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 13 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
• run well
• kick a ball
• walk down stairs
• make lines and circular scribbles
• play alongside other children

4. Perform 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 receive 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 next routine visit 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. Limit sugary drinks and unhealthy snacks.
2. Switch to low-fat or nonfat milk and other low-fat and nonfat dairy products.
3. Limit juice to no more than 4–6 ounces (120–180 ml) a day.

Learning

1. Toddlers learn by interacting with parents, caregivers, and their environment. Limit time in front of a TV or other screens, including computers and smartphones, to no more than one to two hours a day of quality children’s programming.
2. Have a safe play area and allow plenty of time for exploring and active play.
3. Read to your child every day.

Routine Care & Safety

1. Children may start brushing their teeth with a small amount of fluoride toothpaste (no more than the size of a pea). Let your child brush his or her teeth with your guidance. 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 a few months before trying again. A child who uses the potty and is accident-free during the day may still need a diaper at night.
3. 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 — distract your child or remove him or her from frustrating situations.
4. Toddlers look for independence and will test limits. Be sure to establish reasonable and consistent rules. Reinforce positive behaviors.
5. Don’t spank your child. Children don’t make the connection between spanking and the behavior you are trying to correct. If necessary, use a brief time-out to discipline your toddler.
6. Most kids are ready to move from a crib to a regular bed with safety rails between 2 and 3 years.
7. Use a forward-facing car seat with a harness in the back seat until your child reaches the highest weight or height limit allowed by the car-seat manufacturer.
8. To prevent the risk of drowning, do not leave your child alone in the bathtub or in a pool, no matter how shallow the water.
9. 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.

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