Toddlers typically gain 3 to 5 pounds and grow 3 inches in height per year. By age 2, they attain approximately half of their adult height, and the anterior fontanel closes by 18 months.

Vital Signs (Ages 1–3 Years):

• Temperature: Ranges from 37.7°C (99.9°F) at 1 year to 37.2°C (99.0°F) at 3 years.

• Pulse: 80 to 140 beats/min.

• Respirations: 25 to 30 breaths/min.

• Blood Pressure (1–2 years):

◦ Male: Systolic 85–91, Diastolic 37–46.

◦ Female: Systolic 86–89, Diastolic 40–49.

• Pain Assessment: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is used for children aged 2 months to 7 years.

Developmental Stages

Psychosocial (Erikson): The toddler enters the stage of Autonomy vs. Shame and Doubt. This period is marked by the child's desire to exert control, often leading to negativism (the consistent use of "no") and temper tantrums as they struggle between dependence and independence.

Cognitive (Piaget):

• Sensorimotor (12–24 months): Toddlers engage in tertiary circular reactions, experimenting with behaviors and developing object permanence.

• Preoperational (2–7 years): Characteristics include animism (attributing lifelike qualities to objects), domestic mimicry (imitating household tasks), and symbolic thought.

Motor and Language Milestones:

• Gross Motor: Toddlers walk independently by 15–18 months. By 24 months, they can kick a ball and walk up stairs; by 30 months, they jump with both feet.

• Fine Motor: Skills progress from using a spoon at 15 months to turning doorknobs at 30 months and copying a circle by 36 months.

• Language: Receptive language (understanding) develops faster than expressive language. Speech evolves from single words ("mama/dada") at 15 months to telegraphic speech (2-3 word sentences like "want cookie") by 24 months.

Social and Safety: Play is primarily parallel play, where toddlers play alongside but not with other children. Safety is a priority due to increasing mobility; hazards include poisoning, drowning, and burns. Car seats should remain rear-facing until at least age 2 or until the child meets the manufacturer's height/weight requirements.

Vaccination Schedule (12 Months – 3 Years)

The CDC recommends the following immunization schedule for this age group:

• 12 to 15 Months:

◦ Hib (Haemophilus influenzae type b): Booster dose.

◦ PCV (Pneumococcal conjugate): Dose 4.

◦ MMR (Measles, mumps, rubella): Dose 1.

◦ VAR (Varicella): Dose 1.

◦ HepA (Hepatitis A): Dose 1 (routine vaccination is a 2-dose series between 12–23 months, separated by at least 6 months).

• 15 to 18 Months:

◦ DTaP (Diphtheria, tetanus, acellular pertussis): Dose 4.

• 6 to 18 Months (Range):

◦ HepB (Hepatitis B): Dose 3 (must be at least 24 weeks of age).

◦ IPV (Inactivated poliovirus): Dose 3.

• Annual:

◦ Influenza: 1 or 2 doses annually depending on vaccination history