Milestones
A nurse is assessing a 15-month-old during a well-child check. Which gross motor milestone would indicate appropriate development at this age?
The child should be able to walk independently without support.
Walking typically begins around 12 months and is well-established by 15 months. A delay in this milestone could indicate a motor development issue requiring follow-up.
What is the Erikson psychosocial stage for toddlers?
What is autonomy vs. shame and doubt?
A toddler is left alone in a filled bathtub for a few minutes while the caregiver answers a phone call. What is the most significant safety concern in this scenario?
What is the risk of drowning?
Toddlers can drown in as little as 1–2 inches of water. They should never be left unsupervised near any water source, including bathtubs, toilets, or buckets, due to their limited coordination and inability to self-rescue.
A parent asks when they should start potty training their 18-month-old. The child occasionally hides before having a bowel movement but shows little interest in the toilet. What is the nurse’s best recommendation?
What is to wait until the child shows more signs of readiness?
Toilet training should begin when the child shows physical, emotional, and cognitive readiness—such as staying dry for 2+ hours, following simple instructions, and expressing the urge to go. Hiding is a potential early sign, but interest in the toilet and cooperation are also important indicators.
A parent expresses concern that their 2-year-old plays alone and doesn’t interact with other children at daycare. What is the most developmentally appropriate explanation?
What is parallel play?
Parallel play is typical during toddlerhood. Children play alongside others but do not yet engage in cooperative play. This behavior supports social development by allowing observation and imitation in a low-pressure setting.
During a home safety visit, a nurse watches a 2-year-old child climb stairs by holding a caregiver’s hand and placing both feet on each step. What does this observation suggest about the child's motor skills?
This is appropriate for a 2-year-old.
At this age, toddlers lack the coordination for alternating feet on stairs and require support. The behavior demonstrates age-appropriate gross motor development.
A parent says their toddler insists on feeding and dressing themselves, despite making a mess and taking a long time. What is the best interpretation of this behavior?
What is the development of independence and self-control?
This behavior is normal in toddlers who are learning self-help skills. It reflects progress in both psychosocial development and fine motor coordination, supporting autonomy and confidence.
A caregiver allows a 20-month-old to ride in a forward-facing car seat because “they hate riding backward.” What is the most appropriate safety recommendation?
What is keep the child rear-facing until at least age 2?
Rear-facing car seats provide better protection for the head, neck, and spine during a collision. Current guidelines recommend children remain rear-facing until they reach the maximum height or weight limit of the car seat.
The parent of a 2½-year-old says their child was nearly toilet trained but has started having frequent accidents since a new baby was born. What should the nurse explain about this behavior?
What is regression related to stress or change in routine?
Regression is common in toddlers during stressful life events, such as the birth of a sibling. The child may temporarily lose previously acquired skills. Reassurance, patience, and returning to a supportive routine without punishment are the best responses.
At a well-child visit, the nurse asks about the toddler's dental care. The parent says, “We haven’t taken him to the dentist yet because he still has baby teeth.” What is the correct recommendation?
What is to begin dental visits by age 1 or within 6 months of the first tooth eruption?
Early dental visits help establish healthy oral care, identify early signs of decay, and educate parents about brushing, fluoride, and bottle use. Even baby teeth are at risk for cavities.
Which observed behavior would best demonstrate expected gross motor development in an 18-month-old during a clinic visit?
Throwing a ball overhead while standing is a key gross motor milestone at 18 months.
It requires coordination, balance, and emerging core strength, and it reflects appropriate progression in physical development.
A nurse observes a toddler pretending to talk on a toy phone and feed a doll. What type of play is this?
What is symbolic or imitative play?
This type of play begins in toddlerhood and is essential for cognitive development. It reflects the child's ability to use objects symbolically and to learn through observation and role play.
During a home visit, the nurse sees that the toddler’s crib has soft bedding, pillows, and stuffed animals. What is the most immediate safety risk?
What is the risk of suffocation?
Soft bedding and loose items increase the risk of suffocation and Sudden Unexplained Infant Death (SUID). Cribs should be kept bare, with only a fitted sheet and no additional items, especially for children under 18 months.
A caregiver reports that their toddler resists sitting on the potty and becomes upset when prompted. The parent says, “He’ll just have to learn to deal with it.” How should the nurse guide the parent?
What is to avoid forcing the child and use positive reinforcement?
Toilet training should be a low-pressure process. Forcing or punishing the child can create anxiety or power struggles, delaying success. The nurse should recommend using praise, routine, and modeling to encourage cooperation when the child is ready.
A parent reports that their 2-year-old still uses a bottle to fall asleep and drinks about 20 ounces of milk overnight. What is the most appropriate guidance?
What is to begin bottle weaning and reduce nighttime milk intake?
Extended bottle use increases the risk of dental caries and may interfere with appetite for solid foods. Weaning should start by 12–18 months, with a transition to cups and bedtime routines that do not involve feeding.
The parent of a 2-year-old expresses concern that their child is only able to stack six blocks. What should the nurse explain about this milestone?
Stacking six blocks is a normal fine motor skill for a 2-year-old.
This activity shows the child is developing the necessary coordination, grip strength, and motor planning expected at this age.
A toddler laughs after being told they hurt another child’s feelings. The parent says, “He doesn't care what he did.” What cognitive limitation explains this reaction?
What is egocentrism?
Egocentrism, a feature of Piaget’s preoperational stage, limits a toddler’s ability to understand another person’s perspective. This is not a lack of empathy, but rather a normal cognitive limitation.
A parent gives their toddler whole grapes and sliced hot dogs during lunch. What should the nurse teach about this feeding practice?
What is the risk of choking?
Whole grapes and round pieces of hot dog are common choking hazards for toddlers. These foods should be cut lengthwise and into small pieces. Toddlers lack the molar coordination to chew and swallow such items safely.
A 2-year-old stays dry for several hours at a time and tells their parent when they need to urinate, but refuses to sit on the potty. What is the next best step?
What is to continue offering opportunities without pressure?
This child shows multiple signs of readiness but may need more time to become emotionally comfortable. Consistent routines, encouragement, and potty-friendly tools (like training seats) can support the transition without creating resistance.
What stage of Piaget’s theory do toddlers begin to transition into after the sensorimotor phase?
What is the preoperational stage?
Around age 2, toddlers begin moving from sensorimotor to preoperational thinking. This stage includes symbolic play, egocentrism, and limited logical reasoning, reflecting early cognitive expansion beyond physical interaction.
A nurse is observing a 30-month-old during a developmental assessment. Which of the following would be considered typical gross motor behavior at this age?
Jumping with both feet in place is a normal skill for a 30-month-old. More advanced tasks like balancing on one foot or hopping appear closer to age 3 or later. The child is progressing appropriately.
A parent reports their toddler imitates adult behaviors like sweeping and talking on the phone. What is the child demonstrating?
What is learning through imitation?
Toddlers learn social roles, routines, and communication by mimicking adults. Imitation is a key method of cognitive and behavioral development in early childhood.
What is the maximum recommended daily intake of milk for a toddler?
What is 16 to 24 ounces per day?
Exceeding 24 oz of milk daily can displace iron-rich foods and contribute to iron-deficiency anemia. Limiting milk and promoting a variety of foods helps support balanced toddler nutrition.
What does the TOILET mnemonic stand for?
What is
t: two+ hours of dry diaper
o: on/off the potty
i: interest
l: likes to sit on toilet
e: experience regular bowel movements
t: tell you they have to go
What behavior in toddlerhood is characterized by persistent refusal, especially the word “no”?
What is negativism?
Negativism is a normal expression of autonomy and independence. Toddlers use "no" to assert control and explore boundaries, which is developmentally appropriate during the autonomy vs. shame and doubt stage.