The toddler period (12 to 36 months) is defined by mobility, language, and the drive for independence. Toddlers can move fast and reach almost anything, but they have no sense of danger, little impulse control, and limited language to express frustration. Growth slows compared with infancy, so appetite falls — often alarming parents — while motor, cognitive, and social skills expand rapidly.

Physical growth

Developmental milestones (CDC 2022) — skills that most children (75% or more) show by each age

Additional expected skills: climbs stairs by crawling around 15–18 months and may come down backward; stairs with alternating feet going up at about 3 years; tricycle around 3 years; block tower of about 6 blocks at 2 years and 8 or more at 3 years; standing briefly on one foot at about 3 years.

Cognitive (Piaget): end of sensorimotor (tertiary circular reactions — experimenting, throwing toys to see what happens; then mental representation and deferred imitation) → preoperational from about 2 years: symbolic (pretend) play, egocentrism, magical thinking, limited sense of time.

Psychosocial (Erikson: autonomy vs. shame and doubt; Freud: anal stage)

• Negativism ("No!") — a way to assert independence, not defiance
• Ritualism — insists on the same cup, same bedtime routine; routine gives security
• Temper tantrums — frustration exceeds language and control
• Separation anxiety peaks; transitional objects (blanket, toy) comfort
• Parallel play — plays beside, not with, peers; possessive ("mine"), difficulty sharing
• Sibling rivalry and regression when a new baby arrives

• Growth measurement at each visit; switch from recumbent length to standing height after about 2 years; BMI-for-age from 2 years
• Standardized developmental screening at 18 and 30 months; autism screening (M-CHAT-R/F) at 18 and 24 months
• Hemoglobin screening per risk (iron deficiency is common with excess milk)
• Blood lead testing at 12 and 24 months (required for all Medicaid-enrolled children in the US, with catch-up to 72 months if never tested; others per state or local risk rules). Levels at or above the CDC blood lead reference value of 3.5 µg/dL (0.17 µmol/L) need confirmation, a search for the exposure source, and follow-up
• Oral health assessment; fluoride varnish every 3–6 months in primary care
• Vision screening (instrument-based) and hearing surveillance

Management is anticipatory guidance and early referral when screening is abnormal.

Nutrition

• Physiologic anorexia — appetite decreases because growth slows; offer small portions, 3 meals and 2–3 healthy snacks; the child decides how much to eat
• Whole cow's milk from 12 to 24 months (then low-fat); limit to about 480–720 mL (16–24 oz) per day — more causes iron-deficiency anemia and displaces food
• Juice: none is needed; if given, no more than 120 mL (4 oz) per day of 100% juice for ages 1–3, in a cup
• Food jags (wanting one food) and picky eating are normal; repeated exposure (10–15 times) improves acceptance
• Choking risk continues until about 4 years: cut grapes and hot dogs lengthwise and into small pieces; avoid whole nuts, popcorn, hard candy
• Eat at the table, seated and supervised; no eating while running

Dental

• Wean from the bottle by about 12–18 months (ideally close to 12 months); never put to bed with a bottle of milk or juice (early childhood caries)
• Brush twice daily with a smear of fluoride toothpaste until age 3 (pea-size after 3); parent brushes; regular dental visits

Toilet training

• Begin when the child shows readiness, usually not before 18–24 months:
  • Physical: walks well, stays dry for about 2 hours, has regular bowel movements, can pull pants up and down
  • Cognitive and emotional: understands and communicates the urge, wants to please, imitates adults
• Bowel control usually comes before bladder control; daytime before nighttime (nighttime dryness often not until 4–5 years)
• Positive, relaxed approach; never punish accidents; expect regression with stress (new sibling, hospitalization)

Listed in priority order.

1. Injury prevention — the leading cause of death after infancy
   • Car seat: rear-facing as long as possible, until the child reaches the seat's rear-facing height or weight limit (for most children well beyond age 2), then forward-facing with a harness; always in the back seat
   • Drowning: toddlers can drown in a few centimeters of water — constant arm's-length supervision near water, empty buckets and tubs, four-sided pool fencing
   • Poisoning: medicines and chemicals locked up and out of sight, in original child-resistant containers; beware button batteries, magnets, laundry detergent pods, and adult nicotine products; if ingestion is suspected, call poison control or emergency services — do not induce vomiting
   • Burns: turn pot handles inward, keep hot drinks away, cover outlets, water heater at 49 °C (120 °F) or lower
   • Falls: stair gates, window guards or stops, anchor furniture and TVs to the wall
   • Choking and suffocation: small toy parts, balloons, plastic bags, cords from blinds
2. Approach toddlers carefully in health care: keep the parent present, approach slowly, use a toy to engage, examine on the parent's lap, and do invasive steps last; never shame ("Big kids don't cry")
3. Support autonomy: offer limited, real choices ("red cup or blue cup?"), let them help with simple tasks, keep routines and rituals, allow a comfort object
4. Guidance for behavior
   • Temper tantrums: ensure safety, stay calm, ignore the tantrum without giving in, praise calm behavior afterward; prevent triggers (hunger, fatigue)
   • Time-out about 1 minute per year of age in a boring, safe place
   • Consistent limits by all caregivers; positive reinforcement; no spanking or harsh verbal punishment
5. Screening and referral — developmental delay, autism signs, speech delay, hearing concerns
6. Promote language and learning: read daily, name objects, respond to attempts at speech; simple puzzles, shape sorters, push-pull toys, blocks, crayons; limit screens (from 18–24 months only high-quality content watched together; for 2–5 years no more than 1 hour per day)
7. Sleep: about 11–14 hours per 24 hours including a nap; consistent bedtime routine; move from crib to bed when the child can climb out

• "No," tantrums, and rituals are normal signs of growing independence
• Decreased appetite is expected; do not force-feed or use food as a reward
• Toilet training works when the child is ready — watch for readiness, stay positive
• Separation anxiety: say goodbye briefly and warmly, promise to return, and return as promised; do not sneak away
• Parallel play is the normal play style; toddlers are not yet ready to share
• Keep the poison control number in the phone
• Plan for a new sibling: involve the toddler, expect some regression

• Not walking by about 18 months; no words by about 16–18 months; no two-word phrases by 24 months
• Loss of language or social skills at any age (autism spectrum disorder red flag); little eye contact, no pointing, no response to name
• Persistent toe-walking, marked asymmetry of gait, or bowing that worsens after age 2
• Iron-deficiency anemia (pallor, fatigue, pica) — often linked to excess milk; lead exposure
• Severe or frequent tantrums with self-injury, or tantrums persisting beyond 5 years
• Injuries that do not match developmental ability or history — consider maltreatment
• Suspected ingestion of button battery or magnets — emergency (esophageal burns, bowel perforation)

• Toddler = 12–36 months; weight 4 × birth weight by 2.5 years; height at 2 years ≈ half adult height
• Weight estimate (age × 2) + 8 kg; height estimate (age × 6) + 77 cm
• Walks alone by 15–18 months; kicks ball and runs by 24 months; jumps with both feet by 30 months
• Two-word phrases by 24 months; about 50 words by 30 months
• Autonomy vs. shame and doubt; negativism, ritualism, tantrums, parallel play
• Toilet training readiness: sphincter control 18–24 months; never punish accidents
• Physiologic anorexia; whole milk 12–24 months, max 16–24 oz/day
• Choking foods until about 4 years
• Rear-facing car seat as long as the seat allows
• Poisoning: lock up, original containers, call poison control — do not induce vomiting
• Tantrums: ignore safely; time-out 1 minute per year
• Autism screening 18 and 24 months