Child Neurologist Shares Insights on the 5 Stages of Toddler Development

Children grow fast; before you know it, they’re already moving on from crawling around in diapers to running around the house. For first-time parents, childhood milestones can be an important indicator of your toddler’s development. This will help you adjust how you communicate, teach and even play with them. Paying attention to your child’s development can also help you spot any delays or abnormalities that may arise. We sat down with Dr Sofiah Ali, Consultant Paediatrician and Paediatric Neurologist at Subang Jaya Medical Centre, to learn more about the 5 stages of toddler development. Dr Sofiah Ali, Consultant Paediatrician and Paediatric Neurologist at Subang Jaya Medical Centre Q1: What are the key milestones in a toddler's social development? Toddlers, aged 1 to 4 years, demonstrate their social development through interactive communication like body language and verbal cues. Their responses, smiles, and interactions with peers are essential. It is concerning if they prefer to play alone, show disinterest when called, or lack responsiveness. As toddlers grow, they should develop an interest in socialising and begin to follow the group. However, simply imitating others without true integration can be worrisome. After 2 years old, social development becomes more complex as they learn about sharing, turn-taking, and empathy. By 3 to 4 years old, toddlers engage more with others, express empathy and sympathy, and have interactions with their peer group. It is crucial to expose them to different people and avoid overprotection. The limited peer interactions during the pandemic have led to slower development, separation anxiety, and social anxiety. Hence, exposure to diverse behaviours, such as understanding win/lose and my turn/your turn, is crucial for their development. Once they attend kindergarten, children learn even more through group learning. For example, they observe and learn from peers on how to communicate their needs to the teacher. This peer interaction facilitates their learning. If a 3-year-old child still does not speak or has minimal interactive communication, it alerts parents. However, if the child can follow simple instructions and understand, it indicates normal development in other areas. Even before 18 months old, speech issues (they should learn 6 to 10 single words by then) and lack of responsiveness to their name or other forms of communication are worrisome signs. Q2: How does a toddler's cognitive ability evolve during toddlerhood? Cognitive development is interconnected with speech development, making it challenging to separate the two. Development varies among individuals, with some meeting developmental norms earlier or later. Around 5% of toddlers develop ahead of the norms. By 10 to 12 months old, toddlers should be able to clap hands, wave goodbye, and give high fives. By 18 months old, they typically speak 6 to 10 single words with meaning such as ‘mama’, ‘papa’, ‘water’, understand simple instructions like raising their hand or identifying body parts when being asked to. Letter recognition usually starts around 4 years old. Q3: What are the biggest challenges parents face during the toddler stage? Behavioural challenges arise, such as resistance to following instructions or tantrums. Toddlers can also exhibit aggression, crankiness, self-hitting, or head-banging. Parental guidance and training from an early-stage help mitigate these behaviours. Setting boundaries, not always fulfilling every request, and consistent training are important to prevent unpleasant behaviour. For example, don’t always carry them up when they cry. Q4: How can parents foster language development in their toddlers? Language development has its own developmental norms; however, it can begin prenatally. You can talk to the baby in the womb, engaging in communication, e.g., ask the baby 'how are you today?', ‘when you grow up, do you want to be an engineer?' Once the baby is born, you can talk to and interact with him or her during baby massages and regularly reading books before bedtime from around 6 months old to enhance language development. Increased communication and exposure to language contribute to early word formation. During preverbal stage, the more you communicate or read to the baby, the more the words are registered. Toddlers usually can speak a vocabulary of at least single words by 18 months and sentences by age 3. However, guidance on appropriate language use and effective communication are needed so that they would learn what is good word, bad word, the proper way to request or say no. Q5: What role does play have in a toddler's development? Play, especially in group activities, plays a crucial role in a toddler's holistic development. It impacts gross and fine motor skills, as well as social and language development. Starting from around 1 year old, appropriate play activities can be introduced to engage toddlers. Role-playing, such as playing pretend to ‘masak-masak’ or acting as a firefighter, a policeman or a doctor, allows for interaction and communication, which are essential for socialisation and the development of EQ. Interacting during play is crucial. For example, if toddlers are left to play with LEGO on their own, they may build numerous sets. However, their EQ may not develop properly as they lack communication, socialisation, and an understanding of rules and regulations. Both IQ and EQ are important, but EQ holds greater significance. By repeatedly engaging in group play, following rules, taking turns, and adhering to regulations, toddlers can develop strong EQ alongside their cognitive abilities. Play fosters normal development and enhances intelligence. Q6: What are some behavioural issues that may arise during toddlerhood? Behavioural issues such as tantrums, kicking, spitting, biting, head-banging, and grabbing things abruptly can emerge during the toddler stage. To prevent these issues, training and guidance should begin at an early age. If such issues already exist, changing parenting techniques and firm, repeated guidance are necessary. Addressing behavioural concerns earlier is preferable, as it becomes progressively more challenging to modify behaviour as children grow older. Therefore, prevention is always better than managing it at a later stage. Q7: How can parents manage their toddler's tantrums effectively? When it comes to anger management, it is normal for individuals to experience a range of emotions, including anger, happiness, excitement, and anxiety. However, if these emotions become overwhelming and excessive, seeking help and learning how to manage them is important. Early training before the development of problematic social behaviour is crucial. Exposing toddlers to situations where they learn to tolerate winning and losing, taking turns, and distinguishing right from wrong is essential. Additionally, parents should guide their children on how to handle scolding or reprimands effectively. Most parents often express instructions without providing proper guidance. In today's digital age, excessive screen time can contribute to behavioural issues. Excessive screen activity fosters selfishness and an inability to tolerate others' turns. Children may become accustomed to getting what they want immediately, leading to fights over screen time. Minimising screen time and engaging their senses in other activities is necessary. Positive reinforcement is valuable, but there are instances where minimal negative reinforcement can be utilised. For example, instead of giving in to a tantrum, parents can choose to walk away, continue their tasks, or distract the child with a toy. Guiding the child towards the right way to communicate and manage emotions, along with promoting relaxation techniques like deep breathing or hugging, can help address tantrums effectively. Q8: What are the key elements of a healthy sleep routine for a toddler? Sleep is not solely about the duration but also the timing of sleep. Quality of sleep is essential for brainwave development, promoting calmness, memory consolidation, creativity, and focus. The duration of sleep varies with age. In the first three months, babies sleep a lot and wake up around three times at night. As they grow, they sleep less during the day, more at night, and have fewer nighttime awakenings. On average, 6 to 8 hours of sleep is sufficient for children, but the timing of sleep is important. It's preferable for them to sleep before 10 p.m., even if they wake up early and go back to sleep later. Sleeping at midnight or later and waking up at 10 a.m. may provide enough duration but lacks the crucial timing for alpha wave development. Thus, both duration and timing are important considerations for a healthy sleep routine. Q9: How can parents encourage their toddler's independence while ensuring their safety? When allowing toddlers to engage in activities outside the home, it's essential to have adult supervision. Depending on the activity, appropriate safety measures should be taken, such as using knee or elbow protectors for climbing. Encouraging independence is vital for EQ, but safety should always be a priority. Parents can let toddlers explore their surroundings while providing guidance. For instance, when teaching swimming with appropriate equipment, it's important to educate children on ensuring their own safety, such as avoiding dangerous swimming areas. Training should align with developmental norms, allowing toddlers to engage in age-appropriate activities like walking, running, and crawling. Group activities can be conducted with proper guidance and safety measures in place. Q10: What are some effective strategies for toilet training a toddler? Toilet training can vary for each child, and parental involvement is crucial. It is advisable to start toilet training as early as possible, aiming to have them trained by 3 years old, particularly for urination. One technique is to observe the toddler's facial expression, posture, or signs of hiding when they need to urinate. As soon as these signs are noticed, take them to the toilet, remove their pants, and place them on a potty or toilet bowl. Repeat this process consistently and persistently, starting as young as 2 or 2.5 years old. Continuous communication is essential, explaining that urine should go in the toilet and reinforcing the behaviour. Another strategy is to remove their diapers during weekends when you are available at home. A typical adult can hold urine for about 4 hours, while children can hold it for 3 to 4 hours. At home, take the toddler to the toilet every 2 hours. It is not necessary to do it every 15 minutes, as it can be exhausting and lead to giving up halfway. Even if accidents occur, remain patient, clean up, and continue with the routine. With persistence, consistency, and repetition, the goal can be achieved in less than two months. The child will learn to associate the feeling of urine, removing pants, and using the toilet. This process indirectly teaches other skills as well. Starting toilet training earlier, ideally before kindergarten, is beneficial. Beginning gradually around the age of 2 allows time to reach the goal of toilet training before starting kindergarten. Remember, starting earlier tends to yield better results. Source: Dr Sofiah Ali, Consultant Paediatrician and Paediatric Neurologist at Subang Jaya Medical Centre Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner. For more insightful stories and fun recipes, stay tuned to Motherhood Story!

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