As a nurse, nurse educator, patient advocate, or maybe a future parent someday, the knowledge of a child’s developmental milestones makes us equipped in planning the best steps for a child’s welfare.
We must be familiar with what to expect in a child’s growth and development, especially the Toddler stage. This post will review the motor skills, body changes, speech, cognitive development, behavior, social interaction, and the appropriate approach of care for children aged 1-3 years old.
Growth and Developmental Milestones of Toddlers (1-3 Years Old)
During the toddler stage, the physical changes slow down as compared to the infancy stage. But this is the stage where you expect to witness gradual changes in their mental, fine, and gross motor skills.
This is where the child is curious about their environment and wants to explore and do things on their own. They start to realize that they can function autonomously without their caregiver and that their actions influence the people surrounding them.
As a nurse, the knowledge of the approach and interventions for a toddler is geared towards the child’s safety, protection, and health. This acronym “TODDLER” might help to remember the concept of care for toddlers.
- T – Temper Tantrums
- O – Out of Harm’s Way / Safety
- D – Ditch the Diapers: Start the Potty Training
- D – Developmental Stage Theory
- L – Loves Saying “NO”
- E – Eating Habits
- R – Rivalry, Rituals, and Regression
Since a toddler finds their autonomy or independence, they easily get agitated or stressed if they don’t get what they want. As a result, the toddlers have temper tantrums where they have disruptive and unpleasant outbursts. These temper tantrums are not just a response to frustrations; it’s also a result of hunger and tiredness.
What will you expect in a child going through a temper tantrum? There will be many screaming, crying, shouting, throwing items, rolling on the floor, and stomping their feet.
Temper tantrums are a normal part of childhood, and it will pass as the child grows older. As a nurse, just educate the parent on how to approach this situation.
- Stay calm and do not get angry with the child as this may only worsen the temper tantrum.
- Ignore the behavior and go about your business.
- Look for a distraction or change location.
- Avoid the causes of temper tantrums: hunger or sleepiness. Be consistent with their meal and nap time every day to avoid these instances.
- Lead them to make their own choices so they will feel independent.
- Acknowledge their good behavior (e.g., You did a very good job, well done, I’m so proud of you)
- Prepare the toddler for a change in environment or situation.
Out of Harm’s Way / Safety
Toddlers will always be curious, so expect them to move around a lot. This puts them at high risk of exposure to danger, accidents, or injuries. That is why their safety must be the number one priority.
As a nurse, you must educate the parents about the common dangers toddlers are exposed to. In this way, parents must avoid this at all costs and be more aware of the toddler’s surroundings. It is important to mention the acronym DANGERS on the most common safety hazard.
- D – Drowning in the pool or beach
- A – Auto Vehicular accident
- N – Nose-dive or any type of falls
- G – Get burns (stove, hot surfaces)
- E – Eating hazardous or chemical substances
- R – Rifles (playing with guns)
- S – Suffocation and choking hazard
Ditch the Diapers and Start the Potty Training
One of the most important milestones of toddlers is potty training. At 18-24 months, the urethral and anal sphincter can now be controlled. Toddlers can control their bowels first, as compared to the urinary bladder.
By three years old, a toddler can be potty trained during the daytime. When they sleep at night, it is recommended to use diapers because they are expected to get past this at 4-5 years old.
The nurse must educate the parents of the signs that their toddlers are ready for potty training; just remember the acronym TOILET.
- T – They tell you they have to go
- O – On and Off potty by themselves or their pants
- I – Interest or willingness to go potty
- L – Likes sitting in the toilet for 5-10 minutes
- E – Experiencing the same time of bowel movement.
- T – Two hours or more of dry diapers
Developmental Stage Theory
There are two theories nurses must take note of when talking about milestones: the Theory of Cognitive Development by Jean Piaget and Erickson’s Stages of Development.
Jean Piaget’s Theory of Cognitive Development: This theory explains that interaction and biological maturation, a child’s cognitive skills, develops. In the Theory of Cognitive Development, a toddler is in the sensorimotor (0-2-year-old) or proportional stage (2 to 7 years old).
So how do nurses educate the parents on what to expect about their cognitive skills during this stage? Here’s are the critical points to remember:
- Type of Play: Parallel Play (they observe the other kids playing but do not play with them)
- Recommended Toys: Blocks, Toys that need to be assembled, push and pull toys (e.g., wagons, carts, cars, strollers), stuffed toys, pretend plays (e.g., cooking set, doctor’s kit, building tools), crayons, or other coloring materials, interactive and colorful books, balls.
- Please note that toddlers are like a sponge; they mimic everyone’s words and activities around them.
Erickson’s Stages of Development: This theory explains toddlers’ trait, which is Autonomy vs. Shame and Doubt. As mentioned earlier, toddlers develop independence, get curious, and become aware that their actions affect the people around them.
Nurses must encourage parents to support the child’s discovery of their independence by building their self-confidence. Here are some tips to remember:
- Provide instances where their independence is developed (e.g., potty training, eating, get dressed, choosing their toys, food choices, activities)
- Give positive feedback on what they do and avoid punishing them for their wrongdoings.
- At this stage, the child develops separation anxiety, and this must be dealt with well.
Loves saying, “NO.”
This is the stage where the child loves saying NO because they won’t do anything they don’t like as part of their feeling of autonomy. They do the opposite of what they are asked, and here’s what nurses should educate parents: GIVE THEM OPTIONS.
Let them have the freedom to choose by giving them options. Do not make demands of what they should do because you’ll end up getting a NO answer.
One of the challenges of parenting a toddler is their eating habits. It is best to remind the parents of these eating tips for toddlers:
- Small, frequent, and healthy meals: It’s hard to give three full meals to a toddler in one day. It is best to provide short but frequent meals, maybe 2-3 hours apart each day. You can give nutritional snacks like fruits, vegetables, meat, water, or milk.
- What to avoid: Avoid giving toddlers junk foods, processed meats, fatty foods, sugary foods, and as much as possible, limit their juice intake. Avoid toddlers falling asleep with a bottle in their mouth, as this may lead to dental caries. Avoid chunky or oversized foods that are hard to chew because these are choking hazards.
- What to do: Use fun plates, spoon, and fork, napkins, design on tables. They eat depending on how the food looks like, making the food always presentable and fun to look at.
Rivalry, Rituals, and Regression
The three R’s of toddlers: Rivalry, Rituals, and Regression is an essential topic for nurses to tackle to parents. This way, they can understand more why their child acts this way.
- Rivalry: This is especially when they have a baby brother or sister—the problem roots from the change of routine and parents’ divided attention. Parents can make their toddlers feel involved in their little sibling’s care, making them feel independent and reliable. Be aware that toddlers may hurt their new sibling, so you must watch out for this.
- Rituals: Toddlers want a regular routine, which may cause tantrums when they don’t do their everyday tasks. This is their comfort zone, and the feeling of easiness enables them to learn a new skill. As much as possible, maintaining their routine. If this is not possible, slowly transition them to change their expectations.
- Regression: Regression is the process where toddlers return to their infancy stage or lose their developmental skills (e.g., potty training, speech, or play). This is caused by stress and being overwhelmed by learning new skills or changes in their routine. Parents should not force or punish the toddler if they go through regression. Just identify what causes the stress, do something about it, and just help the child develop their skill at their own pace.