Advanced Pediatrics

100 East Street SE, Suite 301

Vienna, VA 22180
(P) 703.938.5555

(F) 703.319.8580


24 Months Old

At two years of age your baby enters toddlerhood.  Often mislabeled the "terrible 2's" this age is full of exploration and testing boundaries.  The challenges of sleep, eating, and potty training depend on the establishment of routines and clear expectations. 


It’s so difficult to follow the ups and downs of a two-year-old. One moment she’s beaming and friendly; the next she’s sullen and weepy—and often for no apparent reason. These mood swings, however, are just part of growing up. They are signs of the emotional changes taking place as your child struggles to take control of actions, impulses, feelings, and her body.








Vaccinations for this visit

We recommend the following vaccines:


  • Hepatitis A

​Recommended Tests

The following tests are only done based upon risk factors being present.  Please take a few moments to help us determine whether these tests are warranted for your child:




What to Expect

Sleep

  • Bedtime routine:  It's crucial to set a nighttime routine and stick to it.  A child's biological clock functions best with a specific daily schedule, and going to sleep at the same time every day helps her body know when to wind down.  Research has also shown that kids who have rules about bedtime have higher scores on tests of language, literacy, and math skills. Make your bedtime pattern a special time to bond. Choose a few calming activities, like braiding your child's hair after her bath, reading, and saying good night to her toys together. And remember to take your time; if you rush through the process, it could create tension and may just make her less sleepy.

  • Co-Sleeping:  When a child prefers sleeping next to his parents, it's a sign of his trust and love. But once you get in the habit of letting him into your bed, it's a difficult pattern to break, and he may become dependent on your proximity to fall back to sleep.   To help your child stay in his own bed, there are a number of approaches you can take.  Going cold turkey (locking your door at bedtime and not opening it until the next morning) can be an effective method.   If you'd prefer a more gradual approach, put a sleeping bag in your room. Tell your child this is his space to sleep if he wants to be near you during the night but that he can't come into your bed. If he does climb in bed, take him back to his own room (or his sleeping bag) every time. Be ready for a challenge.  Your child will protest and cry to test how serious you are.  Don’t give up!

  • Fears:  The same creativity that lets your child conjure up pretend friends and elaborate games of pirates can also lead her to think there are monsters under her bed.  It's normal for preschoolers to have these fears because, developmentally, they've realized that people exist even when they can't see them.  The key to handling your child's night frights is not only to say that everything's okay, but to act as though it is. Start by reinforcing the message that there are no such things as monsters. Go in the closet or look under the bed together to prove there's nothing lurking in the dark spaces.   In addition to getting a night-light, you can make the room feel safer by leaving a flashlight on her nightstand or getting a soothing white-noise machine. Before you leave her room, remind her that you're right down the hall and won't let anything happen to her.

Feeding


  • By age two, your toddler should be eating three healthy meals a day, plus one or two snacks. He can eat the same food as the rest of the family.

  • Don’t be alarmed, however, if he doesn’t always meet this ideal. Many toddlers resist eating certain foods, or for long periods insist on eating only one or two favorite foods. The more you struggle with your child over his eating preferences, the more determined he’ll be to defy you. As we suggested earlier, if you offer him a variety of foods and leave the choices to him, he’ll eventually consume a balanced diet on his own. He may be more interested in healthful foods if he can feed them to himself. So, whenever possible, offer him finger foods (i.e., fresh fruits or raw vegetables other than carrots and celery) instead of cooked ones that require a fork or spoon to eat.

  • Do not fixate on amounts and do not make mealtimes a battle. Do, however, pay attention to adopting healthy eating habits and making healthy food choices as a family. Sitting as a family at mealtime is the beginning of a good habit, too!

    At age two, he can use a spoon, drink from a cup with just one hand, and feed himself a wide variety of finger foods. But while he can eat properly, he’s still learning to chew and swallow efficiently, and may gulp his food when he’s in a hurry to get on with playing. For that reason, the risk of choking is high, so avoid the following foods, which could be swallowed whole and block the windpipe:  hot dogs (unless sliced lengthwise, then across), whole raw carrots, spoonfuls of peanut butter, nuts (especially peanuts), raw cherries with pits, round, hard candies or gum, raw celery, whole grapes, and marshmallows.

 

Development


  • When he oversteps a limit and is pulled back, he often reacts with anger and frustration, possibly with a temper tantrum or sullen rage. He may even strike back by hitting, biting, or kicking. At this age, he just doesn’t have much control over his emotional impulses, so his anger and frustration tend to erupt suddenly in the form of crying, hitting, or screaming. It’s his only way of dealing with the difficult realities of life. He may even act out in ways that unintentionally harm himself or others. It’s all part of being two.

  • Your two-year-old not only understands most of what you say to him, but also speaks with a rapidly growing vocabulary of fifty or more words. Over the course of this year, he’ll graduate from two- or three-word sentences (“Drink juice,” “Mommy want cookie”) to those with four, five, or even six words (“Where’s the ball, Daddy?” “Dolly sit in my lap”). He’s also beginning to use pronouns (I, you, me, we, they) and understands the concept of “mine” (“I want my cup,” “I see my mommy”). Pay attention to how he also is using language to describe ideas and information and to express his physical or emotional needs and desires.

  • At this time, there’s more variation in language development than in any other area. While some preschoolers develop language skills at a steady rate, others seem to master words in an uneven manner. And some children are naturally more talkative than others. This doesn’t mean that the more verbal children are necessarily smarter or more advanced than the quieter ones, nor does it even mean that they have richer vocabularies. In fact, the quiet child may know just as many words but be choosier about speaking them. As a general rule, boys start talking later than girls, but this variation—like most others mentioned above—tends to even out as children reach school age.

  • He will be able to match similar shapes when you give him shape sorting toys and simple jigsaw puzzles. He’ll also begin to recognize the purpose of numbers in counting objects—especially the number two. He may show a serious attachment to a comfort object, such as a blanket or his thumb that he sucks on.

  • Reasoning with your two-year-old is often difficult. After all, he views everything in extremely simple terms. He still often confuses fantasy with reality unless he’s actively playing make-believe. Therefore, during this stage, be sure to choose your own words carefully: Comments that you think are funny or playful—such as “If you eat more cereal, you’ll explode”—actually may panic him, since he won’t know you’re joking.


Safety

  • Install baby gates and block stairs.  Toddlers are still mastering the whole walking thing, and they lose their balance a lot.  Install wall-mounted baby gates at both the top and bottom of stairs, and cushion corners and edges of tables and fireplace hearths with padding to protect your child from banging her head on them if she topples over.

  • Install carbon monoxide detectors.  Low to moderate levels of this colorless and odorless gas can cause symptoms similar to the flu (without fever). But as levels increase, the toxic effects of carbon monoxide (CO) can be deadly, especially for children, because the gas prevents oxygen from getting to the heart and brain. If you don't have carbon-monoxide alarms outside bedrooms and other sleeping areas, you may not know your family's being poisoned until it's too late.

  • Lock up potential poisons.  That means not only cleaners, medications, and caustic cosmetic items like nail-polish remover but also perfume, bath oil, mouthwash, aftershave, and vitamins. More than 1 million kids are poisoned by ingesting common household items every year. Post the Poison Control Center's toll-free number (800-222-1222) near every phone in your house.

Activities


  • Add actions to your child’s favorite nursery rhymes.  Easy action rhymes include “Here We Go ‘Round the Mulberry Bush,” “Jack Be Nimble,” “This is the Way We Wash Our Clothes,” “Ring Around the Rosey,” and “London Bridge.”
    Take time to draw with your child when he or she wants to get our paper and crayons.  Draw large shapes and let your child color them in.  Take turns.

  • Show your child how to make snakes, balls, or roll-out pancakes with a small rolling pin using PlayDoh.  Use large cookie cutters to make new Play-Doh shapes.

  • Play “Follow the Leader.”  Walk on tiptoes, walk backward, and walk slow or fast with big steps and little steps.
    Play Target Toss with a large bucket or box and bean bags or balls.  Help your child count how many he or she gets in the target.  A ball or yarn or rolled-up socks also work well for an indoor target game.

  • Children at this age love to pretend and rally enjoy it when you can pretend with them.  Pretend you are different animals, like a dog or cat.  Make animal sounds and actions.  Let your child be the pet owner who pets and feeds you.

  • Your child will begin to be able to make choices.  Help her or him choose what to wear each day by giving a choice between two pairs of socks, two shirts, and so forth.  Give choices at other times like snack or mealtime.

  • Action is an important part of a child’s life. Play a game with a ball where you give directions and your child does the actions, such as “roll the ball.”  Kick, throw, push, bounce, and catch are other good actions.  Take turns giving the directions.