3. Biologic growth:
1. weight :
Average weight gain is 1.8 – 2.7 kg / year
Birth weight quadriples at 21/2 years
2. Height
height increases about 10 to 12.5cm/ year
at 2yrs ht is about 85 cm
Arms and legs grow at a faster rate than head and
trunk
Lumbar lordosis of spine is less evident
Legs have a bowing appearance ( tibial torsion )
Ratio of upper segment : lower segment= 1.7 : 1
4. Head circumference
The rate of increase in head circumference slows
HC is equal to CC by 1 to 2 yrs
The rate of increase slows until at age 5 yrs
At 2 yrs HC IS 49 TO 50 cm
• The anterior fontanel closes between 1 and 11/2 yrs of
age
Chest circumference
• Continues to increase in size and exceeds head
circumference during the toddler year. AP diameter is
less than lateral diameter.
• Midarm circumference: 13 – 16 cm.
DENTITION
• Central incisors - 6 to 8 months
• Lateral incisors - 8 to 11 months
• Canines-16 to 20 months
• First molars-10 to 16 months
• Second molars-20 to 30 months
5. Physiologic parameters
Temperature : 97.8 – 98.4 ° f
Pulse : 1-2 years – 110 -130/ mt
3 years - 100-120/mt
Respiration : 24-40/mt
Blood pressure : systolic: 91 – 93 mmhg
diastolic: 56 mmhg
6. Maturation of system
The physiologic functioning of the body is mature by the
end of the toddler period with the exception of the
endocrine and reproductive system.
• INTEGUMENTARY SYSTEM
• The resistance of the skin to infection and its ability to
prevent fluid loss is increased as the epidermis and the
dermis become more tightly connected to each other.
• Sebum production is inadequate.
• CARDIOVASCULAR SYSTEM
• Pulse rate is 110/mt
• Blood pressure is 99/64mmhg
• The heart and blood vessels increase in size.
• The need for Hb is greater than during infancy, a slightly
higher RBC count is necessary.
7. RESPIRATORY SYSTEM
The structure increase in size, with increase in thoracic
volume.
Thus leading to decrease in respiratory rate 26/mt
Because of short straight eustachian tube through
infection easily reach the ears from the nasopharynx.
Respirations are still abdominal
Genitourinary system:
By 2 years, toddler is able to conserve water &
concentrate urine.
Myelination of nerves to urethral sphincter & increased
ability of bladder to control urine helps in controlling
elimination.
8. GASTROINTESTINAL SYSTEM
The salivary gland reaches functional maturity
by the end of second yr
The capacity of stomach increases
HCL secretion in stomach increases,providing
protection against various types of organism
IMMUNE SYSTEM
Because passive immunity from the mother
decreases during infancy, immunization is
essential
The production of IgM,reaches adult levels
during later part of first yr of life
NERVOUS SYSTEM
The number of brain cells is complete by the
beginning of toddler period .
9. They continue to grow until the brain has reached
2/3rd
of its adult size at 2yrs and 3/4th
of adult size
by 3yrs of age.
As the child matures, specific areas of brain
develop, such as brocas area for speech.
Other areas of the cerebral cortex develops as the
child achieves motor control of the extremities
and sphincters.
Myelination of the spinal cord is achieved
gradualy as toddlers show increasing
ability to exert control over posture and
coordinated movements
As a result , the child is able to stand alone before
being able to walk, and to walk before running and
jumping
After 2yrs , myelination slows down to reach
completion during puberty.
10. Motor development
GROSS MOTOR SKILL
Development of locomotion
By 12 to 13 months walks alone
using a wide stance
By 18 months try to run but fall
easily
At 2 yrs walk up and down stairs
2 ½ yrs jump using both feet
Stand on one foot
Walk on tip toe
11. FINE MOTOR DEVELOPMENT
By 12 months able to grasp a very small
object
by 15 months can drop a raisin into a
narrow neck bottle. Builds a tower of 2-3
cubes.
By 18 months can throw a ball overhand.
Builds tower of 3-4 cubes
By 2yrs use their hands to build towers.
Builds a tower of 6-7 cubes.
By 3yrs draw a circles on paper .
Builds a tower of 8 cubes.
Good hand finger coordination.
SENSORY DEVELOPMENT
Visual acuity of 20/40
The sense of hearing smell, taste
and touch increasingly developed
12. PSYCHOSOCIAL OR EMOTIONAL
DEVELOPMENT( eric ericksons)
AUTONOMY VS SHAME AND
DOUBT
• Learning to assert self in
the expression of needs,
desires and wants.
• If not allowed to do so,
experiences shame &
doubt.
• Coping skills – temper
tantrums, crying,
negativisim, breath holding
spells
13. Psychosexual development
(seigmund freud)
THE ANAL STAGE
The child operates primarily on the
basis of the id or instincts,the pleasure
principle
The child begins to operate on the basis
of ego,the part of the psyche that
posses consciousness
Attains pleasure by learning to regulate
elimination of bowel and bladder.
14. Spiritual development ( fowlers)
Intutive –projecttive faith- that is a
faith derived from the parents or
significant others. The child imitates
religious behavior, such as bowing
the head in prayer, but does
not understand the
meanings.
15. Cognitive development (jean piaget)
SENSORY MOTOR STAGE(BIRTH TO 2YRS)
Substage 5(12 to18 months) tertiary circular
reaction – child develops variations of old
responses in approaching a new object. ( trial
& error method)
Substage 6(18 months to 2yrs) the inventions
of new means through mental combinations.
Deferred imitations and invisible displacement
occurs at this stage.
Preoperational stage(2 to 7yrs) the childs
thinking is based on concrete perceptions and
actions on immediate environment. Child uses
one word to several rather similar persons or
objects.
16. Moral development( kohlberg)
STAGE 0(BIRTH TO 2YRS)
during this stage the toddler
function on the basis of the
good is what the child likes
and want.
STAGE 1(2YRS TO 3YRS)
This period is of punishment-
obedience orientation.
17. LANGUAGE DEVELOPMENT
Approximately 4 words are spoken at 1
year
300 words at 2 years of age
Buliding the vocabulary
The child a vocabulary first of nouns of
1 syllable (ma,ma da,da)
Use of more difficult nouns relating to
objects and people in the environment .
Constantly asks questions.
Talks whether audience present or
not.states own names.
Makes specific sound errors ( s, sh,
ch,z)
18. RECEPTIVE LANGUAGE.
By 15 months recognise names of
various parts of body.
Responds to familiar commads.
By 18 months identifies pictures of
familiar objects when named
By 2yrs , understands more
complex sentences
Identifies 4 body parts when
named.
By 30 months ,identifies 5 body
parts when named.
20. NEEDS OF TODDLERS
LOVE AND SECURITY
SEPARATION ANXIETY
REGRESSION
DEPENDANCE PROGRESSING
TO INDEPENDENCE IN SELF
CARE
TOILET TRAINING
DEVELOPING SELFESTEEM
HEALTH PROMOTION AND
ANTICIPATORY GUIDANCE
21. NUTRITION
the daily calorie requirement is
100kcal per kg during toddler period
ACCIDENTS PREVENTION
Accidence are the largest single cause
of mortality and disability between the
ages of 1-4 years.
