24 Month Well-Child Visit

Your little one is 2! So much has happened since the last check up – language ability has exploded, activity is constant, and exploration of abilities and the environment continues. What can you expect at this visit with the Pediatrician?

Vitals – Heart rate and respiratory rate will be counted, temperature is taken.

Growth measurements – Length/height and weight continue to be measured and plotted on growth curves for age and gender. If possible, your child will now stand for height measurements rather than lay down. Growth charts transition from 0-24mo charts to 2y-20y charts. BMI, or Body Mass Index, is now determined as well. The BMI is s a person’s weight in kilograms (kg) divided by the square of height in meters. Higher BMI can be an indicator of high body fatness. BMI can be used to screen for weight categories that may lead to health problems but it is not diagnostic of the health of an individual by itself. It is another marker we use to help determine the health of your child. 

Development –

• Social: They engage in “parallel play” with others – playing alongside but not with. They are usually ready to start toilet training within the next 6-12 months. Tantrums continue and may escalate. 
• Speech & Language: They have approximately 50 words and are starting to combine words into short 2-3 word phrases. You should be able to understand half of what your child says. 
• Gross (large) motor: They can kick a ball, jump up with two feet, run well, and climb a ladder 
• Fine motor: They can stack blocks and turn individual pages in books. They can turn knobs and open lids. They can draw straight lines. 

Questions from the Pediatrician – your child’s doctor will ask questions about nutrition and meals, sleeping, voiding (urination) and stooling (bowel movements), and development.

Nutrition – Continue to offer your toddler a variety of fruits, vegetables, proteins, dairy, fats, and carbohydrates. Promote family meal times with snacks in between. Allow your toddler to decide how much to eat at once.  Avoid fruit juices or other sweetened beverages. 

Healthy Teeth – brushing your toddler’s teeth before bed should be an important part of the nighttime routine. Clean teeth and avoidance of any bottles or sippy cups before bedtime can help prevent cavities even in very young children. Your child should be seen by the dentist every 6 months for check ups and cleanings. 

Exam – your toddler will have a head-to-toe exam at every well-child visit. 

Vaccinations – The CDC recommended vaccination schedule continues between 12-24 months of age, though the timing of vaccines is more of a range rather than specific dates. Your Pediatrician will discuss these in detail with you at your visit. Your toddler may receive the Hepatitis A booster vaccine at this visit if it was not given at 18 months. I discuss toddler vaccines in depth in another post if you would like more detailed information. 

Questions from you – you will likely have questions about proper developmental milestones, nutrition, sleep habits, and behavior. Bring your questions to the visit and never hesitate to ask your child’s Pediatrician about your concerns.

Safety information – part of every well-child visit is discussion of safety that is appropriate for age. For toddlers, this includes:

• sleep practices – toddlers should start to transition to a “big kid” bed, which could be a crib with one side rail removed or a stand-alone bed. Avoid using sippy cups at bedtime. 
• car seat instructions – toddlers should continue to be in their car seats, in the back seat, facing backwards until at least age 2 or as long as they comfortably fit. Never leave your child in the car alone. 
• water safety – toddlers should never be left alone in the water, even if it is only a few inches or only for a short amount of time. Drowning occurs quickly. 
• fall risks – toddlers are climbers. Make sure furniture such as bookshelves and dressers are attached securely to the wall when possible. Watch them closely on playgrounds.
• choking – toddlers will not always chew foods well so make sure foods are cut into tiny pieces. Avoid contact with small objects and plastic bags. 
• baby proofing – make sure all cleaning supplies, medications, and chemicals are up high or locked away. Check your floors and lower cabinets/shelves for small objects. Use outlet covers and hide electrical cords. Place barriers around space heaters and fireplaces. 
• sun exposure – avoid direct exposure during the middle of the day as much as possible. Use hats and long sleeves. Use sunscreen with a high SPF. 
• firearms – remove all firearms from the home, if possible. Otherwise, ensure they are locked in a safe and stored unloaded. 

Next visit:  3 years

If you enjoyed this post, please sign up below to subscribe for blog emails. You will receive notification when new posts are available.