11/19/23, 8:17 AM Exam 2 Pediatrics
Exam 2 Peds
Growth & Dev of Toddlers pg. 992
Both physical growth and acquisition of new motor skills slow somewhat during toddler yrs
Height and weight continue to ↑ steadily but slower than infancy growth happens in
spurts rather than linearly step-like growth
Averages weight at 2 y/o is 26lbs and height is 34 inches
Dentition primary teeth in place (start to get teeth at 6 months) teach them to brush
their teeth and maybe floss, you’ll have to help them pg. 1010 read more
Avg toddler weight gain 1.36 to 2.27kg (3 to 5lbs)/year length/height ↑ an avg of 7.62
cm (3 inches)/year head circumference ↑ about 2.54 cm (1 in) and then ↑an avg of of
1.27 cm (0.5 in)/year until 5 y/o head size becomes more proportional to rest of body
near 3 y/o
Toddlers generally reach half their adult height by 2 y/o
Major Toddler Tasks
Differentiation of self from significant others
Tolerates separation from parent
Ability to withstand delayed gratification
Control over bodily functions
Acquisition of socially acceptable behavior
Verbal means of communication
Ability to interact w/others in a less egocentric manner
Speak 100-200 words
Physiological Systems
Myelination of the brain and spinal cord is usually complete around 24 months improved
coordination and ability to exercise sphincter control for bladder and bowel mastery
HR ↓ and BP ↑ in toddlerhood
Urine output should be 1 mL/kg/hr urethra still remains short making them for
susceptible to UTIs than adults (male and female)
↑ ability to maintain body temp body is becoming more proportional
they start to produce antibodies against infections
Psychosocial Development pg. 994
Erickson defines the toddler period as a time of autonomy versus shame and doubt it’s a
time of exerting independence
The toddler is struggling for self-mastery and to do for themselves what others have been
doing for them
They may quickly chg from happy and pleasant to crying and screaming
Exertion of independence results in toddler’s fav response “no” will answer “no” even if
they mean “yes”
Separation anxiety in a place can cope w/brief separation leave something important
to you w/the child “watch my sweater, don’t let anyone take it and I’ll be back”
Coping mechanisms
o Regression returns to prev behavior
about:blank 1/38
,11/19/23, 8:17 AM Exam 2 Pediatrics
o Ritualism maintains sameness will watch the same show over and over. Will
cry until you play the same one. It’s important to do things on a schedule, dinner
time, bed time, do things at the same time everyday
Motor Skill Development pg. 995
Walking progresses to running, climbing, and jumping
Pushing or pulling a toy, throwing a ball, and pedaling a tricycle are accomplished in
toddlerhood
Fine motor progress from holding and pinching to the ability to manage utensils dev
of hand-eye coordination
As toddler’s master a new task, they have the confidence to conquer the next one ↑self-
esteem
The toddler who is eager to face challenges will dev more quickly than a reluctant one
Gross motor walks well, climbs stairs
Fine motor ↑ coordination, grasp and release
Gross Motor Skills
Large muscle groups are starting to strengthen
“toddler gait” doesn’t walk smoothly legs are planted wide apart, toes are pointed
forward, and toddler sways from side to side after 6 months, gait is smoother by 3 y/o
toddler walks in heel-to-toe fashion
toddler may fall often but will try to catch themselves parachute reflex
since they are just learning thoughts and feeling verbally, they will use physical actions to
express themselves running, jumping, hitting
Age Expected Gross Motor Skill Expected Fine Motor Skill
12-15 months Walks independently Feeds self finger foods
Uses index finger to point
18 months Climbs stairs w/assistance Masters reaching, grasping and releasing:
Pulls toys while walking stacks blocks, puts things in slots
Turns book pages
Removes shoes and socks (single if board
book, multiple if paper)
Stacks four cubes
24 months Runs Build tower of 6-7 cubes
Kicks ball Right or left handed
Can stand on tiptoe Imitates circular and vertical strokes
Carries several toys, or a Scribbles and paints
large toy while walking Starting to turn knobs
Climbs onto and down from Puts round pegs into holes
furniture w/o assistance
36 months Climbs wall Undresses self
Pedals tricycle Copies circle
Runs easily Builds tower of 9-10 cubes
Walks up and down stairs Holds pencil in writing position
w/alternate feet Screws/unscrews lids, nuts, bolts
about:blank 2/38
,11/19/23, 8:17 AM Exam 2 Pediatrics
Bends over easily w/o Turns book pages one at a time
falling
Adaptive Behaviors pg. 997
language young toddler begins to use short sentences and will progress to a vocab of 50
words by 2 y/o and understands over 200 words
o Echolalia repetition of words and phrases w/o understanding
o Telegraphic speech by 3 y/o speech that only contains essential words
personal-social ↑independence
Play parallel play 2 kids sitting in a sandbox scooping sand into their buckets, not
talking to each other. Not playing together, but doing the same thing they like toys that
make noise as toddlers
Nutrition pg. 1006
Forming healthy eating habits early is impt bc the child will continue these choices later in
life
Breastfeeding for at least 12 months then for as long as mutually agreeable btwn child and
mother breastfeeding into toddlerhood is beneficial nutritional, immunological, and
emotional benefits
Weaning from bottle should occur by 12-15 months prolonged use = dental caries
Physiologic anorexia due to slowed growth growth slows so they don’t eat as much, the
baby is fine. A fat baby is not a healthy baby
Will experience food jags may only prefer one particular food for several days, then not
want it again for weeks
Praise toddler for trying something new but never punish them for not wanting to try
something
Juice intake can lead to obesity in children, since they like the sweet taste, they drink
excessive amounts it also causes them to get full and they don’t eat their food
↓ calorie and protein needs
picky, fussy eater
use nutritious snacks, small portions, finger foods and a variety of food groups
Safety poisoning they see colorful cleaning products and want to get into them. Also,
don’t call medicine candy bc they’ll want to get into it
Adequate calcium intake and appropriate exercise lay the foundation for proper bone
mineralization avg of 500mg Ca/day dairy products are primary source of dietary Ca
Iron deficiency anemia in 1st 2 yrs of life is assoc w/dev and psychomotor delays child
stops getting nutrients needed from breast milk bc it’s replaced w/cow milk give iron
fortified cereals and other foods rich in iron and Vitamin C
Fat and cholesterol should not be restricted in children younger than 2 y/o growing
rapidly
Encourage toddlers to drink water limit juice 4-6 oz/day and milk 16-24 oz/day serve
milk/juice w/meals or snacks
Offer 3 full meals and 2 snacks/day ¼ of what an adult would eat
Parent provides food and toddler decides on how much to eat mouthing, and spitting out
food and eating it again is normal, don’t scold child
about:blank 3/38
, 11/19/23, 8:17 AM Exam 2 Pediatrics
Serve food at room temp and cut into small pieces
Toddlers most often eat with their fingers but they need to learn to use utensils provide
child-size utensils that are dull
Parental Concerns
Discipline
o Limit setting for safety and security
o Separate child from the behavior
o Teach right behavior if child takes something from someone, you need to teach
them who it belongs to and give it back
o Ignore temper tantrums
o Time-out more than 1-2 mins is too much, they don’t have maturity for it 30
seconds is best
o Avoid questions that cannot be answered yes/no they don’t understand much
more so keep answers simple
Toilet Training pg. 1013
When myelination of spinal cord is achieved around 2 y/o, toddler is capable of exercising
voluntary control over the sphincters
Parent should approach this in a calm, positive, nonthreatening manner initially may be
helpful for child to watch same sex parent using toilet
Start w/child fully clothed on potty while parent talks about what it’s used for/when
After a week or longer, remove dirty diaper and place contents into potty
Next, have toddler sit on potty w/o diaper/pants on
Definite need for physical, psychological, and language readiness
Praise success
If no success, wait don’t scold them for an accident, it evokes shame and doubt just
celebrate when they do it
Kids are afraid of falling in the toilet
Toddlers are ready when:
o Bowel mvmts occur on a fairly reg schedule
o They express knowledge of need to pee/poop could be through verbalization, chg
in activity, or gestures: looks into or grabs diaper, squats, crosses legs, grimaces
and/or grunts, hides behind a door or couch when defecating
o The diaper is not always wet (indicates ability to hold urine for a period of time)
o Willing to follow instructions
o Walks well alone and is able to pull their pants down
o Follows caregiver to bathroom
o Climbs onto the potty chair or toilet
Usually the best time to achieve success w/defecation is following a meal when they have
achieved success w/bowel control, bladder control will come next
It may be months before nighttime bladder control is achieved
After a couple of successful weeks, toddler can start wearing training pants when they
have an accident, gently remind them about toileting and let them help clean up , never
punish for accidents
about:blank 4/38
Exam 2 Peds
Growth & Dev of Toddlers pg. 992
Both physical growth and acquisition of new motor skills slow somewhat during toddler yrs
Height and weight continue to ↑ steadily but slower than infancy growth happens in
spurts rather than linearly step-like growth
Averages weight at 2 y/o is 26lbs and height is 34 inches
Dentition primary teeth in place (start to get teeth at 6 months) teach them to brush
their teeth and maybe floss, you’ll have to help them pg. 1010 read more
Avg toddler weight gain 1.36 to 2.27kg (3 to 5lbs)/year length/height ↑ an avg of 7.62
cm (3 inches)/year head circumference ↑ about 2.54 cm (1 in) and then ↑an avg of of
1.27 cm (0.5 in)/year until 5 y/o head size becomes more proportional to rest of body
near 3 y/o
Toddlers generally reach half their adult height by 2 y/o
Major Toddler Tasks
Differentiation of self from significant others
Tolerates separation from parent
Ability to withstand delayed gratification
Control over bodily functions
Acquisition of socially acceptable behavior
Verbal means of communication
Ability to interact w/others in a less egocentric manner
Speak 100-200 words
Physiological Systems
Myelination of the brain and spinal cord is usually complete around 24 months improved
coordination and ability to exercise sphincter control for bladder and bowel mastery
HR ↓ and BP ↑ in toddlerhood
Urine output should be 1 mL/kg/hr urethra still remains short making them for
susceptible to UTIs than adults (male and female)
↑ ability to maintain body temp body is becoming more proportional
they start to produce antibodies against infections
Psychosocial Development pg. 994
Erickson defines the toddler period as a time of autonomy versus shame and doubt it’s a
time of exerting independence
The toddler is struggling for self-mastery and to do for themselves what others have been
doing for them
They may quickly chg from happy and pleasant to crying and screaming
Exertion of independence results in toddler’s fav response “no” will answer “no” even if
they mean “yes”
Separation anxiety in a place can cope w/brief separation leave something important
to you w/the child “watch my sweater, don’t let anyone take it and I’ll be back”
Coping mechanisms
o Regression returns to prev behavior
about:blank 1/38
,11/19/23, 8:17 AM Exam 2 Pediatrics
o Ritualism maintains sameness will watch the same show over and over. Will
cry until you play the same one. It’s important to do things on a schedule, dinner
time, bed time, do things at the same time everyday
Motor Skill Development pg. 995
Walking progresses to running, climbing, and jumping
Pushing or pulling a toy, throwing a ball, and pedaling a tricycle are accomplished in
toddlerhood
Fine motor progress from holding and pinching to the ability to manage utensils dev
of hand-eye coordination
As toddler’s master a new task, they have the confidence to conquer the next one ↑self-
esteem
The toddler who is eager to face challenges will dev more quickly than a reluctant one
Gross motor walks well, climbs stairs
Fine motor ↑ coordination, grasp and release
Gross Motor Skills
Large muscle groups are starting to strengthen
“toddler gait” doesn’t walk smoothly legs are planted wide apart, toes are pointed
forward, and toddler sways from side to side after 6 months, gait is smoother by 3 y/o
toddler walks in heel-to-toe fashion
toddler may fall often but will try to catch themselves parachute reflex
since they are just learning thoughts and feeling verbally, they will use physical actions to
express themselves running, jumping, hitting
Age Expected Gross Motor Skill Expected Fine Motor Skill
12-15 months Walks independently Feeds self finger foods
Uses index finger to point
18 months Climbs stairs w/assistance Masters reaching, grasping and releasing:
Pulls toys while walking stacks blocks, puts things in slots
Turns book pages
Removes shoes and socks (single if board
book, multiple if paper)
Stacks four cubes
24 months Runs Build tower of 6-7 cubes
Kicks ball Right or left handed
Can stand on tiptoe Imitates circular and vertical strokes
Carries several toys, or a Scribbles and paints
large toy while walking Starting to turn knobs
Climbs onto and down from Puts round pegs into holes
furniture w/o assistance
36 months Climbs wall Undresses self
Pedals tricycle Copies circle
Runs easily Builds tower of 9-10 cubes
Walks up and down stairs Holds pencil in writing position
w/alternate feet Screws/unscrews lids, nuts, bolts
about:blank 2/38
,11/19/23, 8:17 AM Exam 2 Pediatrics
Bends over easily w/o Turns book pages one at a time
falling
Adaptive Behaviors pg. 997
language young toddler begins to use short sentences and will progress to a vocab of 50
words by 2 y/o and understands over 200 words
o Echolalia repetition of words and phrases w/o understanding
o Telegraphic speech by 3 y/o speech that only contains essential words
personal-social ↑independence
Play parallel play 2 kids sitting in a sandbox scooping sand into their buckets, not
talking to each other. Not playing together, but doing the same thing they like toys that
make noise as toddlers
Nutrition pg. 1006
Forming healthy eating habits early is impt bc the child will continue these choices later in
life
Breastfeeding for at least 12 months then for as long as mutually agreeable btwn child and
mother breastfeeding into toddlerhood is beneficial nutritional, immunological, and
emotional benefits
Weaning from bottle should occur by 12-15 months prolonged use = dental caries
Physiologic anorexia due to slowed growth growth slows so they don’t eat as much, the
baby is fine. A fat baby is not a healthy baby
Will experience food jags may only prefer one particular food for several days, then not
want it again for weeks
Praise toddler for trying something new but never punish them for not wanting to try
something
Juice intake can lead to obesity in children, since they like the sweet taste, they drink
excessive amounts it also causes them to get full and they don’t eat their food
↓ calorie and protein needs
picky, fussy eater
use nutritious snacks, small portions, finger foods and a variety of food groups
Safety poisoning they see colorful cleaning products and want to get into them. Also,
don’t call medicine candy bc they’ll want to get into it
Adequate calcium intake and appropriate exercise lay the foundation for proper bone
mineralization avg of 500mg Ca/day dairy products are primary source of dietary Ca
Iron deficiency anemia in 1st 2 yrs of life is assoc w/dev and psychomotor delays child
stops getting nutrients needed from breast milk bc it’s replaced w/cow milk give iron
fortified cereals and other foods rich in iron and Vitamin C
Fat and cholesterol should not be restricted in children younger than 2 y/o growing
rapidly
Encourage toddlers to drink water limit juice 4-6 oz/day and milk 16-24 oz/day serve
milk/juice w/meals or snacks
Offer 3 full meals and 2 snacks/day ¼ of what an adult would eat
Parent provides food and toddler decides on how much to eat mouthing, and spitting out
food and eating it again is normal, don’t scold child
about:blank 3/38
, 11/19/23, 8:17 AM Exam 2 Pediatrics
Serve food at room temp and cut into small pieces
Toddlers most often eat with their fingers but they need to learn to use utensils provide
child-size utensils that are dull
Parental Concerns
Discipline
o Limit setting for safety and security
o Separate child from the behavior
o Teach right behavior if child takes something from someone, you need to teach
them who it belongs to and give it back
o Ignore temper tantrums
o Time-out more than 1-2 mins is too much, they don’t have maturity for it 30
seconds is best
o Avoid questions that cannot be answered yes/no they don’t understand much
more so keep answers simple
Toilet Training pg. 1013
When myelination of spinal cord is achieved around 2 y/o, toddler is capable of exercising
voluntary control over the sphincters
Parent should approach this in a calm, positive, nonthreatening manner initially may be
helpful for child to watch same sex parent using toilet
Start w/child fully clothed on potty while parent talks about what it’s used for/when
After a week or longer, remove dirty diaper and place contents into potty
Next, have toddler sit on potty w/o diaper/pants on
Definite need for physical, psychological, and language readiness
Praise success
If no success, wait don’t scold them for an accident, it evokes shame and doubt just
celebrate when they do it
Kids are afraid of falling in the toilet
Toddlers are ready when:
o Bowel mvmts occur on a fairly reg schedule
o They express knowledge of need to pee/poop could be through verbalization, chg
in activity, or gestures: looks into or grabs diaper, squats, crosses legs, grimaces
and/or grunts, hides behind a door or couch when defecating
o The diaper is not always wet (indicates ability to hold urine for a period of time)
o Willing to follow instructions
o Walks well alone and is able to pull their pants down
o Follows caregiver to bathroom
o Climbs onto the potty chair or toilet
Usually the best time to achieve success w/defecation is following a meal when they have
achieved success w/bowel control, bladder control will come next
It may be months before nighttime bladder control is achieved
After a couple of successful weeks, toddler can start wearing training pants when they
have an accident, gently remind them about toileting and let them help clean up , never
punish for accidents
about:blank 4/38
