Information

Toddlers are children ages 1 - 3.

THEORIES

Jean Piaget, in the cognitive (thought) development theory, includes the following:

Early use of instruments or tools
Following visual (then later, invisible) displacement (moving from one place to another) of objects
Understanding that objects and people are there even if you can't see them (object and people permanence)

Erik H. Erikson's personal-social development theory says the toddler stage represents Autonomy (independence) vs. Shame or Doubt. The child learns to adjust to society's demands, while trying to maintain independence and a sense of self.

These milestones are typical of children in the toddler stages. Some variation is normal. If you have questions about your child's development, contact your health care provider.

PHYSICAL DEVELOPMENT

The following are signs of expected physical development in a toddler:

GROSS MOTOR SKILLS (use of large muscles in the legs and arms)

Stands alone well by 12 months
Walks well by 12 - 15 months (if the child is not walking by 18 months, he or she should be evaluated by a health care provider)
Learns to walk backwards and up steps with help at about 16 - 18 months
Throws a ball overhand and kicks a ball forward at about 18 - 24 months
Jumps in place by about 24 months
Rides a tricycle and stands briefly on one foot by about 36 months

FINE MOTOR SKILLS (use of small muscles in hands and fingers)

Makes tower of three cubes by around 15 months
Scribbles by 15 - 18 months
Can use spoon and drink from a cup by 24 months
Can copy a circle by 36 months

LANGUAGE DEVELOPMENT

Uses 2 - 3 words (other than Mama or Dada) at 12 - 15 months
Understands and follows simple commands ("bring to Mommy") at 14 - 16 months
Names pictures of items and animals at 18 - 24 months
Points to named body parts at 18 - 24 months
Begins to say his or her own name at 22 - 24 months
Combines 2 words at 16 to 24 months -- there is a range of ages at which children are first able to combine words into sentences; if a toddler cannot do so by 24 months, parents should consult their health care provider
Knows gender and age by 36 months

SOCIAL DEVELOPMENT

Indicates some needs by pointing at 12 - 15 months
Looks for help when in trouble by 18 months
Helps to undress and put things away by 18 - 24 months
Listens to stories when shown pictures and can tell about immediate experiences by 24 months
Can engage in pretend play and simple games by 24 - 36 months

BEHAVIOR

Toddlers are always trying to be more independent. This creates not only special safety concerns, but discipline challenges. The child must be taught -- in a consistent manner -- the limits of appropriate vs. inappropriate behavior.

When toddlers try out activities they can't quite do yet, they can get frustrated and angry. Breath-holding, crying, screaming, and temper tantrums may be daily occurrences.

It is important for a child to learn from experiences and to be able to rely on consistent boundaries between acceptable and unacceptable behaviors.

SAFETY

Toddler safety is very important.

It is important for parents to recognize that the child can now walk, run, climb, jump, and explore. This new stage of movement makes child-proofing the home essential. Window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features are essential.
As during the infancy period, place the toddler in a safety restraint (toddler car seat) when riding in a car.
Do not leave a toddler unattended for even short periods of time. Remember, more accidents occur during the toddler years than at any other stage of childhood.
Introduce and strictly stick to rules about not playing in streets or crossing without an adult.
Falls are a major cause of injury. Keep gates or doors to stairways closed, and use guards for all windows above the ground floor. Do not leave chairs or ladders in areas that are likely to tempt the toddler into climbing up to explore new heights. Use corner guards on furniture in areas where the toddler is likely to walk, play, or run.
Childhood poisonings are a frequent source of illness and death during the toddler years. Keep all medications in a locked cabinet. Keep all toxic household products (polishes, acids, cleaning solutions, chlorine bleach, lighter fluid, insecticides, or poisons) in a locked cabinet or closet. Many household plants may cause illness if eaten. Toad stools and other garden plants may cause serious illness or death. Get a list of these common plants from your pediatrician.
If a family member owns a firearm, make sure it is unloaded and locked up in a secure place.
Keep toddlers away from the kitchen with a safety gate, or place them in a playpen or high chair. This will eliminate the danger of burns from pulling hot foods off the stove or bumping into the hot oven door.
Toddlers love to play in water, but should never be allowed to do so alone. A toddler may drown even in shallow water in a bathtub. Parent-child swimming lessons can be another safe and enjoyable way for toddlers to play in water. Never leave a child unattended near a pool, open toilet, or bathtub. Toddlers cannot learn how to swim and cannot be independent near any body of water.

PARENTING TIPS

The toddler years are the time to begin instilling values, reasoning, and incentives in the child, so that they learn accepted rules of behavior. It is important for parents to be consistent both in modeling behavior (behaving the way you want your child to behave),and in addressing appropriate versus inappropriate behavior in the child. Recognize and reward positive behavior. You can introduce time-outs for negative behavior, or for going beyond the limits you set for your child.
The toddler's favorite word may seem to be "NO!!!" It is important for parents not to fall into a pattern of negative behavior with yelling, spanking, and threatening of their own.
Teach children the proper names of body parts.
Stress the unique, individual qualities of the child.
Teach concepts of please, thank you, and sharing with others.
Read to the child on a regular basis -- it will enhance the development of verbal skills.
Toddlers thrive on regularity. Major changes in their routine are challenging for them. Toddlers should have regular nap, bed, snack, and meal times.
Toddlers should not be allowed to eat many snacks throughout the day. Multiple snack times tend to suppress their appetite for regular meals, which tend to be more balanced.
Travel and guests can be expected to disrupt the child's routine and make them more irritable. The best responses to these situations are reassurance and reestablishing routine in a calm way.

References

Feigelman S. The second year. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 9.

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