Well Child Visit Handout - 2 Years

TWO YEARS
 
Date of Visit:  ___________
Weight:           ___________
Height:            ___________
HC:                 ___________
 
NORMAL DEVELOPMENT:  Your toddler . . .    
 
•  Is full of energy!  He/she runs, jumps, climbs stairs, and opens doors.
•  Can go up and downstairs one step at a time.
•  Has a vivid imagination.
•  Likes to color and scribble—imitates circular strokes with a crayon.
•  Puts on and takes off clothes.
•  Will begin to be more assertive, independent, and perhaps resistant and negative to some things (like going to bed).
•  Enjoys helping with simple tasks.
•  Will probably toilet train during this year (see Toilet Training Handout).
•  Starts to speak in short sentences.
 
DIET:
•  Toddlers have definite food likes and dislikes and their appetites vary from one day to the next.  If your child is a picky eater, provide small portions so he/she is not overwhelmed.
•  Milk intake should be approximately 16-24 ounces per day of whole milk, 2% milk, or skim milk.
•  Make nutritious choices!  Fruits and vegetables are healthy snacks.
•  Avoid foods that are easily choked on such as hard candies, lifesavers, gum, peanuts, popcorn, raw carrot sticks, and whole grapes.  Cut hot dogs lengthwise in tiny pieces.
 
HYGIENE:
•  Teeth may be cleaned with a soft child’s toothbrush and toothpaste with fluoride.  A child’s fluoride toothpaste can be introduced now.  Good tooth care is important—try to brush twice a day, once by an adult and once by your child.
•  Use a mild soap like Dove or Caress for bathing.
 
DISCIPLINE
 •  Toddlers should not decide when it is time for bed—that is a decision to be made by parents.
•  Bedtime routine helps (but not if you allow them to prolong bedtime).
•  Consistency is essential.  Think about issues and decide beforehand how you will handle them.  Everyone in the family needs to have the same rules.
•  It is important to set limits for your child—consistent, realistic, and positive!
•  Develop routines that your toddler can count on—routine especially at bedtime and mealtime.
•  Be sure to note good behavior—children thrive on positive reinforcement.
 
SAFETY:
•  Use a car safety seat appropriate for toddlers every time your child is in a car.  Place the child safety seat in the backseat.
•  Keep all poisons, medicines, cleaners, vitamins, and iron supplements out of reach and with childproof caps where possible.  Keep the POISON CONTROL CENTER phone number handy (1-800-222-1222).  If your child ingests something harmful, call the Poison Control Center immediately.
•  Install smoke alarms on every floor and change batteries twice a year.
•  Never leave your toddler alone in the car or in the house.
•  Turn the hot water heater temperature to 120-130 degrees Fahrenheit to avoid burns.
•  Never leave your child unattended in the bathtub, pool, or near water even for a moment!
•  Keep matches away from your child and balloons and bandages out of his/her mouth.
•  Teach street safety (meaning “Never Go Near the Street” without supervision).  
•  Always supervise outdoor play.
•  Do not expect young children to supervise your toddler at home or on the playground.
 
ACTIVITIES:
•  Read to your child, sing to and with him/her, play “hide and seek,” “pretend,” and “dress up.”  These activities are a wonderful way for your child to learn, explore, expend energy, and develop a vivid imagination (Recommendation:  Jim Trelease’s Read Aloud Handbook).
•  Limit TV watching.  Be very careful what you allow your child to watch.  Most TV shows are not appropriate for young children.  “Sesame Street Productions”, “Mister Roger’s Neighborhood”, “Captain Kangaroo”, "Dora The Explorer", "Bob the Builder" and other similar shows are good choices.  
 •  Blocks, simple puzzles, pedal cars, musical toys, wagons, dolls, doctor’s kits, Playdough, plastic dishes, and beach balls.
 
HEALTH MAINTENANCE:
•  IMMUNIZATIONS:  None given at this visit.
 
LAB TESTS:
•  A blood sample will be taken to measure your child’s blood lead level for lead poisoning and to measure hemoglobin to screen for anemia.  Any abnormal results will be discussed (see Lead Poisoning Handout).
 
ANTICIPATORY GUIDANCE:  (Information credited to Brazelton’s Touchpoints)
•  Toilet training:  You can continue to look for and support signs of readiness for toilet training.  The beginning steps can include talking about what wet and dry mean and focusing on the ability to undress and dress in preparation for toileting.  If you have not already purchased a potty seat, you can now do so.
•  Emotionality:  Be prepared for negativism at this age.  Try to reflect the child’s feelings with words and provide firm but comforting support when the child loses control to help the child gain an understanding of his/her emotional limits.
•  Aggression:  Often children can become aggressive when confronted by peers who get in his/her way or want the same toy he/she does.  Prepare your child for these encounters and let him/her know that you expect the behavior to be controlled.
•  Responsibility:  It is not too early to begin assigning the child household chores.  When a sense of competence is beginning to bloom at this, these patterns of helpfulness and responsibility can begin to be established.
•  Television:  Children of this age are particularly vulnerable to the negative effects of television because their imagination is increasing and learning is still largely dependent upon physical activity.  Try to limit the amount and type of television your child watches.