From Eighteen to Twenty-four Months

Your 18-month-old toddler has been walking for some time now and isgetting better at it every day. He is also developing other new abilities and

skills, loves to explore and to play games. Despite this progress, your toddlermay feel dissatisfied with his abilities and frustrated when he can’t do what he

wants to do. Failure and frustration often lead to temper tantrums. Safety is a concern andincreased supervision is needed for your child at this age. This is the final Baby Your Baby newsletter you will receive. We hope that you and your childhave benefited from the information we have shared with you. Good luck in the future andhappy parenting!

Your DevelopingBaby

GENERAL DEVELOPMENTThe 18 to 24-month-old’s growth iscontinuing, but at a slower pace thanbefore. He will have about 16 teeth. Heshould be sleeping 10-12 hours a nightand taking a nap during the day.

DEVELOPMENT OFLARGE MUSCLES By now your toddler has learned how torun. He may, however, need to stop beforehe can change directions. He is learninghow to walk up and down stairs (but notyet alternating feet). He can throw a ball,seat himself in a child’s chair, and climbeverything, so it’s time to keep a closewatch.

DEVELOPMENT OFSMALL MUSCLES This is a time for your child to refine theskills he has been learning. His scribblingwill mature into lines and attempts atcircles. He will build toy block towerseasily and can operate some of his toyswithout your help.

DEVELOPMENT OFSELF-HELP SKILLS Your toddler is a busy person. He has littleinterest in food and will graduallyimprove cup and spoon use so he spillsless. Remember that his rate of growth hasslowed greatly and that he may eat well atonly one meal each day. Don’t worryabout his changing attitude toward food.Dressing is an area of interest to him nowand he will take off some simple clothesby himself. With some help from you, hemay be able to take his shoes off if theyare untied.

DEVELOPMENT OFSOCIAL SKILLS Your toddler is becoming an individualwith a unique personality and strong likesand dislikes. You can expect more negativebehavior from your 18 to 24-month-old.He may now resist foods and activities heonce enjoyed. Give him time to conform.Avoid saying things as if he has a choice,if in fact it is something he must do. Forexample, don’t ask him if he wants to goto bed; tell him it is time for him to go tobed. Your child has a longer attention spannow and may work alone on a project orat play for 10-15 minutes or longer. He isstarting to develop reasoning skills butstill has poor judgment and little sense ofdanger. He is impulsive and very curious,but will try to understand yourexplanations if you keep them very simpleand very short.

You can record your baby’s importantdevelopmental milestones in the BabyYour Baby Health Keepsake.

Temper, Temper!What happens to those sweet babies welove so much? They turn intoindependent-minded toddlers, that’swhat! Still loveable, still appealing, andvery busy. The “terrible twos” might betterbe called the “testing twos.” Your toddleris learning a lot – about his body’s abilities,about expressing his ideas and controllinghis impulses, and about what other peopleexpect of him. He learns by testing andtrying out, exploring and experimenting.In the process, some unhappy experiencesare bound to occur, and failure andfrustration lead to temper tantrums!

Every child has his share of tantrums andevery parent has been embarrassed bythem. Parents sometimes fear their childmay injure himself by hitting his head orholding his breath. Not so – nature healsbruises and insists on breathing. Nor doesthe child hate the parent; his anger isdirected at whatever or whomever ishandy.

Children are quick to discover, however,that tantrums can be used to get parents togive in to unreasonable demands. Beunderstanding of your child’sunhappiness, but don’t be a pushover!

Planning, and lots of patience, can go along way toward making life with atoddler more comfortable for everyone.Remember the following:

• A tired, overwhelmed or overstimulatedchild is “set up” for tantrums.Avoid situations that stress your toddler when he is tired, such as shopping trips.

Schedule visits forwell child care andimmunizations at

18 months and 24 months of age

Instead, schedule them when he isrested, and leave before things get out ofhand.

• Predictable routines for daily activitiesare important to small children.Establish a consistent schedule for meals,naps, bedtime, bathtime and playtime.Toys, furniture and play areas should besafe and allow the child to move, exploreand make a mess. Children of this ageare seldom able to play together or toshare toys peacefully. Arrange yourchild’s schedule and surroundings withhis needs and limitations in mind.

• Power struggles lead to tantrums. Whenever you can, let your toddlermake his own choices (be sure eitherchoice is okay with you): pink sweater oryellow coat; teddy bear or clown; applejuice or milk. Don’t “sweat the smallstuff,” it isn’t worth it. On importantissues, your actions can be more effectivethan words; toddlers seldom understand“reasons.”

Sometimes, simply substituting anothertoy or activity or using a toy as bait willwork. Other times, you may need toassert your authority by moving thechild bodily or taking somethingdangerous away from him. Never ask“Do you want to ...?” unless a “No”response is OK! Instead, try “Let’s ...together” and carry out the activity withhim.

• A toddler is always testing the limitsbecause learning what’s expected takestime and practice.You can help by setting clear, consistentlimits and reinforcing them courteouslybut firmly. Teach what is acceptable,and show what you mean – don’t justtalk about it. And, be prepared to do soover and over again. When the childdoes remember and act appropriately,notice this and show your approval.

• When your child loses control, keepyours.Hitting back, harsh punishment, ridiculeand cruel words make matters worse. Ifthe situation allows, just walk into thenext room. If you’re away from home,you may need to carry the child to thecar and wait with him until he cancontrol himself. Some toddlers (not all)can accept up to five minutes (no more)in a time-out chair or corner. The idea is“no audience equals shorter tantrums.”With experience you’ll find what worksbest with your child. When the storm

blows over, don’t apologize or hold agrudge. Be ready to show him that he’sstill loved and you’re glad to have himback.

• If you feel your self-control is slipping,be sure the child is in a safe environment(preferably in the care of anotherresponsible person), then get away byyourself until you can get a firm grip onyour emotions.Take a walk, take a shower, call a friend– whatever puts things back intoperspective for you. If tantrums seem tobe happening constantly, or if thingsseem to be getting worse, don’t bereluctant to seek help. It sometimeshappens that a child’s outspoken angeror frustration triggers emotions that canbe very disturbing to even the mostcaring parents. Don’t deal with theseproblems alone; help is available. Callyour health care provider or local healthdepartment about resources in yourarea.

Hearing andSpeech

The following checklist is a guide tonormal hearing and speech developmentfor an 18 to 24-month-old baby. As timegoes by, check to see if your baby can domost of the things listed below:� Searches for sounds in all directions� By two years of age is starting to use

two-word phrases, such as “Me go,”“Mama bye-bye” or “Want drink”

� By age two years, parents canunderstand at least half of the child’stalking

� Uses “Yes” and “No” by speaking ornodding and shaking his head

� Follows simple instructions with realobjects such as “Get ball,” “Push car”or “Throw ball”

� Sometimes repeats requests� Asks 1 to 2 word questions like

“more?”, “where kitty?”, or “go bye-bye?”

Here are some suggestions for speechactivities:

• Take your child with you when youvisit the store, garage, or zoo, dig in thegarden, plant seeds, etc. Talk aboutwhat you see when you’re there,making sure your child is included inthe activities. This may mean that youcan’t achieve as much as you would byyourself.

• Make sure you are a good speech

model at all times – talk slowly, simplyand clearly. Give one direction at atime.

• Read simple picture books to him,pointing out the actions in the pictures.

You can also stimulate your two-year-oldchild’s speech and language by:

• repeating new words over and over.• helping your child listen and follow

instructions by playing games: “Pick upthe ball,” “Touch Daddy’s nose.”

• talking about what you are doing.• playing music with your child.• listening to your child when he is talking,

never saying “I don’t understand you.”• carrying on a conversation with him.• asking questions to stimulate additional

thought and language.

NutritionAt this age, toddlers do not accept newfoods readily and it may take offering anew food as many as 15 times before theywill accept them. In addition, toddlers maybecome “picky” and not eat very much. Itis important for parents to not be alarmedand know that during this age toddlers arenot growing as quickly. Despite being“picky” and changes in growth rates,parents need to encourage toddlers by rolemodeling healthy eating behaviors.

Children may need to eat frequently at thisage because their stomachs are small andthey need lots of energy for their activities.Because snacking becomes an importantsource of nutrition for children at this age,planning nutritious between meal snacks isimportant.

A nutritious snack should satisfy yourchild’s hunger for at least a couple ofhours. Foods you choose should containsome protein, carbohydrate, and fat. Mostfoods that are good for meals are also goodchoices for snacks.

Toddlers find comfortin consistency and

order, things that theycan count on.

When preparing snacks, choose foods fromMyPyramid: whole grain breads andcereals, fruits, vegetables, meats, and milk.Don’t serve foods high in sugar and fat.

Good ideas include the followingcombinations:• 1/4 bagel and 100% juice• string cheese and mini bagels• banana milkshake• cheese and crackers• fruit and yogurt with graham crackers• milk and unsweetened cereal• soft burritos with cheese & low-fat

refried beans• oatmeal cookies and milk• soft vegetables (zucchini, cooked carrots)

with cottage cheese dip• zucchini bread and fruit slices• pudding or applesauce

It is important to continue to offer a varietyof foods. It is okay if they don’t like it thefirst time. Keep trying every couple ofweeks.

Healthy TeethIf you haven’t already done so, give yourchild his own special toothbrush. It shouldbe small and have soft bristles.

At first, you’ll need to do most of thebrushing for your child until he developsthe necessary skills, usually at about ageseven to eight. Use only a small amount oftoothpaste because toddlers don’t spit welland will probably swallow it.

It’s important that your child receivessome form of daily fluoride (fluoridatedwater or fluoride supplements). TheAmerican Dental Association recommendsthat children receive adequate fluoridethrough 16 years of age.

A final reminder! If your child is stilldrinking from a bottle or sippy cup, weanhim as quickly as possible to prevent babybottle tooth decay.

Toilet TrainingOpinions about when and how to toilettrain are much like noses – everybody hasone. The age at which a child may be toilettrained is highly individual. In general, aparent and child will have better success ifthe task is not approached until at least 18 months of age. Even this may be tooearly for some children.Age is not a reliable indicator of when a

child is capable of being toilet trained.Instead, watch for the following signs thatthe basic skills needed for bowel andbladder control have developed.

1. Muscle Control: Voluntary control ofspecific muscles must be achieved beforetoilet training. Such muscle control usuallyexists once a child remains dry throughhis naps and occasionally through thenight.

2. Communication: Children must be ableto tell parents (by word or gesture) whenthey need to go to the bathroom. Thechildren must be able to recognize andcommunicate “the need to go.”

3. Desire: Getting rid of messy diapers isusually the parent’s desire, not the child’s.However, children want to please theirparents and will imitate desired behavior.Children should imitate other behaviorsand show a desire to place other things(such as toys) where they belong.

These three basic factors are usuallypresent by about 2 1/2 years of age,sometimes earlier, but not before 18 months of age.

SleepParents have tried all kinds of strategies toget their children to take naps or go to bedwithout crying and struggling for hours.On one extreme, there are those parentswho let their child cry himself to sleep,while others rock, hold and pick up thechild every time he cries. Other parentssimply let the child sleep in their bed. Themiddle of the road approach along with areasonable bedtime routine seems to workbest.

CRYINGThere is no simple solution to preventbedtime crying, but there is a way to gettoddlers to sleep without crying too much.

If your child cries after tucking him in, goback in five minutes and reassure him thateverything is okay. Don’t stay long or pickhim up. If he’s still crying five minuteslater, go in again and repeat the sameprocedure. As your child begins to weardown, his cries will change to whimpers.Now, you need only return every 10minutes. You’ll find that after severalnights, the crying periods will shorten.

BEDTIME ROUTINEToddlers find comfort in consistency andorder, things that they can count on. Thisis especially true with bedtime. Aconsistent time for going to bed and aregular bedtime routine will help yourchild sleep better.

A bedtime routine should have a period ofunwinding. This may include a bath torelax your child, brushing teeth, selectingtoys to sleep with, tucking in a stuffedanimal, storytelling, a drink of water,kisses and hugs and a tuck-in.

You’ll probably want to limit the numberof items in the routine so you don’t spendhalf the night getting your child to bed.Start the routine about 30 minutes beforebedtime. Try not to rush or hurry. Thismakes it harder to create a peaceful mood.

NAPTIMEThere is a wide variation in the amount ofdaytime sleep toddlers need. Sometoddlers still take two naps, while othersare ready to give them up altogether. Tohelp your toddler nap, follow some of thesame steps you use during the nighttimeroutine.

You’ll find that your child naps betterwhen he has played actively, followed bya quiet time. Overstimulation and rough-housing make it harder for your child tofall asleep. Parents can try to arrange theirschedules to let their child nap longenough so he’ll be happy and haveenough energy while he’s awake.

Finally, don’t send your toddler to bed asa punishment during the day. It maycreate unpleasant associations and he mayreject his bed at naptime and at night. Finda better way to show your disapproval.

SLEEPING WITH PARENTS Children learn that they are separateindividuals by sleeping in their own beds.Sleeping away from parents helps themlearn that separating from parents is notan awful thing. It’s good preparation forfuture separations, such as being left witha babysitter and starting school. (There are

always exceptions, such as when the childis sick or when there has been a familycrisis.)

ImmunizationsBy 15 to 18 months your child should havecompleted a primary series of DTP, Polio,Haemophilus Influenzae type b (Hib),Hepatitis B, and MMR vaccines to beconsidered adequately immunized. Theseimmunizations are necessary for your childto have the greatest amount of protectionfrom disease.

If your child is up-to-date, the nextimmunizations he’ll receive are thepreschool DTP, MMR, and Polioimmunizations at the four-or five-year wellchild care visit.

SafetyYour child and his world are developingrapidly during this time. Your child isactive, curious, and eager to explore. Hecan walk, run, jump, climb, get into, onto,under and around more than ever before.He spends more time in outdoor play andactivity. As his activity and ability to movearound quickly increase, so do the risksand hazards of unintentional injury.A key factor in reducing or increasing theserisks is the parents’ perception of the childand the dangers to his safety. Because thetoddler is no longer a “helpless infant,”parents may overestimate his ability torecognize and avoid dangerous situations.Or they may underestimate how fragileand vulnerable he is, and how quickly hecan get into trouble. For these reasons,parents may fail to provide adequate

protection and supervision.

CHILD PASSENGER SAFETYChildren need to be in a child safety seatuntil 80 pounds or 4’9”. Seatbelts are madefor adults – children still need extraprotection so don’t take them out too early!When your child hits 40 pounds, move himinto a booster seat.

WATER SAFETYYour child may love the water, but he canquickly drown if left unattended for only aminute or two. Don’t assume that theamount of water is too little or too shallowto be dangerous. Small children havedrowned in only a few inches of water inbathtubs, water pails, toilets, and wadingpools. A fence, gate, wall or other barrierdoes not always ensure protection. Theonly safe solution is constant supervision.

Never leave your small child unattendedin or near water.

NEIGHBORHOOD SAFETYThe neighborhood is full of fun anddiscovery for the toddler. The danger hereis from the cars and other motor vehiclesthat travel up and down the street, pull inand out of driveways, and park and pullaway from curbs. The toddler may bebehind, in front of, or under a vehicle, andtoo small to be seen by the driver. Again,the key to unintentional injury preventionis adult supervision. The small child shouldnot play in this dangerous environment.

Never allow your child to playunattended in the vicinity of streets,driveways, alleys, or other areas wheremotor vehicles are present.

PLAY EQUIPMENT SAFETYPlay equipment provides great fun and isbeneficial to a child’s growth anddevelopment. However, swings, slides,climbers, teeter-totters, merry-go-rounds,and trampolines present real dangers forthe small child. Much of public and homeplay equipment is designed for olderchildren – not for the toddler. But leftunsupervised, the toddler may try toimitate the “big kids,” and use theequipment unsafely. The result can beserious injury from falls, pinching, headand spinal cord injury – even strangulation.Once again, the only adequate preventionis adult supervision.

Never allow your child to playunattended on playground equipment.

Remember, the active and curious toddlerneeds proper supervision in all hisactivities. Your child’s safety depends onyou.

Postpartum Healthfor Mom

These days, you are probably busychasing your toddler around the house.That’s good! You are using energy,burning calories and strengthening yourmuscles with all that activity. But don’tforget to take care of yourself, as well. Thisis the time that you might want toconsider joining a walking club, or momand baby classes that are especiallydesigned for new mothers. You may alsowant to start including game playing withyour child into your fitness goals: playingtag, sprinting, jumping rope, splashing ina shallow kiddie pool.

PHYSICAL ACTIVITYIf you plan to go to a gym that has a baby-sitting facility, it’s important that youcheck out the sitter and the space beforeyou drop off your child. Watch how yourbaby interacts with the other children.Trust your instincts. If you like the sitterand facility, it’s a good idea to get yourchild familiar with the person and spacebefore leaving them alone – otherwise youmay spend most of your workout timerunning from your workout to your cryingchild. While this may be good exercise, it’snot terribly relaxing.

NUTRITIONIf you haven’t been able to drop some ofyour “baby weight” yet, maybe it is timeto take a fresh look at your eating habits. Itis important that you know what, when,where and how much you eat. Before youstart to change your eating habits, start afood diary. Write down every bite of foodyou eat, what time of day, where you ateit, how much you ate and how you werefeeling when you ate it. After about 2weeks of keeping track, you will see whenyou are taking in those extra calories thatare quickly stored as fat and can startmaking healthy changes.

The information contained in this newsletter is not a substitute for personal medical, psychiatric, or psychological advice, and readers are urged to consult their health care providers concerning specific questions or problems.