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Pediatric Guidance

2-year guidance

Introduction

Your toddler is now 2 years old. Most of the advice from the 18-month page still applies, but I will provide all the relevant advice here so you do not need to read through the 18-month page as well, and I will emphasize what is different now that your child is older. If you have questions about how any of this should apply to your child, please check with your child's healthcare team.

Sleep

At 2 years most toddlers will sleep ~12 hours per day, which includes one ~2 hour nap. You can read more about this here. There are some safety concerns to keep in mind, and many toddlers have various sleeping problems that you will want to address to help everyone sleep better. This often begins with establishing a consistent bedtime routine. You can look through general guidance below, and read through the "Helpful articles" for more detailed information.

Sleep safety

The following picture shows several potential safety concerns of a toddler sleeping in a crib. Click on the explanation below to understand each of these concerns.

safe sleep image

Bedtime routine

Toddlers respond well to routines. Having similar nap times each day and a consistent bedtime routine is key to helping your toddler sleep well throughout the night. The point of the routine is to show your toddler it is time to sleep and help them calm down so they can sleep well. Click on the button below for tips about a bedtime routine.

  • keep the lights low with no screens on an hour before bed
  • tell your toddler that it is time to get ready for bed - do not ask them if they want to get ready for bed
  • have a consistent start and end time, usually totaling 30-45 minutes
  • give a warm bath and change into pajamas
  • if needed, offer a snack with some protein (foods with protein include meat, eggs, cheese, peanut butter) so your toddler is not too hungry overnight
  • brush your child's teeth and do not offer any milk after brushing - they can have some water if needed
  • perform a calming activity (such as reading a book, gentle stretches, a massage, or whatever else your toddler enjoys that is not activating)
  • use a consistent phrase and method to say goodnight

For some of these steps you can offer your toddler choices. By letting them choose which snack to eat, which book to read, or which activity to do, they will feel more in control. This can help them go to sleep more easily.

Sleep problems

There are many different reasons toddlers may have trouble sleeping well. You can click on any of the cards below to learn about specific issues:

Wakes often

Gets up early

Stays up late

Fear of dark

Nightmares

Night terrors

Snoring

Sleep walking

Bed-sharing

Noise/climate

Nutrition

At 2 years old the nutrition recommmendations are similar to 18 months; your child should eat structured meals and snacks including all the food groups and primarily drink water and milk. You can read through more specific advice below.

Feeding advice

When feeding your child it is just as important to consider how you provide the food in addition to what you actually provide. Toddlers respond well to structure and routines, so you will want to have a good mealtime structure to use when feeding your child. Click on the button below for meal and snack structure advice.

  • Offer 3 meals and 2-3 snacks per day while keeping meal and snack time consistent.
  • Your toddler should sit upright in a safe place (such as a high chair or a booster seat) while eating.
  • Sit with your child while eating and talk to them.
  • Remove any distractions during meal time, in particular any screens.
  • Meal time can be only 10-15 minutes, though it can go longer if your toddler prefers.
  • Avoid snacks in between set eating times so your child is hungry when it is time to eat. If your toddler says they are hungry shortly after they ate, try to distract them as they may just want attention. If they still seem hungry then offer a small snack.

It is also very important to continue the "responsive feeding" principles from the first year of life. While you are now setting the meal and snack times, you should still allow your child to determine how much they want to eat each time food is available. Click on the button below for further advice.

  • Toddlers have good and bad days of eating. Some days they will eat a lot, some days they will not eat much at all. This is completely normal, and you do not need to worry that your child is not eating enough on the bad eating days.
  • Practice the Satter Division of Resonsibility in Feeding. You are responsible for what foods to offer your child, where to offer them, and when to offer them. Your child is responsible for whether they want to eat them and how much they want to eat.
  • Expanding on the above advice, do not try to force your child to eat specific foods and do not make them eat all of the food served. This removes stress from meal time and makes a more pleasant experience for your child; generally it is best to not fight over meals.
  • If you are concerned that your child may be eating too much or too little, your child's healthcare team will let you know at the check-ups if there are any growth concerns, and then you can decide to change things based on how your child is growing.

Liquids

The American Academy of Pediatrics recommends breastfeeding for up to 2 years or beyond if desired. If you continue breastfeeding, you may still need to give your child vitamin D supplements, and you can ask your child's healthcare team about this. Otherwise, click on the cards below to learn about milk, water, juice, and how to provide these drinks to your toddler.

Milk?

Water?

Juice?

How to give?

Foods

Click on the cards below to learn about what foods to provide, what foods to avoid, how to prepare the foods for your toddler to eat, and how much you should give.

What to give

What to avoid

Food prep

Portion sizes

Sample menus for toddlers

A sample menu for 1-2 year olds is shown here, and a sample menu for a 2-year old is shown here. Children age 3 years old can follow a menu similar to the 2-year old menu with slightly larger portion sizes. Remember, these are just examples. As long as you stick to the generally healthy eating principles described above you can adjust these menus in many different ways.

Peeing/pooping

At 2 years your toddler may be ready to start potty training, though many children are not ready until they are closer to 3 years old. You can read about this below. Otherwise, the poop may change some as your toddler's diet changes, but your child should be going regularly and the poop should be soft. You only need to be concerned if:

  • the poop is hard or watery consistently
  • the poop is dark black, a shade of red, or pale
  • your child pees much more or less than usual

If any of the above concerns occur, let your child's healthcare team know.

Potty training

At 2 years old your child may be ready to begin potty training, but they may not be developmentally ready yet. Some children are not ready until they are 3 years old; you can avoid a lot of frustration by not trying to potty train too early. Make sure your child is not constipated before attempting to potty train. There is lots of advice in this series of articles, and the following video is helpful to watch for some general tips:

Safety

Now that your child is 2 years old, you need to be even more careful about making sure the home is safe, as your toddler will get into many things. I will go through several of the primary safety concerns for toddlers in the cards below, and you can read through the "Helpful Websites" for more general information.

Helpful websites

*This website is based in Australia so any discussion of laws or what is required may not apply to the United States.

Below are several different safety topics, click on each topic to learn more about them.

General

Car safety

Ingestions

Choking/CPR

Sleep

Toys

Water/Bath

Burns/Fire

Equipment

Outdoors

Home/Pets

Vaccines

At 2-3 years no vaccines are generally recommended if your child is caught up at this point. If your child is not caught up, you can ask your child's healthcare team what they are due for.

Your child may receive a flu vaccine (if it is the flu season) and a COVID-19 vaccine. Your child may need additional doses of the flu and COVID-19 vaccines for full protection, so you can ask your pediatrician about scheduling for this before the next check-up.

All the childhood vaccines have been given to millions of people and we know that they are safe and effective. If you would like more information, look through the "Helpful Websites" listed below:

Common questions

Many parents have similar questions about their 2 year old children. Feel free to look through some of the most common ones below.

FAQ

Conclusion

Enjoy your time with your toddler! There are many choices you can make to help influence your child's growth and development. Thankfully, you do not need to be perfect, and you should not worry about doing everything correctly every time. As long as you understand the main ideas presented here, you should be in a good position to help your child grow and develop well. If you have any additional questions make sure to check with your child's healthcare team.

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