Two Year Visit

2 Year Old Check Up

You’ve made it to 2 years, and now you may be worried about the “terrible two’s” as this third year has often been called.  Actually, the third year can be one of the most exciting and delightful times in your child’s life and yours.  At the same time, it will be demanding, intense, and undoubtedly full of some tension at times.


By 2, most children have a good vocabulary and can express their needs.  Many are using 2 and 3 word sentences. Most love books and enjoy pointing out familiar objects.  Crayons, finger paints, and clay are favorite play things with supervision.  Children at this age are running and climbing well.  Many have mastered the stairs, doorknobs, and screw tops can often be opened, so this is a time to survey the cupboards and put dangerous objects and medications as well as treasured knick knacks, up and out of reach.  This is the peak age for poison ingestion.  Call poison control at 1-800-222-1222 if you suspect your child has gotten into a toxic substance.

Management of the demanding and inflexible 2 year old tries everyone’s patience and it helps to have an afternoon a week out of the house if that is possible.  This is a time when children cannot adjust to transition easily, and they are best handled by avoiding direct confrontation.  Use of “time outs” or “as soon as we finish this we’ll do that” will often prevent a resolute “no”.  Anticipating activity will help a 2 year old prepare themselves.  If you can be flexible when your child cannot, a good deal of frustration can be avoided.  Conflicts will occur.  When you have made a rule, don’t give in though the tantrum may rage!

Development seems to occur in cycles, and children go through behavioral stages during which life may go smoothly for a while, followed by turmoil.  Two year olds express emotions intensely, often going from one extreme to the other with no concept of compromise and sharing.  They are often rigid, inflexible, and domineering.  At the same time, they are enthusiastic, energetic, and loving.  By the third birthday much of this behavior is more positive.


Most two years old are too interested in their world to sit still for meals and do not eat well.  They are also famed food faddists.  Tuna fish or peanut butter may remain the staple for weeks only to be followed by a preference for macaroni and cheese.  Often feeding them small, attractive portions earlier then the rest of the family will keep them busy, and dinner hour will be more peaceful. We also recommend switching to low fat milk at this age.  The goal is to have your child drink skim or 1% milk.  You may need to do this gradually so they can get used to it.  Whole milk is 4% so switch to 2% and then to 1% and then to skim milk if you wish.

The AAP recommends vitamin D supplementation for all infants, children, and adolescents.    After reviewing the literature, it certainly looks like many children may benefit from vitamin D, although not everyone necessarily needs it.   Some children are more at risk for vitamin D deficiency than others.  Risk factors for vitamin D deficiency include dark skin (African-americans, Indians, Hispanics), time spent indoors and not out in the sunlight (particularly in the winter months), low amount of milk consumption (less than 16 oz a day), and exclusively breastfed infants.   The recommended dose is 400 IU (international units) once daily.  This can be bought over the counter in either a single drop form, or with a larger dropper.  Read the label carefully when dosing this to your child.  Too much vitamin D can be harmful.


Life is too exciting for the average 2 year old to allow for sleep.  Firmness and set routine which helps the child prepare for bedtime will help.  Sleep requirements very widely.  Most 2 year olds need 10-11 hours of sleep and a 1-2 hour nap, but many need much less and may have given up a nap by now.


Many children can recognize the urge to defecate and urinate by age 2 and can communicate this well enough to begin toilet training.  Success with toilet training depends first of all on the maturation of muscle functions so that bowels and bladder control can be attained.  This occurs sometime during the third year in most children.  A low-key approach, overlooking accidents produces best results.  For some reason, boys achieve bowel and bladder control later than girls and many are 3 or over before they are trained.


Don’t give up on your car seat now, though you may be tempted to do so.  Serious injuries can occur to unrestrained children in the car, even with hard braking or minor collisions.  Car seats should always be in the back seat.  Never put a child in a car seat in the front of a car with or without a passenger side air bag.  At this point you may now turn the car seat to be forward facing.


Present day parents are often confused as to how to discipline their children.  Many parents strive to raise their children with an all encompassing love which will overcome any problems.  Love, however, must be accompanied by discipline.  Without firm limit setting and reasonable expectations clearly communicated and consistently enforced, children grow up to expect society to cater to them.  When tantrums bring results, children expect the community to respond in like manner.

Setting limits, that is, determining a set of rules and expectations in your home to which you expect your child to conform is the first step in effective discipline.  We often do this unconsciously, but to effectively communicate guidelines to a child, parents must be clear in their own minds what they are asking.

Any limit setting can generate tension, but it is through successful resolution of conflicts that the emotional growth necessary for adult maturity occurs.  A 2 year old will struggle against a bedtime because they must assert their own independence; however they will eventually learn that they must go to bed and when given praise for their effort, they will be a happy and secure in their new found accomplishment.  The key is consistency.

A good parent resource for discipline is