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04/12/2023 St.Phn MBARUKU SAID
AVERAGE ACHIEVEMENTS OF A TODDLER 18 MONTHS
PHYSICALAnterior fontanel closed - may be closed as early as 12
monthsAbdomen protrudes
Physiological anorexia due to decreased growthHas sphincter control
MOTOR
Walks-seldom falls-sideways and backwardCan walk upstairs holding with one hand
Can attempt jumping
04/12/2023 St.Phn MBARUKU SAID
Av of toddler 18month cont…
Sits self in small chair Climbs on furniture Gets into everything, explores drawers
even waste baskets Pushes light furniture around room Throws ball overhead without falling Scribbles vigorously Turns pages in a book Can put things into a hole
04/12/2023 St.Phn MBARUKU SAID
Av of18month cont….
SELF CARE Holds cup with both hands and can hand
it to care giver, put it down or drops it. Eats with spoon and turns spoon in
mouth Spills frequently May play with food Negativism and high activity level May interfere with eating
04/12/2023 St.Phn MBARUKU SAID
Av of 18 month cont…
Removes and unzips simple garments Complains when wet May indicate need to toilet Increased readiness for bowel and
bladder control May control bowel movement May smear feces
04/12/2023 St.Phn MBARUKU SAID
Av of 18 moth cont…
SENSORY Intense interest in pictures Identifies various shapes PSYCHOSOCIAL Sense of autonomy (a feeling of independence) Egocentric Autonomous behavior increasing Negativism and dawdling predominant Have temper tantrums Aware of strangers
04/12/2023 St.Phn MBARUKU SAID
Av of 18 monthcont…
Seeks help when in trouble May resist to sleep for sometime Bed rituals begins Imitates parents behavior Possessiveness begins Gender identity begins INTELLECTUAL Is comfortable when hearing parents voice Short attention span Begins sense of time and anticipation of events Begins to think Beginning traces of memory Experiments actively to achieve goals
04/12/2023 St.Phn MBARUKU SAID
Av of 18 month cont…
LANGUAGE Speaks an average of 10 real words Name pictures Uses words than gestures to express desire About 25% of vocalization is intelligible PLAY STIMULATION Enjoys solitary play or watching activities of
others Has a favorite toy
04/12/2023 St.Phn MBARUKU SAID
Av of 18month cont..
Provide: For motor play Large hollow wooden blocks Balls Pull toys Low swing with arms and back Low slide Rocking chair or horse Low wheeled toys to ride Small chair and table Running and chasing games
04/12/2023 St.Phn MBARUKU SAID
Av of 18 month cont…
For creative play Container with openings into which blocks of
different shapes can be placed Blocks, bowls, tumblers Finger paints Large crayon Clay Bells around wrist or ankle Sand toys (shovels, pail) Stuffed animals and dolls to drug, sit upon or hug Imitates parental actions in play
04/12/2023 St.Phn MBARUKU SAID
AVERAGE ACHIEVEMENTS OF A TODDLER 24 MONTHS (2 YEARS)
PHYSICAL Weight approximately 11.8-12.7 kg Height approximately 82.5 -85 cm Gained 10 -12 cm in second year Adult height is about twice height at 2 years Chest circumference exceeds head
circumference Anterior posterior diameter less than lateral
diameter Head circumference 49-50 cm Pulse 110 + 20 –average 100 beats/minute
04/12/2023 St.Phn MBARUKU SAID
AV of 24month cont…
Respiration 26-28/minute Blood pressure 99/64 + 26/24 Landau reflex completely disappeared Approximately has 16 temporary teeth Physiologic function is mature except
endocrine and reproductive Abdomen protrudes less than in 18
months May control daytime bowel and bladder
04/12/2023 St.Phn MBARUKU SAID
Av 24month cont…
MOTOR Can walk with heel toe gait Walks backwards in imitation Runs more quickly with few falls Jumps Kicks large ball Builds tower of 6-7 cubes Makes cubes into a train Turns pages of a book one at a time Opens door by turning knob May run away Unscrews lid or jar Folds paper once (imitating)
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont…
SELF CARE Drinks well from a small glass held in one
hand Puts spoon in mouth occasionally with one
hand Plays with food Can use a straw May request certain foods Pulls on own simple garments Removes most of own clothing Verbalizes toilet needs
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont…
Usually bowel trained with occasional accidents Usually urinates when taken to toilet Toilet trained in day time May still smear stool May brush teeth with help Attempts to wash self in tub or shower SENSORY Accommodation well developed Inserts square objects into its appropriate place or
hole May develop strabismus (squint)
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont…
PSYCHOSOCIAL Sense: Has sense of autonomy Still egocentric in both thought and behavior Separation anxiety continues Shows early signs of individuality Independent from care giver Is possessive (mine not yours) Does want to share possessions May push other children as if they are objects
out of his way May want to make friends but doesn’t know how
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont…
Pulls other persons to show them something Does not want to sleep so has many
demands before bed time Upset by changes in routine Thumb sucking decreased Focuses on own wishes Violent temper tantrums decreasing PSYCHOSEXUAL Anal stage
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont…
INTELLECTUAL OR COGNITIVE Attention span is longer Memory increases Starts to understand past present and
future Increased sense of time- can anticipate
events and can wait for them. Can pretend
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont…
LANGUAGE Understands more complex sentences Can obey 2 commands given at the same time Enjoys stories with pictures No longer use jargon Knows about 300 words Refers to self by first name Uses pronouns I, me, mine Asks what’s, who’s that Tells about immediate experiences Identifies familiar objects Verbalizes need for drink, food and toileting May use the word now meaningfully About 66% of vocalization are intelligible
04/12/2023 St.Phn MBARUKU SAID
Av 24 month
PLAY AND STIMULATION Little social interaction with other children Begins to learn to replace toys in their proper
place Frequently idle (dawdles) Pulls wagon Manipulates play materials such as clay, finger
paints, brush paints Sings songs Needs large puzzles and toys to take apart Enjoys hearing stories with pictures
04/12/2023 St.Phn MBARUKU SAID
Av 24 month cont..
Takes favorite toys to bed Mimic domestic activities of parents Enjoys playing with dolls
04/12/2023 St.Phn MBARUKU SAID
AVERAGE ACHIEVEMENTS OF A TODDLER AT 30 MONTHS
PHYSICAL Weight –gains about 5kg between 1 and
3 years Weight is quadrupled Height increases about 6-8 cm during the
third year Has a full set of 20 temporary teeth Daytime bowel and bladder control
possibly established
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
MOTOR Can stand on one foot momentarily Walks on 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 the
floor Jumps fro step or low chair Can throw a large ball 4-5 feet Can ride a walker or pedal car
04/12/2023 St.Phn MBARUKU SAID
Av at 30month cont…
Builds a tower of 8 cubes Adds chimney to train or cubes Imitates circular strokes Holds crayon with fingers instead of entire
hand Good hand-finger coordination SELF CARE Can feed himself with occasional spilling Pours from a jug often spilling Gets a drink without assistance
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
Distinguishes between finger and spoon food Chews with mouth closed DRESSING Puts arm through large arm hole Buttons a large front button Unbuttons large front buttons Helps to put things away TOILET AND GROOMING Mastery of daytime bowel and bladder control May go to the toilet himself
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
Control bowel at 26 months -Controls urination 30 months Needs assistance with wiping Attempts to wash hands adequately Can partially dry hands upon reminder SENSORY Recalls visual images
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont..
PSYCHOSOCIAL Sense of autonomy (1-3 years) Theoretically autonomy is achieved at the
end of toddler period. If it is not achieved a sense of shame and doubt predominates
Still egocentric Learns to cope with separation anxiety Independent behavior increases Achieves some self control based on self
esteem rather than fear
04/12/2023 St.Phn MBARUKU SAID
Av at30 month cont…
Reluctant to go to bed Negativism and dawdling continue Temper tantrums may or may not
decrease Imitates sex role behavior of adults Knows own sex PSYCHOSEXUAL Anal stage (1-3 years)
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont..
INTELLECTUAL Concept of time still limited Begins causal thinking Problem solving through trial and error LANGUAGE Identifies five body parts when named Gives full name (first and last) if asked Uses appropriate pronoun when referring to self “I” Uses plurals and past tense of verbs Talks constantly
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
Asks why Uses 4-5 word sentences About 75 % of vocalizations are intelligible PLAY STIMULATION Helps to put things away Pretends in play Motor play Pushes and steers toys well
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
Needs Large cars Trucks Cardboard boxes Block trains that interlock Carries breakable objects
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
CREATIVE PLAY They need: Clay Finger paints Large crayons Large wooden puzzles Sand box toys String to string beads or lace large shoes Bright colored construction Paper to fold or cut with blunt scissors
04/12/2023 St.Phn MBARUKU SAID
AV at 30 month cont…
Quiet play Cloth or cardboard books Toys for water play DRAMATIC PLAY Baby doll and doll equipment Toys for house keeping such as small broom and dust cloth Play telephone The toddler’s curiosity may lead the child into danger for
example: Motor vehicle accidents Bath tub drowning Hot fluid scalding
04/12/2023 St.Phn MBARUKU SAID
Av at 30 month cont…
Electric shock leading to death Poisonous substances can kill the toddler Drugs can also kill or overdose Kerosene can kill Try as much as possible that all these are
out of reach of children
04/12/2023 St.Phn MBARUKU SAID
THE GENERAL NEEDS OF A TODDLER
The basic needs of a toddler are: Love and security Discipline leading to self control Progression to independence Achievement of control of bodily
functions Nutrition Accident prevention
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Love and security Parental love should be constant,
unconditional and openly expressed even when the child is misbehaving
This type of love enables the toddler to grow and to reach out for more mature goals since the child feels loved and secure, the frustrations everyone endures in the process of maturation can be handled
04/12/2023 St.Phn MBARUKU SAID
GENERAL NEEDS CONT…
Both boys and girls give their first love to their primary caregiver usually the mother, when the father gives the same care as the mother the toddler generally feels attached to and secure with both parents
Toddlers may develop separation anxiety if the primary caregiver leaves them alone for example in a nursery school or hospital
This is evidenced by: Restlessness Hyperactivity Depression manifested by crying and withdrawal
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Regression to earlier modes of behavior (Regression is returning to an earlier or
former state or type of behavior) The parents should understand that such
behaviors are normal Toddlers who are attempting to achieve
autonomy may become overwhelmed by separation anxiety when the parents attention is diverted from them to a new sibling or when they enter nursery school or are admitted to a hospital thus they regress
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
They may return to earlier behaviors such as demanding to drink from a nursery bottle, refusing to cooperate in toilet training and loosing the various skills that they tried so hard to achieve
The best way to handle a child’s regression is simply to ignore it.
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Discipline leading to self control Proverbs 22:6 “Teach a child to choose the right path and
when he is older he will remain upon it.” Discipline means establishing and adhering to
standards of behavior for the toddler with the goal of self control
It includes Setting of limits (rules and guidelines) These must be set on the daily behavior of
children if they feel secure
04/12/2023 St.Phn MBARUKU SAID
General needs cont …
Reinforcement of approved behavior by deepening this trusting bond between parents and child is preferred over material rewards.
Constructive discipline helps the child to better behaved and happier
Qualities of constructive discipline Consistency Clarity Firmness- parents must mean what they say and say
what they mean Immediacy Encouragement of independence
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Disciplinary action A loving reward is more consistently
effective in disciplining a child than punitive actions BUT:
Punishment is a useful tool if used with discretion
Punishment should be given privately and with respect
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Examples of punishment Physical punishment Explaining or reprimanding Disregarding or ignoring- This should be avoided if there
is danger of physical harm to the child Taking time out- this means that the child is removed
from any positive reinforcement when misbehavior occurs
Instead of the parents giving a scolding or spanking for
unwanted behavior the child is placed in a boring situation for a specified period of time. No playing is permitted
This will be perceived as a punishment
04/12/2023 St.Phn MBARUKU SAID
General needs cont….
The toddler ultimately gives up the misbehavior in order to return to the family group
Outcomes of discipline Parents must define reality for their children and through
guidance and discipline, help them in their striving for maturity
Types of parents who fail in this period Those that are over demanding and insist upon perfection in
behavior This causes intense anxiety and guilt in their children Those who set no limits or over permissive These fail to provide security and help to their children to
learn to live harmoniously in society
04/12/2023 St.Phn MBARUKU SAID
General needs ont…
Those who provide inconsistent discipline These make their children to find difficulties to develop
stable behavioral control and values Among the procedures for discipline the safest is the use
of time out or isolation Disciplinary action may sometimes be necessary but
remember children still need compassion, understanding and respect for their developing independence
DEPENDENCE PROGRESSING TO INDEPENDENCE IN SELF
CARE By the time children reach 3 years of age they are
beginning their journey to independence in self care
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Children learn to care for themselves initially by attempting to imitate the actions of their parents and siblings
The achievements in self care includes Feeding Dressing Toilet Grooming
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
ACHIEVING CONTROL OF BODILY FUNCTIONS Achieving control of bodily functions of
defecation and urination is one of the major tasks of the toddler period
The relative importance of this achievement depends on the culture and the socioeconomic status of the child’s family.
In some groups, toddlers do not wear nappies or pants and are permitted to move through the home and environment excreting at will. In these families toilet training is not emphasized so the children in effect must train themselves
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Process of toilet training The parents record the times the child eliminates
for several days This record provides the toddlers own schedule for
training that is when it is appropriate to place the child on a comfortable child sized toilet sit or potty chair
The potty chair should be used only in the toilet room or bathroom so that the act of excretion is associated with this one location
The parents take the child to the bathroom and calmly explain in simple language what is to be done.
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Specific words that are widely understood to indicate the acts of defecation and urination are used
The parents stay with the toddler during the entire process.
Do not allow the child to play at this time The accidents that occur during the
process of toilet training should be ignored A two year old toddler is generally toilet
trained in the day time
04/12/2023 St.Phn MBARUKU SAID
General needs cont…..
The 21/2 years old may have begun to master night time bladder control however accidents are common
Night time bladder control may not be complete until the child is 4-5 years of age
Fecal smearing This behavior occur between the ages 15-18
months The desire to smear may be sublimated by
providing clay, damp sand and mud
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
The 21/2 years old may have begun to master night time bladder control however accidents are common
Night time bladder control may not be complete until the child is 4-5 years of age
Fecal smearing This behavior occur between the ages 15-18
months The desire to smear may be sublimated by
providing clay, damp sand and mud
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Therefore avoid shaming and ridicule A young child who is categorized as being
“good” or “bad” usually lives up to the appropriate expectation.
The child’s own effort also promotes or reduces self esteem
Patience and persistence are necessary in helping children develop self esteem as they become able to cope with life in their world
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
PLAY AND STIMULATION Functions of play: Play during the toddler period stimulates all
areas of growth and development The social importance of play increases as the
child grows Active play encourages gross and fine muscle
development-surplus energy is worked off When playing besides and watching others they
seem to want to be friendly but at this time their social skills are inadequate so adult supervision is necessary
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
Play assist the toddler to fully develop the concept of object permanence
They develop very early understanding of moral values They learn differentiate between right and wrong when
they are taught not to hurt others in play They develop language and speech when they talk to
toys, pets, others parents Reading and singing to child helps Negative feelings and tensions can be released in an
approved way for example an angry child can find relief by pounding soft balls or begs through holes in a board or tossing bean bags
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
PLAY RESPONSES In early toddler period play is free and
spontaneous They are in most cases destructive They normally claim their own toys by
saying “mine, mine” They learn sharing later Do not encourage them to give up their
toy until later on.
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
PLAY RESPONSES In early toddler period play is free and spontaneous They are in most cases destructive They normally claim their own toys by saying “mine,
mine” They learn sharing later Do not encourage them to give up their toy until later
on. NUTRITION Nutritional intake include the essential nutrients in the
amount necessary for maintenance, replacement and growth of tissue and for energy
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
They are usually 3 well spaced small meals with in between nutritious snacks each day.
Toddlers need less food per unit of body weight during the second year of life than infants because the growth rate is less rapid.
At about 18 months toddlers develop what is known as physiological anorexia
If inadequate amounts of vitamins and minerals especially iron are not obtained in the diet because of the anorexia supplements can be prescribed
Children may prefer playing than eating, so take care of the meal times
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
ACCIDENT PREVENTION Accidents are the largest single cause of mortality
and disability between the ages of 1-4 years Accidents include Motor vehicle accidents Drowning Burns Suffocation Falls Poisoning Other injuries e.g. cuts
04/12/2023 St.Phn MBARUKU SAID
General needs cont…
When parents understand their child’s level of growth and development they can predict the hazardous situations that may result in an accident then judge how much responsibility the child can assume for self protection
If the child is injured accidentally point to the child the cause of the accident and it will be a lesson to the child.