CHAPTER I

PRELIMINARY

A. Background
Children have a characteristic that always growing and developing from conception
until the end of adolescence. This is what distinguishes children from adults. Children are
not small adults.Children show characteristics of growth and development that appropriate
for their age. An important period in child development is childhood. Because at this time
the basic growth that will affect and determine the child's next development. During this
time the development of language skills, creativity, social awareness, emotional awareness
and intelligence runs very fast. Psycho-social development is strongly influenced by the
environment and the interaction between children and their parents. Child development
will be optimal if social interaction is sought according to the needs of children at various
stages of development.
At age Toddler the child experiences an amazing leap of progress. Not only
physical progress but also socially and emotionally. In toddlers, a child can be very happy,
busy, and even angry.Psychosocial is growing rapidly, while physical growth is slowing
down. Pre-school age is a magical period of gaining experience from activity and
curiosity, so it requires the attention of big parents.

B. Formulation of the problem

a. What does growth and development mean?
b. What is the toddler age?
c. How to identify growth and development at toddler?
d. What are the characteristics of toddler age?
e. What about the toddler age health process?

C. Aim
a. Students know about growth and development.
b. Student / I knows the age of toddler.
c. Students know the identification of growth and development in toddler

1
d. Students know the characteristics of toddler age.
e. Students know the toddler age health process.

2
 CHAPTER II
DISCUSSION

A. Concept Growth and anthropometry child Toddler age

1. Understanding Toddler
Toddlers are children aged 12 - 36 months (1-3 years) in this period the child tries
to find out how things work and how to control others through anger, rejection, and
stubborn actions. This is a very important period to achieve optimal growth and intellectual
development (Perry, 1998).
Growth is the increase in the number and size of cells in all body parts which can
be quantitatively measured. Whereas development is a perfect increase in the functioning
of body tools that can be achieved through growing learning maturity. (Wong's, 2000).
Age 1 year is an age that is full of various interesting things including changing in
how to eat, how to move, also in the desires and attitudes or feelings of the child when told
to do something that he does not like, this will state the attitude and instincts say "no" good
with words and deeds, even though it is actually liked (psychologists call it
negativism). This reality is different when you are under one year old, your little one will
be a very annoying investigator, they will sneak into every corner of the house, touch all
the objects they find, shake tables and chairs, drop any objects that can be dropped, climb
what can be climbed, insert small objects into larger objects and so on. (Hurlock, 2002)
At the age of 2 years the little one tends to follow his parents here and there, join in
sweeping, mopping, watering the plants, all this is done with sincerity. At the age of 2 years
the child has begun to learn to get along, he is very happy to watch other children play,
feelings of fear and anxiety often occur when his parents leave their own children. Suppose
parents have to travel a long time or decide to return.
Children at 3 years are usually easier to control because children are already in
emotional development, so they take their father and mother as special people. The attitude
of hostility and stupidity that appears between the ages of 2.5 to 3 years seems to be
diminishing, the attitude towards parents is not only friendly but very friendly and
warm. Children become very obedient to their parents, so they will behave well and
accordingly. If their wishes are contrary to the wishes of their parents, because they are

3
 still living beings who have their own opinions. At the age of 3 years, children tend to
imitate anyone their parents do every day, called the identification process. In this process
the character of the child is formed much more formed from the instructions received from
the parents, such as forming their own model, fostering personality, forming a basic attitude
towards work, parents and themselves (Hurlock, 2002).
2. Toddler
Toddler is a child who is a child between the ages of 12 to 36 months. The toddler
is characterized by increased independence that is strengthened by greater physical and
cognitive mobility. Toddlers have their own characteristics in various areas of growth and
development.
At this stage experienced by an individual begins when the baby reaches the age of
3 years. Physical development includes the operation of all taste and body systems with
varying degrees, complex brain development and high environmental influences, growth
and physical development (skills) take place quickly. Cognitive development includes the
ability to learn and remember events that currently occur, the use of symbols and the ability
to solve problems at the end of the second year, and the development of understanding and
language quickly. Psychosocial development includes forming a close relationship with
parents, caregivers and other people with strength, the development of a self-awareness
system, a change from dependence to being independent. Increase interest with other
children of the same age.
3. Anthropometry

(meh diisi apa)

B. The Concept of Childhood Toddler Development
1. Psychosocial Development
Erikson saw a period of 18 months to 3 years as a time when developmental
tasks centered on Autonomy were a shame and doubt. Toddlers begin the
development of their autonomy by highlighting themselves by often saying "no".
They also often feel hopeless because of the restraint of their behavior and at the
age of 1 to 3 years they have a characteristic behavior, which is often called
"Temper Tantrum". But gradually they will be able to control their emotions with
help from parents.

4
 Developmental period Autonomy is a time when children begin to hold
social contacts. Toddlers become very curious and ask questions. At this age
children become more creative, even though the products produced from their
activities may not be perfect. Stress responses that usually appear in toddlers are
separation anxiety and regression. For example, toddlers get very worried when
they have to separate from their parents. Regression or returning to the earlier stage
of development can be seen when the toddler "wet", or using baby powder. Nurses
can help explain to parents that this is normal and that it shows that toddlers are
beginning to try to determine their position in the family.
During toddler age, the ability to understand and express language develops
rapidly. His ability to understand words is more advanced than his ability to express
words and ideas. At the age of 1 year, toddlers can recognize their own names.
2. Cognitive Development
According to Piaget, toddlers are at the 5th and 6th stages of the
sensorimotor phase and begin the preconception phase around the age of 2 years.
At the fifth level, toddlers solve the problem through a trial-and-error process. At
the sixth level, toddlers can solve problems through thinking. For example, when a
child is given a new toy, the toddler will not immediately take the toy and see how
the toy works, but they will pay close attention and think about how the toy works.
During the preconception phase, toddlers wherever possible develop cognitive and
intellectual skills. They learn about the order of time. They begin to think
symbolically, for example: chairs may be likened to a safe place, while blankets are
identical to comfort.
a.) Sensory phase of the motor
12-24 moths rapid development, is still modest in the ability to find a reason.
13-18 months taking an active experiment to achieve the objectives
previously, start making rational decisions and intellectual reasons.
 Feeling different from others is shown by the courage to do things that
are risky, without parents
 Be aware of the consequences, and cannot transfer new knowledge
 Not able to apply perfect objects

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 19-24 months is the end of the sensorimotor stage which can predict
something that has an influence on it, Imitation by increasing symbols,
starting to feel anticipating time, temperature, remembering and being able
to wait and think and behave egocentrically.
b.) Pre conceptual phase
With characteristics:
a. Egocentrism
Inability to place situations from other people's perspectives so that the
Implications of Children need opinions / reasons from others
b. Transductive
Bad transfer of values
Reasons from one part to another implicate accept the child's reasons
c. Global Organization
Changes to one part will change all parts and implications of accepting the
child's reasons.
d. Centration
Focus more than one aspect rather than the possibility of other alternatives.
e. Animism
Distinguishing living activities from dead objects keep the implications so
that children are not afraid.
f. Irreversibility
Inability to reverse & change physical actions taken. Implications give
positive rewards & instructions.
g. Magical
Believe that the mind has the power and effect of something. Implications
explain that the mind does not cause anything & it does not aim.
h. Inability to conserve
Not able to think that something can change in size, shape, volume, length.
Implications for changing perceptions of children's views

3. Moral Development

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 According to Kohlberg, the first level of moral development is pre-
conventional when children respond to "good" or "bad" labels. During the second
year of life, children begin to learn to know some activities that bring influence and
approval. They also know certain rituals, such as repeating parts of prayers. At the
age of two years, toddlers learn about their parents' behavior related to moral affairs.

4. Spiritual Development
The toddler level in spiritual development is undifferentiating. Toddlers
may know some religious practices, but mainly they need to learn about knowledge
and emotional reactions, rather than determining the beliefs that will be followed.
Toddlers may repeat a few prayers when going to sleep and adjust to certain rituals,
because this will produce an influence and appreciation. This parent's response
increases the sense of security at toddler.

5. Biological Development
Gross and Fine Motor Development
The major gross motorbike skill years in the development of locomotion. By 12 to
13 months of age toddlers walk alone, using wide stance for extra balance, by 18
months they try to run easily. Between 2 and 3 years of age, refining the upright,
biped position in evidence has improved coordination and equilibrium. By age 2
years toddlers can walk up and down stairs, and by age 2½ years they jumped using
both feet, stand on one foot for a second or two, and manage a few steps on tiptoe.
By the end of the second year they were on one foot stand, tiptoe walk, and climb
stairs with alternate footing.
Fine motor development is demonstrated in increasingly skillful manual
dexterity. Once toddlers achieve a pincer grasp, usually at 9 to 10 months of age,
they combine this skill with others developing sensory and cognitive abilities. For
example, by age 12, they are able to grasp a very small object. By age 15 months
they can drop a pellet into a narrow- checked bottle. Casting or throwing objects
and retrieving them into an almost obsessive activity about 15 months. By 18
months of age they can be a ball overhand without losing their balance.

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 Mastery of gross and fine motor skills are evident in all phases of the
child's activities, such as play, dressing, language comprehension, response to
discipline, social interaction, and propensity for injuries.
C. Development at a toddler (1-3 years)
Children can do:
• scribbling
• Stringing 2 words/mentioning words
• Active play
• Follow the parents.
• walk several steps/without help.
• wear/take off clothes.
• drink from a cup without help
• kicking the ball forward
• jump in place/with both feet
• walk up by holding one hand
• walk up and down at one time
• arrange 8 tower beams.
D. Age Limit
Limits at toddler age are 1 to 3 years.
a. Characteristics of Toddler Age
At toddler age have the following characteristics:
i.Development Psychosocial
Erikson looks at a period of 18 months to 3 years as a time when
developmental tasks are centered on Autonomy, shame and hesitation. Toddlers
begin the development of their autonomy by asserting themselves by saying the
word "no" often. They also often feel hopeless because of the restraint of their
behavior and at the age of 1 to 3 years they have a characteristic behavior, which
is often called "Temper Tantrum". But gradually they will be able to control
their emotions with help from parents.
Developmental period Autonomy is a time when children begin to hold
social contacts. Toddlers become very curious and ask questions. At this age

8
 children become more creative, even though the products produced from their
activities may not be perfect. Stress responses that usually appear in toddlers
are separation anxiety and regression. For example, toddlers get very worried
when they have to separate from their parents. Regression or returning to the
earlier stage of development can be seen when the toddler "wet", or using baby
powder. Nurses can help explain to parents that this is normal and that it shows
that toddlers are beginning to try to determine their position in the family.
During toddler age, the ability to understand and express language develops
rapidly. His ability to understand words is more advanced than his ability to
express words and ideas. At the age of 1 year, toddlers can recognize their own
names.
ii.Psychosexual Development (Phase Anal)
Body focus: Children's area
Developmental tasks: Learning to regulate defecation and urination.
Development crisis : Toilet training
General coping skills: sucking thumbs, perming hair into knots.
Sexual needs: Pleasant sensation related to the excretory function,
children actively explore the body.
Play : Children love playing with excreta (feces)
The role of parents: Helps children reach continence without controls that

are too tight or over permissive.

iii.Cognitive Development
According to Piaget, toddlers are at the 5th and 6th stages of the
sensorimotor phase and begin the preconception phase around the age of 2
years. At the fifth level, toddlers solve the problem through a trial-and-error
process. At the sixth level, toddlers can solve problems through thinking. For
example, when a child is given a new toy, the toddler will not immediately take
the toy and see how the toy works, but they will pay close attention and think
about how the toy works.
During the preconception phase, toddlers wherever possible develop
cognitive and intellectual skills. They learn about the order of time. They begin

9
 to think symbolically, for example: chairs may be likened to a safe place, while
blankets are identical to comfort.

iv.Moral Development
According to Kohlberg, the first level of moral development is pre-
conventional when children respond to "good" or "bad" labels. During the
second year of life, children begin to learn to know some activities that bring
influence and approval. They also know certain rituals, such as repeating parts
of prayers. At the age of two years, toddlers learn about their parents' behavior
related to moral affairs.
v.Spiritual Development
The toddler level in spiritual development is undifferentiating. Toddlers
may know some religious practices, but mainly they need to learn about
knowledge and emotional reactions, rather than determining the beliefs that will
be followed. Toddlers may repeat a few prayers when going to sleep and adjust
to certain rituals, because this will produce an influence and appreciation. This
parent's response increases the sense of security at toddler.
vi.Nutritional needs
Nutrition is a substance needed by the body to grow and develop. Every
child has different nutrient needs and children have unique characteristics in
consuming these foods or nutrients. Therefore, to determine the right food for
children, determine the number of needs of each nutrient, then determine the
type of food that can be selected to be processed according to the desired menu,
also determine the schedule of feeding and note the portion spent.
The types of nutrients needed by the body are water, protein, fat,
carbohydrates, vitamins and minerals.
Characteristics of fulfilling the nutritional needs of toddler children:
 Children are difficult or less willing to eat
 The child's appetite often changes which may be enough to eat today
and the next day eat a little

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  Usually children like certain types of food
 Children get bored quickly and can't stand eating while sitting for a
long time
E. Toys
Toys are the inanimate objects with which children interact, and cognitive
development appears to be related to the variety and accessibility of objects for children
to explore, experiment, with, and come to know. Access to playthings, particulary during
the earlier years, correlates with the accessibility of care-givers who make objects
available, react to children’s responses to the object, encourage further exploration, and
talk about what is happening. Consequently, although they can be significant un
themselves, playthings assume an especially important aspect as a medium of social
interchange.
Selecting Toys
The type of toys chosen by and provided for children can facilitate and development
in the areas just described. Toys that are small replicas of the culture and its tools help
children assimilate their culture and learn gender and occupational roles. Toy that require
pushing, pulling, rolling, and manipulating teach children about the physical properties pf
the items and halp develop muscles and coordination. Such toys also allow toddlers to use
newly developed fine and gross motor skills; children can push, pull and bang away on
such objectsand release frustration rather than acting out with inappropriate behavior.
Toodlers can learn rules and the basic elements of cooperative and organization through
board games.
Because they can be employed in a variety of ways, raw materials or
multidimensional toys are best for enhancing skills and stimulating the imagination.
Through manipulation, playthings such as boxes, clay, and blocks can assume a multitude
of symbolic forms and inspire creative impulses. For example, building blocks can be used
to construct a variety of structures, to count, and to learn shapes and size.” Educational”
toys such as puzzles are less flexible. Families can encourage children’s toy play in a
number of ways.
Play materials do not need to be expensive or elaborate.

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 Infants and small children get enjoyment from smple kitchen utensils such as wooden
spoons and small plastic plates to bang, pot lids to clang together, and a nest to measuring
spoons to rattle. Empty cartons, especially oversized ones used to ship furniture, can
assume the function of clobroom, hideaways, and other private place for slidingin winter.
Paper is a fascinating and versatile raw material for children of any age, and most books
on toy materials include recipes for play dough and fnger paint.
Toy Safety
The selecting of toys and play equipment is a joint effort between parents and
children, but evaluating their safety is the adult’s responsibility. Government agencies do
not inspect and police all toys on the market. Therefore adults who purchase play
equipment need to evaluate its safety, including toys that are gifts or those that are
purchased bay the children themselves, adults should also be alert to notices of defevtive
toys and manufacturer recalls. Parents and health care workers can obtail information on a
variety of recalled products and can repot potentially dangerous toys and child products to
the U.S. Consumer Product Safety Commission* or, in Canada, the Canadian Toy Testing
Council.
F. Playing

(meh diisi apa)

Age Motoric / Play Language Social / Cognition

Rough motoric
 Say 4 to 6 words
 Walk without help
 Request an object
 Climb up the stairs
by showing it
 Kneel without
 Understanding
12-15 months support
simple commands
Fine motoric
 Use the word "no"
 Nice to drop
despite agreeing to
objects on the
the request
floor

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  Can build 2 tower  Tolerate
boxes separation from
 Release the grains parents
into the narrow  Can imitate
neck of the bottle parents cleaning
 Scribble the house
spontaneously (sweeping,
 Use the cup well wiping, folding
clothes)
 Eat it yourself and
eat a little
 Kiss and hug
parents
 Emotional
expression,
tantrum temper
16-18 months Rough motoric  Say 10 more
 Run clumsy and words  A good imitator
often fall  Appoint general  Set the spoon well
 Walk up the stairs objects such as  Removing gloves,
with 1 hand shoes or balls and socks and zippers
holding on 2 or 3 body parts  Began to realize
 Pull and push toys the ownership of
 Jump with both "my game"
feet  Develop
 Sit alone in a chair dependence on
 Throw the ball transition objects
from one hand to such as "security
another without blankets"
falling
Fine motoric
 Build towers 3 to
4 boxes

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  Flip the book page
2 or 3 sheets at a
time
 In drawing make
the pressure match
the imitation

Rough motoric
 The vocabulary is
 Go up and down
about 300 words
the stairs yourself
 Use 2-3 words in a
with 2 feet at each
sentence
step
 Use my pronouns,
 Running balanced
you, and me
with wide steps
 Understand direct
 Catch objects
orders
without falling
 Mention the first
name by showing
himself
Fine motoric
19-24 months  Disclose the need
 Kick the ball well
for food, drink and
 Build towers with
toileting
6-7 boxes
 Talk incessantly
 Arrange 2 or more
 Temper tantrum is
boxes resembling
decreasing
a train
 Encourage people
 Flip one page of a
to show them
book
something
 Drawing imitates
 Increased
vertical and
independence
circular
 Dress alone
movements

14
  Squeeze the  Parallel game
doorbell and open stage
the latch  Has further
attention
Rough motoric  Mention the first
 Jump with both name and last
feet name
 Jump or step from  Point to yourself
the chair with the right
 Stand briefly on pronouns
one leg  Use plural words
 Take 2 steps at the  Mention one color
tip of the big toe  Can be separated
Fine motoric from the mother
 Build 8 tower more easily
boxes  In playing, helping
24-30 months  Good finger to get rid of
coordination, something, can
holding the crayon bring glassware,
with your fingers push with good
instead of grasping control
 Move your finger  Began to
independently recognize gender
 Draws, mimics differences
vertical and themselves
horizontal  Can go to the
movements and toilet by yourself
crosses except for
splashing

G. Health Problems
1.At the age of Toddler health problems that often occur are
A. Accident

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 A. Car accidents, sinking, burning, poisoning and falling.
B. The possibility of such an accident can occur because of all the
curiosity and love to feel and taste everything.
2.Vision problems
At the age of Toddler, the child needs to undergo a visual examination to determine
the presence of abnormalities in vision
3. Dental caries
Caries teeth common in toddler age, usually caused by excessive intake of sweet
foods or use old milk bottle at nap time or bed nights
4. Respiratory and ear infections
Respiratory and ear infections often occur throughout the toddler period

G. Communication with toddlers

a. Verbal communication has not been effective, because it is not yet fluent in
speaking.
b. Use simple, short words known to children because children can only receive
information literally.
c. Very egocentric, only seeing something centered on him (communication centered
on him).
d. Often behaving at the examiner's favor hand and crying at the examiner approach
him.
e. Children have not been able to understand abstraction, so use short and concrete
terms.
f. Introduce the tools to be used, including how they work.
g. Give praise for the things achieved.
h. Use fun objects.
i. Contract time with patients and family, when action will be taken.
j. Given the opportunity to hold the tools especially for Preschool children (by
looking at the circumstances, to how the tool will be used).

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H. Settlement of Problems in Growing Toddler
• Discuss the importance of imitation of children and the need to involve children in
various activities.
• Talk about the approach taken for realistic toilet training and expectations.
• Emphasize the uniqueness of the toddler's thinking process, especially the language
used, lack of understanding of time and inability to see events from other people's
perspectives.
• Emphasize to instill concrete discipline.
I. How to care for a toddler (1-3 years)
Treatment at this age consists of:
1) Child hygiene
a. Bathe with soap 2x a day.
b. Wash your hair with shampoo three times a week
c. Wash your hands with soap before eating, after defecating, urinating and after playing
d. Take care of children's cleanliness
e. Nail and hand nail clippers if long
f. Teach defecation and small water in the toilet
g. Keep clothes, toys and beds clean.
h. Keep food and drink clean

2) Dental care
a. If the teeth have not yet grown, clean the gums after each suckles with a cloth soaked
in warm water.
b. Teach children to brush their own teeth
c. Don't get used to eating sweet and sticky foods
d. Check every 6 months to the health center/dentist

3) Nutrition
a. Continue giving to eat adult food.
b. Add the portion to ½ plate

17
c. Give a snack twice a day
d. Don't gives sweet foods before meals, because it can reduce appetite.

4) Immunization
Aims to protect children from disease, prevent children with disabilities,
and prevent child deaths. Immunization that must be obtained is Hepatitis B, BCG,
Polio, DPT, and Measles at the age of 0-9 months.
5) Sleep
Children need about 12 to 14 hours to sleep.

6) Keep children out of danger.

a. Items suspected of being food/drink:
• Drugs
• Rat poison
• Kerosene
• Soap/detergent
b. Hot objects:
• Stove
• Iron
• Hot water flask
c. Dangerous objects:
• Knife
• Power cable
d. Don't let children play close:
• Wells
• Swimming
• River

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 CHAPTER III
CONCLUSION

Growth is a physical change and an increase in size. Whereas development is an increase

in the complexity of functions and advancement of skills.
At the age of toddler the increase in body age occurs gradually rather than linearly which
shows the characteristics, acceleration or deceleration of growth.
Health Problems at the age of Toddler Health problems that often occur are:
 Accident
 Vision problems
 Dental caries
 Respiratory and ear infections
The focus of Child Nursing is the provision of safe and effective nursing care for children
(neonates, infants, toddlers, preschoolers, school-age and adolescents) in the family context
according to the level of development both healthy and sick directly or indirectly, both at
home, in the community or in the hospital by applying various theories, concepts and
principles of nursing.

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 BIBLIOGRAPHY

Ari, Sulistyawati. 2014. Detection of Child Growth. Salemba Medika. Jakarta

Barbara, Konzier.2010. Fundamental Textbook for Nursing, 7th Edition Volume 1.EGC. Jakarta
Dian, Adriyana.2011. Growth and Therapy Play in Children. Salemba Medika.
Jakarta
Dwi, Sulity. 2011. Growth in the Development of Children and Teenagers. Tim. Jakarta
Supartini. Yupi. 2004. Basic concepts of child nursing. EGC. Jakarta

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