Heidi murkoff arlene eisenberg sandee hathaway what to expect the toddler years (v5 0)

Your Separation AnxietyResistance to the Cup Weaning From the Bottle Introducing Cow’s Milk How to Wean From the Breast When to Wean From Breastfeeding WHAT IT’S IMPORTANT TO KNOW: Getti

WHAT TO EXPECT THE TODDLER YEARS

Heidi Murkoff

Arlene Eisenberg Sandee Hathaway, B.S.N.

Sharon Mazel

Foreword by Morris Green, M.D., F.A.A.P.

Perry W Lesh Professor of Pediatrics Indiana University Medical Center

Copyright © 1994, 1996, 2009 by What to Expect LLC Book illustrations copyright © 1994, 2009 by Marika Hahn What to Expect® is a registered trademark of What to Expect LLC.

All rights reserved No portion of this book may be reproduced—mechanically, electronically, or by any other means, including

photocopying—without written permission of the publisher.

Published simultaneously in Canada by Thomas Allen & Son Limited.

Library of Congress Cataloging-in-Publication Data is available

ISBN 978-0-7611-5214-9 Material in “What Your Toddler May Be Doing Now”:

Adapted from the Denver Developmental Materials, W K Frankenburg, M.D.

By permission of the author Height, Weight and Head Circumference Charts, pages 862–65:

Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and

Health Promotion (2000).

Book design: Lisa Hollander with Janet Vicario Front cover illustration: Tim O’Brien based on a photograph by Penny Gentieu/babystock Back cover illustration: Tim O’Brien based on

a photograph from Getty Images Cover quilt: Lynn Parmentier, Quilt Creations, www.quiltcreations.net

Quilt photography: Davies + Starr Book illustrations: Marika Hahn Workman books are available at special discounts when purchased in bulk for premiums and sales promotions as well as for fund-raising

or educational use Special editions or book excerpts can also be created to specification For details, contact the Special Sales Director

at the address below.

Workman Publishing Company, Inc.

225 Varick Street New York, NY 10014 Manufactured in the United States of America

First printing 2009

60 59 58 57 56 55 54

Note: All children are unique and this book is not intended to substitute for the advice of your pediatrician or other physician who should

be consulted on toddler matters, especially when a child shows any sign of illness or unusual behavior.

To Elizabeth, the toddler we could always turn to; and to Emma, Wyatt, Rachel, and Ethan,

whose toddler years are gone but certainly not forgotten.

To Howard, Erik, and Tim, our partners in parenting, and our very best friends.

A Million Thanks

Much like the eight toddlers we’ve had the pleasure of parenting, What to Expect the Toddler Years

has presented us with countless challenges And in the four years that it has taken us to research,write, and produce it, we’ve been lucky enough to work with many wonderful people who have

assisted us in facing those challenges Now, with the book in hand (make that two hands; at 900 pluspages, one hand won’t do), we’d like to take the opportunity to express our thanks to those who havehelped put it there:

All the readers of our previous books, not only for their input, insights (keep those cards and letterscoming!), and their loyalty (so greatly appreciated), but for their patience as they waited (and waited,and waited) for this book’s arrival

Elizabeth Hathaway, toddler-come-lately, for obligingly posing for countless knock-knee photos,for always doing everything “by the book,” and for generally being the right age at the right time

Dr Morris Green, our esteemed and distinguished medical advisor, who never flinched (at leastvisibly) at the endless piles of paper we sent him, who painstakingly crossed our medical t’s anddotted our medical i’s, who brought not just scientific knowledge, but great sensitivity to the task, andwho worked at laser speed no matter how busy he was on other projects

Suzanne Rafer, our intrepid editor and good friend (she’d have to be), who waded through the sea

of manuscript with her usual grace, style, sense of humor, and more “flags” than the United Nationswill ever see

The entire Workman team and extended family, but especially Lisa Hollander and Janet Vicario fortheir artistic expertise; Judit Bodnar for perceptive copy-editing, and Joan L Giurdanella and RobSternitzky for attentive proofreading; David Schiller for copy that lets readers tell our books by theircovers; and Peter Workman for his wisdom, understanding, and patience

Marika Hahn for adorning the book with so many adorable toddlers

Dr Mark Widome for his invaluable support and assistance, particularly on matters of toddlersafety and first aid And the many others who’ve lent their expertise, including Carole Marcus, M.D.,

J Rutt Reigart, M.D., Kathy Leonard, M.D., Al Mooney, M.D., Shelly Bazes, C.N.P., W K

Frankenburg, M.D., Beverly Bresnick, Cate D’Amboise, Sara Jacobs, Ann Wimpheimer, Alan

Friedman, Sue Kellerman, Wendy Sax, Barbara Braun, Susanna Morgenthau, Mimi Gelb, Eve

Coulson, Aliza Cotton, Michael Rand, and the moms and dads who’ve plied us with questions at ourparenting groups and seminars

The terrific staff at the American Academy of Pediatrics, including Michael Copeland, Carolyn

Kolbaba, Leslee Williams, and former staff member Michelle Weber, for helping to keep our booksaccurate and up-to-date.

The editors of Contemporary Pediatrics for invaluable assistance whenever called upon; Juliann

Goldman of C.S.P.I.; and N.A.P.N.A.P

Tameka Hall and Niurka Zameta, crackerjack assistants, who kept up with filing mountains ofarticles from journals and newsletters, checked phone numbers, and otherwise kept our office going

Abby and Norman Murkoff and, as always, Mildred and Harry Scharaga for unflagging support

FOREWORD: A PEDIATRICIAN’S PRESCRIPTION

INTRODUCTION: A TALE OF “TWO” TODDLERS

BEFORE YOU BEGIN

How to Use What to Expect: The Toddler Years

What Your Toddler May Be Doing Now

A Note to Nontraditional Families

PART ONE: THE SECOND AND THIRD YEARS

CHAPTER ONE: THE THIRTEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU CAN EXPECT AT THE ONE-YEAR CHECKUP

WHAT YOU MAY BE WONDERING ABOUT

Frequent Falls

Safety Warning

Bumping Into Things

Slow Gross-Motor Development

Slowpoke Walker

Ensuring a Good Fit

Selecting Shoes for the Walker

Your Separation Anxiety

Resistance to the Cup

Weaning From the Bottle

Introducing Cow’s Milk

How to Wean From the Breast

When to Wean From Breastfeeding

WHAT IT’S IMPORTANT TO KNOW: Getting Your Toddler Talking

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Other People Have Rights

Other People Have Feelings, Too

C HAPTER T WO : THE FOURTEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

WHAT IT’S IMPORTANT TO KNOW: Play Is the Toddler’s Work

Toys for Tots Early in the Second Year

Containing the Clutter

Buy Right

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: All About Grandparents

CHAPTER THREE: THE FIFTEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU CAN EXPECT AT THE FIFTEEN-MONTH CHECKUP

WHAT YOU MAY BE WONDERING ABOUT

Birthmarks, A Year Later

WHAT IT’S IMPORTANT TO KNOW: Accentuating the Senses

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Nobody’s Perfect

C HAPTER F OUR : THE SIXTEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

A Preference for Mommy

Leaving a Sleeping Toddler with a Sitter

Continued Mouthing of Objects

Bath Rejection

Readiness for Potty Learning

Book Consumption

Climbing Capers

Crooked Teeth

Crankiness From Teething

WHAT IT’S IMPORTANT TO KNOW: How to Encourage Learning, Thinking, and New Experiences

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Reading Is Fundamental

C HAPTER F IVE : THE SEVENTEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

Strange Stools

Fridge Opening

Throwing Habit

Clinginess During Play Group

Setting Up a Play Group

Annoying Habits Picked Up at Play Group

Screeching and Screaming

Make Discipline a Laughing Matter

Disciplining Techniques That Work

To Spank or Not to Spank

When Spanking Becomes Abuse

Never Shake a Toddler

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: The ABC’s of P’s and Q’s—Introducing Manners

CHAPTER SIX: THE EIGHTEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU CAN EXPECT AT THE EIGHTEEN-MONTH CHECKUP

WHAT YOU MAY BE WONDERING ABOUT

Another Baby—When?

Impatience (Now!)

Telephone Interference

Interfering With Visitors

WHAT IT’S IMPORTANT TO KNOW: All About TV and Toddlers

The Ten Commandments of Wise TV Viewing

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: The Values You Value

CHAPTER SEVEN: THE NINETEENTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

Night Wandering

Escape from the Crib

Night Waking Due to Teething

Snoring

A Chronically Runny Nose

Hyperactivity

Energy Outlets for Tots

Relaxation Techniques for Tots

Wandering Off

Resistance to Nail Trimming

WHAT IT’S IMPORTANT TO KNOW: How Toddlers Make Friends

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Kindness Toward Animals

CHAPTER EIGHT: THE TWENTIETH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

Shift From Difficult Baby to Difficult Toddler

Living with Your Difficult Toddler

Wall Art and Other Destructive Drawing

Try It Quiet

Aversion to Cleanliness

Playground Timidity

Oversensitivity

WHAT IT’S IMPORTANT TO KNOW: Dealing With Toddler Fears and Phobias

The Why of Toddler Fears

What’s That Pitter Patter?

Coping With Toddler Fears

Facing Fears

When Little Fears Get Too Big

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: The Joy of Giving

CHAPTER NINE: THE TWENTY-FIRST MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

The Observer

You’re Not Alone

Difficulty Loving a Toddler

Sexual Identity

Stifling a Son’s Emotions

Challenging a Daughter

Is It Time to Take Them Out to the Ball Game (or a Movie, or Play, or Concert?)

Guns and Other War Toys

Making Routines Routine

Unreasonableness

WHAT IT’S IMPORTANT TO KNOW: The Art of Comforting (Kissing and Making Better)

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: All About Right and Wrong

CHAPTER TEN: THE TWENTY-SECOND MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

Trouble with Taking Turns

Protecting Your Valuables

Shopping with Toddlers: Mission Impossible

Fascination With the Mechanical

Getting Caught in the Act

Exploration of the Genitals

Readiness for Potty Learning Now

Toilet Learning and a New Baby

Generosity Turned Selfish

WHAT IT’S IMPORTANT TO KNOW: Traveling With Your Toddler

Traveling Toddler’s Tummy

Bedding Down: Selecting a Place to Stay

Curbing the Queasies

Junior Jet Lag

Packing for the Road

Tantrums on the Go

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: All About Sharing

CHAPTER ELEVEN: THE TWENTY-THIRD MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

Five O’Clock Frazzles

Noisiness in Public Places

Cheer Achievement But How Much?

Happiness Is a Warm Parent

Grammatical Errors

Pronoun Mix-Ups

ABC’s and 1, 2, 3’s

WHAT IT’S IMPORTANT TO KNOW: Building Self-Esteem

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: The Importance of Fitness

CHAPTER TWELVE: THE TWENTY-FOURTH MONTH

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU CAN EXPECT AT THE TWO-YEAR CHECKUP

WHAT YOU MAY BE WONDERING ABOUT

The Second Birthday Party

Why? Why? Why?

Toilet Learning Reversals

Fear of the Doctor

Block the Ouch!

Fear of the Dentist

Fear of the Barber

Tell It Like It Is

Fear of Falling Asleep

Night Waking Now

Good Eating Habits

Booster Seat Rejection

A Toddler Who’s a Follower

WHAT IT’S IMPORTANT TO KNOW: Taming Tantrums

What’s Behind Your Toddler’s Tantrums?

Tantrums Aren’t Just for Kids

Heading off Tantrums

Dealing with Tantrums

After the Storm

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Everybody’s Different

CHAPTER THIRTEEN: THE 25TH TO 27TH MONTHS

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

Constant Spilling

Fat and Cholesterol Intake Now

Cholesterol Levels in Children

Starting Chewable Vitamins

Restlessness at Religious Services

Total Concentration on Play

Refusal to Take Time for Meals

The “Gimmes”

Talking to Your Toddler at Two

Whims

WHAT IT’S IMPORTANT TO KNOW: Encouraging Creativity and Imagination

Creativity

Copy Cat

Imagination

Getting Creative With Techniques

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: What’s a Mommy? A Daddy? Sorting Through Gender Roles

CHAPTER FOURTEEN: THE 28TH TO 30TH MONTHS

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

The Child Who Has Everything

Disciplining Other People’s Children

The Family Bed

Frustration with Difficult Tasks

Fear of Trying

Excessive Independence

Stuttering

Interest in Erections

Dawdling in the Morning

Dawdling While Walking

Inability to Follow Directions

Separation Anxiety at Preschool

A Calm-at-School, Wired-at-Home Toddler

WHAT IT’S IMPORTANT TO KNOW: Accepting Individual Temperaments

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Living by the Rules

CHAPTER FIFTEEN: THE 31ST TO 33RD MONTHS

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU MAY BE WONDERING ABOUT

The Facts of Life

The New Facts of Life

Parental Displays of Affection

Bribes and Rewards

WHAT IT’S IMPORTANT TO KNOW: Communicating with Your Child

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: Caring About the Earth—Teaching Environmental Concern

CHAPTER SIXTEEN: THE 34TH TO 36TH MONTHS

WHAT YOUR TODDLER MAY BE DOING NOW

WHAT YOU CAN EXPECT AT THE THREE-YEAR CHECKUP

WHAT YOU MAY BE WONDERING ABOUT

Sleep Requirements

Fear of the Dark

Toileting Setbacks

Urine Accidents

Handling Sucking Habits Now

Disinterest in Potty Learning

Bed-Wetting

Growing Pains

Name Calling

Speech That’s Still Unclear

Frightening Fairy Tales

The Third Birthday Party

WHAT IT’S IMPORTANT TO KNOW: The Superchild Syndrome

Introducing the ABC’s and 1, 2, 3’s

Nurturing the Scientist in Your Toddler

Signs of the Superchild Syndrome

WHAT IT’S IMPORTANT FOR YOUR TODDLER TO KNOW: The Importance of Being Honest

What About Those Little White Lies?

PART TWO: TODDLER CARE, HEALTH, AND SAFETY

CHAPTER SEVENTEEN: TODDLER CARE PRIMER

FROM SKIN CARE TO DRESSING TIPS

Caring for Your Toddler’s Skin

Take a Good Look at Your Toddler’s Skin

At Greater Risk Under the Sun

Decoding SPFs

The Most Common Toddler Skin Problems

Types of Diaper Rash

Caring for Your Toddler’s Hair

Gummy Hair

Most Common Toddler Hair/Scalp Problems

Caring for Your Toddler’s Nails

Caring for Your Toddler’s Eyes

Spotting Vision Problems

Most Common Vision Problems in Toddlers

Checking Your Toddler’s Eyes

If Your Toddler Needs Glasses

Caring for Your Toddler’s Ears and Hearing

What’s Too Loud?

Pierced Ears

Signs of a Hearing Problem

Caring for Your Toddler’s Teeth

Fluorides for Fighting Decay

Most Common Teeth and Mouth ProblemsCaring for Your Little Girl’s Genitals

Most Common Genital Problems in Little GirlsCaring for Your Little Boy’s Genitals

Most Common Genital Problems in Little Boys

The In-Again, Out-Again Testicle

Dressing Your Toddler

Tricks of the Dressing Trade

CHAPTER EIGHTEEN: FEEDING YOUR TODDLER THE TODDLER DIET

The Toddler Diet Nine Basic Principles

White Whole Wheat?

The Frosting on the Flakes

Introducing the Toddler Diet Daily Dozen

Variety Is More Than the Spice of Life

Fat Sense

Milk Measures

Juice Facts

WEIGHTY CONCERNS: Your Toddler’s Growth

The Tubby Toddler

Sample Toddler Menu

The Broccoli Connection

The Thin Toddler

Maybe They Really Do Grow Overnight

Slow Growth

How Does Your Toddler Grow?

TACTICS FOR THE TABLE

Finessing the Finicky Eater

Fast Food—Fun or Folly?

Gratifying a Snack Attack

Fun with Food

A Limited Dietary Repertoire

Rejection of a Favorite Food

A Vegetarian Diet

Dairy Protein Choices for Toddlers

Vegetarian Protein Choices for Toddlers

SAFE FOOD, SAFE WATER

Monitoring Food Safety—at Home and Away

Dining Out With a Toddler

The Cutting Board Dilemma

Monitoring Chemical Consumption

Monitoring Cooking, Serving, and Storage Utensils

Choking Risks

Monitoring Water Safety

CHAPTER NINETEEN: ALL ABOUT TOILET LEARNING READY?

The Don’ts of Toddler Toilet Learning

WHEN ACCIDENTS HAPPEN

Why Accidents Happen

When an Older Child Resists

’Tis the Season?

WHAT YOU MAY BE WONDERING ABOUT

Switching to Training Pants

Diaper Rejection

Hygiene Hype

Wiping Wrangles

Fear of Flushing

When to Take a Stand

The Movable Potty Chair

A Girl Who Wants to Stand

Fascination with Stool

Switching to the Toilet

A New Diaper Rash at Night

A Diaper for Bowel Movements

Toilet Learning and Preschool

Staying Dry at Night

CHAPTER TWENTY: KEEPING YOUR TODDLER HEALTHY IMMUNIZATION: Preventing Major Communicable Diseases

Recommended Immunizations

When to Call the Doctor After an Immunization

Don’t Miss an Opportunity

AAP Immunization Recommendations

Immunization Myths—Dispelled

Getting Shots: Your Toddler’s Tears and Fears

When Your Child Is Immunized

THE DOCTOR AND THE TODDLER

The Parent-Physician Partnership

The Role of the Pediatric Nurse-Practitioner

When to Call the Doctor

Looking for Dr Right

Before You Call the Doctor

Appendicitis Warnings

Parent’s Intuition

ALL ABOUT FEVER

Know Your Toddler

Taking Your Toddler’s Temperature

Reading the Thermometer

Evaluating a Fever

Febrile Convulsions

Treating a Fever

Dosages for Acetaminophen and Ibuprofen

Typical Body Temperatures

CARING FOR A SICK TODDLER

At Home

In the Hospital

WHEN MEDICATION IS NEEDED

What You Should Know

THE MOST COMMON TODDLER HEALTH PROBLEMS

Common Cold (Upper Respiratory Infection, or URI)

Otitis Media (Middle-Ear Inflammation)

Preventing the Spread of Illness

Tubes for Toddlers

Otitis Media with Effusion, or Serous Otitis Media

Sinusitis

Sore Throat

Tonsils and Adenoids: Taking Them Out Is No Longer In One Picture is Worth

Urinary Tract Infection (UTI)

Treating Your Toddler’s Symptoms

CHAPTER TWENTY-ONE: KEEPING YOUR TODDLER SAFE

Change Your Ways

Change Your Toddler

Dressing for Safety

Change Your Toddler’s Surroundings

Lead Can Lead to Trouble

Food for Thought

Safe Heights

No Gun Is a Safe Gun

Indoor Pest Control: Sorry for Pests, Still Safe for ToddlersPutting Worry in Perspective

Poison Control

JPMA Certified Safe for Kids

Designed for Safety

Red Light Greenery

CHAPTER TWENTY-TWO: TREATING TODDLER INJURIES FIRST AID FOR THE TODDLER

Poison Guidelines You Shold Know

Poison Ivy, Poison Oak, Poison Sumac

Puncture Wounds

Scalds

Scrapes

Seizures

Stocking the Medicine Chest

Severed Limb or Digit

FIRST AID FOR TODDLERS: CHOKING AND BREATHING EMERGENCIES

Check, Call, Care, and A-B-C

Rescue Breathing for Toddlers

Cardiopulmonary Resuscitation (CPR): Children Over One Year

FIRST AID FOR A CHOKING TODDLER

CHAPTER TWENTY-THREE: YOUR SPECIAL-NEEDS CHILD

Helping Your Special-Needs Child

Free Testing

Who Can Help?

Living With and Loving Your Special Child

It’s the Law

Residential Care

Home Care

SOME CHRONIC HEALTH PROBLEMS

AIDS (Acquired Immunodeficiency Syndrome) and HIV InfectionAllergy

Helping the Healthy Sibling

The Very-Low-Birth-Weight Baby as a Toddler

Visual Impairment—Legal Blindness

PART THREE: THE TODDLER IN THE FAMILY

CHAPTER TWENTY-Four: THE TODDLER AS SIBLING

WHAT YOU MAY BE WONDERING ABOUT

Sibling Rivalry

Even-Steven

Adoring Toddler, Intolerant Sibling

Adoring Sib, Intolerant Toddler

Siblings 101

Sibling Slugfests

Stepping into a Stepfamily

Two Children—Two Bedtimes?

Toy Safety Among Siblings

Shortchanging Number Two

Walk a Yard in Your Toddler’s Shoes

Keeping Your Cool

Crying in Front of Your Toddler

One-on-One for Fun

Surviving with Two Under Two

Time for Yourself

Guilt About Working

Homesickness

Misgivings About Staying Home

The Full-Time Father

When Your Heart’s at Home, but You’re at Work Having It All—Your Way

Not Feeling Like a Parent

Staying Sane in the Fast Lane

Working Outside the Home and Discipline

Toddler-Free Travels

Leaving Home Without Your Toddler

Frequent Business Trips

A Sick Parent—Coping with Serious Illness

Dealing with Death

Talking About Death

Deciding About the Funeral

CHAPTER TWENTY-SIX: WHEN OTHERS CARE FOR YOUR CHILD WHAT ARE THE CHILD-CARE OPTIONS?

Most Common Options

Baby-sitter Plus Child

Signs of Substance Abuse in a Caregiver

Family Day Care (or Group Home Care)

Sources of Help and Information

Group Day-Care or Preschool Program

Preschool Admissions

An Occasional Sitter

MAKING CHILD CARE WORK

Working with an In-Home CaregiverEvaluating Your Current Child CareDealing with a Change in Child CareGetting Ready for Preschool

Getting Into the Swing

SPECIAL CONCERNS

The Sick Child and Child Care

Recognizing Abuse

Concern About Abuse

Can Child Care Be Too Good?

PART FOUR: READY REFERENCE

WHAT CAN I DO NOW?

THE TODDLER DIET RECIPES

COMMON HOME REMEDIES

Humidifying

COMMON TODDLER ILLNESSES

HEIGHT AND WEIGHT CHARTS

HEAD CIRCUMFERENCE CHARTS

HEALTH HISTORY

MOMENTS TO REMEMBER

INDEX

A Pediatrician’s Prescription

This wonderfully informative book is destined to win blue ribbons for authoritativeness, readability,and usefulness One of the things that impressed me most as I read it was how thoroughly it preparesparents to understand the needs, behavior, and development of their toddlers, while offering hundreds

of valuable suggestions on their care, guidance, and management (Perhaps that last word should be inquotes With toddlers, it’s never really clear who manages whom.)

But What to Expect the Toddler Years is more than a user-friendly technical handbook The

authors present the developmental essentials of the difficult but delightful toddler years in such anaccessible and empathic manner that appreciative parents will undoubtedly recommend this book totheir friends as a genuine household necessity

It has become increasingly clear that a child’s first three years of life largely determine his or herfuture developmental trajectory To a large extent, these early years set the stage for later outcomes inpersonal health, emotional development, educational attainment, social competence, self-confidence,self-reliance, and positive human relationships Parental investment in the coin of nurturance, care,love, and understanding during this formative age period brings both short- and long-term dividends

This latest addition to the What to Expect series helps parents to achieve these dividends in

several ways It helps parents know what to expect from their toddlers at various ages and stages, andreassuringly maps the wide range of normality It guides parents in the always challenging, often

daunting task of helping the toddler deal successfully with such key developmental issues as goodnutrition, timely immunization, safe play, sound sleep, weaning, speech, separation, self-discipline,good health and hygiene habits, as well as various child-care situations

Considerable attention is given to practical suggestions for the prevention of behavioral and

developmental problems But the authors not only help parents to avoid the negative, they stronglyaccentuate positive values with innumerable sidebars devoted to the care and nurturing of the

toddler’s understanding of right, wrong, and the gray areas in between

Temper tantrums? Breath-holding spells? Sleep disorders? Biting? Short attention span? Speechdelay? Toileting worries? Autonomy? Negativity? Resistance to limits? Along with why such

behavioral and developmental problems happen, detailed guidance is offered on ways to get them tostop—or at least to minimize them These recommendations are developmentally based, in keepingwith the child’s chronological age, needs, and abilities

Parents themselves are not neglected A principal goal of the book is to provide frequently

overwhelmed and sometimes despairing parents with the kind of information that promotes

confidence, self-esteem, resiliency, and feelings of effectiveness Common parental questions

(including those of parents working outside the home) are posed and comprehensively and

reassuringly answered Parent–toddler interaction and communication are strongly promoted as ways

to give a young child and his or her parents a good start Throughout the book, the toddler is viewed

in the context of his or her family, with an emphasis on identifying and augmenting the strengths ofboth

The authors’ thoughtful advice and suggestions are intended to help readers enjoy their toddlers—

to take a positive approach to the challenges of their formative years, to understand what often seem

to be (but often aren’t) irrational behaviors and to put them in perspective, to accept and respect eachchild as a unique individual and contribute to the realization of that child’s potential

This book directly responds to the sensible desire of today’s parents for information that fits ourtimes, a period characterized by rapid changes in the family and our society This highly skilled

synthesis of childrearing principles, savvy from the social, behavioral, and biologic sciences, andsuccessful medical practice is clearly unsurpassed among child-care guides It is an outstandingvolume—one that will be extremely useful to both parents and professionals

Morris Green, M.D., F.A.A.P.

Perry W Lesh Professor of Pediatrics

Indiana University Medical Center

A Tale of “Two” Toddlers

It was the best of the times, it was the worst of times It was Emma’s toddler years

Shoes hurled across the room because they didn’t “feel good” on her feet Crackers rejected

because they had a corner broken A swimsuit donned on a frigid January morning, a snowsuit donned

on a scorching August afternoon Sit-down strikes on grimy New York City sidewalks (when therewas no bus in sight), lie-down strikes in front of the candy display at the supermarket (when sweetsweren’t on the shopping list) Daily tantrums, nightly sleep problems; battles fought at the dinner table(“Don’t wanna eat that!”), at the closet (“Don’t wanna wear that!”), at the playground (“Don’t wanna

go yet!”) Stubbornness that wouldn’t quit, a temper to rival a marine drill sergeant’s, ritualistic

behavior that bordered on the obsessive–compulsive

And then, there was that smile—a smile that, in one endearing flash of pearly baby whites, couldturn a hardened parental heart into a helpless pool of sentimental slush And those hugs—spontaneousoutbursts of unaffected affection more delicious (and more addictive) than imported chocolate

truffles And that voice—cuter than a voice has a right to be, uttering achingly adorable

mispronunciation after mispronunciation (“bia” for banana, “pe-um” for peanut butter, “ga-ga” fordaddy) And those moments—those thousand-and-one enchanting moments, the ones that made meforget the tantrums and the negativity, that entertained me, charmed me, and made me feel blessed.The way she “nursed” her teddy bears while I nursed her baby brother The way she poured “tea” forher dolls, and administered shots to sickly stuffed animals The way she sang to herself while sheswung on the swings, and babbled to herself while she flipped the pages of her picture books Theway she scoured the park for caterpillars and butterflies to catch and observe in her “bug house.” Theway she moved, the way she cuddled, the way she laughed, the way she played, the way she slept

If there has yet to be a more difficult time in the raising of Emma, there has also yet to be a moredelightful one Though I’ve thoroughly enjoyed every era of Emma (from newborn to preteen; I’ll getback to you on adolescence), the toddler years—more harrowing than any roller coaster ride, and yet,much more intoxicating; a series of ups and downs that at once confused, captivated, exasperated, andexhilarated—were among my favorite years

Of course, that’s easy to say now—now that Emma has evolved from an irrational two-year-old to

a reasonable (most of the time), responsible, and responsive eleven-year-old, now that I have nearly

a decade of time-heals-all perspective between me and those shoe-hurlings (we never did find thatsneaker) It was decidedly less easy to say, or to feel, when Emma was a toddler

If only I’d understood then what experience has helped me to understand now That, to paraphrasethe popular (but unprintable) aphorism, toddler behavior happens And it has to happen—as

inevitably as those two front teeth, as surely as those first steps It doesn’t happen because you’re badparents, and it doesn’t happen because your toddler’s a bad child—it happens because it’s supposed

to happen and because it needs to happen Toddlers don’t do what they do to drive their parents todistraction (though that’s often the result); they do what they do to grow, to mature, to come to termswith coming of age

So it is to those trying, terrific, irrepressible, irresistible, completely confounding creatures wecall toddlers—and to the parents who struggle to understand them—that this book is dedicated Inhopes that it will help parents of toddlers appreciate the best of times, cope with the worst of times—enjoy all the times that are the toddler years.

Heidi Murkoff

Before You Begin

How to Use W HAT TO E XPECT THE T ODDLER Y EARS

When it comes to parenting, there are few absolutes (one, of course, being that every child needs to

be loved) and there is no one “right way” (with the exception of issues that affect a child’s safety andhealth) Use this book for suggestions, for insights, for explanations, for examples—but use it to

supplement and support rather than supplant your own instincts Let it inspire you, not inhibit you.Different parenting techniques work for different children (even for different children within the samefamily, and the same child under different circumstances); different parenting styles suit differentparents and the same parent at different times of life Let this book serve as a guide as you use yourskills, talents, instincts, and knowledge of yourself and your child (no one knows you and your child

as well as you do) to try to discover what works best in your family

What Your Toddler May Be Doing Now

Every child is unique; each develops at his or her own pace Because few children are perfectlyaverage or typical, comparisons are not very useful And though we may be concerned about the childwho lags behind his or her peers, that child may later make great leaps forward, catching up or evensurpassing them

Nevertheless, most of us want to know how our own child is doing in relation to other children, atleast once in a while To help you determine where your toddler’s development fits within the widerange of normal, we’ve developed a monthly milestone scale of achievements for the second year,and a quarterly milestone scale for the third year, into which virtually all toddlers fall These scalesare based on the widely respected Denver II scale, with a few added items from the well-regardedELM (Early Language Milestone) scale

Here’s how they work: Each “What Your Toddler May Be Doing Now” milestone scale is

divided into four categories The first, “What your toddler should be able to do,” lists milestones that have been reached by 90% of toddlers by that age The second, “What your toddler will probably be

able to do,” represents milestones that have been reached by 75% of toddlers The third, “What your

toddler may possibly be able to do,” includes milestones that have been reached by 50% of children And the fourth, “What your toddler may even be able to do,” includes milestones reached by 25%.

Most parents will find their toddlers achieving in several different categories at any one time.Some may find that their offspring stay consistently in the same category; others may find their child’soverall development uneven—slow one month, vaulting ahead the next

All of these developmental styles are perfectly normal until proven otherwise Still, there aretimes when a doctor should be consulted For example, when a child consistently fails to achievewhat a child of his or her age “should be able to do,” or when a parent has a gut feeling that

something isn’t right with a child’s development Even then, though an evaluation may be a prudentstep, it may turn out that no problem exists Some children keep moving forward but simply have aslower than average developmental timetable

Use the “What Your Toddler May Be Doing Now” sections of this book to check progress

periodically, if you like, but don’t use them to make judgments about your toddler’s potential—theyare not predictive If you find yourself obsessed with comparing your child to the averages, you may

be better off looking at the milestone scales rarely, or not at all Your child will develop just as well

—and you (and your toddler) may be happier

Keep in mind that the questions and issues discussed in each chapter are less specific to that month

or period than was true in our book What to Expect the First Year Be sure to use the index to help

you find the answers to your concerns

Also remember that toddlers, like babies, don’t develop in a smooth, linear progression There arelots of bumps and humps, spurts and lulls The period before a big step is often one of disorganization

—nothing seems to go right; then all of a sudden, the child is walking or talking up a storm Seeminglystagnant periods, in which there appears to be no progress at all, are actually spent polishing andexpanding new skills; they are necessary to normal development Progress may slow, too, or evenslide backward, during times of stress With adequate support at such times, toddlers usually get rightback on the forward track

A Note to Nontraditional Families

There’s more than one way to raise a family these days Though the so-called “traditional” home

—where a married couple raise the children together—is still perceived as the norm, half of all

American children under eighteen are being raised in nontraditional homes Sometimes by choice,more often by circumstance, more and more families are headed by single parents, usually mothers.And while they’re still a small minority, other types of nontraditional families—including those

headed by solo fathers, unmarried heterosexual or same-sex couples, mothers and fathers sharingcustody in separate homes, and grandparents raising grandchildren—are also growing in number

This book is meant for all kinds of families—traditional and nontraditional For the sake of

simplicity as well as syntax, we sometimes refer to the traditional family rather than trying to addressevery conceivable family configuration But such references are not meant to exclude or offend thoseliving in less traditional arrangements For more on nontraditional families, see Chapter Twenty-Five

PART ONE

The Second and Third Years

CHAPTER ONE

The Thirteenth Month

WHAT YOUR TODDLER MAY BE DOING NOW

By the end of this month, * your toddler

should be able to (see Note ):

pull up to standing position

get into a sitting position

cruise (move from place to place, always holding on)

clap hands (play “patty-cake”)

indicate wants in ways other than crying

Note: If your toddler has not reached these milestones or doesn’t use his or her hands for purposeful

activities like picking things up, consult the doctor or nurse-practitioner This rate of developmentmay well be normal for your child (some children are late bloomers), but it needs to be evaluated.Also check with the doctor if your toddler seems unresponsive, doesn’t smile, makes few or nosounds, doesn’t seem to hear well, is perpetually irritable, or demands constant attention

(Remember, the one-year-old who was born prematurely often lags behind others of the same

chronological age This developmental gap progressively narrows and generally disappears entirelyaround age two.)

will probably be able to:

put an object into a container (by 12½ months)

imitate activities (by 12½ months)

stand alone (by 12½ months)

use 1 recognizable word

may possibly be able to:

drink from a cup

use 2 recognizable words (by 12½ months)

point to a desired object (by 12½ months)

scribble

walk well

may even be able to:

use a spoon/fork (but not exclusively)

remove an article of clothing

point to 1 body part when asked

use an object in imitation

Intellectual development Early in the second year, toddlers are explorers and scientists, picking up,

studying, testing, manipulating, maybe still putting in their mouths, everything in their path Cause andeffect is a major focus They live in the here and now, and do not show much imagination or abstractthinking as yet

Emotional development As the world begins to open up, the toddler, who has come a long way from

the eat-cry-sleep newborn, opens up, too, displaying a wide range of moods, feelings, and behaviors.Expect them and accept them—they are part of growing up This range includes displays of affection,independence, frustration, fear, anger, protest, stubbornness, willfulness, sadness, anxiety, and

puzzlement

WHAT YOU CAN EXPECT AT THE ONE-YEAR CHECKUP

Preparing for the checkup Keep a list of concerns that have come up since the last visit to your

child’s doctor or nurse-practitioner Be sure to bring the questions with you to this visit so you will

be ready when the doctor asks, “Any concerns?” Also jot down new skills your toddler is displaying(clapping hands, waving bye-bye, throwing kisses, walking, climbing) so you won’t be at a loss whenyou’re asked, “What’s your toddler been doing?” Bring along your child’s home health history

record, too, so that height, weight, immunizations, and any other information gleaned from the visitcan be recorded

What the checkup will be like Procedures will vary a bit depending on your child’s doctor or the

nurse-practitioner who conducts health supervision exams, but in most cases, the twelve-month visitwill include:

An assessment of growth (height, weight, head circumference) since the last visit These findingsmay be plotted on growth charts (see pages 862 to 865) and the child’s weight for height evaluatedand compared to previous measurements You can expect that the rate of growth will slow in the

second year Note that children don’t grow gradually, but rather in spurts So your toddler may remainthe same height for a couple of months, then suddenly pick up a full inch or more virtually overnight

Questions about your child’s development, behavior, eating habits, and health since the last visit.There may also be questions about how the family is doing in general, whether there have been anymajor stresses or changes, how siblings (if any) are getting along with your toddler, about how youare coping, about child care arrangements (if any) The doctor or nurse will also want to know

whether you have any other questions or concerns

An informal assessment, based on observation and interview, of physical and intellectual

development, and of hearing and vision

A finger-stick blood test (hematocrit or hemoglobin) if the child is at risk of anemia The test may

be done once routinely between twelve months and four years

If you live in an old home or apartment building, a blood test (blood is drawn and sent to a lab) may

be given to check for lead Some babies may be automatically tested at 1 year; others will be

screened, depending on what kind of housing they live in

A Mantoux tuberculin test (a simple skin test) for children at high risk for TB, such as those whohave traveled abroad or have parents who work in a hospital or jail

Immunizations.

Hib (hemophilus influenza b); may be given at 15 months instead

Other need-to-know advice The doctor or nurse-practitioner may also discuss such topics as good

parenting practices; your toddler’s emerging struggle for independence; discipline; communicatingwith your toddler; nutrition, weaning, and fluoride supplementation, if appropriate; injury prevention;ways of stimulating language; and other issues that will be important in the months ahead

The next checkup If your toddler is in good health, the next visit will be at 15 months Until then, be

sure to call the nurse or doctor if you have any questions that aren’t answered in this book or if yourchild shows any signs of illness (see page 569)

WHAT YOU MAY BE WONDERING ABOUT

Part of the problem is a lack of experience with balance and coordination, which take a lot ofpractice to perfect (If you’ve learned to ice-skate or ride a bike as an adult, you have an inkling ofwhat learning to walk must be like.) Another factor is farsightedness; most children this age can’tclearly see what’s under their nose (see page 5) Judgment, or rather the lack of it, also contributes

So does preoccupation A toddler is more likely to be paying attention to what’s going on around herthan where she’s going And since toddlers are rarely able to concentrate on more than one thing at atime, collisions and spills are the typical result

Though she will continue to make steady progress in the months ahead, chances are your toddlerwill be cruising for a bruising for some time to come It probably won’t be until somewhere aroundher third birthday that she’ll have gained the expertise necessary to be able to steer a steady course—most of the time