Growth Milestones 1-2 years

Growth Milestones - FIFTEEN MONTHS

"Whirlwind of Activity"

It is easy to expect too much of the 15-month-old child. They look so much different from the crawling infant of a few months ago that many parents think their child "is no longer a baby." And while the 15-month-old child is indeed a whirlwind of activity and curiosity, he or she may lack a sense of danger or fear. Your child will try to climb up furniture or put his or her fingers in electrical sockets. Your youngster will touch everything in sight. As a parent, you may not realize what all this means until your child has his or her first temper tantrum, ruins the carpeting or nearly breaks a precious heirloom. Parenting this age is indeed a balancing act, between giving your child freedom to explore while keeping him or her sage. The following comments are designed to help you and your partner enjoy your 15-month-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your child's pediatrician. Never hesitate to ask your doctor for guidance concerning specific problems. This is the reason for regular well-baby checkups.

Parenting and Behavioral Show affection and praise to your toddler for good behavior and accomplishments. Talk to your child about what he or she is doing and seeing. Singing to your child is another way to encourage vocabulary development. Use picture books to enrich his or her vocabulary. Reading books to your youngster will help with language development. It is best to keep rules at a minimum - remove things when possible rather than make issues about them. Long speeches of explanation or argument with a 15-month-old are useless. When something has to be done, do it in a pleasant manner. Discipline should be consistent, but done in a loving, understanding manner. Use the two "I's" of discipline. Ignore and isolate. Temper tantrums, for example, are best handled by ignoring them. If this is not possible, isolate the child by placing him or her in his or her crib, playpen or room for a "time-out." Never use the two "S's" of discipline -shouting and spanking. Positive reinforcement should be encouraged for acceptable behavior. Praise the child for good behavior and build up the child's self-esteem and self-confidence. Your child will begin to experience some frustration. Your youngster will get upset when he or she cannot do something, or when he or she can not do what he or she wants. A child at this age will try crying and screaming to get his or her way, and such protests may become full-blown temper tantrums and breath-holding spells. Trying to reason with or punish your child may actually make the tantrum last longer. It is best to make sure your toddler is in a safe place and then ignore the tantrum You can best do this by not looking directly at her and not speaking to her or about her to others when she can hear what you are saying. Keep family outings with a 15-month-old short and simple. A child this age has a very short attention span and lengthy activities will cause him or her to become irritable and tired. The best toys are stuffed animals, dolls, books and small toys that can be pulled and pushed, filled and emptied, opened and closed. Household items such as plastic measuring cups and empty boxes are other toys your 15-month-old will enjoy. Limit television viewing and do not use the TV as a "baby sitter." Although hitting and biting are common behaviors at this age, the behavior should never be permitted. Don't worry if your child becomes curious about body parts. This is normal at this age. It is best to use the correct terms for genitals. Toddlers may want to imitate what you are doing. Sweeping, dusting, or washing play dishes can be fun for children at this age.

Development The vocabulary for a 15-month-old is usually three to six words that parents can understand and an entire language that they cannot! Will be able to point to one or more body parts. Understands simple commands ("bring me the ball"). Walking has improved and will begin to crawl up stairs. Can feed himself or herself with the use of his or her fingers. Drinks only from a cup, but still may need help in holding it. Recognizes himself or herself in a mirror. Indicates what they want by pulling, pointing, grunting and other methods of communicating Finds an object placed out of sight Points to one or two body parts Scribbles spontaneously

Oral Health Brush your toddler's teeth with a small amount of fluoridated toothpaste. The 15-month-old can not clean his or her teeth by alone. A child this age should be off the bottle and at the very least no bottles to bed. To avoid dental decay, do not give any juice or other sugary substances in bottles. If snacks are given, non-sugary and unsalted foods such as fresh fruits are preferable to candy and chips. Give your child fluoride supplements as recommended by the physician based on the level of fluoride in the toddler's drinking water. Discontinue pacifier use except, perhaps, at nap time and bedtime. Ask your child's doctor when you should make the youngster's first dental appointment.

Feeding Have your child eat with the family and encourage your child to do most of the feeding, even though he or she will be clumsy with the spoon and cup. Parents should not focus on table manners at this age. They will use their fingers and maybe start using a spoon. This will be messy!! Make sure food is cut into small pieces so your baby will not choke (the size of a pencil eraser) Babies still need nutritious snacks like cheese, fruit and vegetables. Some nutritious desserts are baked apples or fresh fruit. Never use food as a reward. The child's weight may stay the same for several months, so appetite will diminish. All you can expect is one fair meal a day. Try not to get into the habit of between meal carbohydrates, cookies and sweets, that will take away his or her appetite for more nourishing foods. If your child still has a bottle, it should be phased out in the next month.

Sleep The afternoon nap is still required by most toddlers. Bedtime problems can occur at this age because of the toddler's desire for independence. Try to be consistent and follow routines.

Immunizations Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule. Normally, no immunizations are given at this checkup unless your child's doctor follows another approved schedule or the child is behind in the immunization schedule. By this age, most children have received the following immunizations (*depending on the doctor's schedule):

	3 doses of Hepatitis B vaccine
	3 or 4 doses of DTaP vaccine *
	3 or 4 doses of HIB vaccine *
	1 dose of the MMR vaccine
	1 dose of the Chickenpox vaccine
	3-4 doses of the Pneumococcal vaccine *
	2-3 doses of the Inactivated Polio Vaccine *
For More Vaccine Information, see: ►Kidsgrowth Vaccine Guide ►The Vaccines and the Diseases they Prevent; ►What Immunizations should my child have had by 12-15 months? ►Keep a record of your child's immunizations. (Click to download an immunization record) Toilet Training The development of readiness for toilet training does not appear until somewhere between 18 and 24 months. Starting toilet training at an early age, even though grandparents will indicate that you were "trained at this age," will only cause the child to rebel and still be in diapers at 3 and 4 years of age. Wait for the signs of readiness: dry periods for at least two hours, knows the difference between wet and dry, can pull pants up and down, wants to learn, and can signal when he or she is about to have a bowel movement. Safety Continue to use a toddler car seat and make sure it is properly secured in the back seat. Use locked doors or secure gates at stairwells. Continue to keep the toddler's environment free of smoke. Avoid foods such as nuts, bacon, popcorn, hot dogs, carrot and celery sticks, whole grapes, tough meat raw vegetables and hard candy which can be aspirated by children. For the same reason, never give a child plastic bags, marbles and balloons. Keep syrup of ipecac in the home to be used to induce vomiting only after instructions from the child's physician or the poison control center. Be careful of plastic bags and balloons Guard against falls. Do not leave a chair in such a position that it enables the child to climb to a dangerously high place Prevent burns and scalds. Hot water thermostats should be set at 120 degrees so that scalding will not occur if the child turns on the hot water. Place the child in a safe place such as the playpen during meal preparation. The kitchen is a dangerous place for a child at this time. Keep hot liquids out of reach. Be careful about ironing. Keep the child away from hot stoves, space heaters, wall heaters and fireplaces. There is no such thing as a childproof cap. Poisons, medications and toxic household products should either be excluded from the home or kept in a locked cabinet. Do not store lye drain cleaners in the home. Never underestimate the ability of the 15-month-old to climb. Ensure the crib mattress is on the lowest rung. Guard against electrical injuries from cords and outlets. Always use sunscreen when the your child goes outside to play. Avoid, when possible, going outside between 10 a.m. and 3 p.m. when the sun's ultraviolet rays are most dangerous. Never leave the 15-month-old unsupervised in or near a swimming pool, bathtub, bucket of water, ditch, well or bathroom. Knowing how to "swim" at this age does not make a child water-safe. Choose caregivers carefully and prohibit spanking. Watch your child carefully around dogs, especially if the dog is unknown or is eating. Keep your toddler away from moving machinery, lawn mowers, overhead garage doors, driveways and streets. Hold your child's hand when you are around traffic Illnesses The 15-month-old will experience respiratory infections, such as colds, ear infections and sinus infections, especially if he or she is in day care or "preschool." Respiratory infections of this type are a normal part of growing up.

Growth Milestones - EIGHTEEN MONTHS

"Mr. No!"

Your sweet little baby has grown up into a toddler, entering a world of boundless energy, curiosity, independence and negativism. Having a toddler brings new challenges to you and your partner as parents. The following comments are designed to help you enjoy your 18-month-old son or daughter. This information not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.

Parenting and Behavioral The 18-month-old child gets around easier and will soon be running. It is easy to except too much of our toddler. He or she looks so different from the crawling baby of a few months ago, and many parents think their youngster is no longer a baby. Keep rules to a minimum. Long speeches of explanation are completely useless. "Because I said so!" should be enough. Be firm and consistent, but loving and understanding with discipline. Praise your toddler for his or her good behavior and accomplishments. Encourage your toddler to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a toddler an open question ("Do you want to take a bath?") unless you are willing to accept the answer. Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). Keep time-out to no more than two minutes per child's age, and be consistent. When disciplining, try to make a verbal separation between the child and his or her behavior ("I love you, but I do not like it when you touch the VCR." Pick-up your toddler, hold him or her, or remove her from dangerous situations. Reassure the toddler once the negative behavior has stopped. Provide alternatives. "No, you cannot play with the telephone, but you can play with these blocks." Avoid power struggles with your toddler. No one wins! The toddler uses a powerful weapon against the parents: the temper tantrum! These occur when the toddler is angry, tired, frustrated, or does not get his or her way. Most of the time, what happens during the tantrum is fairly predictable. Occasionally a child this age my get so angry he or she will hold his or her breath and pass out. Not to worry - once they do, the body's reflexes take over and your child will start breathing again on his or her own. Again, handle temper tantrums with the two I's of discipline - ignore or isolate (time out!). Reinforce self-care and self-expression. Praise what the child does for himself (putting his hand in a sleeve, putting meat on a fork, washing his hands, etc.) Parents should say "...and you did that all by yourself!" The 18-month old child is highly pleased by parental approval. Show affection in the family. Be a good role model by using seat belts, avoiding tobacco and showing respect for others. The toddler is a great imitator. Do not expect the toddler to share toys, wait for his or her food in a restaurant, or be patient while you try on clothes at the store or go food shopping. Early toilet training does not mean your child is super smart. Pushing the toddler will only make him or her rebel and be in diapers even longer. Signs that a child might be ready are dry for periods of about two hours, knows the difference between wet and dry, can pull his or her pants up and down, wants to learn, and can give a signal when he or she is about to have a bowel movement. If you insist on toilet training when your child is not ready, a battle will develop ... and it is a battle you cannot win! Discuss toilet training with your child's pediatrician to get his or her views. Remember that aggressive behaviors - hitting and biting - are common at this age. They are, of course, not acceptable behaviors. How parents respond to them determines if the behavior will continue. Do not discourage your child from using a security object - a stuffed animal, favorite blanket, etc. These are important for a toddler and the child will give it up when he or she is ready. (They usually do not take them to high school!) Despite your child's desire to become independent, you will find the 18-month-old will still cling to a parent. Read simple stories to the child regularly, especially at bedtime, to enrich his verbal expression and increase his interest in the spoken language and his listening skills. Limit television viewing and do not use it as a substitute for interaction with the child. Watch children's programs with the child when possible. The principal caregiver should be encouraged to arrange time for himself/herself. Raising a toddler can often be demanding. Praise the child when they are behaving well, and always show affection

Development Walks fast, walks up stairs with one hand held, kicks a ball. Uses a vocabulary of four to 10 words and may combine two-word phrases. Understands simple directions. Points to some body parts correctly. Shows affection by kissing parents. Feeds himself or herself, drinks from a cup adequately and uses a spoon. Imitates a crayon stroke on paper. Holds and "loves" a doll or stuffed animal; may use a household-type toy (for example, a toy telephone) appropriately. Will sit for a short time and look at pictures in a book. Turns single pages in book or magazine

Oral Health Begin brushing your child's teeth with a tiny, pea-size amount of toothpaste. To protect your toddler's teeth, do not put him or her to bed with a bottle or prop it in his or her mouth. Continue to give your child fluoride supplements as recommended by the pediatrician based on the level of fluoride in the toddler's drinking water. Discontinue pacifier use except, perhaps, at nap time and bedtime. Ask your child's doctor when you should make the youngster's first dental appointment.

Feeding Your baby's appetite is going to continue decreasing during the toddler years. Don't make a "big deal" out of it if your child refuses to eat. No one ever starved with a refrigerator full of food. The toddler's caloric needs are down and he or she is trying to show independence. Develop a "take it or leave it" attitude and do not engage in battles over eating. You cannot win, so why fight? Children this age will determine the amount of food they need. Mealtime should not be a battle. Your toddler probably did not grow much since his or her last checkup. Maybe two inches and a few pounds, but that's all. Share meals as a family whenever possible. This helps your baby learn Make mealtimes pleasant and encourage conversation. Avoid using snacks between meals because the toddler has "not eaten all day." The toddler should be drinking only from a cup and using utensils pretty well to feed himself or herself.

Sleep Encourage your child to console himself or herself by putting them to bed awake. Prepare strategies to deal with night awakening, night fears, nightmares and night terrors. Children this age frequently resist going to sleep. They will usually give you a "test" cry to see if you will return. While it is important to let the toddler know you are there, it is also important to let him or her know that the day is over. Your toddler may start to give up at least one nap. This is sometimes an awkward stage when one nap is not enough and two naps are too many. Never put your child to bed with a bottle. He or she should be off all bottles at this age!

Immunizations Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule. Normally, no immunizations are given at this checkup unless your child's doctor follows another approved schedule or the child is behind in the immunization schedule. By this age, most children have received the following immunizations

	3 doses of Hepatitis B vaccine
	4 doses of DTaP vaccine
	4 doses of HIB vaccine
	1 dose of the MMR vaccine
	1 dose of the Chickenpox vaccine
	4 doses of the Pneumococcal vaccine
	3 doses of the Inactivated Polio Vaccine
►Kidsgrowth Vaccine Guide
►What Immunizations should my child have had by 18 months?
►The Vaccines and the Diseases they Prevent
►Keep a record of your child's immunizations. (Click to download an immunization record)

Toilet Training Some children show readiness for toilet training between 18 and 24 months. When toddlers report to their parents that they have wet or soiled their diaper, they are beginning to be aware that they prefer dryness. This is a good sign and parents should praise their child. Other signs of readiness include long periods of dryness, ability to pull pants up and down, can signal when he or she is about to have a bowel movement and knows the difference between wet and dry. Toddlers are naturally curious about the use of the bathroom by other people, so let them watch you or other family members use the toilet. Starting toilet training before the child is ready will only cause the toddler to rebel and still be in diapers at 3 and 4 years of age. It is important not to put too many demands of a child or shame them during toilet training.

Safety Use car restraints consistently. Ensure stair and window safety. All play outside should be supervised. Toddlers do not understand danger and cannot remember "no." Knowing how to "swim" does not make a child water-safe at this age. Supervise the toddler constantly whenever he or she is in or around water, buckets, the toilet or the bathtub. Continue to empty buckets, tubs or small pools immediately after use. Ensure that swimming pools have a four-sided fence with a self-closing, self-latching gate. If your home uses gas appliances, install and maintain carbon monoxide detectors. Put sun screen on the toddler before going outside to play or swim. Be particularly careful during the hours between 10 a.m. and 3 p.m. when the sun is most dangerous. Continue to keep your toddler's environment free of smoke. Keep the home and car nonsmoking zones. Ensure electric wires, outlets and appliances are inaccessible or protected. Keep medicines, cigarettes, lighters, matches, alcohol, firearms and electrical tools locked up and/or out of the toddler's sight and reach. Always walk behind your car before you back out the driveway. Remember, almost anything in your home can be poisonous. Keep Syrup of Ipecac in the home to be used as directed by the poison control center or the health professional. Keep the number of the poison control center near the telephone. Do not expect your older children to supervise the toddler (e.g., in the house, apartment, playground, or yard). Keep the toddler away from moving machinery, lawn mowers, overhead garage doors, driveways and streets. Ensure that a toddler riding in a seat on an adult's bicycle is wearing a helmet and wear a helmet yourself. Teach the child to use caution when approaching dogs, especially if the dogs are unknown or eating. Keep plastic bags and balloons, and small hard objects out of reach. Cut food into small pieces. Know how to save a choking child. Store toys in a chest without a dropping lid

Illnesses Your toddler might have many colds and other respiratory infections during this time. Children who are in day care will experience more infections than those home with a parent or grandparent. There will be times when you will think you "live" at your pediatricians office, since many viral infections at this age come one after the other.

Growth Milestones - TWO YEARS

"Miss Independent"

By age 2, your child is no longer a baby. He or she can run, has given up drinking from a bottle, and can feed himself or herself pretty well. Every day your 2-year-old says new words and does more things. In spite of these achievements, the two-year-old is still a baby in many ways. The 2-year-old is difficult, if not impossible, to reason with, but still extremely lovable. He or she will assert independence at mealtime, bedtime and during attempts at toilet training. Two-year-olds typically do not know what they want, except they are sure they do not want to do what you want them to do. The 2-year-old will struggle with his or her parents before going into the bathtub, then once in the tub, will struggle with the parents when it's time to get out of the tub. At times, the toddler will be a "handful." Sometimes it is tough to parent a 2-year-old. Yet these years do not have to be "terrible," and can be "terrific." Your child is simply moving from babyhood to childhood. The following comments are designed to help you and your parents enjoy your 2-year-old while continuing to gain confidence in yourselves as parents. This information is not intended as a substitute for well-baby visits by your child's pediatrician. Never hesitate to ask your doctor for guidance concerning specific problems. This is the reason for regular well-baby checkups.

Parenting and Behavioral Use picture books to enrich your child's vocabulary. Reading books to your child will help with language development. Arrange times for safe running and exploring outdoors. Playmates are important, so allow your child to experience playing with peers. This can be accomplished in a preschool, play group or just having another 2-year-olds over for a few hours. Do not expect sharing at this age. Limit television viewing. Do not use the TV as a baby sitter or as a substitute for interaction with your child. Watch children's programs with the child when possible. Turn the TV off during meals. Do not worry if your child becomes curious about body parts. This is normal at this age. It is best to use the correct terms for genitals. Spend time teaching your child how to play. Encourage imaginative play and sharing of toys (but do not be surprised if the 2-year-old does not want to share his or her toys with anyone else). The 2-year-old may adopt a security object (such as a blanket, favorite stuffed toy, etc.) that he or she keeps with him or her most of the time. This is normal and the youngster will give it up when he or she is ready. Parents should continue to take some time for themselves. Show affection in the family. Keep family outings with a 2-year-old short and simple. The child this age has a short attention span and lengthy activities will cause the child to become irritable and tired. Allow any older siblings to have things he or she does not have to share with the 2-year-old. Many parents are beginning to plan for another child around this time. If you are, discuss with your pediatrician the best way to discuss the expected baby and the changes that will occur in the family.

Discipline Discipline is very important at this age. Do not waste your time and breath arguing or reasoning with a 2-year-old. Long speeches of explanation are completely useless. "Because I said so!" should be enough for now, but as they get older more explanations will be needed. Discipline should be firm and consistent, but loving and understanding. Praise your child for his or her good behavior and accomplishments. Encourage your 2-year-old to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a 2-year old an open question ("Do you want to take a bath") unless you are willing to accept the answer. Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). When disciplining, try to make a verbal separation between the child and the behavior ("I love you, but I do not like it when you touch the VCR.") Provide alternatives. If your 2-year old is playing with something you do not want him or her to have, replace it with another object or toy that your child enjoys. "No, you cannot play with the telephone, but you can play with these blocks." This avoids a fight and does not place children in a situation where they'll say "no." Avoid power struggles. No one wins! The 2-year-old still uses the temper tantrum as a weapon against parents. These occur when the child is angry, tired, frustrated or does not get his or her way. Again, handle temper tantrums with the two I's of discipline - ignore or isolate (time out!). Teach. Decide on a few rules (most of which have to do with the child's safety) and enforce them. Use time out immediately when rules are broken by placing the child alone for 2 minutes.

Development Climbs up steps alone, one step at a time holding the stair rail or the parent's hand. Jumps off the floor with both feet. Opens doors. Kicks a ball. Can wash and dry hands. Climbs on furniture. Uses a spoon and cup well. Asks frequent questions: "What is that?" Enjoys imitating adult activities. Two year olds often go through a short period of mild speech abnormalities (like stuttering). Selects and uses a toy appropriately (feeds a doll, hammers pegs in a cobbler's bench). Most 2-year-olds have a vocabulary of 50 or more words, although this number varies with the sex of the child (girls speak more than boys), if the child has older siblings (who will speak for him or her) or if two languages are spoken in the house.

Oral Health Check with your child's pediatrician concerning when and how often to see the dentist. The child will imitate a sibling or parent in the use of a toothbrush so take advantage of this to teach brushing. It is OK to use a small amount of fluoridated toothpaste. Second molars usually appear.

Feeding The 2-year-old will eat barely enough to keep a bird alive. Appetite is finicky and will vary from meal to meal and day to day. The child is not doing much growing at this stage so he or she does not need much food to survive. Your child will only gain three or four pounds during this year. Do not expect three good meals a day. Family meals are important so let your 2-year-old eat with you to make him or her feel part of the family. Do not make mealtime a battle over food. Let you child's appetite be your guide and let him or her (within reason) choose what foods to eat. Never use food as a reward (for example, avoid saying "eat your meal and you will get dessert") The child can name foods and tell parents his or her likes and dislikes. The 2-year-old frequently wants the same thing day in and day out. No bottles! May change to 2% milk if approved by your pediatrician. Discuss a vitamin/fluoride supplement with your child's doctor. Continue to give fluoride supplementation if the water is lacking in fluoride. Make sure your child's caregiver is following your feeding instructions.

Sleep In general, an afternoon nap is still required by most 2-year-olds. The child should sleep in his or her own bed if feasible. (Discuss the move from a crib to a regular bed with your child's doctor.) A 2-year-old's bedtime is usually between 7 p.m. and 8 p.m. Certain sleep problems are common during this time, including refusing to go to bed, getting out of bed and wandering around the house at night, and night terrors and nightmares. "Stalling techniques" are common at bed and nap time, such as "I have to go potty" to "I want a drink of water." A series of rituals works well to help your 2-year-old go to sleep. This is an excellent time to read a book to your youngster.

Toilet Training The term "toilet training" should be discarded since we do not actually "train" the child. The 2-year-old simply learns to control his or her urine and bowel movements when he or she is developmentally ready, just as the child learned to sit, walk and talk. Regardless of how hard you try, you cannot speed up your child's schedule and teach the youngster before he or she is ready. In fact, by over-training, you may delay the process by making your child tense and nervous, resulting in a rebellion. The last thing parents want to do is to make toilet training become a battle ground. Pick your battles, and this should not be one of them! If your child has a bowel movement at the same time every day, you may sit him or her on a little potty chair and "catch it." A favorable response from you sends a message to your child. If on the other hand, his or her bowel movement occur at irregular times during the day, watch for a characteristic expression and posture that indicates a bowel movement. When this occurs, pick up your child and put him or her on the potty. If nothing happens in a few minutes, or if your child is alarmed in any way, take him or her off the potty. Your child's incentive to control bladder and bowel movements is to please you, the person he or she looks to for love. Therefore, praise your child's accomplishments and let him or her know you are pleased. When your child has an "accident," stay calm and don't punish. If you act distressed or angry when the child fails, training may be delayed. Signs of toilet learning readiness include awakening from a nap with a dry diaper, having bowel movements at the same time each day, being able to say "wee-wee" or "poopee", etc., knowing when he or she has to go, and being able to take off his or her own clothes. Remember, by pushing your child, scolding or being impatient, you will only delay the development of voluntary control, and possibly lay the groundwork for a real "toilet problem" in years to come.

Safety Continue to use proper car safety restraints in the back seat of every car trip. The greatest risk to your child's health is a motor vehicle accident. Remember, it is impossible for you to protect your child during an accident by just holding him or her. Always walk behind your car before backing out of the driveway. Beware of chewing or picking at old painted surfaces. Keep firearms out of the home or in a locked, out of sight container, unloaded. Pools must be gated. Knowing how to "swim" does not make a child water- safe at this age. Never leave a child unattended in a bathtub, even for a few seconds. Ensure the child wears a life vest if boating. Falls from kitchen cabinets and down stairs occur frequently at this age. Never leave a chair in such a position that your child can use it to climb to a dangerously high place. Be careful of items that can be left at counter level elsewhere, such as knives, scissors, cleaning agents, nail polish remover, household repair items, weed killers, insecticides, gasoline, oil, kerosene, lighter fluid and all medicines. Always keep potentially poisonous things in the items' original containers. Never put poisons in food containers or bottles. Be careful what you put in the waste basket ... 2-year-olds love to stick there hands in the trash. There is no such thing as a "child proof cap." Ingestion of toxic substances is common at this age. Never buy toys or other objects that can cut or be ingested. Suffocation by plastic bags and balloons occurs at this age. Always supervise when your child is playing near a street. Remember, a child at this age does not understand danger or remember "no"; they cannot count on being aware of the outside hazards. Be especially careful when using power lawn mowers and other power tools. Never leave a child unattended in a car or a house. Keep Syrup of Ipecac in the home to be used only as directed by your child's doctor or the poison control center. Keep the phone number of the poison control center near the telephone. Test smoke detectors to ensure they are working properly. If your home uses gas appliances, install and maintain carbon monoxide detectors. Continue to use a water proof sunscreen on your child before going outside. Avoid the hours between 10 a.m. and 3 p.m., when the sun is the most dangerous.

Illnesses The 2-year-old may continue to experience respiratory infections, such as colds, ear infections and sinus infections. Respiratory infections of this type are a normal part of growing up.

Immunizations Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule. Normally, no immunizations are given at this checkup unless your child is behind in the immunization schedule. Hepatitis A (HepA) may be administered at this visit for children living in selected states. Annual flu vaccines may be recommended for children with chronic illnesses like asthma and heart defects. Check with your doctor. Some physicians at 2 years do a hemoglobin or hematocrit determination to check for anemia ("low blood"). This requires a small poke on the finger to obtain a drop of blood. A urinalysis will also be done if the child is toilet trained. By this age, most children have received the following immunizations:

	3 doses of Hepatitis B vaccine
	4 doses of DTaP vaccine
	4 doses of HIB vaccine
	1 dose of the MMR vaccine
	1 dose of the Chickenpox vaccine
	4 doses of the Pneumococcal vaccine
	3 doses of the Inactivated Polio Vaccine
	3 doses of Rotavirus

►Kidsgrowth Vaccine Guide

►The Vaccines and the Diseases they Prevent

►Keep a record of your child's immunizations. (Click to download a blank immunization record)

Check your child's progress with our Growth Charts.