milestones- TODDLERS & PRESCHOOLERS

Learning Outcomes

  • Understand the developmental milestones of the toddler.
  • Apply Piaget and Erikson stages to the development of a toddler.
  • Apply health promotion and safety strategies as they apply to the toddler.

Routine Well Visits

  • Schedule for Pediatric Checkups:
    • One-year visit.
    • Follow-up visits at:
    • 15 months
    • 18 months
    • 24 months
    • Transition to every six months after 24 months.
  • Autism Screening:
    • Conducted at 18 months and repeated at 24 months.
    • Can be conducted earlier if signs of autism are present.
    • Signs may include:
      • Lack of social contact
      • Lack of interaction
      • Potential delayed speech.
  • Growth Measurement:
    • Measurement includes:
    • Head circumference
    • Height (until age two, measured lying down)
    • Weight

Developmental Stages

  • Erikson's Stage for Toddlers:
    • Stage of Autonomy vs. Shame and Doubt.
  • Piaget's Cognitive Development Stage:
    • Primarily in the Sensorimotor Stage until age two.
    • Transitioning to Preoperational Stage, characterized by the intuitive substage.

Communication with Toddlers

  • Importance of using age-appropriate language.
  • Engage with parents to address common concerns:
    • Perception of toddler’s eating habits (not enough intake).
    • Growth Expectations:
      • By age two, children typically:
      • Quadruple their birth weight.
      • Reach half of their adult height.
      • Growth occurs in spurts, may not strictly follow growth curves.

Physical Growth and Development

  • Transition from baby fat to lean muscle.
  • Common physical characteristics:
    • Protruding belly (normal due to underdeveloped abdominal muscles).
    • Bow-legged stance (due to large trunk bearing weight).
  • Motor Skill Development:
    • By 12-13 months:
    • Begin walking with a wide stance.
    • By 18 months:
    • Can walk up stairs while holding onto something with one hand.
    • By two years:
    • Walks up and down stairs one step at a time.
    • Begins to engage in jumping activities.
    • Can kick a ball.

Feeding and Self-Feeding Skills

  • Initiation of feeding solids around six months of age.
  • Fine Motor Skills:
    • Development of pincer grasp by six months.
    • Drinking from a cup by one year; weaning off the bottle.
    • Beginning to stack blocks and use a spoon, though spilling is common.
  • Encouraging Independence:
    • By age two, toddlers:
    • Begin to scribble.
    • Attempt to dress themselves (usually inaccurately).

Language Development

  • Language milestones:
    • One year: typically say 2-5 words (e.g., mama, dada).
    • Two years: around 50 words; understand more complex language but may be hard to understand.
    • By three years: Know their age and gender, can count to three.
  • Encourage readiness for toilet training around two years:
    • Signs of readiness:
    • Toddlers may show discomfort with wet diapers.
    • Typically trained by ages three to three and a half.
    • Bowel control often established before bladder control.

Social Interaction and Play

  • Understanding of social play:
    • Toddlers play next to rather than with one another (parallel play).
    • Engage in imitation of household activities (e.g., pretend cooking).
  • Egocentrism:
    • Limited perspective taking; little awareness of others’ viewpoints.

Behavior and Discipline

  • Frustration leads to temper tantrums; toddlers possess more receptive language than expressive.
  • Recommended strategies for discipline:
    • Consistency in setting boundaries and limits.
    • Use of time-out as a form of discipline.
    • Encourage positive behavior with praise or reward systems (e.g., stickers).
    • Limit yes/no questions to avoid power struggles.
    • Offer choices instead (e.g., storybook vs. song).

Health and Nutrition

  • Sleep Requirements:
    • Toddlers need approximately 11-12 hours of sleep, often including a single daily nap.
  • Nutrition Recommendations:
    • Breastfeeding is encouraged until mutually desired.
    • After age one, transition to whole milk, then 2% or skim.
    • Limit juice to 4 ounces daily.
    • Ensure to monitor iron levels, especially in case of allergies.

Safety Considerations

  • Emphasize vigilant supervision of toddlers when around infants.
  • Common Safety Hazards:
    • Risk of choking and poisoning due to exploration of environments.
    • Importance of education on household dangers and safe practices (e.g., covering electrical outlets).
  • Vehicle Safety:
    • Car seats must be rear-facing until age two or four, and children must not ride in the front seat.
  • Injury Prevention:
    • Mortalities in toddlers often due to accidents, primarily burns or poisonings.

Social Development and Family Dynamics

  • Family plays a crucial role in a toddler’s psychosocial and cognitive skill development.
  • Discussion of potential sibling rivalry as family dynamics shift with a new baby.

Conclusion on Toddler Development

  • Maintain focus on developmental milestones, apply Piaget and Erikson stages appropriately to toddlers, and implement effective health promotion strategies securely.

Preschooler Development

  • Erikson's Stage: Initiative vs. Guilt
    • Preschoolers love to take on new tasks and feel a sense of initiative.
  • Cognitive Development (Piaget):
    • Transitioning from preoperational to concrete operational (around age 6-7).
    • Magical thinking persists; toys and objects often perceived as alive.

Physical Growth in Preschoolers

  • Growth: approximately 6-9 cm per year and weight gain of 2-3 kg per year.
  • Gross Motor Skills:
    • By age 3: Able to tricycle, throw balls, alternate feet going down stairs.
    • By age 4: Hopping, starting to learn to skate and swim.

Fine Motor Skills

  • Skills develop as preschoolers can:
    • Copy simple shapes and figures.
    • By age 5: Some may be able to print their name and tie shoelaces.

Language Skills

  • Vocabulary rapidly increases; three years old typically use three-word sentences.
  • Encourage parents to facilitate age-appropriate language development and socialization skills.

Preparation for Preschool

  • Indicators of readiness for preschool include:
    • Ability to focus for short periods (10-15 minutes).
    • Participation in activities requiring follow directions.
  • Parental support for reading, rhymes, and social activities is important.

Vision and Health Screening

  • Vision screening recommended by age four and as part of kindergarten exams.
  • Importance of addressing visual impairments early to support learning.

Safety and Nutrition

  • Reinforcement of safety education:
    • Help children identify safe adults.
    • Educate proper food handling and hygiene practices.
  • Nutritional guidelines:
    • Emphasis on healthy eating habits, limiting juice, ensuring balanced diet rich in fruits and vegetables.

Parent Interaction

  • Addressing common fears in preschoolers (e.g., fear of dark or being left alone).
  • Encourage routines around bedtime and other transitions.

Monitoring Behavior and progression

  • Awareness in both social behavior and aggressive tendencies in preschool age.
  • Importance of discussing aggression and monitoring for safe interactions.

Conclusion on Preschool Development

  • Comprehensive understanding of milestones will aid in assessing and facilitating healthy development in preschool children.