TODDLER

ANTICIPATORY
GUIDANCE
OBJECTIVES
Describe appropriate assessment techniques for the toddler
Review nutrition and dental hygiene recommendations for the toddler
Identify appropriate screen time for toddlers and preschoolers
Describe when a child is ready for toilet training and techniques to ensure success
Identify common behavioral issues in the toddler age group and how to address them
(regression, tantrums)
 ASSESSMENT AND APPROACH
Inspect body area through play:
Examine on parent lap if uncooperative
Call by name
Praise frequently: love praise about rule
following, doing the right thing
Major fears-separation from parents, intrusion
of body orifices, loss of control, and pain.
Use minimal contact initially
Introduce equipment slowly
Let toddler play with equipment
let them experiment, touch tools
 show on parent first; turn it
into a game
Listen to heart, lung, and bowel
sounds whenever quiet
Structured choices when possible:
don’t want to ask if you can do
something, but give choices such
as left side or right side first; let
pick out own bandaids
Traumatic procedures last
PREOPERATIONAL THOUGHT
Egocentrism
 Only see their own perspective; parallel play

Animism
 Lifelike qualities to inanimate objects

Magical Thinking
 Thoughts are all powerful and can cause events  their thoughts are all-powerful and can
cause events
 Serving size
1 tbsp. food per year of age
NUTRITION
Juice
4-6 ounces per day diluted with water
Meals should be held with family at the
table
Milk intake 2-3 cups a day
Frequent small feedings (“grazing”) >1 year whole milk (need the fat/protein)
 Quality over quantity!
>2 years can switch to skim/low fat

Cluster pattern-may eat a lot on Monday

and very little on Tuesday and this is
normal

Avoid bribing to eat: gives them a warped

relationship with food
DENTAL HEALTH
AAP recommends dental visit by 1 year of age
Primary teeth in by 2.5 years
Dental hygiene:
 Supervise amount of toothpaste
 Fluoridation: can use; might even have prescription of fluoride tablets
 Early childhood caries
 Baby bottle tooth decay: don’t send to bed with a bottle
 Avoid chewy, sugary fruit snacks which could be a choking hazard and stick
in molars
LANGUAGE AND MEDIA
EXPOSURE
Less than 2 hours of screen time per day: should be educational
Read with your child-point out what they see  very good for language development
Use correct language: no baby talk
Talk slowly
Watch for regressions in speech development: could be caused by many reasons 
hearing problems, autism, etc.
Toddlers are able to comprehend more words than they can speak

https://brightfutures.aap.org/Bright%20Futures%20Documents/B.ECh.PH.2yr.pdf
SAFETY
Never leave child unattended
Motor Vehicle Injuries
Watch when backing out of the driveway or driving down
Drowning neighborhood streets
Burns
Helmet on bikes
Poisoning
Falls Gun safety: if guns in the home

Aspiration and Car restraints in rear seat

suffocation
Bodily damage Rear facing until at least 2 years of age

Front facing car safety seat 2- 4 years of age: should still have 5-
point harness
SAFETY
Developmentally, why are toddlers at higher risk for these types of
injuries? Egocentrism, big heads, bow-legged, curious,
uncoordinated walking
 Motor vehicles
 Drowning
 Burns
 Accidental poisoning
 Falls
 Choking/suffocation
 Bodily injury
SAFETY
Motor Vehicles
 Able to walk, run, climb and open doors and gates: child locks on doors, in
carseat
 Starting to ride bike/tricycle

Drowning
 Curiosity
 Unaware of danger
 Depth does not matter if toddler cannot swim: bathtub
SAFETY
Burns
 Climb to reach heights
 Pulls on objects: pot handles should be turned around
 Opens drawers, closets, etc
 Unaware of potential heat/fire sources

Accidental Poisoning
 Puts objects in mouth as way of exploring
 Opens drawers/closets/containers
 Climbs
 Cannot read labels
 Don’t leave purses on the ground
SAFETY
Falls
 Opens doors
 Up and down stairs but aren’t very coordinated at it yet
 Questionable depth perception: especially standing at top of stairs
 Unsteady new walkers

Choking/Suffocation
 Puts things in mouth as a way of exploring
 May swallow hard or large bites of food: cut up foods appropriately

Bodily Injury
 Clumsy
 Easily distracted
 Unaware of potential dangers
 TOILET TRAINING
Determine readiness of both parent and
child
 Physical readiness (bowel and bladder-dry after
nap; 2 hours during the day)
 Cognitive readiness (recognize cues, correct
words to express it)
 Psychological readiness (interest in process,
willing  do they follow parent into bathroom,
will they sit on the toilet)
 Motor readiness (able to walk, sit, and remove
clothing with minimal help) Plan for potty breaks
 Parental readiness: stressful time, need focused
Encourage hand hygiene habits
time for potty training for a couple of days

https://brightfutures.aap.org/Bright%20Futures%20Documents/B.ECh.PH.2yr.pdf
 BEHAVIOR
TANTRUMS
REGRESSION
Toddler reverts to a previous level of Toddlers assert their independence by violently
behavior in reaction to stress objecting to discipline, rules, limits
Sources of stress: illness, hospitalization, Inability to control emotions
separation, adjustment to new sibling
Best to ignore regressive behavior while Limited language causes trouble expressing their
praising existing patterns of appropriate emotions
behavior
Try to continue consistent routine and daily Characteristics:
patterns: helps with feelings of security Lie down on floor
Kicking
Screaming
Breath holding
BEHAVIOR
Sibling Rivalry
 Toddlers finally feel that they are in control of their world, then a new baby
is brought home
 May lose their crib or room, favorite toys, etc
 Routine is disrupted, no longer center of parents world
 Different expressions of jealousy
 Preparation is difficulty
 “Time” is a vague concept for toddlers
 Too soon-may lose interest by the time the baby is born
 Talk about it when they become aware of the pregnancy
 Don’t say that the new sibling will be a new playmate, bc would expect baby to be a
playmate immediately
 Emphasize which routines will change and which will stay the same to set expectations
 HOW TO HANDLE TODDLER
BEHAVIOR
Provide praise for positive behavior when it occurs
During tantrums and periods of negativism (saying “no”, offer child control over little things (directed choices) 
boosts self-esteem
Distract, redirect
Choose your battles, don’t overuse timeout
Recognize limits of child, especially in public
Zero tolerance policy for hitting, kicking, biting, etc
Important to be consistent! Parents, grandparents, childcare, etc.

https://healthychildren.org/English/family-life/family-dynamics/communication-discipline/Pages/Temper-Tantrums.aspx
REFERENCES
Hockenberry, M., Wilson, D. & Rodgers, C. (2017) Wong’s Essentials of
Pediatric Nursing (10th ed.). St. Louis, MS: Elsevier, Inc​