Health promotion of the toddler and family

HEALTH PROMOTION
OF THE TODDLER AND
FAMILY
BY NAWAL GALET AL-MATARY

Outline
 PROMOTING OPTIMAL GROWTH AND
DEVELOPMENT
 BIOLOGIIC DEVELOPMENT
 PSYCHOSOCIAL DEVELOPMENT
 CONGNITIVE DEVELOPMENT: SENSORIMOTOR
AND PREOPERATIONAL PHASE
 SPIRITUAL DEVELOPMENT
 DEVELOPMENTOF BODY IMAGE
 DEVELOPMENT OF GENGER IDENTITY
 SOCIAL DEVELOPMENT
 COPING WITH CONCERNS RELATED TO NORMAL
GROWTH AND DEVELOPMENT

Learning objective
 On completion of this chapter the reader will be able
to:
• Identify the major biologic, psychosocial, cognitive,
and social developments during the toddler years.
• Relate separation anxiety and negativism to
development tasks.
• Recognize readiness for toilet training and offer
parents guidelines.
• Help parents foster toddlers language development.

PROMOTING OPTIMAL GROWTH
AND DEVELOPMENT
 The term terrible twos has often been used to describe
the toddler years, the period from 12 to 36 months of
age
 What the word “no” means; and power of temper
tantrums, negativism, and obstinacy.
 Successful mastery of the tasks of this age requires a
strong foundation of trust during infancy and frequently
necessitates guidance from other when parents and
toddlers face the struggles of toilet training, limit
setting, and sibling rivalry.
 Nurses who understand the dynamics of growth and
development of toddlers can help families deal

BIOLOGIIC DEVELOPMENT
1. Proportional changes
2. Sensory changes
3. Maturation of systems
4. Gross and fine motor development

Proportional changes
 Physical growth slows considerably during toddlerhood
 The average weight gain is 8.1 to 2.7 kg (4-6 pounds) per year.
 The rate of increase in height also slows.
 The average height of a 2-year-old child is 86.6 cm (34 inches).
 The rate of increase in head circumference slows and 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 (1 inch).
 The anterior fontanel closes between 1 and 1.5 years of age.
 chest circumference continues to increase in size and exceeds head
circumference during the toddler years. The chests shape also
changes as the transverse, or lateral, diameter exceeds the
anteroposterior diameter. After the second year, the chest
circumference exceeds the abdominal measurement.
 However, toddlers retain a squat, “pot-bellied” appearance because
of their less developed abdominal musculature and short legs.

Sensory changes
 Visual acuity of 20/40 is considered acceperd during
the toddler years.
 The senses of hearing, smell, teste, and touch
become increasingly well developed, coordinated
with each other, and associated with other
experiences
 Another example of the integrated function of the
senses is toddlers development of specific test
preferences. Toddlers are much less likely than
infants to try new food because of their appearance,
texture, or smell, not just their taste.

Maturation of systems
 Most of the physiologic systems are relatively
mature by the end of toddlerhood.
 The volume of the respiratory tract and growth of
associated structures continue to increase during
early childhood, lessening some of factors that
predisposed children to frequent and serious
infections during infancy.
 Under condition of moderate variation in
temperature, toddlers rarely have the difficulties of
young infant in maintaining body temperature. The
mature functioning of the renal system serves to

Cont…
 The digestive processes are fairly complete by the
beginning of toddlerhood.
 One of the more prominent changes of the
gastrointestinal system is the voluntary control of
elimination.
 With complete myelination of the spinal cord, control
of the anal and urethral sphincters is gradually
achiveed.
 The physiologic ability to control the sphincters
probably occurs somewhere between ages 18 and 24
months.

Cont…
 The defense mechanisms of the skin and boold,
particularly phagocytosis, are much more efficient in
toddlers than in infants.
 Rapid growth in neurobehavioral organization
contributes to greater regularity of sleep-wake cycles,
the diminishing of crying and unexplained fussiness, and
the enhanced predictability in mood.
 Valuable stimulants of early brain development include
the various interactions (talking,singing,and
playing)between the toddler and caregivers.
 Adequate nutrition; protection from environmental toxins
such as lead, various drugs, and stress; and promotion
of good health care all contribute to healthy brain growth.

GROSS AND FINE MOTOR
DEVELOPMENT
 The major gross motor skill during the toddler
years is the development of locomotion.
 By 12 to 13 months of age, toddlers walk alone
using a wide stance for extra balance, and by 18
months, they try to run but fall easily.
 Between 2 and 3 years of age, refinement of the
upright, biped position is evident in improved
coordination and equilibrium.
 At age 2 years, toddlers can walk up and down
stairs, and by age 2.5 years, they can stand on
foot, walk on tiptoe, and climb stair with alternate
footing.

Cont…
 Fine motor development is demonstrated in increasingly
skillful manual dexterity .
 For example, by age 12 months, toddlers are able to
grasp a very small object but are unable to release it at
will.
 At 15 months, they can drop a raisin into a narrow-
necked bottle.
 Casting or throwing objects and retrieving them become
almost obsessive activities at about 15 months.
 By 18 months of age, toddlers can throw a ball
overhand without losing their balance.
 By 2 years of age, toddlers use their hands to build
towers, and by 3 years of age, they draw circles on

Psychosocial development
 Toddler are faced with the mastery of several
important tasks. If the need for basic trust has been
satisfied, they are ready to give up dependence for
control, independence, and autonomy. Some of the
specific tasks to be dealt with include:
• Differentiation of self from other, particularly the mother
• Toleration of separation from parent
• Ability to withstand delayed gratification
• Control over bodily functions
• Verbal means of communication
• Ability to interact with other in a less egocentric manner

Developing a sense of autonomy
(Erikson)
 According to erikson (1963),the developmental
task of toddlerhood in acquiring a sense of
autonomy while overcoming a sense of doubt and
shame
 Skillful monitoring and balance of controls by
parents allows a growing rate of realistic
successes and the emergence of autonomy.
 Just as infants have the social modalities of
grasping and biting, toddlers have the newly gaind
modality of holding on and letting go

Cont…
 To hold on and let go is evident with the use of the
hands; mouth;eyes;and,eventually,the sphincters,
when toilet training is begun
 These social modalities are expressed constantly in
the childs play activities,such as throwing objects;
taking objects out of boxes, drawers,or cabinets;
holding on tighter when someone says,"no; don’t
touch";and refusing or spitting out food as taste
prefernces become very strong.
 As toddlers attempt to express their will, they often
act with negativism, the persistent negative response
to requests. The words"no"or "me do" can be their
sole vocabulary. emotions become strongly

Cont…
 Erkson focuses on the development of the ego,
witch may be thought of as reason or common
sense, during this phase of psychosocial
development . children struggle to deal with the
impulses of the id and attempt to tolerate
frustration and learn socially acceptable ways of
interacting with the environment.

COGNITIVE DEVELOPMENT :
SENSORIMOTOR AND
PREOPERATIONAL PHASE (PIAET)
 The period from 12-24 months of age is a
continuation of the final two stages of the
sensorimotor phase. during this time ,the cognitive
processes develop rapidly and at times seem
similar to those of mature thinking. however,
reasoning skills are still primitive and need to be
understood to effectively deal with the typical
behaviors of a child of this age.

Tertiary circular reactions
 In the fifth stage of the sensorimotor phase,
tertiary circular reactions (13-18 months of age),
the child uses active experimentation to achieve
previously unattainable goals
 Awareness of a causal relationship between two
events is apparent.
 After flipping a light switch, toddlers are aware that
a reciprocal response occurs.
 The discovery of objects as objects leads to the
awareness of their spatial relationships.
 Object permanence has also advanced.

INVENTION OF NEW MEANS
THROUGH MENTAL
COMBINATIONS
 From ages 19 to 24 months, children are in the final
sensorimotor stage, invention of new means through
mental combinations .
 Limitation displays deeper meaning and
understanding. There is greater symbolization to
imitation. Children are acutely aware of others actions
and attempt to copy them in gestures and in words.
 Domestic mimicry (imitating household activities)and
sex-role behavior become increasingly common during
this period and during the second year.
 Preoperational though implies that children cannot think
in terms of operations—the ability to manipulate objects
in relation to each other in a logical fashion.

PREOPERATIONAL PHASE
 In children is often discussed in terms of the
child's developmental level because the evolution
of spirituality often parallels cognitive development
 The child's family and environment strongly
influence the child's perception of the world
around him or her, and this often includes
spirituality. Furthermore, family values, beliefs,
customs, and expressions of these influence the
child's perception of his or her spiritual self

DEVELOPMENT OF BOODY
IMAGE
 As in infancy, the development of body image closely
parallels cognitive development. Developing
psychologic understanding provides greater self-
awareness, and young children learn to answer the
question:"who am I?" during the secondyear,
children recognize them-selves in a mirror and make
verbal references to themselves ("Me big").
 With increasing motor ability, toddlers recognize the
usefulness of body parts and gradually learn their
names. They also learn that certain parts of the body
have various meanings; for example, during toilet
training, the genitalia become significant, and
cleanliness is emphasized

CHARACTERISTICS OF
PREOPERTIONAL THOUGT
 As in infancy, the development of body image closely
parallels cognitive development. Developing
psychologic understanding provides greater self-
awareness, and young children learn to answer the
question :"who am I?" during the secondyear, children
recognize them-selves in a mirror and make verbal
references to themselves ("Me big").
 With increasing motor ability, toddlers recognize the
usefulness of body parts and gradually learn their
names. They also learn that certain parts of the body
have various meanings; for example, during toilet
training, the genitalia become significant, and

Spiritual development:
 Just as toddlers explore their environment, they
also explore their bodies and find that touching
certain body parts is pleasurable. Genital
fondling (masturbation ) can occur and involves
manual stimulation, as well as posturing
movement (especially in young girls ) such as
tightening of the thighs or mechanical pressure
applied to the pubic or suprapubic area.

Development of gender identity
 Just as toddlers explore their environment, they
also explore their bodies and find that touching
certain body parts is pleasurable. Genital fondling
(masturbation ) can occur and involves manual
stimulation, as well as posturing movement
(especially in young girls ) such as tightening of the
thighs or mechanical pressure applied to the pubic
or suprapubic area.

Social Development
 A major task of the toddler period is differentiation of
the self form significant others, usually the mother.
The differentiation process consists of two phases:
separation, the childrens emergence from a
symbiotic of two phases: separation, the children's
expression of their individual characteristics in the
environment. Although the process begins during the
latter half of infancy, the major achivements occur
during the toddler years.
 Toddlers have an increased understanding and
awareness of object permanence and some ability to
withstand delayed gratification and tolerate moderate
frustration. As a result, toddlers react differently to

Language :
 The most striking characterstic of language
development during early childhood is the increasing
level of comprehension. Although the number of
words acquired-from about four at 1 year of age to
approximately 300 at age 2 years –is notable, the
ability to comprehend and understand speech is
much greater than the number of words the child can
say.

Personal-social behavior:
 One of the most dramatic aspect of development in the
toddler is personal-social interaction. Personal-social
behaviors are evident in such areas as dressing,
feeding, playing, and establishing self-control. Parents
frequently wonder why their manageable, docile, lovable
infant has turned into a determined, strong-willed,
volatile little tyrant By 15 month of age, children feed
themselves, drink well form a covered cup, and manage
a spoon with considerable spilling.by 2 years, they use a
spoon well, and by 3 years, they may be using a fork .
between ages 2 and 3 years, they eat with the family
and like to help with chores such as setting the table or
removing dishes from the dishwasher, but they lack table
manners and may find it difficult to sit through the
family's entire meal.

Play :
 Play magnifies toddlers physical and
psychosocial development interaction with
people becomes increasingly important.

Reference
 by Marilyn J. Hockenberry PhD RN PNP-BC
FAAN and Kelley Ward PhD RNC
 Study Guide for Wong's Essentials of Pediatric
Nursing,
 NINTH EDITION
 2012
 ELSEVTER

Health promotion of the toddler and family

Health promotion of the toddler and family

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