What to Expect as Your Child Grows:
Well Child Care at 2 Years

Nutrition Family meals are important for your child. They teach your child that eating is a time for being together and to talk to one another. Letting your child eat with you makes him feel like part of the family. Let your child feed himself. Your toddler will get better at using his spoon, with fewer and fewer spills. It is good to let your child help choose what foods to eat. Be sure to give him only healthy food choices. For many children, this is the time to switch from whole milk to a low-fat milk. It is important for your child to be completely off of a bottle. Ask your doctor for help if your child is still using one. Development Spend time teaching your child how to play. Encourage imaginative play and the sharing of toys with others, but do not be surprised that two-year-olds usually do not want to share their toys with anyone else. Mild stuttering is common at this age. It usually goes away on its own by the age of four years. Do not hurry your child's speech. Ask your doctor about your child's speech if you are worried.

Toilet Training

Some children at this age are showing signs that they are ready for toilet training. When your child starts reporting wet or soiled diapers to you, this is a sign that your child prefers to be dry. Praise your child for telling you. Toddlers are naturally curious about other people using the bathroom. If your child seems curious, let him go to the bathroom with you. Buy a potty chair and leave it in a room in which your child normally plays. It is important not to put too many demands on the child or shame the child about toilet training. When your child does use the toilet, let him know how proud you are.

Behavior Control

At this age, children often say "no" or refuse to do what you want them to do. This normal phase of development involves testing the rules that parents make. Parents need to be consistent in following through with reasonable rules. Your rules should not be too strict or too lenient. Enforce the rules fairly every time. Be gentle but firm with your child even when the child wants to break a rule. Many parents find this age difficult, so ask your doctor for advice on managing behavior.

Here are some good methods for helping children learn about rules:

• Divert and substitute. If a child is playing with something you don't want him to have, replace it with another object or toy that he enjoys. This approach avoids a fight and does not place children in a situation where they'll say "no."
• Teach and lead. Have as few rules as necessary and enforce them. These rules should be the rules important for the child's safety. If a rule is broken, after a short, clear, and gentle explanation, immediately find a place for your child to sit alone for two minutes. It is very important that a "time-out" comes immediately after a rule is broken.
• Make consequences as logical as possible. Remember that encouragement and praise are more likely to motivate a young child than threats and fear. Do not threaten a consequence that you do not carry out. If you say there is a consequence for misbehavior and the child misbehaves, carry through with the consequence gently but firmly.
• Be consistent with discipline. Don't make threats that you cannot carry out. If you say you're going to do it, do it.
• Be warm and positive. Children like to please their parents. Give plenty of praise and be enthusiastic. When children misbehave, stay calm and say "We can't do that. The rule is ______." Then repeat the rule.

Reading and Electronic Media

• Children learn about reading skills while watching you read. They start to figure out that printed symbols have certain meanings. Young children love to participate directly with you and the book. They like to open flaps, ask questions, and make comments.
• It is important to set rules about television viewing. Limit the total TV time to no more than an hour per day.

Dental Care

• Brushing teeth regularly after meals is important. Think up a game and make brushing fun.
• Make an appointment for your child to visit the dentist.

Safety Tips

• Child-proof the home. Go through every room in your house and remove anything that is either valuable, dangerous, or messy. Preventive child-proofing will stop many possible discipline problems. Don't expect a child not to get into things just because you said not to.
• Fires and Burns
  - Practice a fire escape plan.
  - Check smoke detectors. Replace the batteries every six months. Check food temperatures carefully. They should not be too hot.
  - Keep hot appliances and cords out of reach.
  - Keep electrical appliances out of the bathroom.
  - Keep matches and lighters out of reach.
  - Do not allow your child to use the stove, microwave, hot curlers, or iron.
  - Turn your water heater down to 120° Fahrenheit.
• Falls
  - Teach your child not to climb on furniture or cabinets. Do not place furniture (on which the child may climb) near windows or on balconies.
  - Install window guards on windows above the first floor (unless it is against your local fire codes).
  - Lock doors to dangerous areas like the basement.
• Car Safety
  - Use an approved toddler car seat correctly.
  - Sometimes toddlers may not want to be placed in car seats. Gently put your child into the car seat every time you ride in the car.
  - Give the child a toy to play with once in the seat.
  - Parents should wear seat belts at all times.
  - Never leave your child alone in a car.
• Pedestrian Safety
  - Hold on to your child when you are near traffic.
  - Provide a play area where balls and riding toys cannot roll into the street.
• Water Safety
  Continuously watch your child around any water.
• Poisoning
  - Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
  - Put a poison center number on all phones.
  - Buy medicines in containers with safety caps.
  - Do not store poisons in any drink bottles, glasses, or jars.

Smoking

• Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
• If you smoke, set a quit date and stop. Set a good example for your child.

Immunizations

Routine infant vaccinations are usually completed before this age. However some children may need to catch up on recommended shots at this visit. Children over six months of age should receive an annual flu shot. Ask your doctor if you have any questions about whether your child needs any vaccines.

Next Visit

A once-a-year check-up is recommended. Before starting school your child will need more vaccinations.

What to Expect as Your Child Grows:
Well Child Care at 3 Years

Nutrition Mealtime should be a pleasant time for the family. Your child should be feeding herself completely on her own now. Serve healthy foods (whole grains, fruits, vegetables, lean meats) and limit fried foods and junk foods. If you are having problems at mealtime, ask your healthcare provider for advice. Development Children at this age often want to do things by themselves and be independent. Be patient and encouraging as your three-year-old child develops new skills and builds self-confidence. Many children still require diapers during the day and/or night. Avoid pushing toilet training too hard. Let your child know how pleased you are as toilet training progresses.

Behavior and Discipline

Positive reinforcement encourages good behavior in three-year-old children. Try to catch your child being good. Tell your child how proud you are when she does what you want her to do. Be positive and enthusiastic with good behavior.

Here are some good methods for helping children learn about rules:

• Divert and substitute. If a child is playing with something you don't want her to have, distract her with another object or toy that she enjoys.
• Teach and lead. Pick your battles carefully. Have as few rules as possible (mainly for your child's safety), and, once established, enforce them all the time. When rules are broken, immediately find a place for your child to sit alone for three minutes. A good example of this is a crib or pack-and-play, where the child is safely confined. It is very important that a time-out comes immediately after a rule is broken. The less you say and the quicker you act, the better.
• Make consequences as logical as possible. For example, if you don't stay in your car seat, the car doesn't go. If you throw your food, you don't get any more and the meal is done.
• Be consistent with discipline. Don't make threats that you cannot carry out. If you say you're going to do it, do it.

Reading and Electronic Media

• Children learn about reading skills while reading with you. They figure out that printed symbols have certain meanings. Young children love to participate directly with you and the book. They open flaps, ask questions, and make comments. Encourage them as they do this.
• Television viewing should be limited each day.
• Computer games can be educational and are great for fine motor skills. However, computer time should be limited as well.

Dental Care

• Brushing teeth regularly after meals is important. Think up a game and make brushing fun.
• It is time to make an appointment for your child to visit the dentist.

Safety Tips

• Child-proof the home. Go through every room in your house and remove anything that is either valuable, dangerous, or messy. Preventive child-proofing will stop many possible discipline problems. Don't expect a child not to get into things just because you said not to do so.
• Fires and Burns
  - Practice a fire escape plan.
  - Check smoke detectors. Replace the batteries if necessary. Check food and water temperatures carefully. They should not be too hot.
  - Keep hot appliances and cords out of reach.
  - Keep electrical appliances out of the bathroom.
  - Keep matches and lighters out of reach.
  - Do not allow your child to use the stove, microwave, hot curlers, or iron.
  - Turn your water heater down to 120° Fahrenheit.
• Falls
  - Teach your child not to climb on furniture or cabinets. Do not place furniture (on which the child may climb) near windows or on balconies.
  - Install window guards on windows above the first floor (unless it is against your local fire codes).
  - Lock doors to dangerous areas like the basement.
• Car Safety
  - Use an approved toddler car seat correctly.
  - Sometimes toddlers may not want to be placed in car seats. Gently put your child into the car seat every time you ride in the car.
  - Give your child a toy to play with once in the seat.
  - Parents should wear seat belts at all times.
  - Never leave your child alone in a car.
• Pedestrian Safety
  - Hold on to your child when you are near traffic.
  - Provide a play area where balls and riding toys cannot roll into the street.
• Water Safety
  - Continuously watch your child around any body of water.
• Poisoning
  - Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
  - Program the poison control center number in all phones.
  - Buy medicines in containers with safety caps.
  - Do not store poisons in any drink bottles, glasses, or jars.

Smoking

• Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
• If you smoke, set a quit date and stop. Set a good example for your child.

Immunizations

• Routine infant vaccinations are usually completed before this age; however, some children may need to catch up on recommended shots at this visit.
• Children over six months of age should receive an annual flu shot.
• Ask your doctor if you have any questions about vaccines.

Next Visit

A once-a-year check-up is recommended.

What to Expect as Your Child Grows:
Well Child Care at 4 Years

Nutrition Your child should always be a part of the family at mealtime. This should be a pleasant time for the family to be together and share stories and experiences. Give small portions of food to your children. Don't expect them to eat everything on their plate. If still hungry, allow them to have seconds. Selecting foods from all food groups (meat, dairy, grains, fruits, and vegetables) is a good way to provide a balanced diet. Choose and eat healthy snacks such as cheese, fruit, peanut butter, or yogurt. Development At this age cooperative play among children is common. Four-year-olds are curious and imaginative. Allow privacy while your child is changing clothes or using the bathroom. When your child starts wanting privacy on her own, let her know that you think this is good. Discipline Breaking rules does occur at this age. Taking away a privilege can be an effective way to handle those situations. Always follow through with what you say when disciplining your child.

Reading and Electronic Media

It is important to set rules about television watching and computer games. You should limit the time allowed for these. Be aware of what is being watched and played. Avoid violent shows and games as well as those with sexual content.

Dental Care

• Brushing teeth and flossing regularly is important. Think of a way to make it fun.
• Make an appointment for your child to see the dentist.
• If your child sucks her thumb, ask your doctor or dentist for advice on how to help her stop.

Safety Tips

• Accidents are the number one cause of serious injury and death in children. Keep your child away from knives, power tools, mowers, and any other dangerous equipment. All firearms should be locked away safely.
• Fires and Burns
  - Practice a fire escape plan.
  - Check smoke detectors and replace the batteries as needed.
  - Keep a fire extinguisher in or near the kitchen.
  - Teach your child never to play with matches or lighters.
  - Teach your child 911.
  - Turn your water heater down to 120° Fahrenheit.
• Falls
  - Never allow your child to climb unattended on chairs, ladders, or cabinets.
  - Do not allow your child to play unattended on stairways.
  - Make sure windows are closed and locked or have screens that cannot be pushed out.
• Car Safety
  - Do not leave your child alone in the car.
• Pedestrian and Bicycle Safety
  - Always supervise street crossing. Your child may start to look in both directions but do not depend on her ability to cross a street alone.
  - All family members should use a bicycle helmet when riding, even when riding a tricycle.
  - Do not allow your child to ride a bicycle (or tricycle) near traffic.
  - Do not buy a bicycle that is too big for your child.
• Water Safety
  - Always watch your child around swimming pools.
  - Swimming lessons are important.
  - If you own a swimming pool, a child-proof fence should be installed around it. Consider taking a CPR class.
• Poisoning
  - Teach your child to take medicines only with supervision.
  - Teach your child never to eat unknown pills or substances.
  - Program the poison center number in all phones.
• Strangers
  - Discuss safety outside the home with your child.
  - Teach your child her address and phone number and how to contact you at work.
  - Teach your child never to go anywhere with someone unless instructed by you.

Smoking

• Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
• If you smoke, set a quit date and stop. Set a good example for your child.

What to Expect at This Visit

• Expect immunizations at the four-year check-up.
• Children over six months of age should receive an annual flu vaccination.

Next Visit

A yearly check-up is recommended.