EARLY CHILDHOOD CARE

Pediatric – it is the science of childcare and scientific treatment of child hood diseases.

Roles of Pediatric Midwife

Primary Caregiver
Team
Coordinator
And
collaborator
Childcare
Counselor advocate Health
Recreationis Educator
t
Social Worker

Child Health and Primary Health Care

1. Primary Level - promote the healthy maturation as a physical ,intellectual , and

emotional being within the context of family and community.

2. Secondary Level – Provide health care for child who requires treatment from
diseases.

3. Tertiary Level – dealing with child disabilities.

Three aspect of Midwifery Practice

1. Family Centered - different methods of coping, family support, appreciating families

as families

2. Traumatic Care – prevention of bodily injuries, prevention or minimize separation

from the family

3. Case management- it approaches to care and cost, improved family satisfaction.

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Importance of Pediatrics

1. Major consumer of health care

2. More vulnerable to various health problems.

3. Majority of child morbidity and mortality are preventable.

4. Needs special care to survive.

5. Wealth for tomorrow's society and nation.

Factors Affecting Child Health

Socio economic
situation

Family Health

Maternal Health

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 Environment

Social
support

Health Care
Facilities

CHILD HEALTH

Pediatric Health Statistics

A. Child Mortality – for children older than one year old ,death rate have always been
less than those for infants.

1. Injuries cause more death and disabilities in children than any

diseases.

eg. motor vehicle accidents majority of death are due to no

use of seat belt.

2.Drowning is second leading cause of death in boys.

Drowning is third leading cause of death in girls.

3.Burns is the second from injury in girls

and third in boys from 1 -14 years old.

B. Child hood Morbidity – it is an illness that limits the activity ,that requires medical.

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attention, hospitalization or result to chronic condition

eg. Congenital Heart Disease

Asthma

Cerebral Palsy

Cystic Fibrosis

Rights of Children

1.Right to name and nationality

2.Right to free education

3.Right to full opportunity to play and recreation

4.Right to enjoy social benefits.

5.Right to special treatment ,education and care of handicapped

6.Right to be among first to receive protection and relief in times of disaster.

7. Right to learn norms, rules ,dignity, of the society.

8.Right to grow up in a spirit of understanding ,tolerance ,peace and universal brotherhood.

9.Right to enjoy all privileges of society and nation.

10.Right to enjoy rights regardless of race,colors, religion ,national and social origin.

11.Right to get recognition.

Growth and Development

Growth – it is the increase in size of a structure.

 Development – increase in skill or ability to function ,maturation of physiologic and

psychosocial system to more complex state.

2 TYPES OF CHANGE

1. QUANTITATIVE – determine by height, weight, chronological age, measured

structural make-up or organization.
2. QUALITATIVE – determine through intelligence, cognitive process, speech and
attitude

ASPECTS OF HUMAN DEVELOPMENT

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1.Physical Development – covers changes in the body, structure, and motor skills.

2. Perceptual Development – refers to the development of sensory capacities such as the

changes witnessed in the seeing and hearing ability of growing infants.

3.Cognitive Development – changes in mental ability, learning capacity, memory,

reasoning, thought processes and language.

4. Personality Development – changes in self concept, gender identity, and one’s quality of
interpersonal relationships.

THE PROCESS OF DEVELOPMENT

1.Pre-natal stage

2.Infancy - 0 -2 years)

3. Early childhood (3 -6 years)

4. Middle childhood (7 -12 years)

5. Adolescence (13 – 19 years)

6. Young adulthood (20 – 35 years)

7.Middle adulthood (36 – 49 years)

8. Late adulthood (50 – above

9. Adult hood

STAGES OF GROWTH AND DEVELOPMENT OF A CHILD

1. First stage - Pre-natal begins from conception to birth.

2. Second stage - Infancy from birth to 12 months

a. Neonatal/newborn - First 28 days or first four weeks of life

b. Infancy - 29th day to 12 months

3. Third stage - Early childhood stage

a. Toddler - 1 year to 3 years old

b. Pre- schooler - 4 to 6 years old

4. Fourth stage - Middle childhood

a. School age - 6 to 12 years old

b. Adolescence - 13 to 19 years old

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 Toddler 1 to 3 years old

A toddler is a young child of 12 to 36 months, who is the age of learning to

walk between infancy and childhood. Toddling usually begins between the ages 12
months. The toddler years are a time of great cognitive, emotional and social
development. The word is derived from the word “to toddle”, which means to walk
unsteadily, like a child of this age. During the toddler stage, most children learn to
walk, talk, solve problems, relate to others, and more. It is also during the toddler
stage that the child also learns a great deal about social role, develops motor skills,
and first starts to use language.

From birth, infants and toddlers are aware of the world around them, and the
ability to grow, develop, and learn occurs quickly as infants begin to explore
through their senses. Gross- motor skills and fine-motor skills are developed during
infancy and toddlerhood.

Toddlers are becoming aware that they are separate individuals from their
parents and the other important people in their worlds. This means that they are
eager to assert themselves, communicate their likes and dislikes, and act
independently as much as they can.

During this period of development, the child acquires a sense of autonomy

and independence through the mastery of various specialized tasks such as
control of body functions, refinement of motor and language skills and acquisition
of socially acceptable behaviour.

Mastering new skills such as how to walk, talk, and use the potty are
developmental milestones. It is exciting to watch you toddler learn new skills. The
normal development of children aged 1-3 includes several areas: Gross motor-
walking, running, climbing. Fine motor- feeding themselves, drawing.

When a child feels hungry, tired, or ill, misbehavior often ensues. Most toddler and
pre-schoolers aren’t good at communicating what they need. As a result, they often
use their behavior to show that they have unmet needs.

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(1 to 2 YEARS)

 A child of this age is developing a sense of awareness of them and realizes

that he is distinct from other people. Never call him names which point out his
unlikeable traits for this will hurt his pride and love for himself.
 He is at the stage wherein he is very possessive of his belongings and refers
to almost anything he hold as “his” allowing him/her to play with his own toys
while also explaining to him why he needs to respect other children’s
belonging minimizes grabbing and quarrelling.
 Because the child is still unable to differentiate the real from imaginary, he
develops fears of things and people we can help by being calm, reassuring
and comforting to his feelings.

1.NORMAL GROWTH AND DEVELOPMENT

A. PHYSICAL DEVELOPMENT
 Two- year old children lose the baby look. Toddlers are usually chubby,
with relatively short legs and a large head. The face appears small
when compared to the skull, but as the toddler grows, the face seems
to grow from under the skull and appears better proportioned. Toddlers
have a pronounced lumbar lordosis and a protruding abdomen. The
abdominal muscles develop gradually with growth and the abdomen
flattens.

WEIGHT

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 Two- year olds can be expected to weigh approximately four times their
birth weight- The weight gain is about 2 kg ( 5 lbs. ) between ages 1
and 2 years and about 1 to 2 kg ( 2 to 5 lbs.) between 2 and 3 years.
The 3- year old weighs about 13.6 kg ( 30 lbs.).

HEIGHT

 A toddler’s height can be measures as height or length. Height is

measured while the toddler stands, and length is measured while the
toddler is in a recumbent position. Although the measurements differ
slightly, nurses must specify which measurements differ is used to
avoid confusion between ages 1 and 2 years, the average growth in
height is 10 to 12 cm ( 4 to 5 in.), and between 2 and 3 years, it slows
to 6 to 8 cm ( 2.5 to 3.5 in.).

BODY CONTOUR

 Toddlers tend to have a prominent abdomen- a pouchy belly- because

although they are walking well, their abdominal muscles are not yet
strong enough to support abdominal contents as well as they will later.
They also have a forward curve of the spine at the sacral area
(lordosis). As they walk longer, this will correct itself naturally. Many
toddlers, in addition, waddle or walk with a wide stance. This stance
seems to increase the lordotic curve, but it keeps them on their feet.

BODY SYSTEMS

a. Respirations slow slightly but continue to be mainly abdominal.

b. The heart rate slows from 110 to 90 bpm; blood pressure increases to
about 99/64 mmhg.
c. The brain develops to about 90% of its adult size.
d. In the respiratory system, the lumens of vessels enlarge progressively
so the threat of lower respiratory infection becomes less.
e. Stomach secretions become more acid; therefore, gastrointestinal
infections also become less common.
f. Stomach capacity increases to the point a child can eat three meals a
day.

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 g. Control of the urinary and sphincters become possible with complete
myelination of the spinal cord.
h. IgG and IgM antibody production becomes mature at 2 years of age.
The passive immunity obtained during intrauterine life is no longer
operative.

TEETH

 Eight new teeth (the canines and the first molars) erupt during the
second year. All 20 deciduous teeth are generally present by 2.5 to 3
years of age(Berger, 2004).

SENSORY ABILITIES

1. Visual acuity is fairly well established at 1 year average estimates of acuity

for the toddlers are 20/70 at 18 months and 20/40 at 2 years of age.
Accommodation to near and far objects is fairly well developed by 18
months and continues to mature with age. At 3 years of age, the toddler
can look away from a toy prior to reaching out and picking it up. This ability
requires the integration of visual and neuromuscular mechanisms.
2. The senses of hearing, taste, smell and touch become increasingly
developed and associated with each other. Hearing in the 3- year old is at
adult levels. The taste buds of the toddler are sensitive to the natural
flavours of food and the 3 year old prefers familiar odours and tastes.

NORMAL VITAL SIGNS

 Respiratory Rate- 20-40 bpm , 20-30 FOR 1-2 YEARS OLD

 Respiratory at Rest-25-30 bpm
 Heart Rate- 90-140 bpm , awake/ 80-130 FOR 1-2 YEARS OLD
 60-90 BPM ASLEEP/80-120 FOR 1-2 YEARS OLD
 HEART RATE AT REST- 70-110
 BLOOD PRESSURE- 95-105/53-66 MMHG/90-100/50-65 FOR 1-2 YEARS
OLD.

TEMPERATURE
 ORAL- 35.5-37.5 °c
 EAR- 36.1-38 °C
 RECTAL- 36.6-38 °C
 AXILLARY-35.9-37.3 °C
 CORE- 97.5-100 °F

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  WEIGHT- 10-14 KGS/ 22-31 LBS

MOTOR ABILITIES

1. One year and Six months (18 months)

- Toddler can pick up raisins or cereal pieces and place them in a
receptacle
- Hold a spoon and a cup and can walk upstairs with assistance.
- They will probably crawl down the stairs.
- Bowel control
2. Two Years old (24 months)
- toddlers can hold a spoon and put it into the mouth correctly.
- able to run, their gait is steady, and they can balance on one
foot and ride a tricycle.
- Learn to undress herself /himselfa

3. Three years old ( 36 months )

- most children are toilet trained, although they still may have
the occasional accident when playing or during the night .
- Day time bladder
B. PSYCHOSOCIAL DEVELOPMENT

a. According to Sigmund Freud, the ages of 2 and 3 years represent the

anal phase of development, when the rectum and anus are the center
of pleasure.
b. Give the child some measures of control and at the same time be
consistent in setting limits so that the child learns the results of
misbehaviours.
c. Develop a sense of self-concept through their immediate social
environment in which their parents play a significant role if the children
social interactions with their parents are negative (e.g., constant
disapproval regarding eating, toilet training, or other behaviour) the
children may begin to see themselves as bad.

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 d. Positive and healthy self-concept with a healthy sense of self-esteem
and security. The toddler is able to deal with periodic failures later in
life without damage to self-esteem.
e. Abandonment is their greatest fear. At this age, the child may have
difficulty accepting a baby- sitter or strongly resist being left by the
parents at a day care centre.
f. Regression or reverting to an earlier development stage may be
indicated by bed-wetting or using baby talk, assist parents by helping
them understand that this behaviour is normal and indicates that these
toddlers are trying to establish their position in the family.
g. Experience with separation helps the child cope with parental
absences. Children need room for exploration and interaction with
other children and adults at the same time; they need to know that the
parental bond of a loving and close relationship remains secure.
h. Toddlers assert their independence by saying “no” or by dawdling.

C. FOSTERING THE TODDLERS PSYCHOSOCIAL DEVELOPMENT

1. Provide toys suitable for the toddler, including some toys challenging
enough to motivate but not so difficult that the toddler will fail (failure
will intensify feelings of self-doubt and shame).
2. Make positive suggestions rather than commands.
3. Avoid an emotional climate of negativism, blame and punishment.
4. Give the toddler choices, all of which are safe; however, limit number to
two or three.
5. When toddler has a temper tantrum, make sure the child is safe, and
then leave.
6. Develop inner control by setting and enforcing consistent, reasonable
limits.
7. Praise the toddler’s accomplishments.
8. Express and dislikes.
9. Display curiosity and ask questions.

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 10. Begin to play and communicate with children and others outside the
immediate family.
11. Understand words such as up, down, cold and hungry.
12. Speak in sentences of three to four words.
13. Imitate religious rituals of the family.

3. PSYCHOSOCIAL CARE/ DEVELOPMENT TO A TODDLER

1. 15 -17 months old

a. Understands simple instructions and commands .
b. Grabs toys of the other children
c. Plays on his own, alongside other children and increasingly interacts
with them.

2. 18-20 months old

a. Names persons, things and familiar sounds .

3. 21-24 months old

a. Exhibits some fears

4. 24-36 months old

a. Becomes more affectionate

b. Develops delight and pride in his own actions .

c. Loves to pretend doing familiar activities like playing parent/

doctor/cooking.

d. Frequently says “no” or engages in a battle of wills.

e. Sometimes resorts to temper tantrums .

f. Indicates body parts.

4. DEVELOPMENT IN ACTIVITIES OF DAILY LIVING

1. Feed self

2. Eat and drink a variety of foods.

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 3. Begin to develop bowel and bladder control.

4. Exhibit a rest and sleep pattern appropriate for age.

5. Dress self.

 HEALTH PROMOTION GUIDELINES FOR TODDLERS

 HEALTH EXAMINATIONS
 At 15 and 18 months and then as recommended by the physician.
 Dental visit starting at age 3.
 Hearing tests by 18 months or earlier.

5.PROTECTIVE MEASURES

 IMMUNIZATIONS- continuing DPT, OPV series, pneumococcal, MMR,

Haemophilic influenza type B, and hepatitis B vaccine as recommended.
 Screenings for tuberculosis and lead poisoning.
 Fluoride supplement if there is inadequate water fluoridation (less than 0.7
part per million).

6.TODDLER SAFETY

 Importance of supervision and teaching child to obey commands.

 Home environment safety measures (e.g., lock medicine cabinet).
 Outdoor safety measures (e.g. close supervision near water).
 Appropriate toys.

7. NUTRITION

 Importance of nutritious meals and snacks.

 Teaching simple mealtime manners.
 Dental care.

8.ELIMINATION

 Toilet training techniques.

9.REST/ SLEEP

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  Dealing with sleep disturbances.

10. PLAY

 Providing adequate space and a variety of activities.

 Toys that allow “acting on” behaviours and provide motor and sensory
stimulation.
 Toddlers love to pretend doing familiar activities like playing parent or doctor,
cooking, etc.

What parents or caregivers should do?

 Provide the child with a box/ trunk full of old dresses/pants and shirts,
bags, shoes and other old household objects like wooden spoons and
plastic bowls. Avoid sharp objects or very small parts that could hurt a
child.

Why should parents or caregivers do these?

 Dramatic play or role playing is avery good medium for the child to
express his thoughts and feelings. He develops awareness of different
roles such as a father, mother, sister, brother and himself in the family.
He learns how to socialize or relate with others.
 Plays on his own, alongside other children and increasingly interacts with
them. Grab toys of the other children.

What Parents or caregivers should do?

 Do not force the child to play with other children if he does not yet like
to do so. But do him opportunities to be with other children. They may
be given the same playthings to minimize conflicts.

Why should parents or caregivers do these?

 It is natural at this stage for the child to play beside other children,
without necessarily interacting with them. Grabbing toys of other
children is one way of interacting and satisfying their curiosity. It helps

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 to teach them to ask permission and to explain why they should learn
to ask or wait.

C.COGNITIVE DEVELOPMENT

 According to Piaget, the toddler completes the fifth and sixth stage of
the sensorimotor phase and starts the preconceptual phase at about 2
years of age. In the fifth stage, the toddler solves problems by a trial-
and error process, By stage 6, toddlers can solve problems mentally for
example, when given a new toy the toddler will not immediately handle

the toy to see how it works, but will instead look at it carefully to think
about how it works.

 During Piaget’s preconception phase. Toddlers develop considerable

cognitive and intellectual skills. They learn about the sequence of time.
They have some symbolic thought, for example, a chair may represent
a place of safety, and a blanket may symbolize comfort. Concept starts
to form in late toddlerhood. A concept develops when the child learns
words to represent classes of objects or thoughts. An example of a
concrete concept is table, representing a number of articles of furniture
that are all different but all tables.

D.MORAL DEVELOPMENT

 According to Kohlberg, the first level of moral development is the

preconvention when children respond to punishment and reward.
During the second year of life, children begin to know that some
activities elicit affection and approval. They also recognize that certain
rituals, such as repeating phrases from prayers, also elicit approval.
This provides children with feelings of security. By 2 years of age,

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 toddlers are learning what attitudes their parents hold about moral
matters.

E.SPIRITUAL DEVELOPMENT

 According to Fowler ( 1981), the toddlers stage of spiritual

development is undifferentiated. Toddlers may be aware of some
religious practices, but they are primarily involved in learning
knowledge and emotional reactions rather than establishing spiritual
beliefs. A toddler may repeat short prayers at bedtime, conforming to a
ritual, because praise and affection result. This parental or caregiver
response enhances the toddler’s sense of security.
 Neonates and Toddlers are acquiring fundamental spiritual qualities of
trust, mutuality, courage, hope and love. Transition to next stage of
faith begins when child’s language and thought begin to allow use of
symbolism.

F. SEXUAL DEVELOPMENT THROUGHOUTLIFE

 Continues to develop gender identity.

 Able to identify own gender.

 CAREGIVER INTERVENTIONS AND TEACHING GUIDELINES

 Body exploration and gender fondling is normal.
 Uses names for body parts.
 Children from single parent home should have contact with adults of
both sexes.

11.HEALTH PROBLEMS

 Toddlers experience significant health problems due to accidents,

visual problems, and dental caries and respiratory and ear
infections.

12. ACCIDENTS

 Accidents are the leading cause of mortality of toddlers. They are

curious and like to feel and taste everything. The most common

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 causes of fatal injuries are automobile accidents, drowning, burns,
poisoning and falls. Parents or other caregivers need to take the
appropriate preventive measures to guard against these health
threats.
 MOTOR VEHICLES
 Maintain child in car seat; do not be distracted from safe driving by
a child in a car, do not allow child to play outside unsupervised. Do
not allow child to operate electronic garage doors.
 Supervise toddlers who are too young to be left alone on a tricycle.
 Teach safety with pedalling toys (look before crossing driveways;
do not cross streets) but do not expect that toddler will obey these
rules at all times (in other words, stay close by).
 FALLS
 Keep house windows closed or keep secure screens in place.
 Place gates at top and bottom of stairs. Supervise at play
grounds.
 Do not allow child to walk with sharp object in hand or mouth.
 Raise crib rails and check to make sure they are locked before
walking away from crib.
 ASPIRATION
 Examine toys for small parts that could be aspirated; remove
toys that appear dangerous. Do not feed toddler popcorn,
peanuts, etc.; urge children not to eat while running. Do not
leave toddler alone with a balloon.
 DROWNING
 Do not leave toddler alone in a bathtub or near water ( including
buckets of cleaning water and washing machines.)
 ANIMAL BITES
 Do not allow toddler to approach strange dogs.
 Supervise child’s play with family pets.
 POISONING
 Never present medication as candy. Buy medication with
childproof caps; put away immediately after use.
 Never take medication in front of child.
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  Place all medication and poisons in locked cabinets or overhead
shelves where a child cannot reach it.
 Always store food orb substances in their original containers.
 Know the names of house plants and find out if they are
poisonous. (Call regional poison control centre for information.)
 Hang plants or set them on high surfaces beyond toddler’s
grasp.
 Post telephone number of nearest poison centre by the
telephone.
 BURNS
 Buy flame-retardant clothing.
 Cook on the back burners of stove if possible and turn handles
of pots toward back of stove to prevent toddler from reaching up
and pulling them down.
 Use cool-mist vaporizer rather than steam vaporizer or remain in
room when vaporizer is operating so child is not tempted to play
with it.
 Keep screen in front of fireplace or heater.
 Monitor toddlers carefully when they are near lit candles.
 Do not leave toddlers unsupervised near hot-water faucets.
 Check temperature setting for hot-water heater and turn down
thermostat it is over 125 degrees fahreinheight.
 Do not leave coffee/tea pots on a table where child can reach
them.
 Never drink hot beverages when a child is sitting on your lap or
playing within reach.
 Do not allow toddlers to blow out matches ( teach that fire is not
fun); store matches out of reach.
 Keep electric wires and cords out of toddler’s reach; cover
electrical outlets with safety plugs.

GENERAL

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  Know whereabouts of toddlers at all times. Toddlers can climb onto
chairs,stools, etc., they could not manage before;can turn door knobs
and go places they could not go before.
 Be aware that the frequency of accidents increases when the family is
under stress and therefore less attentive to children. Special
precautions must be taken at these times.
 Be aware some children are more active, curious, and impulsive and
therefore more vulnerable to accident than others.

13. VISUAL PROBLEMS

 During this period, the toddler should be screened for amblyopia

strabismus. Amblyopia (reduced visual acuity in one eye) is usually
the result of strabismus. The child with amblyopia has straight eyes,
whereas the child with strabismus (cross-eye) has a deviant eye.

14. DENTAL CARIES

 Dental caries occur frequently during the toddler period, often as a

result of the excessive intake of sweets or a prolonged use of the
bottle during naps and at bedtime.

15. RESPIRATORY TRACT AND EAR INFECTIONS

 Respiratory and middle ear infections are common during

toddlerhood.
 HEALTH ASSESSMENT AND PROMOTION
 Assessment activities for the toddlers are similar to those for the
infant in terms of measuring weight, length (height) and vital signs.
 Promoting health and wellness includes such areas as accident
prevention, toilet training and good dental hygiene.

G. MOTOR DEVELOPMENT

 Perform gross and fine motor milestones within normal range for age.
For example, by 3 years of age is the toddler able to do the following?

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  Walk up steps without assistance
 Balance on one foot, jump and walk on toes.
 Copy a circle.
 Build a bridge from blocks.
 Ride a tricycle.

H. LANGUAGE DEVELOPMENT

 Parents, often see huge gains in their child’s speech. A toddlers

vocabulary should increase (to too many words to count) and he or she
should routinely combine three or more words in sentences. Kids also
should begin to identify colors and understand descriptive concepts
(big versus little, for example).

Ex: At 1-2 years, your child will learn to use and understand more words and
more types of words. At first, she’ll understand mostly nouns- for
example,’dog,’bus’ and ‘couch’. Eventually, she’ll understand a few verbs- for
example, ‘eat’ and ‘run’. Adjectives come next for example, ‘big’ and ‘blue’.

I. EMOTIONAL DEVELOPMENT
 AUTONOMY- The development task of the toddlers years according to
Erikson ( 1993) is the development of a sense of autonomy versus
shame and doubt. Children who have learned to thrust themselves and
others during the infant year are better prepared to do this than those
who cannot trust themselves or others.
 SOCIALIZATION- Once toddlers are walking well, they become
resistant to sitting in laps and being cuddled. This is not lack of a desire
for socialization but a function of being independent. Fifteen – month
old children are still enthusiastic about interacting with people,
providing those people are willing to follow them where they want to go.
 By 18 months, toddlers imitate the things they see a parent doing, such
as “study” or “sweep” so they seek out parents to observe and initiate
interactions. By 2 or more years, children become aware of gender
differences and may point to other children and identify them as “boy”
or “girl”.

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  PLAY BEHAVIOUR- All during the toddler period, children play beside
the children next to them, not with them. This side-by-side play (often
called parallel play) is not unfriendly but is a normal developmental
sequence that occurs during the toddler period. Caution parents that if
two toddlers are going to play side by side, they must provide duplicate
toys or an argument over one toy is likely to occur.

16. MILESTONES OF CHILD DEVELOPMENT

FIRST YEAR

PHYSICAL and MENTAL

 walks on to furniture.-
 Recognizes him in pictures or the mirror and smile or make faces at
him.
 Triple the birth weight.
 Grow to a height of 50% over birth length.
 Have a head circumference equal to that of the chest.
 Have one to eight teeth.
 Pull to stand
 Walk with help or alone.
 Sit down without help.
 Bang two blocks together.
 Turn through the pages of a book by flipping many pages at a time.

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  Have a pincer grasp.
 Sleep 8-10 hours a night and take one to two naps.

SENSORY AND COGNITIVE DEVELOPMENT

 Learning to eat independently.

 Follows a fast moving object.

 Can respond to sounds.
 Responds to his or her name.
 Understands several words.
 Can say mama, papa, and at least one or two other words.
 Understands simple commands.
 Tries to imitate animal sounds.
 Connects names with objects.
 Understands that objects continue to exist, even when they are not
seen. (object permanence).
 Points to objects with index finger.
 Waves bye bye.,
 May develop attachment to a toy or object.
 Experiences separation anxiety and may cling to parents.
 May make brief journey away from parents to explore in familiar
settings.

LANGUAGE- says his first real words, such as Mama and Dada, a siblings
name, body parts, animal names, or noises like “woof, woof.”
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 14th MONTH

MENTAL- Identifying objects, following simple one step commands like “Get
the ball,” plays by him and initiate play.

MOTOR DEVELOPMENT

 Using a spoon, drinks from a cup

 Walks well alone with wide based gait

 Creep upstairs.
 Builds with blocks.
 Enjoys throwing objects and picking them up.

15th MONTH

LANGUAGE

 says 30 words; uses verbs; asks “what’s that? “to get name
recognition.

FINE MOTOR

 Puts small pellets into small bottles. Scribbles voluntarily with a pencil
or crayon. Holds a spoon well but may still turn it upside down on the
way to mouth.

GROSS MOTOR

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  Walks alone well; can seat self in chair; can creep upstairs.

PLAY

 Can stock 2 blocks; enjoys being read to; recover (exploring sense of
permanence).

VOCALIZATION AND SOCIALIZATION

 Can use 10-15 words.

 Says “ no”
 Indicates when diaper is wet.

18 MONTHS

MOTOR DEVELOPMENT

 Walks sideways and backwards, runs well, falls easily.

 Climbs stairs or up furniture.
 Scribbles vigorously, attempting a straight line.
 Drinks well from a cup, still spills with a spoon.

FINE MOTOR

 No longer rotates a spoon to bring it to mouth.

GROSS MOTOR

 Can run and jump in place. Can walk up and down stairs holding onto a
person’s hand or railing. Typically places both feet on one step before
advancing.

LANGUAGE

 Uses jargoning; names 1 body part.

 Uses phrases composed of adjectives and nouns.
 Begins to have temper tantrums.

PLAY

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  Imitates household chores, dusting, etc.; begins parallel play (playing
beside not with another child).
 Very ritualistic, has favourite toy or blanket.
 Thumb sucking may be at peak.

EMOTIONS AND SELF-IMAGE

23-MONTH OLD CRYING GIRL

24th MONTHS (2 YEARS)

PHYSICAL

 Weight: about 11-13 kg

 Height: about 80-82 cm
 Teeth: 12 temporary

MENTAL- capable of bowel and bladder control; seats self in a child’s chair;

Shows awareness of gender identity.

LANGUAGE: speaks in two-word sentences such as “ Drink milk” or “ Play

ball”, using the words “no” and Mine frequently.50 words, 2 word sentences
(noun and verb), such as “ Daddy go,” “me come”. Vocabulary of about 350
words.

MOTOR DEVELOPMENT

 Obey simple commands

 Helps undress self and put on simple clothes.
 Shows sign of increased autonomy and individuality.

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  Does not share possessions-everything “mine” as in the “Toddler’s
creed”.

FINE MOTOR

 Can open doors by turning doorknobs, unscrew lids.

GROSS MOTOR

 Walks up stairs alone still using both feet on same step at same time.
 .Builds tower of five cubes.
 Control of spoon well-developed
 Toilet trained during daytime.

PLAY

 Parallel play evident.

30 MONTHS (2 ½ YEARS)
 Learning to ride a toy car.

 Teeth: full set of 20 temporary.

 Decreased need for naps.
 Becoming inquisitive.

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MOTOR DEVELOPMENT

Running and falling

27
FINE MOTOR

 Makes simple lines or strokes for crosses with a pencil.

GROSS MOTOR

 Can jump down from chairs.

LANGUAGE

 Vebal language increasing steadily. Knows full name; can name one
color and holds up fingers to show age.
 Talking is the next milestone of which parents are typically aware. A
toddler’s first word often occurs around 12 months, but again this is
only an average. The child will then continue to steadily add to his or
her vocabulary until around the age of 18 months when language
increases rapidly. He or she may learn as many as 7-9 new words a
day. Around this time, toddlers generally know about 50 words. At 21
months is when toddlers begin to incorporate two word phrases into
their vocabulary, such as “I go”, “mama give”, and “baby play”. Before
going to sleep they often engage in a monologue called crib talk in
which they practice conversional skills. At this age, children are
becoming very proficient at conveying their wants and needs to their
parents in a verbal position.

PLAY

 Spends time playing house, imitating parents’ actions; play is “rough-

housing” or active.
 Child plays alongside other children but not with them.
 Mostly free and spontaneous, no rules or regulations.
 Attention span very short and change of toys occurs at frequent
interval.
 Imitation and make-believe play begins by end of second year.

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SQUATTING

YOUNG CHILD PLAYING AT EASE IN A SQUATTING POSITION

GAMES: throwing and retrieving objects.

SUGGESTED TOYS:

 Play furniture, dishes, cooking utensils, play telephone, puzzle with

large pieces, pedal propelled toys, rocking horse, clay crayons, finger
paints, pounding toys, blocks, pushpull toys, balls.

TOILET TRAINING

 Psychological readiness
 Process training.
 Parental response

3 YEARS

MENTAL- putting several thoughts together to tell a story; using about 300
words, Following a story line remembering ideas from it, enjoying nonsense
phrases.

LANGUAGE- speaking in longer sentences.

SOCIAL- at this stage, the child may now be ready to enter pre-school.

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 Separation anxiety may be a problem for other children at this age,
but for other the wanting to be independent and the need to explore
may help in the transition from being a baby to a school kid.

DEVELOPMENTAL MILESTONE

Age Physical Mental Emotional

 Uses one or
 Use gestures
two syllable
or words to
words such as
convey
"ball" or
objects, such
"cookie"
as: Pointing
 Walk alone well.  Can follow a
at a book,
 Drink from a cup (poorly). simple
raising arms
 Turn pages in a book (a command with
to be picked
12–14 few at a time). an associated
up, or saying
mos.  Play ball by rolling or gesture, such
"cup".
tossing it. as: bringing a
 Mimic actions
cup to you
such as
when you point
covering eyes
at it and saying
while playing
"Please bring
Peekaboo.
me the cup".

15–18  Hold a crayon well  Uses 10–20  Address

months enough to scribble. words. others with
 Lift cup up to mouth for  May be able to greetings.
drinking. follow a  Mimic
 Climb onto furniture. command parental
without a activities such
gesture. as cleaning
 Stack two upor talking
blocks. on a

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 telephone.

 Wants to be
independent
 Speaks 20–50 at times. Will
words; throw a
understands tantrum or
many more possibly say
 Stack six "No!".
blocks  Mimics social
 Understands behavior such
 Feed self with a spoon.
non-physical as hugging a
 Run.
relationships teddy bear or
 Climb into a small chair.
such as turning feeding a doll.
19–24  Walk up steps.
on lights or  Self
months
 Helps with dressing:
pushing recognition.
Likes to dress and
buttons.  Displays
undress self.
 Sorting toys. attachment.
 Searching for  Separation
hidden objects. anxiety.
 Problem  Can play
solving through turn-taking
experimentatio games.
n.  Begins to be
ready for
toilet learning

25–36  Advanced mobility and  Speaking in  Knows boys

months
climbing skills. sentences. from girls.
 Increased dexterity with  Ability to be  Shows
small objects, puzzles. independent to preferences,
 Able to dress oneself. primary care such as
giver. clothes and
 Easily learns entertainment

31
 new words,
places and
people's
names.
 Anticipates
routines. .
 Toilet learning  Knows how to
continues play different
 Plays with toys games.
in imaginative
ways.
 Attempts to
sing in-time
with songs.

17.FEEDING YOUR TODDLER

 Children usually hard to feed. Often they crave for foods frequently
seen in advertisements, whether these are junk foods or from fast-food
chains, unconscious of the possible risk in their health due to deficient
nutrient intake. Toddlers are in the process of growth and require more
nutrients to supply a whole day’s energy need for various activities.
 Toddlers eat different amount on different days depending on a day’s
activity, or if they are tired or unwell. Offer a variety of healthy foods
each day. Listed below is a rough guide to the amounts and types of
food to offer. Don’t worry if your child doesn’t actually eat all of these
every day.

18.HERE ARE SOME TIPS ON WHAT TO FEED YOUR TODDLERS

 Vegetables- two to four servings

 Meat, eggs, fish- one to two small servings.
 Fruit- one to two servings.
 Dairy foods (milk, cheese, yogurt) –three servings.
 Breads, cereals, rice and pasta- three to five servings.

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  Eggs- an excellent food for toddlers since since it is a good source of
protein, energy and other nutrients. An egg once a day is enough.
 Growing children need fat in their diet for growth and energy.
However it is best to give.
 High- fibre food or a lot of fruit juice may cause stomach pain and
diarrhoea. Young children may not be able to handle large amounts of
fibre in their diet.
 Children usually eat the same type of food .They like best some
toddlers will only eat two or three types of food for weeks at a time.

19.FOOD FOR TODDLERS

 Acorn squash, almond butter, apples, apricots, rice, bananas,

cheese,yoghurt, avocado, eggs, sweet potatoes, bell pepper,
oranges, black-eyed pea, blueberry, blackberry, beef, beetroots,
broccoli, bulgur, butternut, squash, cabbage, carrot, cashew,
butter, cauliflower, celery, breakfast cereal, cherries, chia seed,
tofu, milk, hummus, etc….

20.MAKE THE FOOD EASY FOR YOUR TODDLER TO EAT:

 Cut food into bite-size pieces.

 Make some foods soft and moist.
 Serve foods near room temperature.
 Use ground meat instead of steak or chops.
 Use a child-size spoon and fork with dull prongs.
 Seat your child a comfortable height in a secure chair.

21.NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE

 Because of a maturing gastrointestinal tract, toddlers can eat most

foods and adjusts to three meals each day. Toddler’s manipulative
skills are sufficiently well developed for them to learn how to feed
themselves. Before the age of 3, when most of the deciduous teeth
have emerged, the toddler is able to bite and chew adult table food.

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  Developing independence may be exhibited through the toddler’s
refusal of certain foods. Meals should be short because of the toddler’s
brief attention span and environmental distractions. Often toddlers
display their liking of rituals by eating foods in a certain order, cutting
foods a specific way or accompanying certain foods with a particular
drink.

22.PERSONAL HYGIENE FOR TODDLERS

 Teaching your child good hygiene habits everyone needs to keep clean
to kill germs and avoid getting sick.

1.Washing hands after eating. Most germs are spread through hand
contact.

2. Showering and bathing…. Children need regular baths or showers.

3. Clean clothes and shoes.

4. Toothbrushing after eating.

 To make sure toddler have good personal hygiene, teach your child to
wash their hands before eating or preparing food after going to the
toilet, and after playing or touching animals or dirty things. Use water
and soap over hands, and wrists, dry hands thoroughly.
 Teaching toddler about personal hygiene and cleanliness and getting
them into a routine early will help them continue to take care of
themselves as they get older.

23.PROMOTING ORAL HEALTH THROUGH THE LIFE SPAN

 Infants and Toddlers. Most dentists recommend that dental hygiene

should begin when the first tooth erupts and be practice after each
feeding. Cleaning can be accomplished by using a wet washcloth or a
cotton ball or small gauze moistened with water.
 Dental caries occur frequently during the toddler period, often as a
result of the excessive intake of sweets or a prolonged use of the bottle

34
 during naps and at bedtime. The nurse should give parents the
following instructions to promote and maintain dental health.
 Beginning at about 18 months of age, brush the child’s teeth with a soft
toothbrush. use only a toothbrush moistened with water at first and
introduce toothpaste later. Use one that contains fluoride.
 Give a fluoride supplement daily or as recommended by the physician
or dentist, unless the drinking water is fluoridated.
 Schedule an initial dental visit for the child at about 2 or 3 years of age
as soon as all 20 primary teeth have erupted.
 Some dentists recommend an inspection type of visit when the child is
about 18 mos. Old to provide an early pleasant introduction to the
dental examination.
 Seek professional dental attention for any problems such as
discolouring of the teeth, chipping, or signs of infection such as
redness and swelling.

24.CONCERNS OF THE FAMILY WITH PHYSICALLY CHALLENGED OR

CHRONICALLY ILL TODDLER

 It may difficult for children with handicaps or disabilities to achieve a

sense of autonomy or independence because they will never be totally
independent. It is important for these children to develop as strong a
sense of autonomy as possible, though, so they see themselves as
independent and can work to become increasingly self- sufficient as
they grow older. It takes courage for an adult to do such things as
move a wheelchair through a busy airport or a concert crowd. Most
important are actions that allow a toddler to be as independent as
possible. If a toddler has physical limitations, for example, he or she
may be unable to explore freely or may not have the physical ability to
pound and manipulate toys as the average toddler does.
 A toddler with a long-term illness or who is physically challenged can
be expected to exhibit normal toddler behaviours, such as temper
tantrums, and to have normal outlooks, such as negativism. Parents
may also mistake particular toddlers insistence’ on having their own
way as a manifestation of illness. Remind these parents the behaviour

35
 is more often an indication of age and development rather than of
illness so they can respond firmly.
 Toilet training is difficult for a child who is hospitalized at periodic
intervals, as success usually requires a consistent caregiver; in
addition, hospitalization can result in regressive behaviours. If a
chronically ill child also has difficulty with ambulation, soiling accidents
may occur beyond the usual age because of inability to reach a
bathroom easily.
 Children who survive a long-term illness are sometimes referred to as
medically fragile or vulnerable children (Green&Sol nit, 1964). Some
parents tend to protect and shelter such a child, and you may have to
remind them even though chronically ill, a toddler will demand
independence and has the right to explore. A child who uses lower-
extremity prosthesis, for example, might prefer to crawl somewhere
rather than wait for help to put the prosthesis in place. Although this
degree of independence is good, parents may have to limit how it is
expressed so the child will learn how to use the prosthesis (for
example, they could make a rule the child must use the prosthesis to
walk but can choose whether to use a spoon when eating).

25.NUTRITION AND THE PHYSICALLY CHALLENGED OR

CHRONICALLY ILL TODDLER

 Toddlers need experience feeding themselves if at all possible. Help

parents accept the accidents that occur with self-feeding, particularly
if the child has difficulty with coordination; suggest finger foods if
possible.
 If on a special diet, children may not be allowed to eat finger foods; if
they are tube fed, they receive no experience with finger foods at all.
For these toddlers, parents should try to provide other, comparable
experiences independence, such as letting them choose what toy to
take to bed.

36
26.NURSING INTERVENTIONS TO HELP A PHYSICALLY CHALLENGED
OR CHRONICALLY ILL CHILD DEVELOP A SENSE OF AUTONOMY

NUTRITITION

 A special diet may limit typical finger foods. Use imagination to offer
other foods not usually eaten this way as finger foods. Allow child to
help pour liquid diet for a tube feeding. Toddlers are frightened by
vomiting because they have no control over it. Check for possibility of
nausea; toddlers have no way to express this other than by not eating.

DRESSING CHANGES

 A child can hold pieces of tape or put tape in place to maintain sense of
control. The child can remove an old bandage if it is not contaminated.
Allow the child to view his or her incision and watch dressing changes;
explaining each step of a procedure as you perform, it helps the child
maintain control.
 Restrain only those body parts necessary during a procedure to allow a
child sense of control.
 Remove all supplies after a procedure, or the child may “redo” the
dressing.

MEDICATION

 Allow children no choice as to whether a medicine will be taken. Do

allow a child to choose a “chaser”, such as milk or juice, after oral
medicine. Do not ask a toddler to indicate a choice of sinjecintravenous
insertion; this is too advanced a decision for a toddler to handle.

REST

 Locate or create a ritual for bedtime (put child into bed, tuck him in,
say, “Goodnight, Bobby.” Tuck in bear. Say, “Goodnight, Bear”). Allow
a choice of toy or cover but not a choice of bedtime or naptime hour.

HYGIENE

37
  Allow a child a choice of bathtub toy or clothing. Allow a child to wash
face and hands to gain control of the situation.
 Allow the child to put toothpaste on a brush, but you should brush or
“touch up” teeth afterward to ensure that all plaque has been removed.

PAIN

 Encourage a child to express pain (“say ‘ouch’ when I pull off the
tape”.).
 Help channel a child’s self-expression to what is acceptable (e.g., the
child may shout but may not kick).

STIMULATION

 Provide a toddler with a toy that can be manipulated, such as boxes

that fit inside one another and can be taken out again, trucks that can
be pushed, and pegs that can be pounded. In a health care setting,
items can usually be found that fit together (boxes from central supply
or plastic vials from the pharmacy). Another action toy: buy a non- latex
balloon and tie it to the crib side to be used as a punching bag, another
one tied to the crib can serve as a leg exerciser.

ELIMINATION

 A child who is toilet trained needs to be encouraged to use a potty

chair or toilet during an illness. Help children with ureter or bowel
stomas to help with changing bags so they are as independent in
bowel function as possible.

27. HOW CAN THE FAMILY CARE FOR AND TEACH THE CHILD AT
EVERY STAGE OF DEVELOPMENT

CORE MESSAGE: Appropriate care, support and stimulation will help the
child grow, develop and learn at different stages of development.

What should parents/ caregivers do?

38
 Ensure that the child is actively fed nutritious food appropriate for each
stage.
 Provide the child with an enjoyable, stimulating and safe environment
for play and exploration.
 Make sure the child has enough opportunities to interact with other
children.
 Be responsive to the physical, social, emotional, and cognitive needs of
the child. Consult the health worker or child development worker about
ways to support the young child’s growth, learning and development.
 Monitor the child’s progress and learning throughout every stage of
growth and development.
 Make sure the child’s brought to a health centre for check-ups,
immunization and developmental screening. If there are problems and
you think your child is developing too slowly, ask for help from the
health or child development.

Why do parents or caregivers do all these?

 Providing the child with a stimulating and safe environment for play and
exploration and engaging the child in social interaction will promote the
child’s physical, cognitive, social and emotional development.
 Understanding the characteristics and emerging needs and skills of
children helps. Keep track of how children are developing to build on
these new skills and abilities and address new issues as well as
problems as they arise.
 Developmental screening is an important way of identifying possible
developmental delays or learning problems that will need proper care
and other interventions.

28.HOW CAN WE PROTECT THE CHILD FROM OTHER COMMON

ILLNESS

CORE MESSAGE: Having your child fully immunize will protect them
from common illnesses.

What should parents/ caregiver do?

39
  Bring the child to the health centrefor immunization.
 Watch for common reactions after immunizations.
 Give the child nutritious foods including multi vitamins and iron
supplements.
 Give fortified foods that carry the sangkap pinoy seal.
 Give enough care and attention to the child by talking, singing,
telling story, strolling, playing, etc.
 Regularly bring the child to the health centre / health and nutrition
past for growth monitoring and promotion and other services.

Why do parents/ caregivers to do all these?

 A fully immunized child is protected against communicable

diseases.
 A well- nourished child has stronger resistance against common
illnesses.
 Quality time spent with a child makes him/her feel secured and
loved that promotes physical, emotional and mental
development. Appropriate caring behaviours are necessary to
help a child take full advantage of available food and health
services.
 Did you know that exercise is important event for toddlers?
Adequate regular activity plays en essential role in both the physical
and mental and development of child. However, toddlers may not like
playing the same game repeatedly, and that means you need to have
several ideas to keep them active.

29.BENEFITS OF PHYSICAL ACTIVITIES FOR TODDLERS

 Develop strength
 Build self-esteem
 Increase stability
 Keep and build muscles, heart and bone stronger.
 Enhance motor skills
 Improve cognitive skills
 Treat ADHD (2)
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41