ALL patients are seen at our Portsmouth office on Saturday and Sunday for sick visits from 9-12 am

Offices:

Hampton

603.929.3838

55 High Street
Suite 102
Hampton, NH 03842

Portsmouth

603.436.7171

330 Borthwick Avenue
Suite 101
Portsmouth, NH 03801

Well Child Visits

The 2-3 Year Visit

Development:
The development of a few important words will give your toddler a new sense of power. It is of great help to be able to name what he wants and how he feels. It is amazing to watch how quickly your child will be labeling and categorizing his world. He will soon have a vocabulary of 50 words and be responding to your requests. By age three, his vocabulary will expand to as many as 900 words, combining words into sentences and asking many questions! Your child, by age 3, can “symbolize” using words for objects so the world of “pretend” becomes a part of his play. Approximately 75% of what most 3 year olds say should be understandable.
 
Socially, the toddler will start to separate from his family more easily and enjoy being with peers. It is not unusual for him to develop an imaginary friend, whom he uses as a scapegoat.
 
Good coordination and smoothness of muscle movements will develop, as well as increased muscle strength. Most children this age enjoy physical activity, have body confidence and enjoy activities such as rolling down a hill and splashing in water. You can enhance your child’s development by just talking with him, helping him to express his feelings and ideas. He will enjoy simple stories and picture books. Provide opportunities for him to interact with children his age, but maintain careful supervision. Remember, “playing” at age 3 consists of enjoying being with and watching each other, with little interchange. When they talk, each may talk on a different topic unrelated to what the other is saying.

Play equipment for large-muscle use and agility, such as climbing gyms, balance beams and swings, are appropriate. Sandboxes and water pools are fine. For fine motor development, your child will enjoy scribbling, puzzles, and playing with a variety of textures, as well as toys with Various shapes and sizes.

Feed/Elimination:
Adequate nutrients and calories can be supplied by simple finger foods. Rely on foods with high- caloric concentration, such as breads, potatoes, peanut butter and cheese. Continue to offer him a variety of foods. Sufficient intake of fluids can be identified by observing the color and odor of the urine. Avoid sweetened drinks such as chocolate milk, juice drinks containing colored sweeteners, and soda drinks. Offer frequent drinks of water, as well as milk.
 
Avoid feeding your toddler while he is “on the run”, as this greatly increases his risk of choking.

Continue to avoid foods which cause choking: popcorn) nuts, peanuts, whole grapes chips, coconut, hot dogs and raw carrots.
 
Regular patterns of bowel movements should be developing and stools will become less affected by different foods. Expect control of bowel movements and daytime wetting by 3 years of age. Schedule regular periods for sitting on the potty. Clothing should be easy to remove. Use “pull-ups” or training pants. Remember to praise his successes and minimize his failures.

Sleep:
By now, your toddler should have a regular pattern of sleep. 10-12 hours per night, and he may decrease to one nap per day. He still may enjoy bedtime rituals and routines Night terrors may persist.

Special Concerns:
Emotional development. Some characteristics of the “terrible twos” can be eliminated if you, as a parent, can appreciate your toddler’s attempts to give up his comfortable baby ways to accept a new world of adjusting to
• play with peers,
• going off without mother to preschool,
• complete toilet training, and
• often adapting to a new baby in the home

Consistency in how you treat your child is particularly important. He is adjusting to  many changes and will vacillate from being extremely dependent to extremely independent Despite the urge to “do it himself’, he turns frequently to his parents for reassurance. It is normal for fears and anxiety to develop at this stage, since memory and fantasy are working well enough to sometimes distort reality. Decreased growth rate. Expect your toddler’s rate of growth to level off. Average rates are approximately 3 inches in height each year and approximately 5 pounds in weight.

Masturbation. Masturbation is a natural result of increased body awareness. It is best to accept this quietly without over emphasizing the behavior. If it becomes a major means of self- satisfaction or you have concerns, feel free to discuss this with us.

Safety:
At this age, your child may be crawling out of the crib. It is important to begin transition into a bed. The bedroom and windows should be checked for safety. A gate can be placed on the bedroom door to keep your toddler from roaming the house while the rest of the family sleeps.

Your toddler now has increased energy and curiosity with little behavior control, which make him more accident prone. When in a car, your child should ALWAYS remain in a car seat. Prevent accidents by constant surveillance and checking the environment to ensure safety wherever you are. Be sure to have emergency numbers posted and instructions available for babysitters.

Immunization:
There will be no routine immunization for your child today. If he has not had chickenpox, a vaccine is available. At age 2, if your doctor or nurse practitioner feels it is necessary, your toddler may have a blood test for anemia and lead poisoning.

                                                                                          adapted from John Chamberlain
                                                                                                               Rose Boynton, et.al.
                                                                                                                           Barton Schmidt