2-Year-Old Well Child Check

Two is a time for exploration and independence. To be two years old is to be always moving—walking, running, climbing and jumping.

Please click here to download the 2 year developmental assessment form that you will need to complete and bring with you to your child's appointment. Due to copyright laws the documents are password protected, the password is child.

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. 

Behavior

Thinking

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. 

Feelings

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. 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. 

Talking

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. 

Playing

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. 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. 

Development

Movement
  • 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
  • Builds tower of 4 or more blocks
Language
  • 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
Cognitive
  • Egocentric thinking--sees herself as the center of the universe
  • Begins make-believe play; starting to develop fears
  • Begins to sort by shapes and colors
Social
  • Solitary and parallel play
  • Ritualistic behavior and need for stability of routine is important
  • Imitates behavior of adults and older children
Emotional
  • Demonstrates increasing independence, yet frustrates easily
  • Exhibits defiant behavior

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-old's 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. 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.

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

Discipline

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. 

Safety

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 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. 

Remember to keep Poison Control's phone number handy. You may also visit Healthychildren.org for age-specific safety tips.

Toilet Training

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 the child the ability to control "peeing" and "pooping"
  • Communication Readiness: the child must be able to indicate the urgency to you; even saying "peepee" or pointing to her diaper is sufficient.
  • Emotional Readiness: the child must show interest or desire to use the potty.
Sleep

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

Dental Care

Your child's teeth should be brushed twice a day, preferably at night, using a soft soft child's toothbrush. A pea-sized dab of fluoridated toothpaste is important to use and is safe if swallowed. Parents need to supervise and brush your child's teeth for them to insure that all teeth are cleaned adequately. The last thing that should touch their teeth before bedtime is their toothbrush.

Next Well Child Visit

The next routine physical examination is at three years of life.