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2 Year Old Well Child Check
Congratulations! You and your baby have made it to two! Now you'd like to know what's next, so here is some information and guidelines to help you. As you read please remember that your two-year-old is unique, and that all two-year-olds do not develop at the same pace. The following information is provided to serve as a general guide to what one can expect during the twelve months that make up age two.
To be two is to be always moving - walking, running, exploring, and testing. Each move is a step towards independence and each day the child moves a little further from the parent for a little longer. It's a challenging time of many changes, most of which happen at home. As your child's first teacher, you can help your child learn, explore, and grow. But regardless of what you do and how well you do it, your two-year-old will go through some very definite developmental changes.
Your two-year-old has the beginnings of a memory and can store pictures in his mind. But he can't connect them, and doesn't understand "cause and effect" or transitions. One psychologist likened this stage to a movie projector full of still pictures, with an unconnected story line. Your child can use symbols and visualize at this stage, and can use a block to represent a car and move it along the rug making car sounds. He can group objects, use them sequentially, and organize them. He may start to write with little straight marks that soon turn into circles and spirals. He thinks getting older is getting bigger, so if you stay the same size you stay the same age. And he has an active imagination, and thinks monsters dwell in the vacuum cleaner and the toilet… just to get him! Oftentimes the two-year-old develops an aversion to taking a bath because he thinks he will go down the drain like the water
Your two-year-old thinks she is a magician, and at her command the world moves. In psychology books, this stage is called "egocentric" and it means the child thinks the rest of the world revolves around her. Mommy appears just for her and the sun and moon follow her. What makes her sad makes everyone around her sad. Although the two-year-old knows you are separate from her, she can't see things through your point of view. She doesn't have a conscience yet, and her memory is not fully developed either. The two-year-old wants instant gratification, and she wants to do things her way. That's why so many fights occur when you try to establish bedtimes, mealtimes, bath times, toilet training, and other routines. Anger is a peak emotion at two, and fear is there, too. In fact, from being a loving baby, the two-year-old moves to a very negative stage. But don't worry, it is a stage, and balance will reign again. If you doubt it, see how tender and gentle your two-year-old can be, and watch for the first signs of empathy as she comforts a friend who is crying.
Talking is a very individual skill and depends on many factors. The two-year-old may have a vocabulary of about 50 words, and may use many gestures to help make meanings clear. At about two, many children begin speaking in two-word sentences, using the two most important words in a thought. Some examples would be "baby up" or "mommy go," with the child emphasizing the most important word. At this stage nouns and action words are spoken to express the most important ideas, and connecting words are left out. The next stages in language are the three-word sentence, phrases, and harder words. One of the two-year-old's favorite words is "no," partly because it's the word used most often to them. They use it to mean "not there," to reject an offer, and to deny a statement. And they use it to proclaim their independence, whether they mean "no" or not.
Playing is the way your child develops her intelligence. It's a rich time - a time to use tools, to find out what works together, and a time to begin to interact with others. Typically a two-year-old will examine a group of objects, group the ones that go together, and create a sequence with the objects. The child who used to throw blocks all over the room is now an organizer, and must put ever single one away before bed. This is the stage at which children begin to interact, and to "parallel play" or play alongside each other without actually sharing. Because two-year-old's learn by imitating, they often mimic the older children and adults around them. If you watch unobtrusively, you'll see your child's play patterns vary. She plays one way with you, differently with children her own age, and differently still with older or younger children.
- Kicks ball with directional intent
- Climbs well including walking up and down stairs, one foot at a time and holds rail for support
- Runs, jumps in place, and bends over without falling
Hand and Finger Skills
- Makes purposeful markings on paper
- Might use one hand more often than the other
- Builds tower of 4 or more blocks
- Starts age 2 with about 25 to 50 words. They should move toward approximately 300 words by age 3
- Uses 2 to 3 word sentences and repeats words others say
- About half of child's speech is understandable
- Points to object or picture when it's named for him
- Recognizes names of familiar people, objects and body parts
- Follows simple instructions
- Searches for new ways to solve problems and wants to learn how to use things
- Egocentric thinking--sees herself as the center of the universe
- Begins make-believe play; starting to develop fears
- Finds objects even when hidden under two or three covers
- Begins to sort by shapes and colors
- Solitary and parallel play
- Ritualistic behavior and need for stability of routine is important
- Imitates behavior of adults and older children
- Increasingly aware of herself as separate from others
- Increasingly enthusiastic about company of other children
- Demonstrates increasing independence, yet frustrates easily
- Exhibits defiant behavior
- Mood swings (i.e.: laughing one minute, crying the next) often for no apparent reason
Indicators for concern
- Does not use two-word sentences by age 2
- Does not imitate actions or words by the end of this period
- Does not pretend play
- Fails to develop a mature heel-toe walking pattern after several months of walking, or walks only on their toes
- Does not follow simple instructions by age 2
- Cannot push a wheeled toy by age 2
- Experiences a dramatic loss of language or social skills they once had
- Does not point or bring objects to you
- Does not respond to name
If your have further concerns about your child's development, please make an appointment.
Autism is one particular developmental disability that is defined by significant impairments in social interaction and communication and the presence of unusual behaviors and interests. If you are worried your child has autism or if you want to find out more information on this subject, then visit our web page which has much information on Autism and make an appointment.
Growth and Nutrition
Between ages two and three, a child's growth rate is slower in comparison to when she was a baby. Expect about 2 ½ to 3 ½ inches of height increase and 3-6 pounds of weight gain for the year. Baby fat should start to disappear and her arms and legs will grow to better "fit" her trunk and head size.
Despite the steady curve of the growth chart, a two-year-olds growth is not typically at a steady pace. In turn, a child's appetite will vary daily and probably meal to meal. She may eat a lot one day and not much the next -- no two days will be the same. At this age a child requires about 40 calories per inch of height per day. Foods from each of the food groups on the Food Guide Pyramid should be offered--the child's overall intake of "enough of the right foods" should balance out over the course of 2 weeks.
Children at age 2 need at least 500 mg of calcium which is easy to achieve. One cup of whole milk has around 300 mg of calcium. However if your child doesn't drink much milk then cheese and yogurt are rich in calcium. Please review our calcium link to make sure your child is receiving enough calcium. Juice contains a large amount of sugar and should be very limited. Water should be offered when the child is thirsty. At 2, only about 1/3 of the child's daily intake should be from fat. As childhood obesity has become an exceedingly prevalent problem, we will start monitoring your child's BMI (Body Mass Index). BMI is a good indicator of body fatness and is determined by a calculation using height and weight and is age specific
Common Issues and Concerns
"THE TERRIBLE TWO'S
The twos are the breakaway years, and in our culture this stage starts somewhere in the first year and lasts about a year and a half. In other cultures, where conformity is emphasized, this period is shorter. But here, where so many complex demands are placed on a child, this turbulent time is necessary to help the child develop qualities that will encourage individuality.
So at two we find the toddler becoming less dependent on the mother, and literally trying to stand alone. It's the time for them to see everything and do everything independently. When things don't go as expected, they become frustrated and many times angry. Then it's often tantrum time: throwing food on the floor, holding their breath, or refusing to budge. Books written about this period call it the "Declaration of Independence" and it is. But because the child does not now what is safe or appropriate behavior, it's a constant struggle for the parents. And the two-year-old does not have a built-in conscience to tell what's right or wrong - that won't happen until four or five.
This time in your lives may be easier if you try to remember that your child does not have a conscience, a memory, an understanding of consequences, and can't explain himself in words. So when you punish, it's important, to make the punishment fit the behavior, both in type and severity. It's important too, for both parents to be consistent about the punishment, and reinforce it when the behavior occurs again. Don't wait to punish - the child must know just what the punishment is for: Explain it clearly, and remember - you're trying to help your child stay safe and grow up to fit into society. So make your punishment immediate, appropriate, and short, and be firm but understanding. Selma Fraiberg, author of The Magic Years, sums it up: "The child cooperates in his training because he wants parental love and approval and he feels parental disapproval as a temporary withdrawal of affection and esteem."
Two-year-olds are great explorers, very inquisitive and resourceful, and do not recognize limits or boundaries-- all qualities that are necessary for normal development but at the same time can add up to an "accident waiting to happen". A parent needs to anticipate any potential dangers that the child could face and to decrease the chances of an accident. By now you've probably child-proofed your home so that all movable, breakable items are kept up beyond the child's reach. You should also cover all electrical outlets, and keep toxic items under lock and key. Handbags should be up and out of reach. Doors should latch, and dangerous areas such as pools and gun closets should be off limits, especially in this testing stage. Accidents are most common when the child is tired and hungry, when he's in a new environment, or when new people are caring for him. If you are pregnant, ill, having trouble with your spouse, rushed, or too busy, an accident could happen. Be sure you know the stage of development your child is in, so you can anticipate new risks.
Remember to keep Poison Control's phone number handy. You may also visit Healthychildren.org for age-specifiic safety tips.
It is best to begin potty training when your child is ready. Readiness to potty train usually occurs between ages 2 and 4 and involves three aspects:
- Physical Readiness: involves maturity of the sphincter muscles which give child ability to control "peeing" and pooping"
- Communication Readiness: child must be able to indicate the urgency to you :even saying "peepee" or pointing to her diaper is sufficient.
- Emotional Readiness: child must show interest or desire to use the potty.
Most two-year-olds will sleep 12-14 hours per day and typically take just one nap a day. Around this time it is best to move them from their crib to a bed
Your child's teeth should be brushed at least once a day, preferably at night, using a soft nylonbristle brush. A pea-sized dab of fluoridated toothpaste can be used. Parents need to supervise and brush your child's teeth for them to insure that all teeth are cleaned adequately.
Remember you are not alone!
Raising a small child is a real responsibility and two can be a frustrating age. It's even harder if you're far from your own family, a single parent, or facing other potentially stressful situations. Reading helps, but sometimes you need other people. When it starts to get to you, it's a good idea to use the support system around you. A walk will help; talking with friends and meeting other mothers in play groups also help. You can always call your doctor, a day-care center, or community social services. You are not alone, but you do have to make the first move before you find yourself taking frustrations out on your child.
The next routine physical examination is at three years of life.