Average achievements of a toddler 18 months

04/12/2023 St.Phn MBARUKU SAID

AVERAGE ACHIEVEMENTS OF A TODDLER 18 MONTHS

PHYSICALAnterior fontanel closed - may be closed as early as 12

monthsAbdomen protrudes

Physiological anorexia due to decreased growthHas sphincter control

MOTOR

Walks-seldom falls-sideways and backwardCan walk upstairs holding with one hand

Can attempt jumping


Av of toddler 18month cont…

Sits self in small chair Climbs on furniture Gets into everything, explores drawers

even waste baskets Pushes light furniture around room Throws ball overhead without falling Scribbles vigorously Turns pages in a book Can put things into a hole


Av of18month cont….

SELF CARE Holds cup with both hands and can hand

it to care giver, put it down or drops it. Eats with spoon and turns spoon in

mouth Spills frequently May play with food Negativism and high activity level May interfere with eating


Av of 18 month cont…

Removes and unzips simple garments Complains when wet May indicate need to toilet Increased readiness for bowel and

bladder control May control bowel movement May smear feces


Av of 18 moth cont…

SENSORY Intense interest in pictures Identifies various shapes PSYCHOSOCIAL Sense of autonomy (a feeling of independence) Egocentric Autonomous behavior increasing Negativism and dawdling predominant Have temper tantrums Aware of strangers


Av of 18 monthcont…

Seeks help when in trouble May resist to sleep for sometime Bed rituals begins Imitates parents behavior Possessiveness begins Gender identity begins INTELLECTUAL Is comfortable when hearing parents voice Short attention span Begins sense of time and anticipation of events Begins to think Beginning traces of memory Experiments actively to achieve goals



LANGUAGE Speaks an average of 10 real words Name pictures Uses words than gestures to express desire About 25% of vocalization is intelligible PLAY STIMULATION Enjoys solitary play or watching activities of

others Has a favorite toy


Av of 18month cont..

Provide: For motor play Large hollow wooden blocks Balls Pull toys Low swing with arms and back Low slide Rocking chair or horse Low wheeled toys to ride Small chair and table Running and chasing games



For creative play Container with openings into which blocks of

different shapes can be placed Blocks, bowls, tumblers Finger paints Large crayon Clay Bells around wrist or ankle Sand toys (shovels, pail) Stuffed animals and dolls to drug, sit upon or hug Imitates parental actions in play


AVERAGE ACHIEVEMENTS OF A TODDLER 24 MONTHS (2 YEARS)

PHYSICAL Weight approximately 11.8-12.7 kg Height approximately 82.5 -85 cm Gained 10 -12 cm in second year Adult height is about twice height at 2 years Chest circumference exceeds head

circumference Anterior posterior diameter less than lateral

diameter Head circumference 49-50 cm Pulse 110 + 20 –average 100 beats/minute


AV of 24month cont…

Respiration 26-28/minute Blood pressure 99/64 + 26/24 Landau reflex completely disappeared Approximately has 16 temporary teeth Physiologic function is mature except

endocrine and reproductive Abdomen protrudes less than in 18

months May control daytime bowel and bladder


Av 24month cont…

MOTOR Can walk with heel toe gait Walks backwards in imitation Runs more quickly with few falls Jumps Kicks large ball Builds tower of 6-7 cubes Makes cubes into a train Turns pages of a book one at a time Opens door by turning knob May run away Unscrews lid or jar Folds paper once (imitating)


Av 24 month cont…

SELF CARE Drinks well from a small glass held in one

hand Puts spoon in mouth occasionally with one

hand Plays with food Can use a straw May request certain foods Pulls on own simple garments Removes most of own clothing Verbalizes toilet needs


Av 24 month cont…

Usually bowel trained with occasional accidents Usually urinates when taken to toilet Toilet trained in day time May still smear stool May brush teeth with help Attempts to wash self in tub or shower SENSORY Accommodation well developed Inserts square objects into its appropriate place or

hole May develop strabismus (squint)


Av 24 month cont…

PSYCHOSOCIAL Sense: Has sense of autonomy Still egocentric in both thought and behavior Separation anxiety continues Shows early signs of individuality Independent from care giver Is possessive (mine not yours) Does want to share possessions May push other children as if they are objects

out of his way May want to make friends but doesn’t know how


Av 24 month cont…

Pulls other persons to show them something Does not want to sleep so has many

demands before bed time Upset by changes in routine Thumb sucking decreased Focuses on own wishes Violent temper tantrums decreasing PSYCHOSEXUAL Anal stage


Av 24 month cont…

INTELLECTUAL OR COGNITIVE Attention span is longer Memory increases Starts to understand past present and

future Increased sense of time- can anticipate

events and can wait for them. Can pretend


Av 24 month cont…

LANGUAGE Understands more complex sentences Can obey 2 commands given at the same time Enjoys stories with pictures No longer use jargon Knows about 300 words Refers to self by first name Uses pronouns I, me, mine Asks what’s, who’s that Tells about immediate experiences Identifies familiar objects Verbalizes need for drink, food and toileting May use the word now meaningfully About 66% of vocalization are intelligible


Av 24 month

PLAY AND STIMULATION Little social interaction with other children Begins to learn to replace toys in their proper

place Frequently idle (dawdles) Pulls wagon Manipulates play materials such as clay, finger

paints, brush paints Sings songs Needs large puzzles and toys to take apart Enjoys hearing stories with pictures


Av 24 month cont..

Takes favorite toys to bed Mimic domestic activities of parents Enjoys playing with dolls


AVERAGE ACHIEVEMENTS OF A TODDLER AT 30 MONTHS

PHYSICAL Weight –gains about 5kg between 1 and

3 years Weight is quadrupled Height increases about 6-8 cm during the

third year Has a full set of 20 temporary teeth Daytime bowel and bladder control

possibly established


Av at 30 month cont…

MOTOR Can stand on one foot momentarily Walks on tiptoe for few steps upon request Walks up and down stairs one foot on a

step alternating feet Jumps well in place with both feet off the

floor Jumps fro step or low chair Can throw a large ball 4-5 feet Can ride a walker or pedal car


Av at 30month cont…

Builds a tower of 8 cubes Adds chimney to train or cubes Imitates circular strokes Holds crayon with fingers instead of entire

hand Good hand-finger coordination SELF CARE Can feed himself with occasional spilling Pours from a jug often spilling Gets a drink without assistance



Distinguishes between finger and spoon food Chews with mouth closed DRESSING Puts arm through large arm hole Buttons a large front button Unbuttons large front buttons Helps to put things away TOILET AND GROOMING Mastery of daytime bowel and bladder control May go to the toilet himself



Control bowel at 26 months -Controls urination 30 months Needs assistance with wiping Attempts to wash hands adequately Can partially dry hands upon reminder SENSORY Recalls visual images


Av at 30 month cont..

PSYCHOSOCIAL Sense of autonomy (1-3 years) Theoretically autonomy is achieved at the

end of toddler period. If it is not achieved a sense of shame and doubt predominates

Still egocentric Learns to cope with separation anxiety Independent behavior increases Achieves some self control based on self

esteem rather than fear


Av at30 month cont…

Reluctant to go to bed Negativism and dawdling continue Temper tantrums may or may not

decrease Imitates sex role behavior of adults Knows own sex PSYCHOSEXUAL Anal stage (1-3 years)


Av at 30 month cont..

INTELLECTUAL Concept of time still limited Begins causal thinking Problem solving through trial and error LANGUAGE Identifies five body parts when named Gives full name (first and last) if asked Uses appropriate pronoun when referring to self “I” Uses plurals and past tense of verbs Talks constantly



Asks why Uses 4-5 word sentences About 75 % of vocalizations are intelligible PLAY STIMULATION Helps to put things away Pretends in play Motor play Pushes and steers toys well



Needs Large cars Trucks Cardboard boxes Block trains that interlock Carries breakable objects



CREATIVE PLAY They need: Clay Finger paints Large crayons Large wooden puzzles Sand box toys String to string beads or lace large shoes Bright colored construction Paper to fold or cut with blunt scissors


AV at 30 month cont…

Quiet play Cloth or cardboard books Toys for water play DRAMATIC PLAY Baby doll and doll equipment Toys for house keeping such as small broom and dust cloth Play telephone The toddler’s curiosity may lead the child into danger for

example: Motor vehicle accidents Bath tub drowning Hot fluid scalding



Electric shock leading to death Poisonous substances can kill the toddler Drugs can also kill or overdose Kerosene can kill Try as much as possible that all these are

out of reach of children


THE GENERAL NEEDS OF A TODDLER

The basic needs of a toddler are: Love and security Discipline leading to self control Progression to independence Achievement of control of bodily

functions Nutrition Accident prevention


General needs cont…

Love and security Parental love should be constant,

unconditional and openly expressed even when the child is misbehaving

This type of love enables the toddler to grow and to reach out for more mature goals since the child feels loved and secure, the frustrations everyone endures in the process of maturation can be handled


GENERAL NEEDS CONT…

Both boys and girls give their first love to their primary caregiver usually the mother, when the father gives the same care as the mother the toddler generally feels attached to and secure with both parents

Toddlers may develop separation anxiety if the primary caregiver leaves them alone for example in a nursery school or hospital

This is evidenced by: Restlessness Hyperactivity Depression manifested by crying and withdrawal



Regression to earlier modes of behavior (Regression is returning to an earlier or

former state or type of behavior) The parents should understand that such

behaviors are normal Toddlers who are attempting to achieve

autonomy may become overwhelmed by separation anxiety when the parents attention is diverted from them to a new sibling or when they enter nursery school or are admitted to a hospital thus they regress



They may return to earlier behaviors such as demanding to drink from a nursery bottle, refusing to cooperate in toilet training and loosing the various skills that they tried so hard to achieve

The best way to handle a child’s regression is simply to ignore it.



Discipline leading to self control Proverbs 22:6 “Teach a child to choose the right path and

when he is older he will remain upon it.” Discipline means establishing and adhering to

standards of behavior for the toddler with the goal of self control

It includes Setting of limits (rules and guidelines) These must be set on the daily behavior of

children if they feel secure


General needs cont …

Reinforcement of approved behavior by deepening this trusting bond between parents and child is preferred over material rewards.

Constructive discipline helps the child to better behaved and happier

Qualities of constructive discipline Consistency Clarity Firmness- parents must mean what they say and say

what they mean Immediacy Encouragement of independence



Disciplinary action A loving reward is more consistently

effective in disciplining a child than punitive actions BUT:

Punishment is a useful tool if used with discretion

Punishment should be given privately and with respect



Examples of punishment Physical punishment Explaining or reprimanding Disregarding or ignoring- This should be avoided if there

is danger of physical harm to the child Taking time out- this means that the child is removed

from any positive reinforcement when misbehavior occurs

Instead of the parents giving a scolding or spanking for

unwanted behavior the child is placed in a boring situation for a specified period of time. No playing is permitted

This will be perceived as a punishment


General needs cont….

The toddler ultimately gives up the misbehavior in order to return to the family group

Outcomes of discipline Parents must define reality for their children and through

guidance and discipline, help them in their striving for maturity

Types of parents who fail in this period Those that are over demanding and insist upon perfection in

behavior This causes intense anxiety and guilt in their children Those who set no limits or over permissive These fail to provide security and help to their children to

learn to live harmoniously in society


General needs ont…

Those who provide inconsistent discipline These make their children to find difficulties to develop

stable behavioral control and values Among the procedures for discipline the safest is the use

of time out or isolation Disciplinary action may sometimes be necessary but

remember children still need compassion, understanding and respect for their developing independence

DEPENDENCE PROGRESSING TO INDEPENDENCE IN SELF

CARE By the time children reach 3 years of age they are

beginning their journey to independence in self care



Children learn to care for themselves initially by attempting to imitate the actions of their parents and siblings

The achievements in self care includes Feeding Dressing Toilet Grooming



ACHIEVING CONTROL OF BODILY FUNCTIONS Achieving control of bodily functions of

defecation and urination is one of the major tasks of the toddler period

The relative importance of this achievement depends on the culture and the socioeconomic status of the child’s family.

In some groups, toddlers do not wear nappies or pants and are permitted to move through the home and environment excreting at will. In these families toilet training is not emphasized so the children in effect must train themselves



Process of toilet training The parents record the times the child eliminates

for several days This record provides the toddlers own schedule for

training that is when it is appropriate to place the child on a comfortable child sized toilet sit or potty chair

The potty chair should be used only in the toilet room or bathroom so that the act of excretion is associated with this one location

The parents take the child to the bathroom and calmly explain in simple language what is to be done.



Specific words that are widely understood to indicate the acts of defecation and urination are used

The parents stay with the toddler during the entire process.

Do not allow the child to play at this time The accidents that occur during the

process of toilet training should be ignored A two year old toddler is generally toilet

trained in the day time


General needs cont…..

The 21/2 years old may have begun to master night time bladder control however accidents are common

Night time bladder control may not be complete until the child is 4-5 years of age

Fecal smearing This behavior occur between the ages 15-18

months The desire to smear may be sublimated by

providing clay, damp sand and mud



The 21/2 years old may have begun to master night time bladder control however accidents are common

Night time bladder control may not be complete until the child is 4-5 years of age

Fecal smearing This behavior occur between the ages 15-18

months The desire to smear may be sublimated by

providing clay, damp sand and mud



Therefore avoid shaming and ridicule A young child who is categorized as being

“good” or “bad” usually lives up to the appropriate expectation.

The child’s own effort also promotes or reduces self esteem

Patience and persistence are necessary in helping children develop self esteem as they become able to cope with life in their world



PLAY AND STIMULATION Functions of play: Play during the toddler period stimulates all

areas of growth and development The social importance of play increases as the

child grows Active play encourages gross and fine muscle

development-surplus energy is worked off When playing besides and watching others they

seem to want to be friendly but at this time their social skills are inadequate so adult supervision is necessary



Play assist the toddler to fully develop the concept of object permanence

They develop very early understanding of moral values They learn differentiate between right and wrong when

they are taught not to hurt others in play They develop language and speech when they talk to

toys, pets, others parents Reading and singing to child helps Negative feelings and tensions can be released in an

approved way for example an angry child can find relief by pounding soft balls or begs through holes in a board or tossing bean bags



PLAY RESPONSES In early toddler period play is free and

spontaneous They are in most cases destructive They normally claim their own toys by

saying “mine, mine” They learn sharing later Do not encourage them to give up their

toy until later on.



PLAY RESPONSES In early toddler period play is free and spontaneous They are in most cases destructive They normally claim their own toys by saying “mine,

mine” They learn sharing later Do not encourage them to give up their toy until later

on. NUTRITION Nutritional intake include the essential nutrients in the

amount necessary for maintenance, replacement and growth of tissue and for energy



They are usually 3 well spaced small meals with in between nutritious snacks each day.

Toddlers need less food per unit of body weight during the second year of life than infants because the growth rate is less rapid.

At about 18 months toddlers develop what is known as physiological anorexia

If inadequate amounts of vitamins and minerals especially iron are not obtained in the diet because of the anorexia supplements can be prescribed

Children may prefer playing than eating, so take care of the meal times



ACCIDENT PREVENTION Accidents are the largest single cause of mortality

and disability between the ages of 1-4 years Accidents include Motor vehicle accidents Drowning Burns Suffocation Falls Poisoning Other injuries e.g. cuts



When parents understand their child’s level of growth and development they can predict the hazardous situations that may result in an accident then judge how much responsibility the child can assume for self protection

If the child is injured accidentally point to the child the cause of the accident and it will be a lesson to the child.

Average achievements of a toddler 18 months

Health & Medicine

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