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Toddler Development

Toddlerhood consists of the years from about 1 to 3 years of age. Dramatic advances occur in language, interpersonal skills, and affective, motor, cognitive and physical growth. Affective development is highlighted by the toddler's striving for autonomy and independence, attachment to family, and the development of impulse control.

Growth Rate and Physical Appearance

After the rapid growth of infancy, the rate of growth slows in the toddler years. After age 2, toddlers gain about 5 lb in weight and 2.5 inches in height each year. Head circumference only increases by about 1 inch from 2 to 12 years. Growth often occurs in spurts.

Growth of the lower extremities often is accompanied by tibial torsion and physiologic bowing of the legs, which usually corrects by age 3 years. The percentage of body fat steadily decreases from 22% at age 1.

Gross Motor Skills

Complex gross motor patterns rapidly develop, and balance and coordination improve. Most children walk without assistance by 18 months.

At 2 years, the stiff, wide-leg gait of early toddlerhood becomes a flexible, steady walking pattern, with heel-toe progression.

Gross Motor Abilities

18 Months

Walking fast, seldom falling

Running stiffly

Walking up stairs with one hand held

Seating self in a small chair

Climbing into an adult chair

Hurling a ball

24 Months

Running well without falling

Walking up and down stairs alone

Kicking a large ball

36 Months

Walking up stairs by alternating feet

Walking well on toes

Pedaling a tricycle

Jumping from a step

Hopping two or three times

Fine Motor Skills

Fine motor development during toddlerhood consists of refinements in reaching, grasping, and manipulating.

The 18-month-old can make a tower of four blocks. One year later, he can stack eight blocks. Most 18-month-olds will hold the crayon in a fist and scribble spontaneously.

Fine Motor Abilities

18 Months

Making a tower of four cubes

Releasing 10 cubes into a cup

Scribbling spontaneously

Imitating a vertically drawn line

24 Months

Building a seven cube tower

Aligning two or more cubes to form a train

Imitating a horizontally drawn line

Beginning circular strokes

Inserting a square block into a square hole

36 Months

Copying a circle

Copying bridges with cubes

Building a tower of 9 to 10 blocks

Drawing a person's head

 

Affective Development

Autonomy and Independence

Because of improved motor skills, the transition from infancy to toddlerhood is marked increased autonomy and independence. The child can move easily away from the parent and begins to test boundaries and limits.

The toddler may refuse to eat unless allowed to feed himself, and the child may no longer may be willing to try new foods.

Impulse Control. Toddlers begin to develop impulse control. The 18-month-old may have minimal impulse control and display several temper tantrums each day. Most 3-year-olds have some degree of self-control.

Successful toileting usually occurs toward the end of the third year when the child becomes able to control his sphincter, undress, get onto the potty, and has the willingness to participate. Although toilet training may be introduced at an earlier age, success with consistent daytime dryness usually is not achieved until about 2.5 years of age.

Social/Emotional Skills

18 Months

Removing a garment

Feeding self and spilling food

Hugging a doll

Pulling a toy

24 Months

Using a spoon; spilling little food

Verbalizing toileting needs

Pulling on a simple garment

Verbalizing immediate experiences

Referring to self by name

36 Months

Showing concern about the actions of others

Playing cooperatively in small groups

Developing the beginnings of true friendships

Playing with imaginary friends

Attachment

Attachment refers to the bond that forms between the infant and the caregiver.

Disorders of attachment may result from inconsistent caregiving and are more common in the presence of poverty, drug use, or emotional illness. Affected toddlers may not show interest in exploring the environment.

Temperament determines how a child approaches a given situation. Ten percent of children are less adaptable and tend to be emotionally negative and are considered "difficult". About 40% of children are "easy," having regular eating and sleeping schedules, adapting well to new situations, and having positive moods. About 15% of toddlers are "slow-to-warm-up," and they are quiet and take longer to adapt to new situations.

Cognitive Development

Toddlerhood is characterized by a transition from sensorimotor to preoperational thinking. During the sensorimotor period, the infant primarily learns about the world by touching, looking, and listening. Preoperational thought is marked by the development of symbolic thinking, as the child becomes capable of forming mental images and begins to solve problems by mental trial and error.

Intellectual Abilities

18 Months

Pointing to named body parts

Understanding of object permanence

Beginning to understand cause and effect

24 Months

Forming mental images of objects

Solving problems by trial and error

Understanding simple time concepts

36 Months

Asking "why" questions

Understanding daily routine

Appreciating special events, such as birthdays

Remembering and reciting nursery rhymes

Repeating three digits

Language

Beginning around age 2 years, toddlers use language to convey their thoughts and needs (eg, hunger). The 18-month-old has a vocabulary of at least 20 words, consisting primarily of the names of caregivers, favorite foods, and activities, he may be starting to put two words together.

After 18 months the toddler begins to put together phrases. Early two and three word sentences.

Language Skills

18 Months

Looking selectively at a book

Using 10 to 20 words

Naming and pointing to one picture card

Naming an object (eg, ball)

Following two-directional commands

24 Months

Using two to three word sentences

Using "I," "me," "you"

Naming three picture cards

Naming two objects

Knowing four-directional commands

36 Months

Using four to five word sentences

Telling stories

Using plurals

Recognizing and naming most common objects

Developmental Monitoring and Anticipatory Guidance

When developmental surveillance suggests delay, a screening test is necessary. When the screening test confirms delay, the clinician should refer the child for a more extensive developmental assessment.

Anticipatory Guidance

During the 12-month visit, the pediatrician should explain that the child soon will begin to experience struggles over autonomy.

More frequent temper tantrums can be expected in the second year of life as the toddler encounters frustration.