Toddler Development (1–3 years) 6 Christina Groark “Sometimes the smallest things take up the most room in your heart.” Winnie the Pooh (A. A. Milne) Learning Objectives After studying this chapter you will be able to: ሁሁ Identify major physical changes in toddlerhood. ሁሁ Describe the typical motor milestones in toddlerhood. ሁሁ Name five best practices for keeping toddlers safe. ሁሁ Distinguish between abilities and limitations of a toddler’s cognitive development. ሁሁ Sequence the typical stages of language development in children ages 1–3 years. ሁሁ Describe strategies for supporting appropriate social-emotional development in toddlers. ሁሁ Identify three signs of readiness for toilet training. ሁሁ Describe typical toddler advances toward independence in bathing, feeding, and dressing. ሁሁ Identify the typical developmental milestones during toddler development by age, and explain how developmental red flags are identified. gro81431_06_c06_121-146.indd 121 4/24/14 11:54 AM Physical Development and Growth Patterns in Toddlerhood Section 6.1  Chapter Outline Chapter Overview 6.1 Physical Development and Growth Patterns in Toddlerhood 6.2 Motor Development in Toddlerhood 6.3 Cognitive Development in Toddlerhood 6.4 Communication Development in Toddlerhood 6.5 Social-Emotional Development in Toddlerhood 6.6 Self-Help Development in Toddlerhood 6.7 Developmental Red Flags and Where to Get Help Summary and Resources Chapter Overview An infant’s entering toddlerhood can be seen as a somewhat natural progression. But the comparison of a 3-year-old child to the 1 year old he or she once was can tell us a much more astounding and marvelous story. A closer look at the changes that take place from the beginning of the second year of life through the fourth year takes us on a journey from a dependent baby focused only on survival, to a running, jumping, problem-solving little person with a unique personality. This journey consists of physical growth, motor development, cognitive advancement, evolved communication, social-emotional progress, and emerging self-help abilities. Advances made in each of the developmental domains introduced in Chapter 1 play interrelated roles in sculpting the unique toddler. Coordinated actions, both physical and emotional, are the true triumph of the typical toddler. Through the toddler’s recognition of self, independence is sought and skills flourish. Behaviors such as tantrums or acts of aggression, used to gain this newly sought-after independence, can appear startling to the naive onlooker. Most of this chapter describes the advances made from 12 months to 3 years. Developmental growth can vary across toddlers of the same chronological age, and development does not always occur evenly across all developmental domains for an individual child. While taking into account this expected variation, caregivers should be ready to identify and quickly address any substantial delays in typical milestones during toddlerhood. 6.1  Physical Development and Growth Patterns in Toddlerhood During toddlerhood, much of a child’s physical development (including muscle growth, bone growth, tooth development, and brain development) is a continuation of that which began during infancy, though some changes can be observed within these growth processes at this time. During this stage, a toddler’s height, weight, and other physical characteristics can be indicators of the child’s overall health. Because physical development continues to be a key process, proper nutrition also remains an important topic of discussion. gro81431_06_c06_121-146.indd 122 4/24/14 11:54 AM Section 6.1  Physical Development and Growth Patterns in Toddlerhood Physical Growth of Muscle and Bones Once children reach toddlerhood, their rates of growth slow significantly compared to the rates of growth observed in infancy. Children begin to take on a form that more closely resembles the adult structure by lengthening and slimming. Many factors contribute to this shift in overall appearance. Baby fat is replaced by muscle and the center of gravity, which is in the chest area for an infant, moves downward toward the core region, as it is in adults. This center-of-gravity shift helps a toddler become more mobile (discussed in the section on motor development). Through these years, toddlers have an abdomen that protrudes due to a lack of developed abdominal muscles. Another important factor in a toddler’s changing appearance is the lengthening of the long bones of the body. The long bones are found in the arms, legs, and fingers. At the end of the long bones are areas around the cartilage known as growth plates. New bone tissue is formed around the growth plates, hardening and strengthening the bones. This process is called ossification (see Figure 6.1). Ossification helps to guard against injury by providing a stronger, more solid frame. Figure 6.1: Ossification of bones ሁሁ New bone tissue is formed around the growth plates. This is where the hardening and strengthening of bones occurs. In the embryo Young person Adult Growth plate gro81431_06_c06_121-146.indd 123 4/24/14 11:54 AM Physical Development and Growth Patterns in Toddlerhood Section 6.1  Tooth Development Toddlerhood also sees children through the process of developing a full set of 20 baby teeth. This process begins in infancy with the eruption of the incisors and typically is complete toward the end of the third year with the appearance of the molars (see Figure 6.2). These teeth will be shed later in childhood and replaced with permanent teeth. These first teeth are called deciduous teeth, which refers to their process of shedding. Figure 6.2: Tooth eruption chart ሁሁ The eruption of teeth occurs according to an approximate schedule during early childhood. Upper teeth Age at eruption (approx.) central incisor 8–12 months lateral incisor 9–13 months canine (cuspid) 16–22 months first molar 13–19 months second molar 23–31 months Lower teeth second molar 25–33 months first molar 14–18 months canine (cuspid) 17–23 months lateral incisor 10–16 months central incisor 6–10 months Source: Essentialbaby.com. (2012). Baby teeth eruption chart. Retrieved from http://www.essentialbaby.com.au/baby/baby-stages-of-development/baby -teeth-eruption-chart-20120917-261k2.html. Brain Development The important brain development that takes place in the prenatal, neonatal, and infancy stages continues in toddlerhood. By the time a child is 2 years old, many of the neurons are connected and significant pruning has occurred. The brain continues to advance. During this time, a fatty coating is produced on the axons that send signals between the neurons. This process is called myelination. Surprisingly, myelination continues throughout life as the brain continuously refines the way information is processed. gro81431_06_c06_121-146.indd 124 4/24/14 11:54 AM Motor Development in Toddlerhood Section 6.2  Physical Growth: Height, Weight, and Physical Characteristics One of the most easily measured indicators of proper development in a child is the rate of physical growth. Parents often look to their child’s height, weight, and other physical characteristics to identify proper overall health. Pediatricians will monitor these indicators also. By 12 months, children are typically three times their birth weight, gaining another 3–6 pounds in the next year and growing another 2–3 inches taller. A typical toddler’s head circumference will grow about 1 inch this year, but the chest circumference is larger than the head circumference. At 2 years, children usually weigh around 30 pounds, gaining about 5 pounds throughout the year, and will reach roughly 36 inches in height by their third birthday. A 3 year old typically weighs 30–40 pounds, and by age 3, the child’s head and chest circumference are roughly equal. Of course, genetics and ethnicity play a role in the child’s expected height and weight. For example, children of African descent tend to be taller than those with Asian or Latino ethnic backgrounds (see Figure 5.2). Nutritional Concerns In some parts of the United States and other developed countries, and especially in lowresource countries, a child’s nutritional needs are jeopardized more frequently by a lack of food availability in general than by poor eating habits and food allergies. Worldwide, many children go without the proper amount and types of food. This lack is known widely as malnutrition. Malnutrition can lead to wasting, a process in which the body’s muscle and fat tissue begin to degrade. When malnutrition is sustained over a longer period of time, with or without wasting, it can lead to permanent growth stunting. When the residents of an area do not have enough available food, or access to food, they are known as food insecure. The U.S. Department of Agriculture Economic Research Service reports that 14.5 percent of U.S. households were food insecure in 2012 (Coleman-Jensen, Nord, & Singh, 2013). In low-income households with children under age 3 years, children experiencing food insecurity are at more developmental risk than are those who are food secure (Rose-Jacobs et al., 2008). Unfortunately, young children are also suffering from another health risk at alarming rates in recent years, especially in the United States. In areas where food is abundant, especially processed food that is high in caloric content from sugars and fats and low in nutritional value, childhood obesity is of growing concern. The Centers for Disease Control and Prevention (2014a) estimates that 17 percent of children ages 2–19 years are obese. Childhood obesity leads to a litany of concerns. In the short term, obese children suffer from negative self-esteem and body image, digestive disorders, and conditions of the pulmonary and endocrine systems. Later in life, childhood obesity can lead to adult obesity, cardiovascular risks, and even premature death (Must & Strauss, 1999). 6.2  Motor Development in Toddlerhood Typically by around 12 months, children are able to use their developing leg muscles, strengthening long bones, and improved coordination to take their first steps. Parents eagerly await the development of this motor skill. Once children are able to walk, a whole new world is open for exploring and toddlers’ seemingly endless energy and boundless curiosity drives them to gro81431_06_c06_121-146.indd 125 4/24/14 11:54 AM Motor Development in Toddlerhood Section 6.2  take advantage of their newfound skill. At this age, children will start off fairly wobbly but will practice walking over and over again to master the skill. Crawling and standing have been mastered. Walking is a typical example of gross motor skill development. Other gross motor skills that typically emerge at this age include throwing overhand, pushing and pulling objects like a toy on a string, and raising arms to be picked up. © Kenishirotie/iStock/Thinkstock ▶▶ A 1 year old develops fine motor skills, The 1-year-old child also further develops fine motor skills. Typically developing children at this age are fairly skilled at using the pincer grasp (see Chapter 5) to retrieve smaller items like Cheerios. As children begin to use this grasp to bring solid food to their mouths, they are able to practice fine motor movements with the lips and tongue to move food into the mouth and to the back of the mouth for swallowing. The debut of new teeth also allows them to practice jaw movements to learn how to chew bits of food. By age 2, walking is becoming more refined, with heel-to-toe movements, including the ability to walk backward. By this time, most children have practiced enough to be able to go up a set of stairs unassisted, although they may have to come down backward or on their behinds. The more children are able to move around to explore their environment, the more skills they are able to develop. At age 2, children are able to grasp a marker or crayon with their full fist and make repeated lines and circles. They often want to do things by themselves and generally enjoy turning pages of a book, helping to prepare food in the kitchen, and generally insist on dressing themselves. However, many of these needed skills are at a novice level so, following Vygotsky’s idea of scaffolding (see Chapter 3), caregivers need to reduce assistance gradually. becoming fairly skilled at using the pincer grasp to pick up and hold small objects. The 3-year-old child is typically able to jump, dance, balance on tiptoes, and walk in a straight line. At this age, children can go up and down steps using alternating feet without help and can even pedal on a tricycle. This is a lively time as children begin to engage in games with rules and use skills like throwing underhand, kicking, and catching. Using their fine motor skills, children find that large buttons and zippers are becoming easier to manage now. A marker or crayon is held with the index and middle finger and the thumb. This is called a tripod grasp. Children begin to favor one hand over the other when completing these tasks but at this age may not yet demonstrate a consistently favored hand. This favoritism is referred to as hand dominance. Historically, hand dominance was approached differently in various cultures. Not long ago, U.S. schoolchildren were forced to use the right hand even when they favored the left. Table 6.1 provides examples of typical motor skills by age. gro81431_06_c06_121-146.indd 126 4/24/14 11:54 AM Section 6.2  Motor Development in Toddlerhood Table 6.1: Observable motor development by age 1 Year 2 Years 3 Years Crawls Runs and stops Balances on one foot Walks (wobbly) Jumps with both feet Jumps up and down– alternating feet Stands Lowers self to floor Releases objects voluntarily Pushes and pulls Walks up stairs (on all fours) Scribbles (large movements) Stacks up to 4 objects Throws overhand Brings food to mouth Walks skillfully Squats and rises easily Turns pages Helps with dressing Walks up stairs unassisted Grasps a marker or crayon with whole hand Stacks up to 6 objects Throws underhand Holds a cup Balances on tiptoes Walks a straight line Climbs a ladder Dresses unassisted Walks up and down steps with alternating feet Traces objects with marker or crayon Stacks up to 10 objects Pumps on a swing Feeds self with better precision Source: Centers for Disease Control and Prevention. (2014b). Developmental milestones. Retrieved from http://www.cdc.gov /ncbddd/actearly/milestones/. At this stage, caregivers should be aware of the increased opportunity for injury because of the combination of improvements in skill and mobility with insatiable curiosity. Proper precautions and supervision are critical throughout the years when toddlers insist on handling jobs by themselves and frequently explore uncharted territory, but still lack physical control and coordination. Safe Kids Worldwide (2008) reports that “children ages four and under have the highest fatality rate from unintentional injury, more than twice that of all other age groups.” Caregivers are responsible for making sure that the child’s environment is safe. The following describes best practices for childproofing the home: • • • • • • • • • • Cover electrical outlets. Put harmful chemicals, cleaners, paints, and medication well out of children’s reach. Install gates at the top of steps. Turn off and unplug heating appliances (i.e., irons, stoves, curling irons) when finished using them. Install childproof locks on cabinets and rooms that contain dangerous items. Secure loose fabric and cords like curtains, tablecloths, blind cords, and bedding. Make sure that smoke and carbon monoxide detectors are functioning properly. Cover sharp edges on furniture. Secure heavy furniture like bookcases. Empty any standing liquids, such as in sinks, buckets, and bathtubs, and secure toilet lids. Wobbly toddlers who are bravely on the move are bound to get bruises and scrapes. Practicing the proper precautions will minimize harm. It is important to allow children the freedom and creativity to explore their world, test the laws of nature, create new things, try to accomplish tasks on their own, and understand rules and boundaries for themselves, but it is also caregivers’ job to provide an environment that is completely safe for children to use. gro81431_06_c06_121-146.indd 127 4/24/14 11:54 AM Cognitive Development in Toddlerhood Section 6.3  Dana has agreed to watch the neighbor’s boys every day after her morning classes. Ryan, Ethan, and Austin are 6, 3, and 2 years old and are very well behaved. They get along great with Dana, and she loves the time she spends with them, though until today she has only watched the boys at their house down the road. Today, she is going to watch the boys at her apartment, as their mother needs some time to work at their house without the boys there. Although Dana does not have children of her own, she has remembered the important warnings about keeping children safe with childproof locks and gates, especially during the years when children are excited and eager to explore their environment. She had known for a week that the boys would be at her house today, so during that time she was able to get some childproof locks and a gate from the boys’ mother. Before the children arrived at her apartment, she put childproof locks on all of her floor-level cabinets in her bathroom, laundry room, and kitchen (except the cabinet with pots, pans, and bowls that are safe for children’s play). She also used the gate to block off the stairs that lead down to the back door from the kitchen. When the boys came to the door, they had an armful of toys to bring inside. Dana thought, “They will be so busy with those toys. I’m not sure if they will even want to explore my apartment.” Just 20 minutes later, though, the toys were left in the living room, and the boys ventured into the kitchen to explore. Once there, Dana watched as they tried to pull open all of the cabinet doors. Dana was so happy that she had planned ahead to keep the boys safe. Finally, Ethan reached the unlocked cabinet, and looked up at Dana, seemingly to ask, “Is this okay?” Dana smiled and nodded her head, and the boys opened the cabinet and pulled out all of the pots and pans. Dana gave each of the boys a wooden spoon to bang on the pans, and she joined in the musical parade around the kitchen. She felt good about getting her apartment ready for the boys, as she knew that her efforts had kept them safe. 6.3  Cognitive Development in Toddlerhood Significant transformations begin to take place in the domain of cognitive development during toddlerhood. At this age, children can follow simple directions, like “go to the table” or “put down the toy.” Scaffolding is also an important practice for caregivers as toddlers develop in the cognitive domain. Jean Piaget’s theory of cognitive development (see Chapter 3) consists of four main stages. In the first year of life, children begin to combine their senses with their motor responses, mostly in the form of reflexes at this time, called the sensorimotor stage. Object permanence is an important part of Piaget’s sensorimotor stage (see Chapter 5). In the second year of life, children transition into the last half of the sensorimotor stage. Experimentation plays a large role as toddlers begin to consider the properties of the people, objects, animals, and foods in gro81431_06_c06_121-146.indd 128 Stockbyte/Thinkstock ▶▶ Toddlers from about 12 to 18 months of age will conduct their own experiments to learn about their world. This includes stacking blocks until they fall over, or knocking the blocks down themselves. 4/24/14 11:54 AM Cognitive Development in Toddlerhood Section 6.3  their world. Once toddlers are aware of these properties, and are no longer solely focused on themselves or the people close to them, their curiosity builds and builds. From approximately 12 to 18 months, children will actively conduct their own experiments to test their world and learn from it. This is when children are often dubbed “little scientists.” Their experiments now go beyond simply mimicking the behavior they see. Favorite activities include emptying and filling containers, stacking objects until they fall, and taking things apart. These are all ways to test variations in the “rules” of their world. For example, “When I pull the string on my toy and walk, it follows me, but when I pull the string by the window it stays.” This trial and error experimentation is called tertiary circular reactions. Shane is seated at the table for lunch when he accidentally knocks a couple of his blueberries on the floor. He stares at them for a while. His expression is so intent that his aunt decides to watch Shane for a minute before cleaning up the blueberries. Shane picks up another blueberry and drops it next to the others. After staring for a few more seconds, he picks up his cup of milk and throws it at the floor. The lid pops off and milk spills out around the blueberries. Shane’s aunt now decides to step in and clean up after Shane’s little experiment. While some caregivers might view Shane’s actions as a messy annoyance, Piaget would argue that Shane was actively testing his environment through tertiary circular reactions. First, he attempted to repeat the behavior of the first two blueberries with an intentionally dropped blueberry. Second, he tested whether the properties of the fallen blueberry would be the same as the properties of a fallen cup of milk. Once the milk behaved differently than the blueberries, Shane would have to change his mental schema (see Chapter 3) to accommodate that change. The final period of the sensorimotor stage involves solving problems by mentally combining new information taken in about the world around the child. From about 18 to 24 months, children begin to take their experimental “findings” and apply them to form simple solutions to problems in their world. If Shane repeats his experiment with enough variables, he may be able to learn that the food goes away once it lands on the ground. The next time Shane is given a food he does not want to eat, he might be able to solve his problem by dropping it on the floor. Children in the last year of the sensorimotor stage also enjoy hiding and naming objects, and offering toys to others. They are able to understand the relationship between objects, like putting toy people in the toy car, putting a necklace around a stuffed animal’s neck, and keeping a plate with a cup. Simple puzzles with large pieces can be accomplished because spatial recognition is formed. During the end of the sensorimotor stage, a child’s urge to explore might be so strong that it overcomes previous learning about dangers. It is important that curious, mobile children be supervised closely. As children enter their third year of life, they typically also enter into new territory in cognitive development. Piaget calls this the preoperational stage. This stage lasts from 2 years until 6 or 7 years of age. The main function of this stage is to bridge the child’s cognitive development from the sensorimotor stage to the operational stage (Piaget & Inhelder, 1969). In the operational stage, children are able to process thoughts, understand time and quantity, categorize based on more than one dimension, and more (see Chapter 8). However, Piaget describes three main challenges that need to be overcome before a child can move into the operational stage. The first challenge is the child’s inability to take another’s perspective. During the preoperational stage, children are still focused solely on themselves. This self-focus is gro81431_06_c06_121-146.indd 129 4/24/14 11:54 AM Section 6.4  Communication Development in Toddlerhood known as egocentrism. The second challenge is referred to as the confusion of appearance and reality. A preoperational child believes that if the appearance of something is changed, the object’s identity changes also. For example, imagine that you show a child an apple and then you glue a perfectly formed orange peel to the apple. The child would believe that the apple is now an orange. The final challenge is creating relationships between two unrelated ideas without a chain of logic. This is called precausal reasoning. For example, if asked why the mail carrier comes to the house, a child might answer, “Because I finished my breakfast!” Often, precausal reasoning is related to a child’s egocentrism. Children believe events occur in response to their own actions or what is occurring in their immediate world. During the preoperational stage, 2 and 3 year olds can categorize objects, correctly name shapes and colors, try to make mechanical objects work, and use their imagination with objects (e.g., sweeping the floor with a toy truck). Preoperational stage toddlers will also begin to engage in realistic dramatic play, like tying a rope to a stuffed dog to take it for a walk and then offering the toy a drink of water when the walk is over. Table 6.2 offers examples of typical cognitive skills by age. Table 6.2: Cognitive development by age 1 Year 2 Years 3 Years Explores objects in various ways, including by shaking, banging, or throwing Can find objects even when they are hidden under two or three covers Can make toys work with buttons, levers, and moving parts Looks at the correct picture or object when it is named Can complete sentences and rhymes words that are familiar Can do puzzles with three or four pieces Can find hidden things easily Can copy gestures Begins to use objects correctly, including drinking from a cup, brushing own hair Is beginning to sort shapes and colors Plays simple pretend games Can stack four or more blocks Can bang two objects together May use one hand more than the other Can follow simple directions such as “pick up the ball” Names items in a picture book Can put things in a container and take things out of a container Can follow two-step instructions Pretends with dolls, animals, and people Understands the concept of two Can copy a circle with a pencil or crayon Can turn book pages one page at a time Can stack more than six blocks Can screw and unscrew lids on jars and can turn a door handle Source: Centers for Disease Control and Prevention. (2014b). Developmental milestones. Retrieved from http://www.cdc.gov /ncbddd/actearly/milestones/. 6.4  Communication Development in Toddlerhood Communication is an essential part of learning and growing. It involves both language and speech, which are not the same thing. Language refers to the way that people communicate their ideas. It follows rules that are understood. It can be done verbally or by writing, signing, or gro81431_06_c06_121-146.indd 130 4/24/14 11:54 AM Communication Development in Toddlerhood Section 6.4  making other gestures, such as eye blinking or mouth movements (U.S. Department of Health & Human Services, 2010). Speech is just one method of expressing language. That method involves talking using the structures of the mouth, which are the tongue, lips, teeth, and jaw. To be considered as speech, talking must include sounds that are recognizable by others. Perhaps one of the most captivating changes a toddler goes through is the acquisition of language and speech to communicate needs, emotions, and ideas. Around the child’s first birthday, he or she is usually able to say a few one- or two-syllable words like dada, more, and sleep. Although these words are almost always more distinguishable to the caregiver, to outsiders they may sound no different than the babble that has been going on for months. What is interesting is that very young children start by expressing their thoughts through only one word. Hearing a dog barking next door, a child might look at the caregiver and say “dog,” rather than “The dog is barking.” The use of one word to convey an idea is called a holophrase. As language acquisition progresses, more specific ideas are expressed using two-word phrases. In this case, only the most essential words are used to convey the thought, for example, “dog bark.” Communication of thoughts through these short, two-word phrases is called telegraphic speech. Gestures may accompany these phrases to show the context of the idea. In the case of the barking dog, the child may point toward the house next door. The expressive vocabulary of a 1 year old develops from 5 to 50 words; however, children at this age can understand much more than they are able to verbalize (Schafer, 2005). Once at 50 words, a child nearing age 2 will experience a surge of acquired vocabulary referred to as a word explosion. Children at 2 years communicate their own ideas through very short phrases, usually consisting of no more than five words. These words tend to focus on objects, people, and actions. Even as children’s vocabulary grows from 50 to 300 words or more, they continue to understand much more than their vocabulary would indicate. Singing and rhyming are fun ways to practice vocabulary, pronunciation, and sentence structure. At around age 3, children begin to add more information to their ideas. These ideas are now expressed as short sentences, often using adjectives. A typically developing 3 year old may know up to 1,000 words. Children also recognize the importance of the order of the words early, even when they are still using only two words. A toddler recognizes the difference between “that dog is barking” and “is that dog barking.” We also do not hear children changing the order of words to say nonsense like “barking is dog that.” At age 3, children also enjoy story time and actively participate by following along in a book or adding their own lines if given the opportunity. Questioning to engage others in conversation is also prevalent at 3 years. Children may ask “why” or follow up on an idea with a question, like “Did she go?” Children acquiring language for communication also understand the importance of aspects outside of vocabulary and word structure to convey their ideas. Cadence, tone, volume, and inflection are all used to change meaning, and are often paired with appropriate gestures and facial expressions. Table 6.3 summarizes typical communication skills achieved, by age. Madison ran to her father on the playground. “Oh! Swing, daddy!” she yelled. “Okay, Maddy. I’ll push you on the swing,” her father replied. “What color?” she asked, pointing to the swing as they walked holding hands. “You know what color that is, Maddy. What color is the swing?” he asked her. “Blue!” she exclaimed and smiled widely at her father, waiting for a reaction. “Really?” asked her father. “No!” She burst into giggles. “It’s red. Red. Red, red, red. RED!” she repeated in a sing-song tone while she swung her father’s hand back and forth. “Yes, Maddy, the swing is red. Now let’s swing!” gro81431_06_c06_121-146.indd 131 4/24/14 11:54 AM Section 6.4  Communication Development in Toddlerhood Table 6.3: Communication development by age 1 Year 2 Years 3 Years Can respond to simple verbal requests Can point to things when they are named Can follow instructions with two or three steps Can make sounds with a change in tone; beginning to sound more like speech Can say sentences with two to four words Can understand prepositions such as in, on, and under Can use gestures, like shaking head “no” or waving “bye-bye” Can say mama and dada and some exclamations like uh-oh! Tries to say words that others say 18 months: Can say many single words 18 months: Can say and shake head “no” 18 months: Can point to show someone what she or he wants Can point to pictures when they are named Can follow simple instructions Can repeat words that were heard in others’ conversation Can point to things in a book Knows names of people who are familiar Knows names of body parts Is able to name most familiar things Can say first name, age, and sex Can name a friend Can say words like I, me, we, and you and some plurals like dogs and cats Can talk well enough for strangers to understand much of the time Can have a conversation with two to three sentences Source: Centers for Disease Control and Prevention. (2014b). Developmental milestones. Retrieved from http://www.cdc.gov /ncbddd/actearly/milestones/. How children develop language has been debated. Behaviorist B. F. Skinner (1957) describes the theory that language is taught to children through everyday interactions and immersion in language in their environment, and that parents and caregivers are the primary “teachers.” They are in fact quite suited for this role because they, sometimes unknowingly, provide all of the right encouragement, instruction, and reward for language to develop in small children. Many parents will mimic their child’s babbling back to them. When children make sounds, the behavior is reinforced by parents picking them up, smiling, and talking to them. Parents and caregivers alike naturally point to objects and repeat their names. If a child repeats the name back, he or she is praised and cheered. When children reach the developmental stage of using one word, parents add words to help them complete their thoughts. According to Skinner, parents’ repetition of words and sentences is the instruction necessary for verbal development. Noam Chomsky (1986) disagreed with Skinner. He wrote that language is too complex to learn through informal or formal instruction. Sentences can be created that have never been produced before, with the speaker having no exposure to that sentence in the environment. The number of sentences one can create is limitless, and one is not limited by experiences (Wen, 2013). Chomsky believed that humans have an innate ability to develop language. According to Chomsky, we have an inherent and unconscious understanding of the system and structure of language, called universal grammar, with a genetic capacity to acquire language, called a “language acquisition device” (Chomsky, 1986). With regard to this innate ability of learning language, humans do not need to rely solely on the external environment to attain the use of language. Alternatively, the social-pragmatic language development theory states that humans are all social beings. Because communication is inherent to social beings, infants instinctively seek to learn language because of their desire to communicate with other humans. In this theory, the emotional draw behind conveying messages is more important than learning the words gro81431_06_c06_121-146.indd 132 4/24/14 11:54 AM Social-Emotional Development in Toddlerhood Section 6.5  themselves. In one study, infants and toddlers learned language better from an in-person instructor than from watching that instructor on video (Roseberry, Hirsh-Pasek, ParishMorris, & Golinkoff, 2009). This indicates that the social component of language development is key. Following up on this idea of the integration of social and language learning and putting it into the current context, caregivers must recognize that technology and interactive media are here to stay and will be part of most children’s lives. Therefore, if used appropriately, technology can be introduced as early as toddlerhood in a way that supplements their learning and development. For instance, toddlers can become intrigued and comfortable with interactive components of technology by learning that when they push buttons, toggle switches, or turn handles, the toy responds in specific ways, as in the case of a traditional jack-in-the-box. Children between 12 months and 3 years of age enjoy exploration through manipulation, fitting the requirement of many aspects of technology. They are also progressing in social and communication skills. Thus, interactive media and social networking, when in the context of interacting with adults and enhancing relationships, can complement other methods of learning. MEDIA, TECHNOLOGY, AND EARLY CHILDHOOD: TODDLERS AND TECHNOLOGY, LET’S STAY IN TOUCH At the age of 30 months, Timmy enjoys looking in his dad’s computer “photo file” at digital pictures of family members. He recognizes and names grandparents and other extended family members who live in another state and loves their actual visits during the holidays. To further his interest in them and their daily surroundings and activities, Timmy’s parents have begun to use Skype. Timmy uses this software to connect with his Aunt Bridget almost every Sunday. He looks forward to that time of the week and seems to talk more and more each time, answering her simple questions, such as what he has done that week and what mischief his dog, Buddy, has gotten into. He ends each Skype visit by sending Aunt Bridget kisses and hugs. As Timmy nears his third birthday, his parents are helping him use parts of the computer independently. He sits on his mother’s lap and with her hand over his, she gently guides him through correct movements while talking and pointing out what is happening on the computer screen. He is getting particularly good at using the mouse and the keyboard arrows to initiate and practice age-appropriate educational games. Timmy’s parents report that he is becoming comfortable with these basic computer skills and is likely to be ready to participate in his child-care setting’s “technology play area” when he moves into preschool next year. 6.5  Social-Emotional Development in Toddlerhood Toddlerhood is a noteworthy time in the social-emotional domain of development. Infants spend the first year of life consumed with survival and comfort. In many ways they are aware of only their own existence. As a child enters into the second year of life, an important transformation takes place. Typically at this age, children develop an awareness of their existence as a separate entity from other people, other animals, and other objects around them. Even though 1 year olds are still concerned primarily with their own needs, recognizing that others exist in their world is essential for developing an understanding that others have thoughts and feelings that may be different from their own. As 1 year olds embark on this journey of discovery, they are also likely to experience very powerful emotions, positive and negative. Children gro81431_06_c06_121-146.indd 133 4/24/14 11:54 AM Social-Emotional Development in Toddlerhood Section 6.5  might be extremely excited in anticipation of something they enjoy, or express intense anger when a situation does not go their way. Sometimes these intense waves of emotion may seem irrational or nonsensical and toddlers may have a hard time recovering. This can be extremely frustrating for caregivers and they need to be immensely patient. As the recognition of others’ emotions becomes more sophisticated, toddlers will also begin to express the same emotions they see others experiencing, like crying when someone else is hurt or sad. This identification and appreciation for another’s emotions is called empathy. Empathy is an important step for later social-emotional development and is cultivated gradually over years. Interest in peers also tends to emerge at this time, although not necessarily interaction. Often, as 1 year olds begin to notice other children, their first reaction is curiosity. At this age a child might approach another child quietly, watch the other child play independently, and even play separately but alongside the child. This early stage of peer-to-peer interest is called parallel play (see Table 6.4 for a more detailed look at the categories of social participation, identified by sociologist Mildred Parten). As this scenario plays out more often and interest in other children is apparent, caregivers encourage interactions. Caregivers can facilitate and encourage peer-to-peer interaction by asking both children questions, closely supervising turn-taking activities, and helping to resolve conflict. It is the adult’s role to support positive interactions with other children. For example, it can be helpful to redirect a child’s attention if interactions turn negative or tense. Table 6.4: Parten’s categories of social participation Category Definition Unoccupied behavior The child is not playing but is occupied by watching anything of interest from moment to moment. Solitary play The child plays alone and with different toys than children who are playing near the child. No effort is made to move nearer to the other children. Onlooker Parallel activity Associative play Cooperative or organized supplementary play The child watches other children play, sitting or standing near the other children to observe what is happening. The child talks to, asks questions of, and gives suggestions to the children observed, but does not take part in the play. The child plays beside other children, not with them. Though the child plays independently, he or she chooses a toy or an activity that is similar to that of children playing near. The child plays with others. The children talk about the toy or activity and children exchange play items. All children take part in very similar play, but each child plays as he or she wants, and no organization of the play occurs. A group of children is organized for some end, including making something, achieving a goal, engaging in dramatic play, or playing a formal game. A child either belongs or does not belong in the group. Play is directed by one or two group members. Different roles are taken and a division of labor can be observed with aims at achieving the goal. Source: Parten, M. B. (1932). Social participation among pre-school children. Journal of Abnormal and Social Psychology, 27(3), 243. A strong bond with caregivers, often parents, is also an important benchmark in socialemotional development. By around age 1, a child should have a strong and healthy attachment to the primary caregiver (see Chapter 3). As children begin to experience intense emotions, this bond may make it difficult to leave the caregiver at times. It is most important that children experiencing these emotions feel safe and secure at all times, even when it is necessary to leave the ones with whom they have bonded. Adult-child relationships are gro81431_06_c06_121-146.indd 134 4/24/14 11:54 AM Social-Emotional Development in Toddlerhood Section 6.5  essential for optimal social-emotional development of a toddler. Often, a toddler’s bond with a caregiver, combined with recognition of others and newly found motor skills, will lead to a strong desire to help the caregiver with daily routines and tasks. Even though it may not be most efficient, allowing a toddler to safely help with a job can be valuable to development across domains. During the third year of life, a child continues to grow in the different areas of social-emotional development discussed previously. Recognition of others’ thoughts and feelings develops into a truer sense of empathy. A 2 year old will begin to interact more with peers and engage in turn-taking games and role-playing. Play incorporates more activity and creativity, often modeling adults’ daily behaviors such as shopping, cleaning, and eating meals together. Playing interactively in roughly structured ways is referred to as associative play. Sharing skills will begin to emerge in 2 year olds and mature by age 3, although it is a gradual process. Sharing is often a difficult social-emotional skill for toddlers to master and may require a lot of © David Clark/iStock/Thinkstock supervision and support from caregivers. Set▶▶ Within their social-emotional ting rules with appropriate consequences for development, toddlers learn to share and take 2 year olds can help foster appropriate social turns with friends. interactions overall. Adults can also help to keep a positive focus on friendships by talking about good qualities of peers in a toddler’s social circle, taking pictures of friends and revisiting them later, and remembering positive interactions with the toddler. Every morning at the child-care center, Justin and Steven are so excited to see each other. They both smile and run to each other. For the past few weeks, without fail, there has been screaming and tears within 5 minutes if a teacher isn’t available to help them play together. Steven has been coming to this particular center for over a year, since he was about 8 months old. He has grown personally attached to many of the toys. Although Justin is newer to the center, he is almost 3 years old. Justin does not have any siblings, so he is not used to sharing toys at home. The three teachers in the room have quickly picked up on this routine interaction between Justin and Steven. It would be easier to keep the boys separated while they play, but the teachers agree that there is a special bond between them that could develop into something wonderful for everyone if it is cultivated correctly. The teachers have decided to take shifts helping the boys share toys, take turns, and talk about their interactions. The teachers think that after a few months the boys may be able to play independently. Today, Justin and Steven built a railroad out of blocks together without any help from the teachers. Then they included another toddler in taking turns to ride the tricycle down the railroad. The peaceful playtime lasted almost 25 minutes without needing a teacher to intervene. A huge improvement! Although more social interactions take place at this age, it is also a time when toddlers strongly value their independent existence. This can be observed easily in toddlers who quickly answer no to any request or suggestion. Their sense of self as an individual includes gro81431_06_c06_121-146.indd 135 4/24/14 11:54 AM Section 6.6  Self-Help Development in Toddlerhood a recognition of separate thoughts and feelings and an appreciation for the freedom to act on those perspectives. This is known as autonomy. Toddlers who have developed a sense of autonomy without the ability to compromise can be tough for caregivers to handle, but autonomy is an essential component of social-emotional development and will lead to the skills required for a well-balanced, happy child. Along with autonomy, awareness of different genders and conventional gender roles form at this age, and a rudimentary understanding of behavior as good versus bad emerges. Across all aspects of toddlers’ social-emotional development, emphasis on the process and not just the result is important (see Table 6.5). Talking about social interactions, both positive and negative, can be a helpful exercise for toddlers. Discussing what events occurred during the interaction, what happened as a result of the behaviors, and what alternative options were available can help children begin to recognize cause and effect. Talking about situations that have just transpired is also helpful to acknowledging emotions, accepting why there are certain emotions, and developing an internal process for considering alternatives to aggressive behavior. Discussions should always be developmentally appropriate. Table 6.5: Social-emotional development by age 1 Year 2 Years 3 Years Is shy or nervous around strangers Copies other individuals, particularly adults and older children Copies adults and peers Shows preference for certain things and people Is gaining more and more independence Cries when primary caregivers leave May show fear in certain situations Gives a caregiver a book when wanting to hear a story Tries to gain attention by repeating sounds or actions Helps with dressing by putting out an arm or a leg Plays games including peek-aboo and pat-a-cake Gets excited when around other children Shows defiant behavior at times Mainly plays beside other children, but begins to include other children in play Without prompting, shows affection for friends Can take turns when playing games Shows concern for a friend who is crying Understands what is meant by mine and his or hers Shows a variety of emotions Is able to separate easily from primary caregivers Sometimes gets upset with routine changes Can dress and undresses himself or herself Source: Centers for Disease Control and Prevention. (2014b). Developmental milestones. Retrieved from http://www.cdc.gov /ncbddd/actearly/milestones/. 6.6  Self-Help Development in Toddlerhood Typically developing toddlers are well equipped to start their journey toward independence with everyday tasks like dressing, bathing, and feeding. Although a long road remains to reach true independence, children can start assisting with these self-help tasks at 1 year of age. Often children at this age take pride in accomplishing these tasks rather than having a caregiver do it for them. gro81431_06_c06_121-146.indd 136 4/24/14 11:54 AM Self-Help Development in Toddlerhood Section 6.6  Sleeping Sleep patterns and habits are a function of a child’s genes, routines, and environment. One study estimated that up to 30 percent of children younger than age 3 suffer from sleep problems (Sadeh, Mindell, Luedtke, & Wiegand, 2009). A toddler typically sleeps 10–12 hours a night and takes midday naps. If a nap is missed or the daytime was particularly active, a child of this age may nod off early or sleep a bit longer than usual. This should not be concerning. At age 3, children often begin to phase out daytime naps, although this is almost always a gradual process. To help with the transition, a set “quiet time” midday is helpful. Toddlers may have trouble falling asleep at night and may talk to themselves, sing, play with pillows and covers, or even escape bed and wander. Having a nighttime routine like a bedtime story or a soothing song often aids a child to transition to sleep time. By age 3, children may want to practice their bedtime routine independently or even begin to transition away from the bedtime routine altogether. Toddlers may also test the idea of getting up early with renewed energy and excitement for a new day. Rewarding very early risers with food and activity reinforces the behavior and may result in regular early risers and very tired parents. Although proper sleep for the child is of the utmost importance, overtired parents may be irritable and less alert. If a parent is suffering from sleep deprivation, it is much more difficult to be responsive to the child’s needs. Children who develop habits of short sleep duration under age 3 and a half have lower cognitive performance by age 6 (Touchette, Petit, Tremblay, & Montplaisir, 2009). However, forcing very young children to sleep according to the parents’ schedule may not be productive either. Establishing routines as early as possible is an effective way to reinforce sleep patterns. TIPS ON TODDLERS AND SLEEP • • • • • Stick to the same set bedtimes and wake-up times each day. Don’t shortchange naptime, either—make sure that it does not occur too late in the day and that it is not too brief—either situation will result in lack of a good night’s sleep. Maintain a consistent bedtime routine. Establish calm and enjoyable activities in the 30 minutes right before bedtime, such as taking a bath or reading bedtime stories to help a child wind down. It is helpful to set clear limits as to how many books you will read or songs you will sing. Allow the child to choose routines such as which pajamas to wear and which stuffed animal to take to bed. The choice of security object (stuffed animal or blanket) helps a child feel more relaxed at bedtime and all through the night. Make sure the bedroom environment is quiet, cool, dark, and comfortable for sleeping. A nightlight or area light on the very lowest dimmer setting is fine. Playing soft, soothing music is fine. Remember to reserve the bed for sleeping only. It should not be used as a platform for playing. Television watching in the bedroom should not be allowed. Any other form of screen time (e.g., tablets, smart phone) should not be part of the bedroom environment. These technologies can overstimulate the child and make it harder to fall asleep later. Limit food and drink (especially any drinks containing caffeine) before bedtime. Remember that many clear beverages contain caffeine, so read labels. Tuck a child into bed in a sleepy but awake state. This will help the child learn to fall asleep on his or her own and help the child return to sleep in the event of a middle-ofthe-night awakening. Source: From Cleveland Clinic. (n.d.). Sleep in toddlers and preschoolers. Copyright © The Cleveland Clinic Foundation. Reprinted by permission. Retrieved from http://my.clevelandclinic.org/disorders/sleep_disorders/hic_sleep_in _toddlers_and_preschoolers.aspx. gro81431_06_c06_121-146.indd 137 4/24/14 11:54 AM Self-Help Development in Toddlerhood Section 6.6  Feeding and Eating Mealtimes provide great opportunities for toddlers to explore new textures and tastes, learn new words, test social expectations, and develop new motor skills. At 12 months of age, a child will have a decreased appetite, compared to infancy. Children will often go through periods in which they have a limited number of preferred foods, leading adults to label them as “picky eaters.” These periods of narrowed food preferences are called food jags (Groark & Song, 2012). © powershot/iStock/Thinkstock Tania will only eat her grandmother’s ▶▶ With the ability to hold and maneuver a spoon, tomato sauce right now. Breakfast, toddlers can feed themselves independently. lunch, snacks . . . . I don’t really know what to do. It’s frustrating when we are out somewhere, but more than that I worry that she’s not getting enough different kinds of nutrition. Tania’s pediatrician said it’s just a phase and she’ll grow out of it. So as long as she’s eating something, it will be just fine. I guess she [the pediatrician] knows best. I’ll just keep trying to put tomato sauce on different things to trick her into eating other foods. Maybe she’ll find other things that she likes that way!—Mother of 16-month-old Tania At about age 1, children begin to learn to feed themselves by picking up small food pieces with their hands, holding a spoon, and maneuvering a cup for drinking. TIPS ON FEEDING A TODDLER • • • • • • gro81431_06_c06_121-146.indd 138 • Set a good example. Eat healthy and simple meals yourself so that the child can see how he or she should also be eating. • Toddlers learn about their food by playing with it, so let them! Don’t punish the child for touching what’s on the table. Encourage the child to learn to eat independently by letting him or her practice with cups and silverware. Snacks should be treated like small meals, offered every 2–3 hours. Children under 2 years of age typically only eat 1–2 tablespoons of each different food, so start by offering them these small amounts. Allow the child to let you know when he or she is satisfied, or is still hungry, rather than making the decision for him or her. Offer soft foods such as fresh fruit (bananas, peaches, pears, watermelon) and cooked vegetables. Don’t give toddlers raw vegetables, because they can choke on them. Small bites are best, so cut up anything big into more manageable pieces for the child. Keep track of the number of bottles the child drinks in a day in order to make sure the child is balancing those calories with calories from healthy meals. (continued) 4/24/14 11:54 AM Self-Help Development in Toddlerhood Section 6.6  TIPS ON FEEDING A TODDLER (continued) • • • Toddlers typically love cereals and grains, so offer them things such as crackers, bread, pancakes, noodles, rice, and hot and cold cereal. A toddler should have about 16 ounces of whole milk or other dairy per day. Whole milk is preferred over low-fat or skim because it better promotes brain growth. Ultimately, children eat whatever their caregivers feed them, so make sure that the food you are offering is healthy. Only offer treats like candy, sweetened beverages, chips, and fried food sparingly. Source: Adapted from University of Pittsburgh Office of Child Development. (2007b). My toddler won’t eat. Retrieved from http://www.ocd.pitt.edu/Default.aspx?webPageID=298&parentPageId=6. At age 2, toddlers may still have strong food preferences, but the variety of foods they are willing to eat begins to broaden. They might express a preference for foods they can easily identify, avoiding foods that are blended or foods that are new to them. Healthy snacks between meals should be provided. At about this age, children can begin to learn manners at mealtime by mimicking the behavior displayed by older children and adults and also by being told the appropriate behaviors and expected responses like please and thank you. At age 3, children are often open to trying different foods, although certain preferences or dislikes may persist. Eating independence also is taking shape so that children may want to take their own servings and make their own decisions about which foods to eat. However, they may need help judging portions. In addition, healthy eating habits should already be encouraged by providing nutritious foods. See the section on physical growth for more about nutrition. Many infants transition from breast milk or formula to solid foods at no later than 12 months of age. Proper nutrition for a toddler is crucial for optimal function of the systems that regulate sleep, digestion, cognition, and emotions. Because the growth rate is beginning to slow, toddlers’ appetites may begin to decrease. At the same time, the introduction to a whole new world of solid foods may leave children wanting sweets and processed foods that offer calories and fill them up without providing the appropriate nutrition for growth. Vitamins and nutrients such as iron, calcium, and zinc need to find their way into a child’s diet. Proteins and carbohydrates also are important components of a healthy diet, encouraging physical growth in these early years. A serious complication at this age is the prevalence of food allergies. Many children cannot consume foods like peanuts, tree nuts, soy, wheat, shellfish, and even dairy (including cow’s milk), all of which offer specific nutritional benefits. Finding substitutions for the nutrition these foods provide can be difficult. Thankfully, many children grow out of food allergies later in life. Elimination From ages 1–3 years, an important transformation in elimination takes place. The process starts with the child’s recognition of a soiled diaper. At around age 1, the child will often start to let a trusted adult know when the diaper needs to be changed. As awareness progresses, the child may become uncomfortable or embarrassed in a soiled diaper. This is the time when toddlers begin to develop some bladder control and the duration between soiled diapers lengthens as their muscles allow them to control bowel function. Toddlers show their gro81431_06_c06_121-146.indd 139 4/24/14 11:54 AM Self-Help Development in Toddlerhood Section 6.6  interest in the act of toileting by watching others use the toilet and mimicking the behavior themselves. True bladder and bowel control is not achieved until age 3. At this time, toilet training is usually well under way and toddlers have fewer accidents than before. Some may even stay dry through the night; however, there is no cause for concern if a child still has frequent accidents at night. It is important not to force toilet training until the child has the necessary skills and abilities (see Table 6.6). Toilet training too early can cause stress for the child and may actually delay toileting. Table 6.6: Time to toilet train The American Academy of Pediatrics suggests the following signs that a child is ready for toilet training: • The child can imitate his or her parents’ behavior. • The child can put things where they belong. • The child can demonstrate independence by saying no. • The child can express interest in toilet training. • The child can walk and is ready to sit. • The child can communicate his or her need to eliminate. • The child is able to pull clothes up and down. Source: From American Academy of Pediatrics. (1999). Toilet training guidelines: Clinicians—The role of the clinician in toilet training. Pediatrics, 103(6), 1364–1366. Copyright © 1999 American Academy of Pediatrics. Reprinted by permission. TIPS ON TOILET LEARNING • • • • • • • • Pay attention to his or her behavior in order to recognize the signals that he or she has to use the bathroom. • Lots of toddlers tend to go to the bathroom at the same times every day, so keep an eye on the time. Teach the child proper bathroom hygiene, such as wiping front-to-back for girls, and to always wash hands after going. If the child is having trouble going to the bathroom, try running the water in the sink or tub. Show him or her how to check for dryness. This will give him or her a greater sense of independence about his or her progress while learning. Make sure that all of the child’s caregivers are offering their consistent support and encouragement to him or her. When using a child’s potty, make sure the child sees you put the contents of the potty into the toilet after he or she is done. However, don’t flush the toilet until the later stages of toilet training. Dress the child in bottoms that he or she can take off easily, like a skirt or pants with an elastic waistband instead of a zipper or buttons. Most importantly, be patient with the child, and try to understand his or her feelings. Don’t shame or embarrass the child, or force him or her to use the toilet. Don’t fight about toilet training or talk about the child’s progress with other people in front of him or her. Never withhold fluid from the child, and never punish him or her for having an accident; frequent accidents may be a sign that the child just isn’t ready to toilet train yet. Source: Adapted from University of Pittsburgh Office of Child Development. (n.d.). Toilet learning. Retrieved from http:// www.ocd.pitt.edu/Files/PDF/Foster/27758_ocd_toilet_learning.pdf. gro81431_06_c06_121-146.indd 140 4/24/14 11:54 AM Developmental Red Flags and Where to Get Help Section 6.7  Hygiene Since a toddler should never be left alone in a filled bathtub, bathtime provides the caregiver and child an opportunity to communicate and play. This is a time when the child can begin to learn the importance of cleanliness and the actions needed to bathe. At about 1 year, children may mimic the actions of a caregiver by attempting to wash themselves. They may also express interest in the ritual by holding the washcloth and exploring the soap. Many toddlers enjoy baths and like to take time to play. Encouraging time for play during baths keeps the outlook on bathing positive. By age 3, children will usually be able to actively participate in the bathing process by washing themselves and can even begin to brush their own teeth. These activities should be monitored to ensure proper hygiene. Dressing Toddlers will continue to develop the skills needed for dressing. Many of these abilities come from their physical growth and develop in the motor domain, as discussed earlier in this chapter. Initially, children express an interest in helping with simple dressing activities like finding armholes and stepping into pant legs. Later, at around age 2 years, children begin to practice this important daily task by taking on and off clothes, often throughout the day and regardless of their location. As their fine motor skills develop, children are able to assist with buttons, zippers, snaps, and Velcro. 6.7  Developmental Red Flags and Where to Get Help As discussed in previous chapters, a young child’s development occurs through a series of progressive stages with periods of alternating large and small gains. The timing of typical developmental milestones may vary greatly over a wide age range. Temporary delays are not considered developmental delays. Similarly, not reaching a milestone by the indicated age does not confirm the presence of a developmental delay. Even so, there are certain milestones that should occur to indicate typical development in a child. Because early identification of any developmental delays results in earlier treatment options and services, leading to better results for the child, it is best practice to seek professional assistance if a child does not align with the developmental milestones indicated in Table 6.7. Table 6.7: Developmental milestones At 12 months: • Uses a few gestures, one after another, to get needs met, like giving, showing, reaching, waving, and pointing. • Plays peek-a-boo, patty cake, or other social games. • Makes sounds, like ma, ba, na, da, and ga. • Turns to the person speaking when his or her name is called. At 15 months: • Exchanges many back-and-forth smiles, sounds, and gestures. • Uses pointing or other “showing” gestures to draw attention to something of interest. gro81431_06_c06_121-146.indd 141 (continued) 4/24/14 11:54 AM Developmental Red Flags and Where to Get Help Section 6.7  Table 6.7: Developmental milestones (continued) At 15 12 months: (continued) • Uses different sounds to get needs met and to draw attention to something of interest. • Uses and understands at least three words, such as mama, dada, bottle, or bye-bye. At 18 months: • Uses lots of gestures with words to get needs met, like pointing or taking others by the hand and saying, “Want juice.” • Uses at least four different consonants in babbling or words, such as m, n, p, b, t, and d. • Uses and understands at least 10 words. • Shows that he or she knows the names of familiar people or body parts by pointing to or looking at them when they are named. • Demonstrates simple pretend play, like feeding a doll or stuffed animal, and attracting the attention of others by looking up at them. At 24 months: • Participates in pretend play with more than one action, like feeding the doll and then putting the doll to bed. • Uses and understands at least 50 words. • Uses at least two words together (without imitating or repeating) and in a way that makes sense, like “Want juice.” • Enjoys being next to children of the same age and shows interest in playing with them, perhaps giving a toy to another child. • Looks for familiar objects out of sight when asked. At 36 months: • Enjoys pretending to play different characters or talking to dolls or action figures. • Enjoys playing with children of the same age, perhaps showing and telling another child about a favorite toy. • Uses thoughts and actions together in speech and in play in a way that makes sense, like saying, “Sleepy, go take nap” or “Baby hungry, feed bottle.” • Answers what, where, and who questions easily. • Talks about interests and feelings about the past and the future. Source: Copyright © 2001–2014 by First Signs, Inc.; http://firstsigns.org. The key social, emotional, and communication milestones were compiled from the following sources: Greenspan, S. I. & Lewis, N. (2000). Building healthy minds; Prizant, B. M., Wetherby, A. M., & Roberts, J. E. (2000). Communication disorders in infants and toddlers. In C. Zeannah (Ed.) Handbook of infant mental health (2nd ed.) New York: Guilford Press; Wetherby, A. M. (1999). Babies learn to talk at an amazing rate, First words project. Florida State University. Any significant delays in the milestones described in Table 6.7 are considered developmental red flags. Concerns caused by red flags should first be discussed with parents in a sensitive and respectful manner. It is important that parents understand that investigating red flags is a precautionary measure. Parents should be advised to speak with their child’s pediatrician for more information, or can be connected directly with a developmental specialist for further assessment. If a delay is identified, the earliest possible intervention yields the best developmental results for the child. Early intervention services may include speech and language, audiology, medical, nutritional, physical therapy, occupational therapy, gro81431_06_c06_121-146.indd 142 4/24/14 11:54 AM Summary and Resources family counseling, assistive technologies, and more. Many low- or no-cost services are available for families that qualify. More information can be found in the Web Resources provided at the end of this chapter. Summary and Resources Toddlerhood is a significant stage in a child’s development. Progress in each domain is interconnected. Communication skills are essential for social-emotional development and cognitive advancement, just as physical growth is necessary for improvement in motor skills. Attentive and responsive care from trusted adults is essential for optimal development in all domains. Caregivers who interact regularly with young children, discuss life’s challenges in age-appropriate ways, and provide scaffolding support for emerging skills help toddlers to develop communication, social-emotional, cognitive, and gross and fine motor skills along with increased independence in daily tasks. By the age of 3, a child has an emerging personality, a special way of interacting with adults and peers, individual likes and dislikes, and a unique way of viewing the world. Each of these differences lays the groundwork for further advancement in the developmental domains in the years to come and eventually leads to a unique individual. Key Terms and Concepts associative play  Play that is interactive and roughly structured, with no formal organization. autonomy  The sense of the self as an individual, with a recognition of separate thoughts and feelings and an appreciation for the freedom to act on those perspectives. deciduous teeth  The first set of teeth, named for their process of shedding. egocentrism  A child’s sole focus on himself or herself with an inability to take another’s perspective. empathy  The identification and appreciation for another individual’s emotions. food jags  Periods of narrowed food preferences. growth plates  The areas surrounding the cartilage at the end of long bones that form new bone tissue. gro81431_06_c06_121-146.indd 143 hand dominance  The favoring of one hand over the other. holophrase  The use of one word to convey an idea. malnutrition  The lack of proper amounts and types of food, which can lead to the degradation of muscle and fat tissue in the body. myelination  The process by which a fatty coating is produced on the axons that send signals between the neurons. ossification  The process of the hardening and strengthening of bones. parallel play  An early stage of peer-to-peer interest in which a child watches another child play independently or plays separately but alongside another child. precausal reasoning  The creation of relationships between two unrelated ideas without a chain of logic, often related to egocentrism. 4/24/14 11:54 AM Summary and Resources preoperational stage  Piaget stage of cognitive development that occurs from 2 to 6 or 7 years of age, bridging the child’s cognitive development from the sensorimotor stage to the operational stage. During this stage, children can categorize objects, correctly name shapes and colors, try to make mechanical objects work, use their imagination with objects, and begin to engage in realistic dramatic play. telegraphic speech  Communication of thoughts through short two-word phrases, sometimes with accompanying gestures. tertiary circular reactions  The trial-anderror experimentation that children carry out while actively trying to learn about their environment. tripod grasp  A fine-motor grasp in which an object is held with the index and middle fingers and the thumb. wasting  A process by which the body’s muscle and fat tissue begin to degrade as an outcome of malnutrition. word explosion  A surge of acquired vocabulary at around the age of 2 years. Discussion Questions 1. Why is safety an essential consideration when caring for a toddler? Discuss key recommendations for keeping the child’s environment safe. 2. You are working with a mother and her 12-month-old child. She is frustrated that her daughter “keeps being bad” by repeatedly throwing her food on the floor. How would you reframe this behavior to the mother, based on what you know about development at this age? What recommendations would you give the mother for dealing with this behavior? 3. Discuss the three main challenges that children need to overcome in order to move from Piaget’s preoperational stage to the operational stage. What can caregivers do to support children in mastering these concepts? 4. Explain the various theories of language development in toddlers. Which theory do you feel best explains the rapid acquisition of language in this age group? 5. If a toddler is removed from her home due to neglect, how might this affect her social-emotional development? What can the child’s foster family do to help her during this transition? 6. How might a child’s culture affect his or her acquisition of self-feeding skills and food preferences? 7. How do you know when a child is ready to begin toilet training? What are potential drawbacks to starting this process too early? 8. Why is early detection of developmental delay important? How will you determine if the child is “significantly delayed,” warranting a referral for further evaluation? Provide examples of two or three red flags for each age group. Observational Activities The following activities encourage opportunities to see child development in action. Arranging occasions to observe or interact with children of various ages creates critical moments to synthesize the learning in this text. 1. Witnessing motor progression; park it. Children of various ages can be seen at parks or indoor play spaces. As you observe children’s motor activities in one of these gro81431_06_c06_121-146.indd 144 4/24/14 11:54 AM Summary and Resources settings, use Table 6.1 to predict the age group into which the children at play fit. If you are comfortable, introduce yourself to the parents, explain this class activity, and inquire about the ages of their children. 2. Witnessing language growth; monkey around. Observing children interacting with or observing animals is an excellent way to hear the range of words, sounds, and gestures they know. Visit a zoo, an aviary, or a pet store and watch children of various ages talk about or mimic the animals they see. Take note of the number of words and sentences used and the depth of vocabulary, by age. 3. Witnessing empathy; face time. Toddlers love silly faces. Arrange a time (and obtain permission from the parents) to play an interactive game with a toddler. Begin by introducing the feelings game and asking the child if he or she can guess what you might be feeling. Cover your face with your hands and then show various emotions (e.g., happy, sad, angry) when you reveal your face. See if the child would like to quiz you on the faces he or she can make. Web Resources Centers for Disease Control and Prevention http://www.cdc.gov/obesity/childhood/ This website provides basic information about childhood obesity, facts about the epidemic in the United States, causes, and strategies. It also provides tools and resources, such as a body mass index (BMI) calculator, and further information on nutrition. U.S. Consumer Product Safety Division http://www.cpsc.gov/en/Safety-Education/Safety-Guides/Kids-and-Babies/Childproofing -Your-Home--12-Safety-Devices-To-Protect-Your-Children/ This webpage provides tips for childproofing your home for optimal safety with a young child in the house. Safe Kids Worldwide http://www.safekids.org/safetytips/field_age/little-kids-1%E2%80%934-years This webpage provides safety information for “little kids” ages 1–4 years. Topics include safety related to biking, boating, medications, playgrounds, toys, and sports as well as pedestrian and water safety, and more. First Signs www.firstsigns.org This one-page summary aims to educate caregivers on screening, diagnosis, and treatment of autism and other disorders. National Early Childhood Technical Assistance Center http://www.nectac.org/~pdfs/pubs/nnotes21.pdf This document provides information on state requirements for eligibility for services under the Individuals With Disabilities Education Improvement Act of 2004. gro81431_06_c06_121-146.indd 145 4/24/14 11:54 AM gro81431_06_c06_121-146.indd 146 4/24/14 11:54 AM
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