Your Child's Checkup: 2 Years (24 Months)

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child's weight, height, and head circumference and plot the measurements on the growth charts. Your doctor will also calculate and plot your child's body mass index (BMI).

2. Administer a screening (test) that helps with the early identification of autism.

3. Ask questions, address concerns, and provide guidance about how your toddler is:

Eating. Don't be surprised if your toddler skips meals occasionally or loves something one day and won't touch it the next. Schedule three meals and two or three nutritious snacks a day. You're in charge of the menu, but let your child be in charge of how much of it he or she eats.

Peeing and pooping. Most children are ready to begin potty training between 2 and 3 years. You may have noticed signs your child is ready to start potty training, including:

• showing interest in the toilet (watching a parent or sibling in the bathroom, sitting on potty chair)
• staying dry for longer periods
• pulling pants down and up with assistance
• connecting feeling of having to go with peeing and pooping
• communicating that diaper is wet or dirty

Sleeping. Generally 2-year-olds need about 11 to 14 hours of sleep a day, including one nap.

Developing. By 2 years, it's common for many children to:

• say more than 50 words
• put two words together to form a sentence ("I go!")
• be understood at least half the time
• follow a two-step command ("Pick up the ball and bring it to me.")
• run well
• kick a ball
• walk down stairs
• make lines and circular scribbles
• play alongside other children

4. Do a physical exam with your child undressed while you are present. This will include an eye exam, tooth exam, listening to the heart and lungs, and paying attention to your toddler's motor skills, use of language, and behavior.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it's important that your child get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child's risk for lead exposure, anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child's next checkup at 30 months:

Feeding

1. Food "jags" are common during the toddler years. Even if your child seems to get stuck on one food, continue to offer a variety of nutritious choices.
2. Let your child decide what to eat, and when he or she is full. Serve healthy snacks and avoid sugary drinks.
3. Switch to low-fat or nonfat milk, or a fortified-milk alternative like almond or soy milk. Offer dairy products that are low-fat or nonfat.
4. Limit juice to no more than 4 ounces (120 ml) a day.

Learning

1. Toddlers learn by interacting with parents, caregivers, and their environment. Limit screen time (TV, computers, tablets, or other screens) to no more than 1–2 hours a day of quality children's programming. Watch with your child.
2. Have a safe play area and allow plenty of time for exploring and active play. Play often together.
3. Read to your child every day.

Routine Care & Safety

1. Let your child brush his or her teeth with your guidance. Twice a day, use a small amount of toothpaste (about the size of a pea) with a soft toothbrush. Go over any areas that may have been missed. If you haven't already, schedule a dentist visit.
2. Look for the signs that your child is ready to start potty training. If he or she doesn't show interest, it's OK to wait before trying again. A child who uses the potty and is accident-free during the day may still need a diaper at night.
3. Set reasonable and consistent rules. Use praise to encourage good behavior and be positive when redirecting unwanted behavior
4. Tantrums are common at this age, and tend to be worse when children are tired or hungry. Try to head off tantrums before they happen — find a distraction or remove your child from frustrating situations.
5. Don't spank your child. Children don't make the connection between spanking and the behavior you're trying to correct. You can use a brief time-out to discipline your toddler.
6. Keep your child in a rear-facing car seat until he or she reaches the highest weight or height limit allowed by the seat's manufacturer. Previous advice was to turn kids around by age 2. Now, safety experts say to do this based on a child's size, not age. So, small children can stay rear-facing until age 3 or 4.
7. Watch your child closely when playing outside and on playground equipment. Make sure your child always wears a helmet when riding a tricycle or is in a seat on an adult bicycle.
8. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.
9. Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your child? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.