What to Expect as Your Child Grows:
Well Child Care at 2½ Years

Nutrition Family meals are important for your child. They teach your child that eating is a time to be together. Letting your child eat with you makes him feel like part of the family. Don’t be surprised by your child’s eating habits. He may love something one day but hate it the next. Serve healthy foods (whole grains, fruits, vegetables, and lean meats). Limit fried foods and junk foods. Development Your child should begin to play with other children. Set up playdates. Encourage imaginative play and the sharing of toys. When talking, your child should put three or four words together. Know correct animal sounds. Can match shapes and colors.

Toilet Training

• Many children will show signs that they are ready for toilet training.
• Dress your child in clothes that can easily be removed.
  Signs for readiness:
  - Staying dry for longer periods
  - Curious about other people using the bathroom
  - Communicating that diaper is wet or dirty
• Develop a potty routine. Place your child on the toilet every 1-2 hours when he/she shows signs of readiness consistently.
• Don’t pick a fight about this; you’ll lose.  In the long run, there will be more success using positives.

Behavior and Discipline

Set your up child for success and have reasonable expectations. Routines help your child know what to expect and will minimize tantrums.

1. 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 “redirecting” approach avoids a fight and does not place children in a situation where they’ll say “no.”
2. 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.
3. 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.
4. Be consistent with discipline. Don't make threats that you cannot carry out. If you say you're going to do it, do it. At the same time, limit the behaviors that you discipline to those that would hurt your child or hurt someone else. Saying “no” too much may mean that “no” loses its meaning.
5. 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. Be sure to also catch your children making “good choices” and praise them! This can be just as important as disciplining the “bad choices.”

Reading and Electronic Media

Read to your child every day. They may want to read the same book over and over.

Reading aloud will help your child prepare for pre-school.

Limit TV and screen time to no more than one to two hours each day. Be aware of what your child is watching.

Dental Care

• Brushing teeth regularly after meals is important. Think up a game and make brushing fun.
• Your child should have already had their first dental appointment. If not, make an appointment to have your child's teeth cleaned.

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 twelve 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. Remember the recommendations are to keep your child “rear facing” until 2 years of age. This has been proven to be the safest position for young children.
  - 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, including buckets, play pools, and the toilet.

• Poisoning
  - Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
  - Program the poison 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. Children should receive an annual flu shot. Ask your doctor if you have any questions about whether your child needs any vaccines.

Insurance Plans We Do Not Take

It is always best to contact your insurance provider to determine if our physicians are in their network. With the recent changes coming from Healthcare Reform, it is increasingly difficult for our office to keep up with the many new Reform Plan names/networks. At this time, there are very few Healthcare Reform Plans that we are participating in. The list below represents all of the plans that we are certain we do not participate in but there could be many more out there. Please contact the insurance carrier and ask if we are in your network.

Medicaid/CHIP

We are unaware of plans chosen for the marketplace.

Flu Vaccine 2017

The best defense against the flu is getting your family vaccinated. Viruses do change, as seen in years past, so it’s important to get a flu vaccine annually. This year’s flu vaccine has four strains (quadrivalent) of flu virus, two A (H1N1 and H3N2) and two B (Phuket/Yamagata and Brisbane/Victoria lineage).

When should you get vaccinated?
Since flu season is so unpredictable, the CDC recommends getting vaccinated as soon as the vaccine is available.

Who should get vaccinated?
Everyone! It’s especially important that children under 5 and particularly those younger than 2, adults age 65 and older, and pregnant women get vaccinated. Since babies under 6 months old are unable to get vaccinated for the flu, anyone that comes in contact with your baby should get a flu vaccine (siblings, parents, grandparents, aunts uncles, daycare providers). Babies under 6 months have a harder time fighting off infection and are at high risk to complications from the flu.

Should I get the mist or the injectable flu vaccine?
Flumist will not be offered again this year. When Flumist was first released it showed a better immune response than the injectable vaccine. However, in recent years, research shows a decline in immunity. 

Will I get the flu from the vaccine?
No. A few patients may experience side effects, runny nose, nasal congestion, sore throat, or pain at the injection site, which may be mistaken for the flu. If you experience flu-like symptoms, most likely, you’ve been exposed to another non-flu virus shortly before receiving the vaccine.

Does the flu vaccine work right away?
Once vaccinated, your body starts making an immune response. It takes two to four weeks after vaccination for antibodies to develop and provide protection against the flu.

A few patients may experience side effects after getting a flu vaccine. However, when compared to a bad case of the flu, they are generally mild. Don’t wait until flu season is here. Get vaccinated today!

For flu vaccine availability, follow us on Facebook.

For more detailed information:
http://www.cdc.gov/flu/keyfacts.htm

https://www.cdc.gov/flu/about/qa/vaccineeffect.htm

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