MARTERNAL CHILD HEALTH CARE 2633 - 30 NURSING
CARE OF A FAMILY WITH A TODDLER LATEST UPDATED
STUDY GUIDE 2026
During the toddler period, the age span from 1 to 3 years, enormous changes take place
in a child and, consequently, in a family. During this period, children accomplish a wide
array of
developmental tasks and change from largely immobile and preverbal infants who are
dependent on caregivers for the fulfillment of most needs to walking, talking young
children with a growing sense of autonomy (independence). To match this growth,
caregivers must also change during
this period. The caregiver task in this period is to support the child’s growing
independence by letting the child experiment with toys or other activities. Because
healthy children and families are constantly being challenged by the process of normal
development, caregivers often have questions about how to guide their child in
different situations and how to cope with special
needs and concerns relevant to this age (Kliegman et al., 2020). Box 30.1 shows
Healthy People 2030 goals that speak to the toddler age group.
Nursing Process Overview FOR HEALTHY DEVELOPMENT OF A TODDLER
ASSESSMENT
Whether a child is seen for a routine checkup or has come to a healthcare center
because of a
specific health concern, assessment begins with a careful health history. Asking about a
toddler’s ability to carry out activities of daily living offers not only assessment
information on the child’s developmental progress but also important clues about the
child–parent relationship. Because
parents see their child daily, they are the best source of information and opinion on
when a child seems to be acting “out of sorts” or “different” (a typical sign a child may
not be feeling well). Careful observation is another crucial element of the nursing
assessment of a toddler, although toddlers may not show typical behavior at a
healthcare visit (e.g., may not talk, may cling to a
parent instead of demonstrating walking).
NURSING DIAGNOSIS
Nursing diagnoses related to growth and development of toddlers usually focus on the
parents’ eagerness to learn more about the parameters of normal growth and
development or issues of safety or care. Examples include: Health-seeking behaviors
related to normal toddler
development Knowledge deficiency related to the best method of toilet training Injury
risk related to impulsiveness of the toddler Impaired family process related to need for
close
supervision of 2-year-old child Health-seeking behaviors for improved family coping
related to the parents’ ability to adjust to the new needs of the child Intake of nutrients
more than needed
related to food choices Sleep deprivation related to lack of bedtime routine
OUTCOME IDENTIFICATION AND PLANNING
To help caregivers resolve a concern during the toddler period, focus on family
education and
anticipatory guidance. Urge caregivers to establish realistic goals and outcomes so they
,can meet the rapidly changing needs of their toddler and learn to cope with typical
toddler behaviors.
IMPLEMENTATION
When teaching about typical toddler behavior, teach caregivers that a good rule is to
think of a toddler as a visitor from a foreign land who wants to participate in everything
the family is doing but doesn’t know the customs or the language. Teach caregivers how
to approach a current
problem but also how to learn adequate methods for resolving similar situations that
are sure to arise in the future. Health visits provide opportunities to help caregivers
learn healthier coping techniques as well as to demonstrate effective communication
skills with the child.
OUTCOME EVALUATION
Expected outcomes must be evaluated frequently during the toddler period
because children change so much and learn so many new skills during this time
that their abilities can change from day to day. Examples of expected outcomes
include: The child maintains a consistent
bedtime routine within the next 2 weeks. Caregivers state they have childproofed their
home by putting a lock on kitchen cabinets by the next clinic visit.
Nursing Assessment of a Toddler’s Growth and Development
An assessment of a toddler begins with the child’s physical growth and skill
development. Box
30.2 describes a typical toddler appearance. Table 30.1 provides some guidelines to
help parents evaluate illness at this age.
TABLE 30.1 PARENTAL DIFFICULTIES IN EVALUATING ILLNESS IN TODDLERS
Problem Guidelines for Parents Evaluating seriousness of illness Toddlers typically
answer “no” to almost all questions; therefore, a question such as “Does your arm
hurt?” may bring a “no”
response even if an arm does hurt. Observing children for indications of illness (e.g.,
holding an arm stiffly, rubbing abdomen, crying when they void) is more helpful. Many
toddlers do not know the words to describe a feeling of nausea or a sore throat. They
reveal these symptoms by not eating. If the child is normally a light eater, as many are,
it is difficult for a parent to
appreciate these signs. Differentiating tiredness from illness Toddlers tend to whine or
sleep when they are either tired or ill. Reviewing the child’s day and activities often helps
to evaluate what is happening. If the child is not tired (it is not nap- or bedtime) or if
there is not a break in usual routine, crying and whining or temper tantrums suggest
illness. Evaluating nutritional
intake Toddlers are normally fussy eaters compared to infants. Evaluating children as to
whether they are active and growing is better than assessing any one day’s food
intake. Age-specific
diseases to be aware of The toddler period is an important age to assess speech
development; children should be further evaluated if they cannot use simple sentences
composed of a noun or pronoun and verb (“me go”) by 2 years of age. As children
begin to walk, they should be
observed for an abnormal gait. Osteomyelitis (bone infection) occurs with a high
frequency in toddlers; symptoms including limping, swollen joints, or arm or leg pain
should be regarded as
serious until ruled otherwise. Toddlers contract 10–12 mild upper respiratory infections
(URIs) a year. Otitis media (middle ear infection) may occur as a complication of URIs.
, The child with an URI who suddenly develops a high fever and pulls or manipulates
their ears should be seen by a primary care provider, as they may have an ear
infection. Children who attend childcare
programs have a higher incidence of hepatitis A, Giardia, and Shigella infections.
Teach parents to report jaundice or diarrhea promptly to a healthcare provider to
detect these infections.
PHYSICAL GROWTH
Although toddlers are making great strides developmentally, their physical growth
begins to slow.
Weight, Height, Head Circumference, and Body Mass Index
Plot weight and height on a standard growth chart for toddlers (available at ) at each
healthcare visit to determine if progress is normal for that individual child. If a child is
not yet walking,
continue to measure height with the child lying down. A child gains only about 5 to 6 lb
(2.5 kg) and 5 in. (12 cm) a year during the toddler period, much less than the rate of
growth during the infant year. As subcutaneous tissue, or baby fat, begins to disappear
toward the end of the second year, the child changes from a plump baby into a leaner,
more muscular child. A toddler’s
appetite decreases accordingly, yet adequate intake of all nutrients is still essential to
meet energy needs (Riley et al., 2018). Head circumference increases only about 2 cm
during the second year compared to about 12 cm during the first year. Head
circumference equals chest circumference at 6 months to 1 year of age. By 2 years of
age, chest circumference should have grown greater
than that of the head. Body mass index (BMI) screening is completed at 24 months to
identify toddlers who are overweight or underweight. A good website to calculate a
child’s BMI is
available via the Centers for Disease Control and Prevention (CDC)
(https://www.cdc.gov/healthyweight/bmi/calculator.html).
Body Contour
Toddlers tend to have a prominent abdomen because, although they are walking well,
their
abdominal muscles are not yet strong (see Fig. 30.1A). They have a forward curve of
the spine at the sacral area (lordosis) that will correct itself naturally. Many toddlers
waddle or walk with a wide stance (see Fig. 30.1B).
Body Systems
Body systems continue to mature during this time. Respirations slow slightly but
continue to be mainly abdominal. Heart rate slows from 110 to 90 beats per minute.
Blood pressure increases to about 99/64 mm Hg. The brain develops to about 90% of its
adult size. In the respiratory system, the lumens of vessels enlarge progressively, so the
incidence of lower respiratory infection
decreases. Stomach secretions become more acidic. Stomach capacity increases to
the point that a child can eat three meals a day. Control of the urinary and anal
sphincters becomes possible with complete myelination of the spinal cord, so toilet
training is possible. Immunoglobulin (Ig)G and IgM antibody production becomes
mature at 2 years of age. Passive immunity
obtained during intrauterine life is no longer operative.
Teeth
Eight new teeth (the canines and the first molars) erupt during the second year. All 20
deciduous teeth are generally present by 2.5 to 3 years of age (Kliegman et al., 2020).
DEVELOPMENTAL MILESTONES
CARE OF A FAMILY WITH A TODDLER LATEST UPDATED
STUDY GUIDE 2026
During the toddler period, the age span from 1 to 3 years, enormous changes take place
in a child and, consequently, in a family. During this period, children accomplish a wide
array of
developmental tasks and change from largely immobile and preverbal infants who are
dependent on caregivers for the fulfillment of most needs to walking, talking young
children with a growing sense of autonomy (independence). To match this growth,
caregivers must also change during
this period. The caregiver task in this period is to support the child’s growing
independence by letting the child experiment with toys or other activities. Because
healthy children and families are constantly being challenged by the process of normal
development, caregivers often have questions about how to guide their child in
different situations and how to cope with special
needs and concerns relevant to this age (Kliegman et al., 2020). Box 30.1 shows
Healthy People 2030 goals that speak to the toddler age group.
Nursing Process Overview FOR HEALTHY DEVELOPMENT OF A TODDLER
ASSESSMENT
Whether a child is seen for a routine checkup or has come to a healthcare center
because of a
specific health concern, assessment begins with a careful health history. Asking about a
toddler’s ability to carry out activities of daily living offers not only assessment
information on the child’s developmental progress but also important clues about the
child–parent relationship. Because
parents see their child daily, they are the best source of information and opinion on
when a child seems to be acting “out of sorts” or “different” (a typical sign a child may
not be feeling well). Careful observation is another crucial element of the nursing
assessment of a toddler, although toddlers may not show typical behavior at a
healthcare visit (e.g., may not talk, may cling to a
parent instead of demonstrating walking).
NURSING DIAGNOSIS
Nursing diagnoses related to growth and development of toddlers usually focus on the
parents’ eagerness to learn more about the parameters of normal growth and
development or issues of safety or care. Examples include: Health-seeking behaviors
related to normal toddler
development Knowledge deficiency related to the best method of toilet training Injury
risk related to impulsiveness of the toddler Impaired family process related to need for
close
supervision of 2-year-old child Health-seeking behaviors for improved family coping
related to the parents’ ability to adjust to the new needs of the child Intake of nutrients
more than needed
related to food choices Sleep deprivation related to lack of bedtime routine
OUTCOME IDENTIFICATION AND PLANNING
To help caregivers resolve a concern during the toddler period, focus on family
education and
anticipatory guidance. Urge caregivers to establish realistic goals and outcomes so they
,can meet the rapidly changing needs of their toddler and learn to cope with typical
toddler behaviors.
IMPLEMENTATION
When teaching about typical toddler behavior, teach caregivers that a good rule is to
think of a toddler as a visitor from a foreign land who wants to participate in everything
the family is doing but doesn’t know the customs or the language. Teach caregivers how
to approach a current
problem but also how to learn adequate methods for resolving similar situations that
are sure to arise in the future. Health visits provide opportunities to help caregivers
learn healthier coping techniques as well as to demonstrate effective communication
skills with the child.
OUTCOME EVALUATION
Expected outcomes must be evaluated frequently during the toddler period
because children change so much and learn so many new skills during this time
that their abilities can change from day to day. Examples of expected outcomes
include: The child maintains a consistent
bedtime routine within the next 2 weeks. Caregivers state they have childproofed their
home by putting a lock on kitchen cabinets by the next clinic visit.
Nursing Assessment of a Toddler’s Growth and Development
An assessment of a toddler begins with the child’s physical growth and skill
development. Box
30.2 describes a typical toddler appearance. Table 30.1 provides some guidelines to
help parents evaluate illness at this age.
TABLE 30.1 PARENTAL DIFFICULTIES IN EVALUATING ILLNESS IN TODDLERS
Problem Guidelines for Parents Evaluating seriousness of illness Toddlers typically
answer “no” to almost all questions; therefore, a question such as “Does your arm
hurt?” may bring a “no”
response even if an arm does hurt. Observing children for indications of illness (e.g.,
holding an arm stiffly, rubbing abdomen, crying when they void) is more helpful. Many
toddlers do not know the words to describe a feeling of nausea or a sore throat. They
reveal these symptoms by not eating. If the child is normally a light eater, as many are,
it is difficult for a parent to
appreciate these signs. Differentiating tiredness from illness Toddlers tend to whine or
sleep when they are either tired or ill. Reviewing the child’s day and activities often helps
to evaluate what is happening. If the child is not tired (it is not nap- or bedtime) or if
there is not a break in usual routine, crying and whining or temper tantrums suggest
illness. Evaluating nutritional
intake Toddlers are normally fussy eaters compared to infants. Evaluating children as to
whether they are active and growing is better than assessing any one day’s food
intake. Age-specific
diseases to be aware of The toddler period is an important age to assess speech
development; children should be further evaluated if they cannot use simple sentences
composed of a noun or pronoun and verb (“me go”) by 2 years of age. As children
begin to walk, they should be
observed for an abnormal gait. Osteomyelitis (bone infection) occurs with a high
frequency in toddlers; symptoms including limping, swollen joints, or arm or leg pain
should be regarded as
serious until ruled otherwise. Toddlers contract 10–12 mild upper respiratory infections
(URIs) a year. Otitis media (middle ear infection) may occur as a complication of URIs.
, The child with an URI who suddenly develops a high fever and pulls or manipulates
their ears should be seen by a primary care provider, as they may have an ear
infection. Children who attend childcare
programs have a higher incidence of hepatitis A, Giardia, and Shigella infections.
Teach parents to report jaundice or diarrhea promptly to a healthcare provider to
detect these infections.
PHYSICAL GROWTH
Although toddlers are making great strides developmentally, their physical growth
begins to slow.
Weight, Height, Head Circumference, and Body Mass Index
Plot weight and height on a standard growth chart for toddlers (available at ) at each
healthcare visit to determine if progress is normal for that individual child. If a child is
not yet walking,
continue to measure height with the child lying down. A child gains only about 5 to 6 lb
(2.5 kg) and 5 in. (12 cm) a year during the toddler period, much less than the rate of
growth during the infant year. As subcutaneous tissue, or baby fat, begins to disappear
toward the end of the second year, the child changes from a plump baby into a leaner,
more muscular child. A toddler’s
appetite decreases accordingly, yet adequate intake of all nutrients is still essential to
meet energy needs (Riley et al., 2018). Head circumference increases only about 2 cm
during the second year compared to about 12 cm during the first year. Head
circumference equals chest circumference at 6 months to 1 year of age. By 2 years of
age, chest circumference should have grown greater
than that of the head. Body mass index (BMI) screening is completed at 24 months to
identify toddlers who are overweight or underweight. A good website to calculate a
child’s BMI is
available via the Centers for Disease Control and Prevention (CDC)
(https://www.cdc.gov/healthyweight/bmi/calculator.html).
Body Contour
Toddlers tend to have a prominent abdomen because, although they are walking well,
their
abdominal muscles are not yet strong (see Fig. 30.1A). They have a forward curve of
the spine at the sacral area (lordosis) that will correct itself naturally. Many toddlers
waddle or walk with a wide stance (see Fig. 30.1B).
Body Systems
Body systems continue to mature during this time. Respirations slow slightly but
continue to be mainly abdominal. Heart rate slows from 110 to 90 beats per minute.
Blood pressure increases to about 99/64 mm Hg. The brain develops to about 90% of its
adult size. In the respiratory system, the lumens of vessels enlarge progressively, so the
incidence of lower respiratory infection
decreases. Stomach secretions become more acidic. Stomach capacity increases to
the point that a child can eat three meals a day. Control of the urinary and anal
sphincters becomes possible with complete myelination of the spinal cord, so toilet
training is possible. Immunoglobulin (Ig)G and IgM antibody production becomes
mature at 2 years of age. Passive immunity
obtained during intrauterine life is no longer operative.
Teeth
Eight new teeth (the canines and the first molars) erupt during the second year. All 20
deciduous teeth are generally present by 2.5 to 3 years of age (Kliegman et al., 2020).
DEVELOPMENTAL MILESTONES
