Well Child Care, 24 Months

PHYSICAL DEVELOPMENT

The child at 24 months can walk, run, and can hold or pull toys while walking. The child can climb on and off furniture and can walk up and down stairs, one at a time. The child scribbles, builds a tower of five or more blocks, and turns the pages of a book. They may begin to show a preference for using one hand over the other.

EMOTIONAL DEVELOPMENT

The child demonstrates increasing independence and may continue to show separation anxiety. The child frequently displays preferences by use of the word "no." Temper tantrums are common.

SOCIAL DEVELOPMENT

The child likes to imitate the behavior of adults and older children and may begin to play together with other children. Children show an interest in participating in common household activities. Children show possessiveness for toys and understand the concept of "mine." Sharing is not common.

MENTAL DEVELOPMENT

At 24 months, the child can point to objects or pictures when named and recognizes the names of familiar people, pets, and body parts. The child has a 50-word vocabulary and can make short sentences of at least 2 words. The child can follow two-step simple commands and will repeat words. The child can sort objects by shape and color and can find objects, even when hidden from sight.

IMMUNIZATIONS

Although not always routine, the caregiver may give some immunizations at this visit if some "catch-up" is needed. Annual influenza or "flu" vaccination is suggested during flu season.

TESTING

The health care provider may screen the 24 month old for anemia, lead poisoning, tuberculosis, high cholesterol, and autism, depending upon risk factors.

NUTRITION AND ORAL HEALTH

  • Change from whole milk to reduced fat milk, 2%, 1%, or skim (non-fat).

  • Daily milk intake should be about 2-3 cups (16-24 ounces).

  • Provide all beverages in a cup and not a bottle.

  • Limit juice to 4-6 ounces per day of a vitamin C containing juice and encourage the child to drink water.

  • Provide a balanced diet, with healthy meals and snacks. Encourage vegetables and fruits.

  • Do not force the child to eat or to finish everything on the plate.

  • Avoid nuts, hard candies, popcorn, and chewing gum.

  • Allow the child to feed themselves with utensils.

  • Brushing teeth after meals and before bedtime should be encouraged.

  • Use a pea-sized amount of toothpaste on the toothbrush.

  • Continue fluoride supplement if recommended by your health care provider.

  • The child should have the first dental visit by the third birthday, if not recommended earlier.

DEVELOPMENT

  • Read books daily and encourage the child to point to objects when named.

  • Recite nursery rhymes and sing songs with your child.

  • Name objects consistently and describe what you are dong while bathing, eating, dressing, and playing.

  • Use imaginative play with dolls, blocks, or common household objects.

  • Some of the child's speech may be difficult to understand. Stuttering is also common.

  • Avoid using "baby talk."

  • Introduce your child to a second language, if used in the household.

  • Consider preschool for your child at this time.

  • Make sure that child care givers are consistent with your discipline routines.

TOILET TRAINING

When a child becomes aware of wet or soiled diapers, the child may be ready for toilet training. Let the child see adults using the toilet. Introduce a child's potty chair, and use lots of praise for successful efforts. Talk to your physician if you need help. Boys usually train later than girls.

SLEEP

  • Use consistent nap-time and bed-time routines.

  • Encourage children to sleep in their own beds.

PARENTING TIPS

  • Spend some one-on-one time with each child.

  • Be consistent about setting limits. Try to use a lot of praise.

  • Offer limited choices when possible.

  • Avoid situations when may cause the child to develop a "temper tantrum," such as trips to the grocery store.

  • Discipline should be consistent and fair. Recognize that the child has limited ability to understand consequences at this age. All adults should be consistent about setting limits. Consider time out as a method of discipline.

  • Minimize television time! Children at this age need active play and social interaction. Any television should be viewed jointly with parents and should be less than one hour per day.

SAFETY

  • Make sure that your home is a safe environment for your child. Keep home water heater set at 120° F (49° C).

  • Provide a tobacco-free and drug-free environment for your child.

  • Always put a helmet on your child when they are riding a tricycle.

  • Use gates at the top of stairs to help prevent falls. Use fences with self-latching gates around pools.

  • Continue to use a car seat that is appropriate for the child's age and size. The child should always ride in the back seat of the vehicle and never in the front seat front with air bags.

  • Equip your home with smoke detectors and change batteries regularly!

  • Keep medications and poisons capped and out of reach.

  • If firearms are kept in the home, both guns and ammunition should be locked separately.

  • Be careful with hot liquids. Make sure that handles on the stove are turned inward rather than out over the edge of the stove to prevent little hands from pulling on them. Knives, heavy objects, and all cleaning supplies should be kept out of reach of children.

  • Always provide direct supervision of your child at all times, including bath time.

  • Make sure that your child is wearing sunscreen which protects against UV-A and UV-B and is at least sun protection factor of 15 (SPF-15) or higher when out in the sun to minimize early sun burning. This can lead to more serious skin trouble later in life.

  • Know the number for poison control in your area and keep it by the phone or on your refrigerator.

WHAT'S NEXT?

Your next visit should be when your child is 30 months old.