Well Child Care, 30 Months

PHYSICAL DEVELOPMENT

The child at 30 months is always on the move, running, jumping, kicking, and climbing. The child scribbles, imitates a vertical line, and builds a tower of at least six.

EMOTIONAL DEVELOPMENT

The child demonstrates increasing independence, expresses a wide range of emotions, and may resist changes in routines. Many parents feel that their child seems somewhat hyperactive at this age.

SOCIAL DEVELOPMENT

The child learns to play with other children and may enjoy going to preschool. The child begins to understand gender differences. At 30 months, children like to participate in common household activities.

MENTAL DEVELOPMENT

By 30 months, the child can name common animals or objects and identify body parts. The child can make short sentences of at least 2–4 words. At least half of the child's speech should be easily understandable.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (Doses only obtained, if needed, to catch up on missed doses in the past.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Doses only obtained, if needed, to catch up on missed doses in the past.)

  • Haemophilus influenzae type b (Hib) vaccine. (Children who have certain high-risk conditions or have missed doses of Hib vaccine in the past should obtain the vaccine.)

  • Pneumococcal conjugate (PCV13) vaccine. (Children who have certain conditions, missed doses in the past, or obtained the 7-valent pneumococcal vaccine should obtain the vaccine as recommended.)

  • Pneumococcal polysaccharide (PPSV23) vaccine. (Children who have certain high-risk conditions should obtain the vaccine as recommended.)

  • Inactivated poliovirus vaccine. (Doses obtained, if needed, to catch up on missed doses in the past.)

  • Influenza vaccine. (Starting at age 6 months, all children should obtain influenza vaccine every year. Infants and children between the ages of 6 months and 8 years who are receiving influenza vaccine for the first time should receive a second dose at least 4 weeks after the first dose. Thereafter, only a single annual dose is recommended.)

  • Measles, mumps, and rubella (MMR) vaccine. (Doses should be obtained, if needed, to catch up on missed doses in the past. A second dose of a 2-dose series should be obtained at age 4–6 years. The second dose may be obtained before 4 years of age if that second dose is obtained at least 4 weeks after the first dose.)

  • Varicella vaccine. (Doses obtained, if needed, to catch up on missed doses in the past. A second dose of a 2-dose series should be obtained at age 4–6 years. If the second dose is obtained before 4 years of age, it is recommended that the second dose be obtained at least 3 months after the first dose.)

  • Hepatitis A virus vaccine. (Children who obtained 1 dose before age 24 months should obtain a second dose 6–18 months after the first dose. A child who has not obtained the vaccine before 2 years of age should obtain the vaccine if he or she is at risk for infection or if hepatitis A protection is desired.)

  • Meningococcal conjugate vaccine. (Children who have certain high-risk conditions, are present during an outbreak, or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

TESTING

The health care provider may screen the 30-month-old for developmental skills.

NUTRITION AND ORAL HEALTH

  • Continue reduced fat milk, either 2%, 1%, or skim (non-fat), at about 16–24 ounces (500–750 mL) each day.

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

  • Limit juice to 4–6 ounces (120–180 mL) each day of a vitamin C containing juice and encourage the child to drink water.

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

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

  • Allow your child to feed himself or herself with utensils.

  • Your child's teeth should be brushed after meals and before bedtime.

  • Give fluoride supplements as directed by your child's health care provider or dentist.

  • Allow fluoride varnish applications to your child's teeth as directed by your child's health care provider or dentist.

DEVELOPMENT

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

  • Recite nursery rhymes and sing songs to your child.

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

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

  • Some of your child's speech may still be difficult to understand.

TOILET TRAINING

Many girls will be toilet trained by this age, while boys may not be toilet trained until age 3. Continue to use praise for success. Nighttime accidents are still common. Avoid using diapers or super absorbent panties while toilet training. Children are easier to train if they appreciate the sensation of wetness.

SLEEP

  • Use consistent naps and bedtime routines.

  • Your child should sleep in his or her own bed.

PARENTING TIPS

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

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

  • Allow the child to make choices when possible.

  • Discipline should be consistent and fair. Recognize that your 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.

  • Limit television time to no more than one hour. Any television should be viewed jointly with parents.

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 he or she is riding a tricycle.

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

  • All children 2 years or older should ride in a forward-facing safety seat with a harness. Forward-facing safety seats should be placed in the rear seat. At a minimum, a child will need a forward-facing safety seat until the age of 4 years.

  • Equip your home with smoke detectors.

  • 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.

  • Children should be protected from sun exposure. You can protect them by dressing them in clothing, hats, and other coverings. Avoid taking your child outdoors during peak sun hours. Sunburns can lead to more serious skin trouble later in life. Make sure that your child always wears sunscreen which protects against UVA and UVB when out in the sun to minimize early sunburning.

  • 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 3 years old.