bucket ).
Specific measures to prevent drowning Includes
 Adult supervision of all children when near any body of water, no matter how large
or small at home or outside at the home.

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 Adequate finishing and cell fencing and self- latching gates around residential
swimming pools.
 BURNS:
Burns rank 3rd for boys and second for girls is the cause of accident that in children
between the age of 1-4 years. This one’s can be caused by fire And Flames contact
with hot Fluids hot surfaces or corrosive household products, faulty or incorrectly use
electricity and prolong exposure to the sun. Burns occur during the toddler years
when the child is learning to climb, reach, grass and explore the word by touching and
pasting but does not have the ability to recognize danger. When the caregiver is
distracted or under pressure, does not supervise the child sufficiently or is not
familiar with the child’s level of growth and development accident are likely to occur.
Several precautions should be taken to prevent the toddler from burns:

 Remove from view any source of fire, such as matches, cigarette lighters for
Fireworks and store them in locked containers.
 Foot burning incense, candles in place that are inaccessible to the toddler.
 To prevent burns of all family members in the event of a fire, practice home Fire
drills.
 Note the toddler's location when cooking or carrying hot liquids.
 Set hot liquids, including grease, far back from the table or counter edge; turn pot
handles towards back of stove.
 Never leave young children unattended in bathroom or kitchens.
 Select the cooking stove, if possible in which the knobs for controlling the burners
are on the top of and not front of where toddler could reach them.
 Place hot objects on high place out of the reach of climbing toddlers.
 Prevent the quotes for electrical appliances like coffee makers, irons, blenders,
mixers and popcorn Poppers from dangling where the toddler can reach them.
 Prevent the toddler from inserting small metal objects (safety pins, paper clips or
hairpins) into electrical outlets by covering them with protective plastic caps or by
making them inaccessible through the placement of furniture.
 Hide electrical wire and extension cord joints from view. Toddlers who lick or suck on
them can suffer disfiguring one of the oral cavity from Electricity short circuit by their
saliva.
 SUFFOCATION:
This brings forth for boys and fifth for girls as the cause of accidental death of
toddlers.
The child may suffocate by aspirating food objects or by enclosure in household
appliances.
Specific points to be considered to prevent suffocation in toddlers

 Cut food into bite sized portions before serving it to toddlers.

 Do not served young children small item of food such as nuts hard Candy, gum or
dried beans.

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 Remove bones from fish, beats of bone from meat and pits or stones from fruit
before serving them to young children.
 Remove small parts of toys and other small household items from the environment
of young children.
 FALLS:
Falls are the fifth-ranked cause of death among boys and forth-ranked among girls
from 1-4 years of age. Although the gross and fine motor activity of toddlers become
increasingly coordinated during this period, their overwhelming curiosity and
intense activity together with a total lake of understanding of danger, lead them into
hazardous situations. Close supervision of young children is the most important
factor to prevent falls. False may still happens if toddler are not properly cloth and
various input devices are not sufficient. False may occurs in homes, play areas for
family vehicles
To prevent the falls during toddler period:
 To prevent tripping and falling, check that Pants legs are not too loose or long.
 Check shoe soles to be sure that they are not too slippery or too rough, which could
cause a child to fall. Check that shoe laces are tied securely.
 Cover accessible windows that can open with well-made screens for metal guards or
lock or nail them shut.
 Place gates at the top of and bottom of stairs to prevent climbing without
supervision.
 In play areas supervisors and teach toddlers how to play safely.
 Skid proof the bottom of the bathtub with nonslip stick one or rubber mat.
 POISONING:
The highest incidence of poisoning occur in the two year old age group causing not
only that but short and long term morbidity as well. Activate mobile toddlers are
likely to come into contact with poisonous at a certain times of the day. For example
early in the morning before the parents awaken young children who are up and
about and hungry may find something Lethal to eat or drink before breakfast is
ready.
The following precautions can prevent toddlers from poisoning:
 Store all potentially toxic substances in a locked closed or an inaccessible area.
 Securely close all containers, including child resistant containers each time a product
is used.
 Do not leave a hazardous product unguarded when in use. Take it along if the
telephone or doorbell rings instead of leaving it where a child can reach it.
 Replace all medications and other potentially toxic substances in their storage areas
immediately after use.
 Never put medications or potentially toxic substances in drinking cups of soft drinks
bottles. Keep harmful substances in their original containers.
 Do not call medicine “candy” or take medication in a child’s presence, because the
child may imitate this behaviour.

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 Discard empty containers of any poisonous substances promptly. Rinse them and
replace their lids before throwing them away.
 Discard old or unlabelled medicines down the drain or toilet.
 Store small appliances that used tiny, disc shaped batteries such as watches hearing
aids, cameras and calculators out of reach of children.
 OTHER TYPES OF INJURIES:
Bodily injuries that can occur to infants can also happen to toddlers. Causes of
injuries to toddlers include sharp objects, protruding, sharp or rough edges on
furniture unstable furniture, falling objects, and unsupervised animals.
 Do not permit toddlers to have a candy or ice cream on sticks while walking because
of the danger if the child falls.
 Do not permit them to have a sharp objects like scissors.
 Purchases furniture that does not have a sharp edges, as do glass top tables, of
edges or protrusion that can injure a small child when walking, running or possibly
falling.
 Clear away knickknacks or unstable lamps that could fall on a child or cause injury if
broken.
 Protect young children from aggressive or unsupervised animals, whether larger or
small.

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 BIBLIOGRAPHY

 Dutta, P. (2009). Pediatric nursing. (2nd ed.). New Delhi: Jaypee Brothers Medical
Publisher. 132
 Hockeberry, M. J., & Wilson, D. (2009). WONG’S: Essential of pediatric nursing. (8TH
ed.). Noida: Elsevier Publisher. 330-341.
 Marlow, W. R., & Redding, B. A. (2006). Textbook of pediatric nursing. (6th ed.).
New Delhi: W. B. Sounders. 723-756.
 Pal, P. (2016). Textbook of pediatric nursing. 1st Edition. New Delhi: Paras Medical
Publisher. 114-119.
 Sharma, R. (2013). Essential of pediatric nursing. First Edition. New Delhi: Jaypee
Brothers Medical Publisher. 84-89.

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 GOVERNMENT COLLEGE OF NURSING
C. R. P. LINE, INDORE
DEMONSTRATION ON: PLAY THERAPHY 1-3 YEAR

SUBMITTED TO SUBMITTED BY

Mrs. J. Philip madam Anita kashyap

M.Sc. (N) Previous year
Mrs. T. Naphtali
GCON, Indore
Mrs. S. Bhoskar

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.

====

26
ROLE OF PLAY IN DEVELOPMENT
Through the universal medium of play, children learn what no one can teach them. They
learn about their world and how to deal with this environment of objects, time, space,
structure, and people. They learn about themselves operating within that environment-
What they can do, how to relate to things and situations and how to adopt themselves
to the demands society makes on them. Play is the work of children. In play children
continually practice the complicated, process of living, communicating and achieving
satisfactory relationship with other people

qnimalSENSORY CHANGES

 Visual acuity of 20/40 is considered acceptable during the toddler years. Full
binocular vision is well developed and any evidence of persistent strabismus requires
professional attention as early as possible to prevent amblyopia. Depth perception
continues to develop, but because of toddlers' lack of motor coordination, falls from
heights continue to be persistent danger. The sense of hearing, smell, taste and
touch become increasingly well developed, coordinated with each other and
associated with other experiences. All of the sense are used to explore the
environment. Toddler visually inspect an object by turning it over; they may taste it,
smell it and touch it several times before they are Satisfied with their investigation
 MATURATION OF SYSTEM:

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  Most of the physiologic systems are relatively mature by the end of toddlerhood.
The volume of the respiratory tract end of toddlerhood. The volume of respiratory
tract and growth of associated structure continue to increase during early childhood,
lessening some of the factors that predisposed children to frequent and serious
infection during infancy. The internal structures of the Year short strength of the
dances and adenoids continues to be large. Is result that is media, tonsillitis and
respiratory tract infections are common.
 Toilets really have difficulties of young infants in maintaining weather temperature.
 The major function of railway systems service floor and the times of stress,
decreasing the risk of dehydration.
 The digestive process are there only completed by the beginning of toddler Hood.
The acidity of the gas present tense continuous increase and has a protective
function because it is capable of destroying many types of bacteria. Stomach
capacitor increases to allow for the usual schedule of 3 meals a day.
 Defence mechanism of the skin and blood, particularly sinusitis are much more
efficient in toddlers than in infants.
 Rapid growth in European organization contributes to Greater regularity of sleep
wake cycles, the definition of crying and unexplained fussiness and the enhanced
predictability in mood.
 Gross motor development:
 Fine motor development
 Psychosocial development

 BODY PROPORTIONS
CHRACTERSTICS OF PLAY

 Self-directed
 Self-selected
 Open-ended
 Voluntary
 Enjoyable
 Flexible
 Motivating
 Individual or group

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