Growth and development - Toddler: Nursing

The toddler period spans years 1 to 3. During this time, toddlers become more independent, active, and curious; they begin to show defiant behavior; and start imitating the behavior of others, especially adults and older children. Although this period is a time of significant advancement in growth and development for the child, it can also be quite a challenging time for parents!

Now, developmental psychologists who were involved in studying toddler development include Jean Piaget, Erik Erikson, and Lawrence Kohlberg.

It’s important to note that growth and development are two different concepts. Growth refers to physical changes in height, weight, and the appearance of the body; whereas development refers to the acquisition of complex motor, cognitive, and social skills, such as walking, speaking, turning a page in a book, or smiling at familiar faces.

Alright, now compared to infancy, both physical growth and acquisition of new motor skills slows down, with the most dramatic changes occurring in bodily proportions. Infants have a relatively large head and short legs and arms.

During toddlerhood, head growth slows down from 2 cm in the second year alone to 2 to 3 cm over the next ten years. At the same time, height and weight continue to increase steadily, though the increase occurs at a slower rate compared to infancy. In fact, toddler’s gains in height and weight tend to occur in spurts rather than in a linear fashion. On average, toddler weight gain is around 1.3 to 2.3 kg per year; and height increases by an average of 7.5 cm per year.

Alright, let’s switch gears and look at toddler development. Typically, this is discussed in terms of developmental milestones that toddlers achieve at certain ages. By looking at these milestones, we can see how the toddler is developing and keep an eye out for any potential problems. There are several types of milestones that should be assessed: motor, cognitive, social, psychosocial, and moral and spiritual; and these are typically checked periodically throughout infancy and childhood.

Starting with motor milestones, by the age of 18 months, a toddler might start running, carrying toys while walking, and they should be able to walk up stairs while holding the rail. At 2 years of age, the toddler might try jumping on both feet, prefer one hand over the other, and can use a fork. Finally, at 3 years of age, they might start riding a bike, getting undressed by themselves, and walk up and down stairs with alternating feet. Throughout toddlerhood, children can start displaying and perfecting fine motor skills, such as building tall tower blocks, fitting a puzzle piece, turning pages in a book, and scribbling and painting.

Moving on to cognitive milestones. Piaget explains that toddlers are in the sensorimotor stage, where they learn about themselves and the world around them by using their senses and manipulating objects.

By 18 months of age, toddlers should be able to use 10 to 25 words and are able to name familiar objects like clothing items or food. They can also start playing with dolls or teddy bears.

At 2 years of age, they should be able to follow 2-step commands, use more than fifty words and form intelligible 2-word phrases, but also understand the difference between pronouns and plural and singular. At this stage, they develop new problem-solving strategies like pulling on a string attached to a toy that is out of reach, they search for lost objects, and they test the limits of things like clothing items or toys (or even their parents!).

Finally, at 3 years old, a child can follow 3-step commands, use more than 200 words and predominantly intelligible 3-4 word phrases, and also state their full name, age, and gender, and they know how to phrase questions. This is also the time where children develop time concepts, identify shapes, compare two items, and count to three.

For social milestones, at 18 months, they should be increasingly independent from caregivers and they start preferring parallel play, which is when kids play next to each other but do not interact. At 2 years old, children throw tantrums, develop a need for control and a sense of egocentrism, manifested by saying “no!” a lot, as well as possessiveness, so they often yell “mine!”. Finally, at 3 years old, children can often easily separate from their parents, though separation anxiety may reemerge at this stage. Other milestones include learning to share toys, show empathy, and playing with others.

For psychosocial milestones, according to Erikson, the toddler is in the second stage of development, autonomy vs shame and doubt. As toddlers begin to explore their environment, they start to learn independence and self-care. If the toddler is unable to achieve autonomy, shame and doubt can result.

In terms of moral and spiritual milestones, Kohlberg places toddlers in the preconventional level of morality, where they begin to develop a sense of right and wrong. Their actions are based on avoiding punishment and the attainment of pleasure.

Finally, let’s have a look at the main physiologic changes during toddlerhood. In the nervous system, a toddler’s brain grows rapidly, causing the head circumference to reach 90% that of the adult size by the age of 2. Myelination of the brain and spinal cord continues to progress, resulting in improved coordination, language skills, and protective reflexes.