Well-Child Visit: 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 a growth chart. Your doctor will also calculate and plot your child's body mass index (BMI).

2. Do 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 3 meals and 2–3 healthy snacks a day. You're in charge of the menu, but let your child be in charge of how much they eat.

Peeing and pooping. Most children are ready to begin potty training when they're 2–3 years old. You may notice signs that your child is ready to start potty training, such as:

• 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 11–14 hours of sleep a day, including naps.

Developing. By 2 years, most children:

• put 2 words together to form a sentence ("More milk.")
• use new gestures other than waving or pointing, like blowing a kiss
• point to things in a book when asked to find them
• point to at least 2 body parts
• notice when others are hurt or upset
• try to use switches, knobs, or buttons
• play with more than 1 toy at a time, like putting toy food on a toy plate
• run and kick a ball
• walk (not climb) up a few stairs with or without help

Talk to your doctor if your toddler is not meeting one or more milestones, or you notice that your toddler had skills but has lost them.

4. Do an 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 vaccines. Vaccines can protect kids from serious childhood illnesses, so it's important that your child get them on time. Vaccine schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may order tests for lead, anemia, high cholesterol, and tuberculosis, if needed.

Looking Ahead

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

Feeding

• Food "jags" are common during the toddler years. Even if your child seems to get stuck on one food, continue to offer a variety.
• Let your child decide what to eat, and when they're full. Serve healthy snacks and avoid sugary drinks.
• Switch to low-fat or nonfat milk, or a fortified, unsweetened soy beverage. Offer other dairy products, like yogurt, that are low-fat or nonfat.
• Limit 100% juice to no more than 4 ounces (120 ml) a day.
• Avoid foods that are high in sugar, salt, and fat and low in nutrients.
• Avoid foods that may cause choking, such as hot dogs, whole grapes, raw veggies, nuts, and hard fruits or candy.

Learning

• 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.
• Have a safe play area and allow plenty of time for exploring and active play. Play often together.
• Read to your child every day.

Routine Care & Safety

• Let your child brush their 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. To help prevent cavities, the doctor or dentist may brush fluoride varnish on your child’s teeth 2–4 times a year.
• Look for the signs that your child is ready to start potty training. If they don'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.
• Set reasonable and consistent rules. Use praise to encourage good behavior and be positive when redirecting unwanted behavior
• 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.
• 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 instead.
• Keep your child in a rear-facing car seat until they reach 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.
• Watch closely when your child is 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.
• 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 can't get to the keys.
• 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.