Peds, part 10: G&D - Toddlers - Development and Parental Guidance

December 22, 2021 Updated: January 17, 2022 8 min read

Full Transcript

Hi, I'm Meris with Level Up RN. And in this video, I'm going to be talking to you about the normal growth and development and expected milestone for toddlers. That's going to be children between one and three years of age. I'm going to be following along using our pediatric flashcards. These are available on our website, If you need to get a set for yourself, I highly recommend it. But if you already have a set, I would invite you to follow along with me. All right, let's get started. So first up, we are talking about some of the physical development of a toddler. They're expected to gain about four to six pounds per year. Their weight should be four times their birth weight at age two and a half. So if we had a 6-pound infant at two and a half years old, they should be 24 pounds, right? Just a general guideline there. Now their height, they grow about three inches per year. So you will see that they really start to grow up instead of out. You know, we have those little pudgy babies, but when they hit that toddler stage, they really start to stretch out kind of. They grow up and they don't gain as much weight as they did when they were infants, because there's a lot of physical development to be done in that first year.
Now, gross motor skills. Remember, we're talking big movements, big muscles here. 15 months, they should be able to walk without help. 18 months, they should be able to jump in place with both feet, so like bunny hop, and throw a ball overhand. So it doesn't necessarily mean they're going to be good at throwing it. They're not going to be joining the MLB or anything like that, but they should be able to throw a ball overhand. By two years of age, they should be able to climb the stairs and kick a ball. Kicking a ball is actually a really interesting skill because it requires both the strength of of being able to actually make contact with that ball and propel it forwards. But it also requires an understanding of where they are in space in relation to that ball. So it's actually a pretty complex skill. Fine motor skills, we're talking little movements, little muscles, fine motor skills. 15 months, they should be able to successfully build a tower of two cubes. You will see that building towers of certain numbers of cubes is a thing. This is a thing that you have to know, and it has to do with the Denver II assessment. This is something that assesses these motor milestones. So with this, building a tower of two cubes at age 15 months. At age 18 months, we should be able to build tower of three to four cubes. We should also be able to use a spoon without rotation. Just meaning that I get it to my mouth and it is in the correct position. Two years, they should be able to build a six to seven cube tower. We love these cubes. And by two and a half years, they should be able to build a tower of eight cubes and draw a circle. I'm going to tell you what my pediatric professor told me, which is when you're talking about drawing shapes, it's circle, square, triangle. So we really go in that alphabetical order. So C, S, T. So circle, square, triangle. So in that two and a half year range, they're able to draw a circle. Circle is actually a pretty easy thing to do, right? I'm just moving my hand around. When we get into the more complex ones, that takes a lot more skill.
Okay. Moving on, we're talking about cognitive and psychosocial development. Cognitive, they're still in that sensory motor stage. So still exploring the world with their senses. When it comes to their language, they are now using hollow phrases, which is a one word sentence. So it's kind of hard to grasp, but a one word sentence would be something like hungry, right? Really what they're saying is I'm hungry. Or no is a hollow phrase, right? Or want. Really they're saying, I want that, but it's a hollow phrase. They should have more than 50 words and two to three word phrases by the age of two. So that's when we see explosive growth in their language, comprehension, and use. So you'll see them go from no language to all of the language very quickly. Now, when we talk about normal behaviors, ritualization is one. So that's like having a comfort item I sleep with, right? Every night, my son has Bear-Bear, right? He's three years old. He sleeps with Bear-Bear every night. If we don't have Bear-Bear, we've got a problem because that's his ritual. Negativism, this means-- it doesn't mean that they're pessimist, it means that they automatically say no. So when my son was two, if I said to him, "Finlay, do you want to have a bite of mommy's sandwich?" He would say, "No." And then he would kind of say like, "What is it?" But their immediate reaction is to say no, and that is negativism. They can also throw temper tantrums. You'll hear about the terrible twos, but really, I think it's the terrible threes. Three has been the bad age for both of my kids. That's been the really hard one for us. But again, it's in that toddler area of development.
And then egocentric, that means like I'm thinking about myself, I'm the center of the universe. But that's very important when you're little because you need to fulfill your own needs so that you can continue to live. And also, you haven't learned how to consider the feelings of others, right? So they're egocentric, so you're going to hear a lot of I want, right? I want that. They don't understand sharing because it hasn't occurred to them that the other person might be sad when they don't get to play with that toy. Now psychosocial development, their Erikson's stage is going to be autonomy versus shame and doubt. When we talk about play, so remember we had solitary play when they were little, and now we have parallel play. So parallel play means I'm playing next to somebody else who is also playing, but we're not playing together. So I'm playing with blocks, and my friend Henry is playing with the cars. We're next to each other, we're not playing together though, that's parallel play. Toys that they like, push and pull toys, wooden puzzles, blocks, and balls.
Moving on now to parental guidance for nutrition. All right, nutrition gets a little bit intense in these ages because they are now eating more solid foods but still at risk for choking. So whole milk should be introduced when a child reaches one year old. So we should phase out-- like formula, for instance, replace it with whole milk. And then at the age of two, they should be transitioned to 2% milk. That whole milk has lots of fat in it, which is awesome for those developing brains. But by age two, we're going to cut down the fat content and go to 2% milk. Easy to remember, two and two. Okay, additional things. We're going to limit milk to two to three servings per day, because too much milk, too much calcium can decrease the child's iron, right? So we can end up with anemia from too much milk. Juice should be either not given at all or limited to four to six ounces per day. My kids' dentist always said that each bottle of juice comes with its own cavity because juice is so sugar-rich. So we really want to limit that intake. Things we want to avoid, again, choking hazards. You can check out the previous video on that. It's common for kids to have physiologic anorexia, which would be less intense way to say that is, I'm too busy to eat. I'm running around. I'm playing with my toys. I don't want to sit down and eat a meal. I'm too busy, mom. So instead, we might have little finger foods that they can snack on while they play, something like that. We can give them like a little plate and say-- like my husband always called it charcuterie. So we would just have little fruits and vegetables and things that could be stable at room temperature, and they would just come and snack on it when they felt like they wanted to.
All right, moving on to toilet training, sleep, and dental health. Toilet training, this is how a child lets you know that they're ready to do toilet training. They're going to tell you that they need to use the bathroom. And that might be right before or right after. That's okay. We're starting to recognize that the two go together. They're going to wake up dry from nap or bedtime, and they're going to stay dry for two hours during the day. That's about how frequently they go to the bathroom. So that would be indication that they're ready to transition that into doing that in the toilet versus in a diaper. Sleep, they're going to sleep 11 to 12 hours a day. That's a lot. So we want to maintain that sleep structure for them. That they have a consistent bedtime. Sleep is so important for brain development and physical development too. Dental health, we don't give bottles of juice or milk at bedtime. We should be brushing teeth right before going to bed. And the parent should be brushing or flossing the child's teeth, and then having the child help them do it. So I always tell my son, "I'm going to brush your teeth first and then you can brush them." And then he kind of just wiggles it around, you know? [laughter] And they should be seeing the dentist twice a year, just like an adult.
Lastly, let's talk about vaccinations. We do have a nice table here for you, separated by age. So between 6 to 18 months, they can get their third dose of hepatitis B. Typically, that's just at the six-month visit, but they would also get IPV. We talked about that in the infant video, but it kind of bleeds over because it can be up to 18 months. Then we have 12 to 15 months, they should be getting MMR, Hib, PCV, and varicella. You'll note that MMR and varicella are present here now because these are live virus vaccines, and children cannot get them until they are at least one year old. 12 to 23 months, hepatitis A. 15 to 18 months DTaP. And one to three years, they should be getting their seasonal influenza vaccine every year, during that time when it is seasonally appropriate. All right. Let me ask you some quiz questions so you can test your knowledge of key facts I provided you. Okay, tell me first, at what age is a child expected to weigh four times their birth weight? At the age of two years, how many cubes should a child be able to stack on top of each other successfully? What type of play does a toddler typically engage in? At the age of two years old, what type of milk should a child be drinking? And tell me, what is the age at which a child may begin to receive live virus vaccines? All right, let me know how you did in the comments. I can't wait to hear and I'm sure you did great. If you need a little refresher, you can always go back and watch this video again. Thanks so much and happy studying.

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