Information on Toddler Milestones

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Toddler Milestones

Height, weight, and other physical progress you haven't already done so during one of your child's well-baby checkups,take a look at the growth curve that should be in her medical chart. Better yet,ask the doctor or office staff for a copy you can continue updating on your own.You'll notice that the average rate of growth during the second year is slower thanit was during the first twelve months. A normal one-year-old will have tripled hisor her birth weight but then will gain only three to five more pounds by age two.Sm-iilarly, regardless of gender, your child will add roughly four inches of heightbetween the first and second birthdays, less than half the height gained during*e first year. Interestingly, while your child's head will increase in circumferencerte-: about an inch over the next twelve months, by age two it will have reached 90 percent of its adult size.

The percentile curves shown on the growth charts begin to diverge more no-ticzably after the first twelve months. In other words, the differences in height andweight between a child who is at the 90th percentile (that is, larger than 90 per-eau of the children his age) and one of the same age who is at the 10th percentileArtlE become more dramatic after the first birthday. For most children, position onthe growth chart depends largely on genetics, with a height and weight trajectorytra will be fairly predictable after the first eighteen to twenty-four months of life&awe been tracked, barring an unusual problem or chronic illness. If your child is'ailing off" a curve—that is, she has been at a certain percentile of weight and%richt for a number of months and then appears to shift to a significantly loweriese during subsequent checkups—a medical or nutritional problem may be predict and your health-care provider may recommend further evaluation.

Even though she will not be making drastic changes in height and weight,baby look will begin to fade away between her first and second birthdays.74if more muscle motion, her arms and legs will look longer and leaner and theaatixnen less prominent. Her face will gradually shift from the round, nonspe-zric -put universally appealing look of a baby to more well-defined features that will give you a preview of her future appearance. As you watch her enthusiasti-cally attempting to blow out two birthday candles, don't be surprised if you findyourself wondering, "Where did my baby go?"

The debut of walking may already haveoccurred two or three months before the first birthday, or it may be a few monthsaway. By eighteen months, your child should have this skill down pat. While earirstarters won't have any long-term advantage over the late bloomers who are oth-erwise normal, they will be somewhat ahead of the game in maturity of their gab..It takes a few months to progress from the broad-based, lurching, hands-IT..,toes-out, frequent-faller "toddling" walk to a smoother, more narrow-based gaiwith fewer falls, improved maneuvering, and—a big thrill for many kids—tleability to use hands to carry things while on the move.
Parents watching a toddler careen around the room may wonder about thealignment of the legs: Are they turned outward too far? Does one foot point in adifferent direction from the other? During the first several weeks of walking, thismay be impossible to answer. If you see an obvious, consistent difference in theorientation of the legs, however, you should have your toddler's health-careprovider watch her move up and down the office corridor. He or she may wanean opinion from an orthopedist to determine whether specific intervention is inorder.

The treatment for the vast majority of toddler gait concerns is "tincture oftime"—they resolve as weeks pass and coordination improves. However, an ob-vious limp or a toddler's sudden unwillingness to walk after she clearly knowshow is always abnormal and should be evaluated medically as soon as possible.

Vision, hearing, and language

The average one-year-old can see well enough to spy small objects across theroom or planes flying overhead. By the age of two he will probably approach nor-mal vision, although it is difficult to measure accurately at this age. If he seemsto be squinting a lot or bringing objects right up to his face before he interactswith them or doesn't seem to be tracking objects with his eyes, an exam by anophthalmologist (a physician who specializes in eye problems) would be a goodidea.' This should also be done if you see obvious crossing of his eyes (even tem-porarily) or if they don't seem to be moving in the same direction.

While major visual problems are uncommon in one-year-olds, hearing canbecome impaired if ear infections and colds—which are not at all unusual in thisage-group—leave persistent thick fluid behind one or both eardrums (see ear acre and concerns, Reference). If the problem persists untreated for weeks ormonths, your child's ability to understand and generate language can be delayed.

If you have any concerns about hearing loss, by all means have ears and hearing checked—the sooner the better. While your health-care provider can usually determine whether there is fluid behind the eardrum or
:itify other physical problems, a detailed assessment of hearing in this age-group requires special training and equipment. A relatively new and painless testurith the intimidating name "brain stern evoked response audiometry" can testhearing without your child's cooperation, but you may have to travel some dis-tance to have it done. If your toddler's physician recommends this test or a con-sultation with an ear, nose, and throat (ENT) specialist, don't hesitate to do so.

Assuming that hearing is intact, your child will probably have a speaking vocabulary of a few words at his first birthday and about ten times that many at hissecond, some of which he may combine into two- or three-word sentences. Whathe can understand, however, will become much more impressive as the year pro-gresses. As he moves past the eighteen-month mark, he will point to all sorts ofthings—people, objects, body parts—when asked about them ("Where is yournose?" "Where's Auntie Linda?"). By the second birthday, the unintelligiblestrings of sounds that sounded like a foreign language at the beginning of therear will be honed down to simple statements or even questions. Even moreamazing is seeing your walking baby, who not long ago lay helpless in a crib, fol-lowing a simple command such as "Go get the ball."

Over the next several months, you will have the unique and important op-portunity to help expand your child's language skills. You won't need a teachingcredential, a master's degree, or special training in child development to do this.Instead, you will simply need to "be there" when you are with him. Keep your antennae up and be ready to give him dozens of little doses of your attention atconversation throughout the day.

Take advantage of his curiosity. When he approaches you with an object or poi/to something and makes a sound (which may rise at the end like a question—"Car?"), you've got his attention. Name the object and say something simpleabout it ("Yes, that's Daddy's car"). He doesn't need a lecture about auto roe-chanics, of course, but don't be afraid to aim your comment a little beyondyou think he might understand.

Talk to him while you're doing everyday chores. Folding clothes may be bor-ing to you, but if he's watching, it doesn't take any extra time to name the 'termor say what you're doing with them. Remember, his little computer is on all the time.

Read to him. Reading simple stories to your child, especially at bedtime, is an ttremely worthwhile activity to begin this year, if you haven't already. (Be surelet him see what you are reading and to identify for him anything he finds inter-esting in the pictures.) His interest and understanding will increase dramaticall,over the course of the year. By age two, in fact, he may be able to fill in the blanksin a story he knows well, anticipating and saying one or more words at favoritespots along the way.

A few cautions about language:

Remember to speak to your child using clear, meaningful words. Use a pleasa
tone of voice, but avoid baby talk, and don't repeat his unique mispronunciatioof words, even if they are cute
Don't make reading to him an issue if he's not interested at the particular story timeyou have in mind. Usually you won't meet much resistance at bedtime when chdren are attentive to just about anything that delays lights-out, but they may notbe as interested during daylight hours.
Don't expect Big Bird, Bert and Ernie, and the rest of the gang on SesameStreet to take care of your child's language development or other learning ex-periences. Even if he pays attention (which at this age he probably won't do forany length of time), live humans who are paying attention to him do a muchbetter job.

Hands, minds, and safety

This year your toddler will continue the process of exploring whatever she findsaround her. Her ability to pick up and manipulate objects both large and small willLome much more refined and coordinated during the coming months. By hersecond birthday, she will enjoy scribbling with crayons (preferably not on the walls),"Licking four or five items and then knocking them over, playing with clay, andItaing pegs of various shapes into similarly shaped holes. Many toddlers also be-mme fascinated with things that go around. Wheels that spin on toy cars, pedals onbicycles, a lazy Susan you don't need anymore, or a saucepan lid turned upsidedawn on the kitchen floor may become objects of your child's greatest affection.

Between eighteen and twenty-four months of age, most toddlers also become enamored with balls; holding, rolling, tossing, watching them bouncemound, and then chasing them hold endless interest and delight. Beware, how-crer, of small round objects (such as marbles) that might be put in the mouthand then accidentally inhaled. Best bet: Buy your toddler her own inexpensive in-linable twelve- to eighteen-inch beach ball. It's quiet, it can't do much damage,she can carry it around when she doesn't want to throw it, and it's easy to replace.

By her second birthday, you may get a preview of your child's preference forming the right or left hand. But she may also use the spoon with her right, scribble with her left, and throw a ball with either. Don't try to push the use of onehand over the other and don't worry about speeding up the process. She'll sortout her handedness in due time.
This year your child will significantly increase her grasp of the way thingswork. Her sense of object permanence—the idea that something is still presentmen if she can't see it—will become more sophisticated. Not only will she learntit, search for a toy she saw you place under two or three blankets or pillows, butibe will also become a whiz at little hide-and-seek activities. If she sees you sticka toy in your pocket, she won't forget where it went.

Brief episodes of playacting and imitation will become more sophisticatedaver the course of the year. Watch her hold the toy phone to her ear (or yours), tryus brush her hair, rock her "baby," or turn the steering wheel on a toy car. As themonths pass, she will try to engage you in some of these scenarios. If you can stopfora few moments to pretend to drink out of the toy cup she offers you or talk onkr phone, you'll make her day. Finding the right balance between responding tothese overtures often enough to satisfy your child but without endless interrup-tion to whatever you're trying to get done is an art in parenting.

Because of your child's maturing motor and problem-solving skills, yourvigilance for her ongoing safety must not only continue but become more so-phisticated. Her developing fine-motor coordination will also include new abili-ties that can lead to new hazards: turning doorknobs, manipulating latches.flipping switches, and pushing buttons. Turn your back for a moment and shemay be locked in the bathroom or out the door and down the street, peering overthe edge of Grandma's swimming pool. Her interest in climbing to precariousnew heights may increase, along with her ability to find new and clever ways target to them.

Her tendency to "gum" everything as a means of gathering information wane, but she may not hesitate to place small objects in her mouth. Rememba-to stay vigilant for any such items that might cause choking if accidentally w-haled. She may very well take a swig or a bite of anything that looks interesting. Medicines, plants, cleaning products, dog food—you name it—nothing islimits for an oral sampling. You cannot assume that a bad taste will keep her from guzzling the furniture polish or anything else. This year and the next are the momrisky for your child's having an accidental ingestion of a dangerous substance.

If you haven't done so by now, buy a small bottle of syrup of ipecac, a dri4that may be used to induce vomiting if your baby eats or drinks something tha-might harm her. You should give a dose of ipecac only if you are told to do so by tindoctor, the emergency department, or a poison-control center. Ipecac should nor '..veused with many substances, especially caustic materials (such as drain cleaner orpetroleum products (such as gasoline or furniture polish) because they can do a;much or more damage on the way up as they have done on the way down. Regarding medications and other items, however, you may be instructed to use ipecac to.empty the stomach. In a child over one year of age, one tablespoon (15 cc) fo-lowed by two glasses of water will induce vomiting, normally within fifteen latwenty minutes.

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