SCENARIO #2

You are the nurse who has been contracted by a local daycare center to provide Growth
and Development education to parents of toddlers. Create an educational program which
addresses each of the following criteria for the Toddler stage of development: Toddler Stage
1 to 3 years of age

General Physical Appearance

1-year-old- pudgy, short legs, cute,
2-3 year-old- more slim, distinct facial features, longer hair, fine hair on legs
Expected Growth
Height
The average toddler grows about 3 inches (7.5 cm) per year
The average 2 year old is about 34 inches (86.5 cm) tall. Height at 2 years is about half
the expected adult height.
Weight
The average toddler gains from 4 to 6 pounds ( 2 to 2.25 kg) per year
The average 2 year old weighs 27 pounds (12.2 kg)
Birth weight quadruples by 2.5 years
Head Circumference
From ages 1 to 2 years, head circumference equals chest circumference
The total increase in head circumference in the second year is 1 inch (2.5 cm), and then
the rate of increase slows to .5 inch (1.3 cm) per year until age 5.
Range of Vital Signs
Age Pulse Respirations Blood Pressure Temperature
(mm Hg)

1-3 90-140 20-30 78-112/48-58 97-100.4/36-38

50%ile for Ht (cm)/wt (Kg) /HC (cm) **

Male height At 18-1/2 months, a boy is 82.40 cm in the 50th percentile. At 24-1/2
months, a boy is 87.66 cm in the 50th percentile.
Female height Girls that are 12 and a half months old are 74.39 cm long in the
50th percentile. At 18-1/2 months they are 80.79 cm long in the 50th percentile.
Girls who are 24-1/2 months old are 86.19 cm in the 50th percentile.
Male weight At 12 and a half months, a boy is 10.45 kg in the 50th percentile. At
18-1/2 months, he will be 9.90 kg-11.80 kg in the 50th percentile. A 24-1/2 month
he will be 12.74 kg in the 50th percentile.
Female weight. A 12-and-a-half-month old girl who weighs 9.66 kg will be in the
50th percentile. At 18-1/2 months, a girl weighs11.08 kg in the 50th percentile. At
24-1/2 months, a baby will weigh 12.13 kg in the 50th percentile.

Figure 1 Head Circumference for Toddlers

Detailed Diet
-Fruits and Veggies: 4 servings per day
-Proteins: 2 servings per day
-Dairy: 16-24 oz per day
-Greens: 4 servings per day

Caloric Needs
Good nutrition fosters normal growth patterns, promotes developmental progression, and helps
prevent disorders (tooth decay, anemia, and immune dysfunction).
a. Growth rate slows dramatically, thus decreasing the childs need for calories, protein and
fluid
b. Calorie requirements are 102 kcal/kg/day
c. By the age of 12 months, the majority of toddlers eat the same food as the rest of the
family
d. At the age of 18 months, many toddlers experience physiologic anorexia and become
picky eaters
e. Toddlers prefer to feed themselves and prefer small portions of their preference
Age Not active Somewhat active Very active

2 to 3 year 1000 to 1200 calories 1000 to 1400 calories 1000 to 1400

calories

2 to 3 years 1000 calories 1000 to 1200 calories 1000 to 1400

calories

Stage of Play
- -Solitary play
- -Parallel paly
Description of expected activities & toys for stage of play
- Toddlers engage in parallel play, which plays alongside, not with others. Imitation is
one of the most common forms of play.
- A short attention span causes toddlers to change toys frequently
a. Purposes of toys in toddlerhood are to enhance locomotion skills (push-pull toys)
and to encourage limitation, language development, and gross and fine motor skills.
b. Toys should be safe (still no detachable or small parts). Safe and age appropriate
toys are:
- Dolls
- Play phones and cloth books
- Rocking horses
 - Riding trucks
- Wooden or plastic puzzles
- Play house
Gross Motor Developmental Abilities
The major gross motor skill of toddlerhood is locomotion
- The toddler walks without help at age 15 months
- The toddler walks upstairs with one hand held at age 18 months
- The toddler walks up and down stairs one step at a time at age 24 months
- The toddler jumps with both feet at age 30 months
- Toddler likes push-and-pull toys
Fine Motor Developmental Abilities
- The toddler builds a two-block tower and scribbles spontaneously at age 15
months
- The toddler builds a three-to-four block tower at age 18 months
- The toddler imitates vertical stroke at age 34 months
- The toddler builds an eight-block and copies a cross at age 30 month
Language Development/Vocabulary
- The toddler uses expressive jargon at age 15 months
- The toddler says about 300 words, uses two-to-three word phrases and
pronounces at age 2 years
- The toddler gives the first and last name and uses plurals at age 3.5 years
Sleep Pattern/Needs
-Total sleep requirements decrease during the second year to an average of about 12
hours daily.
-Most toddlers nap once a day until the second or third year
-Sleep problems are common and may result in fear of separation
-Bedtime rituals and transitional objects that represent security, such as blankets or
stuffed toys, are helpful

Health Promotion/Maintenance/Screening/Immunizations
Assessment 15 months 18 months 24 months
History and recommended recommended recommended
physical exam

Dental exam recommended recommended

Vision and At risk At risk At risk

hearing

Immunizations Hep B Hep B

HIB

DTap DTap

PCV

IPV IPV

MMR

VAR

Influenza Annually Annually Annually

Lead screening Annually

Erikson Stage of Development

Autonomy vs. shame and doubt
-The psychosocial theme is to hold on; to let go
- The toddler has developed a sense of trust and is ready to give up dependence to assert
his budding sense of control and autonomy. Caregivers who encourage the toddler to do
so promote the toddlers independence.
-The toddle can develop a sense of shame and doubt if parents keep him dependent in
areas that where the toddler can use newly learned skills or make the toddler feel
inadequate when attempting these skills
- The toddler begins to master social skills and
1. individuality
2. control over body function
 3. communication with words
4. egocentric interactions with others
Description of Expected Behaviors of the Stage
- Gaining a sense of personal control over the world
- Beginning toilet training
-Learning to control their body functions ultimately leads to a feeling of control and a sense
of independence
- Control over food choices, toy preferences and clothing selection
- Children at this age are becoming increasingly independent and want to gain greater
over what they do and how it is done

Piaget Stage of Development

Sensorimotor
- This stage lasts between ages 12 and 24 months, involves two substages.
- Substage 1 (12 to 18 months): tertiary circular reaction involve trial-and-error
experimentation and persistent exploration
- Substage 2 (18 to 24 months): mental combinations appear, allowing the toddler to
devise new means for accomplishing task
Preconceptual stage of the preoperational phase
- In this stage, which extends between ages 2 and 4, the toddler uses representational
thought to recall past and present events. During this phase the toddler:
a. forms concepts that are not complete or as logical as our adult concepts
b. makes simple classifications
c. associates events with a simultaneous event
d. egocentric thought process

Description of Expected Behaviors of the Stage

-Tertiary Circular Reactions (12-18 months): Children begin a period of trial-and-error

experimentation during the fifth substage. For example, a child may try out different
sounds or actions as a way of getting attention from a caregiver
- Early Representational Thought (18-24 months): Children begin to develop symbols to
represent events or objects in the world in the final sensorimotor substage. During this
time, children begin to move towards understanding the world through mental operations
rather than purely through actions.

-Role playing is important

Stage Appropriate Safety Concerns/Interventions

Toddlers are prone to the same injuries as infants are, including falls, aspiration, poisoning,
suffocation, burns, and motor vehicles and other accidental injuries
a. Falls: instruct the parents to keep crib rails up, place gates across stairways, secure
screens on all open windows, and supervise the toddler at play.
b. Aspiration and poisoning: urge parents to lock all toxic substances away from childs
reach; keep telephone number to poison control available at all times
c. Suffocation and drowning: avoid strong plastic bags and balloons; teach toddler water
safety
d. Burns: advise parents to avoid using tablecloths; teach toddler what hot means
e. Motor vehicle and other accidents: use proper car seats; teach toddler to hold hands and
cross the street safely

References

McKinney, Emily Slone. "Health Promotion During Early Childhood." Maternal-child

Nursing. 4th ed. St. Louis, MO: Elsevier Saunders, 2005. 117-43. Print.

Rathus, S. A. (2011). Childhood and Adolescence: Voyages in Development. Belmont,

CA: Wadsworth, Cengage Learning.