Nutrition

  • Encourage consumption of fresh vegetables, poultry, fish, and trimmed lean meats.
  • Now is the time to switch to nonfat milk. 2 percent and whole milk offer no nutritional advantage and it is a hard transition to make as the child gets older. The quantity of milk should be 12 to 20 ounces a day.
  • Children do not need daily juice.  Despite what our parents taught us juice has no nutritional value The vitamin C provided in juice is not necessary to fight infection and consuming sweet drinks, even 100 percent natural contributes to obesity.
  • Discourage processed meats, chips, candy, and soft drinks.  Keep a handle of fast foods.
  • You should set a regular meal/snack schedule and avoid snacking “on-demand.”  No good comes of food battles.  Your job is to offer the food, the child’s job is to decide to eat it or not.  All children will ultimately eat when they are hungry. Kids are surprisingly well nourished despite “finicky” eating habits and refusal to eat certain kinds of foods.  One good meal daily is typical.
  • The American Academy of Pediatrics now recommends that all children receive a daily multivitamin.The goal is Vitamin D 400 IU and Iron 15 mg daily. We recommend any over the counter multivitamin.

Safety

  1. Always put the child in a car seat while driving!  Use a five point harness until the highest weight or height allowed by your car seat manufacturer. Children should remain in car seats or booster seats until they weigh 80 pounds.
  2. Children should not play on tractors or lawn mowers.
  3. Lock up all medications and household poisons including cleaners, paint thinners, and drain cleaners.  Do not store these products in containers that resemble food containers.
  4. Children must be supervised when playing near a street or driveway.  Never allow play behind vehicles.
  5. Windows and stairs should be guarded with railings or gates.
  6. Constant attention to choking hazards (hot dogs, popcorn, hard candy, and small toys) as well as poisons is an even harder job now that the children are mobile.
  7. It is a good idea to use sunscreen every day.  Choose a product that is hypoallergenic.
  8. Toddlers should be accompanied when in or near water at all times, even a partially filled bathtub.
  9. Call the Poison Control Center if you suspect your child ate a poison: 800-222-1222.

Development

  • Many children are still in cribs.  We suggest they stay in the crib until they climb out or get evicted by another sibling.
  • Most children continue to take one nap per day.  Even if they sometimes do not sleep, it is wise for parents to insist on a quiet period of rest at a regular time each day.
  • Many toddlers are able to show consistent interest in toileting, with most accomplishing this task for both bowel and bladder control by two and a half.  It is appropriate to obtain a potty chair around this age, to discuss its purpose, and to allow the child to observe the parents using the toilet.  It is preferable (and easier for everyone in the long run) to wait for the child to request the opportunity to imitate its use rather than insist on it.  Nudge gently with careful encouragement, applause or stickers (but not candy!).
  • You should encourage your child’s emerging independence and offer choices to the child whenever possible while retaining your authority to make and maintain family rules.  Remind them when their behavior is not what you’d like to see, and always model the kind of actions and language you are looking for.
  • NOW IS THE TIME TO TAKE CONTROL OVER THE TV!  Limit TV watching and video games to half an hour per day.  Keep TV sets and computers out of the bedrooms.

TODAY IMMUNIZATION:

  • Hepatitis A #2 will be given at today’s visit.

If you see any evidence of a sore leg or fever, give your baby Tylenol or Motrin.

(Please see the CDC website for the Vaccine Information Sheet http://www.cdc.gov/vaccines/hcp/vis/index.html?s_cid=cs_748 )

TODAY’S TESTS

We will check your child’s hemoglobin, a measure of anemia, as approximately 10% of children still need more iron.We will also check your child’s lead level today.  This test is a measure of your child’s exposure to lead in the pipes and soil, as well as other environmental exposures.  We will screen your child for risk factors for high cholesterol and if necessary will check a cholesterol level.

Recommended Books:

The Magic Years Selma Frailburg

Making the Terrible Twos Terrific John Rosemond.

Your child’s next routine visit is at three years of age.

NEED DAYCARE FORMS? Don’t forget to drop off your health forms at the front desk or submit them after your check-up here.