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Quick reference medical handouts used by Pediatric offices


Growth Milestones - TWO YEARS


"Miss Independent"

By age 2, your child is no longer a baby. He or she can run, has given up drinking from a bottle, and can feed himself or herself pretty well. Every day your 2-year-old says new words and does more things. In spite of these achievements, the two-year-old is still a baby in many ways. The 2-year-old is difficult, if not impossible, to reason with, but still extremely lovable. He or she will assert independence at mealtime, bedtime and during attempts at toilet training. Two-year-olds typically do not know what they want, except they are sure they do not want to do what you want them to do. The 2-year-old will struggle with his or her parents before going into the bathtub, then once in the tub, will struggle with the parents when it's time to get out of the tub. At times, the toddler will be a "handful." Sometimes it is tough to parent a 2-year-old. Yet these years do not have to be "terrible," and can be "terrific." Your child is simply moving from babyhood to childhood. The following comments are designed to help you and your parents enjoy your 2-year-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your child's pediatrician. Never hesitate to ask your doctor for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
  • Use picture books to enrich your child's vocabulary. Reading books to your child will help with language development.
  • Arrange times for safe running and exploring outdoors.
  • Playmates are important, so allow your child to experience playing with peers. This can be accomplished in a preschool, play group or just having another 2-year-olds over for a few hours. Do not expect sharing at this age.
  • Limit television viewing. Do not use the TV as a baby sitter or as a substitute for interaction with your child. Watch children's programs with the child when possible. Turn the TV off during meals.
  • Do not worry if your child becomes curious about body parts. This is normal at this age. It is best to use the correct terms for genitals.
  • Spend time teaching your child how to play. Encourage imaginative play and sharing of toys (but do not be surprised if the 2-year-old does not want to share his or her toys with anyone else).
  • The 2-year-old may adopt a security object (such as a blanket, favorite stuffed toy, etc.) that he or she keeps with him or her most of the time. This is normal and the youngster will give it up when he or she is ready.
  • Parents should continue to take some time for themselves. Show affection in the family.
  • Keep family outings with a 2-year-old short and simple. The child this age has a short attention span and lengthy activities will cause the child to become irritable and tired.
  • Allow any older siblings to have things he or she does not have to share with the 2-year-old.
  • Many parents are beginning to plan for another child around this time. If you are, discuss with your pediatrician the best way to discuss the expected baby and the changes that will occur in the family.
 
Discipline
  • Discipline is very important at this age. Do not waste your time and breath arguing or reasoning with a 2-year-old. Long speeches of explanation are completely useless. "Because I said so!" should be enough for now, but as they get older more explanations will be needed.
  • Discipline should be firm and consistent, but loving and understanding. Praise your child for his or her good behavior and accomplishments.
  • Encourage your 2-year-old to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a 2-year old an open question ("Do you want to take a bath") unless you are willing to accept the answer.
  • Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). When disciplining, try to make a verbal separation between the child and the behavior ("I love you, but I do not like it when you touch the VCR.")
  • Provide alternatives. If your 2-year old is playing with something you do not want him or her to have, replace it with another object or toy that your child enjoys. "No, you cannot play with the telephone, but you can play with these blocks." This avoids a fight and does not place children in a situation where they'll say "no."
  • Avoid power struggles. No one wins! The 2-year-old still uses the temper tantrum as a weapon against parents. These occur when the child is angry, tired, frustrated or does not get his or her way. Again, handle temper tantrums with the two I's of discipline - ignore or isolate (time out!).
  • Teach. Decide on a few rules (most of which have to do with the child's safety) and enforce them. Use time out immediately when rules are broken by placing the child alone for 2 minutes.
Development
  • Climbs up steps alone, one step at a time holding the stair rail or the parent's hand.
  • Jumps off the floor with both feet.
  • Opens doors.
  • Kicks a ball.
  • Can wash and dry hands.
  • Climbs on furniture.
  • Uses a spoon and cup well.
  • Asks frequent questions: "What is that?"
  • Enjoys imitating adult activities.
  • Two year olds often go through a short period of mild speech abnormalities (like stuttering).
  • Selects and uses a toy appropriately (feeds a doll, hammers pegs in a cobbler's bench).
  • Most 2-year-olds have a vocabulary of 50 or more words, although this number varies with the sex of the child (girls speak more than boys), if the child has older siblings (who will speak for him or her) or if two languages are spoken in the house.
Oral Health
  • Check with your child's pediatrician concerning when and how often to see the dentist.
  • The child will imitate a sibling or parent in the use of a toothbrush so take advantage of this to teach brushing. It is OK to use a small amount of fluoridated toothpaste.
  • Second molars usually appear.
Feeding
  • The 2-year-old will eat barely enough to keep a bird alive. Appetite is finicky and will vary from meal to meal and day to day. The child is not doing much growing at this stage so he or she does not need much food to survive. Your child will only gain three or four pounds during this year. Do not expect three good meals a day.
  • Family meals are important so let your 2-year-old eat with you to make him or her feel part of the family. Do not make mealtime a battle over food. Let you child's appetite be your guide and let him or her (within reason) choose what foods to eat. Never use food as a reward (for example, avoid saying "eat your meal and you will get dessert")
  • The child can name foods and tell parents his or her likes and dislikes.
  • The 2-year-old frequently wants the same thing day in and day out.
  • No bottles!
  • May change to 2% milk if approved by your pediatrician.
  • Discuss a vitamin/fluoride supplement with your child's doctor. Continue to give fluoride supplementation if the water is lacking in fluoride.
  • Make sure your child's caregiver is following your feeding instructions.
Sleep
  • In general, an afternoon nap is still required by most 2-year-olds.
  • The child should sleep in his or her own bed if feasible. (Discuss the move from a crib to a regular bed with your child's doctor.)
  • A 2-year-old's bedtime is usually between 7 p.m. and 8 p.m. Certain sleep problems are common during this time, including refusing to go to bed, getting out of bed and wandering around the house at night, and night terrors and nightmares.
  • "Stalling techniques" are common at bed and nap time, such as "I have to go potty" to "I want a drink of water."
  • A series of rituals works well to help your 2-year-old go to sleep. This is an excellent time to read a book to your youngster.
Toilet Training
  • The term "toilet training" should be discarded since we do not actually "train" the child. The 2-year-old simply learns to control his or her urine and bowel movements when he or she is developmentally ready, just as the child learned to sit, walk and talk. Regardless of how hard you try, you cannot speed up your child's schedule and teach the youngster before he or she is ready. In fact, by over-training, you may delay the process by making your child tense and nervous, resulting in a rebellion. The last thing parents want to do is to make toilet training become a battle ground. Pick your battles, and this should not be one of them!
  • If your child has a bowel movement at the same time every day, you may sit him or her on a little potty chair and "catch it." A favorable response from you sends a message to your child. If on the other hand, his or her bowel movement occur at irregular times during the day, watch for a characteristic expression and posture that indicates a bowel movement. When this occurs, pick up your child and put him or her on the potty. If nothing happens in a few minutes, or if your child is alarmed in any way, take him or her off the potty.
  • Your child's incentive to control bladder and bowel movements is to please you, the person he or she looks to for love. Therefore, praise your child's accomplishments and let him or her know you are pleased. When your child has an "accident," stay calm and don't punish. If you act distressed or angry when the child fails, training may be delayed.
  • Signs of toilet learning readiness include awakening from a nap with a dry diaper, having bowel movements at the same time each day, being able to say "wee-wee" or "poopee", etc., knowing when he or she has to go, and being able to take off his or her own clothes. Remember, by pushing your child, scolding or being impatient, you will only delay the development of voluntary control, and possibly lay the groundwork for a real "toilet problem" in years to come.
Safety
  • Continue to use proper car safety restraints in the back seat of every car trip. The greatest risk to your child's health is a motor vehicle accident. Remember, it is impossible for you to protect your child during an accident by just holding him or her.
  • Always walk behind your car before backing out of the driveway.
  • Beware of chewing or picking at old painted surfaces.
  • Keep firearms out of the home or in a locked, out of sight container, unloaded.
  • Pools must be gated. Knowing how to "swim" does not make a child water- safe at this age. Never leave a child unattended in a bathtub, even for a few seconds. Ensure the child wears a life vest if boating.
  • Falls from kitchen cabinets and down stairs occur frequently at this age. Never leave a chair in such a position that your child can use it to climb to a dangerously high place.
  • Be careful of items that can be left at counter level elsewhere, such as knives, scissors, cleaning agents, nail polish remover, household repair items, weed killers, insecticides, gasoline, oil, kerosene, lighter fluid and all medicines. Always keep potentially poisonous things in the items' original containers. Never put poisons in food containers or bottles.
  • Be careful what you put in the waste basket ... 2-year-olds love to stick there hands in the trash.
  • There is no such thing as a "child proof cap." Ingestion of toxic substances is common at this age.
  • Never buy toys or other objects that can cut or be ingested. Suffocation by plastic bags and balloons occurs at this age.
  • Always supervise when your child is playing near a street. Remember, a child at this age does not understand danger or remember "no"; they cannot count on being aware of the outside hazards.
  • Be especially careful when using power lawn mowers and other power tools.
  • Never leave a child unattended in a car or a house.
  • Keep Syrup of Ipecac in the home to be used only as directed by your child's doctor or the poison control center. Keep the phone number of the poison control center near the telephone.
  • Test smoke detectors to ensure they are working properly.
  • If your home uses gas appliances, install and maintain carbon monoxide detectors.
  • Continue to use a water proof sunscreen on your child before going outside. Avoid the hours between 10 a.m. and 3 p.m., when the sun is the most dangerous.
Illnesses
  • The 2-year-old may continue to experience respiratory infections, such as colds, ear infections and sinus infections. Respiratory infections of this type are a normal part of growing up.
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
  • Normally, no immunizations are given at this checkup unless your child is behind in the immunization schedule.
  • Hepatitis A (HepA) may be administered at this visit for children living in selected states.
  • Annual flu vaccines may be recommended for children with chronic illnesses like asthma and heart defects. Check with your doctor.
  • Some physicians at 2 years do a hemoglobin or hematocrit determination to check for anemia ("low blood"). This requires a small poke on the finger to obtain a drop of blood. A urinalysis will also be done if the child is toilet trained.
  • By this age, most children have received the following immunizations:
3 doses of Hepatitis B vaccine
4 doses of DTaP vaccine
4 doses of HIB vaccine
1 dose of the MMR vaccine
1 dose of the Chickenpox vaccine
4 doses of the Pneumococcal  vaccine
3 doses of the Inactivated Polio Vaccine
3 doses of Rotavirus
 
Kidsgrowth Vaccine Guide
The Vaccines and the Diseases they Prevent
Keep a record of your child's immunizations.  (Click to download a blank immunization record)
Check your child's progress with our Growth Charts.

The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.. Updated 05-08-07
 

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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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