By age one, an infant heading into toddlerhood is typically triple their birth weight and on average, between 28 and 32 inches. By age two, the weight has quadrupled. This makes the average two-year-old between 20 and 40 pounds.  Boys reach about 50 percent and girls 53 percent of their adult height by age two (Santrock, 2013).

Genetic factors play a major role in determining a child’s growth pattern, especially for height and to a lesser extent for weight. Generally, tall parents have children who are tall and short parents have children who are short.

The conditions in which children are raised also influence growth patterns. Children who do not receive adequate nutrition during their early years do not achieve optimal height. They are also at risk for developmental delays and other health concerns due to the lack of adequate nutrients needed to sustain physical growth and brain development.

Physically, a toddler at 18 months (about 1 and a half years) is walking and even running. They are able to pull toys while walking. Toddlers can help undress themselves, drink from a cup, and start to eat with a spoon. They are climbing stairs with assistance.

Bowel and Bladder Control

During the first year of life, infants do not have control over the muscles involved in elimination. They also lack awareness of the physical signs that signal the need for elimination. It is not until the middle of the second year when children may begin to make the connection between the feelings of impending elimination and their outcome. At the end of the second year or the beginning of the third year the potential for toilet training emerges. Control over bowel movements is usually accomplished earlier than bladder control.

When to begin toilet training is a serious concern for many parents. It is important to remember that there is a wide range of individual differences when children will be trained and when they are physically and emotionally ready for this milestone in development. Most children learn to control their bladders and bowels when they are ready, just as they learned to sit and walk. Starting to train a child before he or she is ready can potentially lengthen the process and lead to emotional distress for both the child and parents/caregivers. Only four percent of children are potty trained by age two. One of the key signs of developmental readiness is if a child stays dry for at least two hours. They also need to have the ability to walk independently and remove clothing necessary to use the potty. Approximately 60 percent of children are trained by age three. Only approximately 2 percent are not trained by age four. Girls are generally able to meet this developmental milestone earlier than boys (Berk, 2017).

Safety Concerns

It is very important to make sure that toddlers, just like infants, are supervised at all times. Toddlers are at risk for many types of accidents including falling down stairs, drowning, and getting hit by cars if they wander off. Parents need to make sure that their homes are toddler-proofed. Electrical outlets need to be covered. Hazardous materials such as chemicals and household cleaners need to be stored out of reach and ideally locked up out of harm’s way. Medication needs to be made inaccessible as well as access to any firearms that a family may own. Toddlers are fast. They also have Houdini-like skills when it comes to escape and getting into things that they shouldn’t have access to. As a toddler learns to walk, they will also begin the art of climbing. If the child is still sleeping in a crib, mattresses should be at their lowest setting and monitored closely because the toddler will soon learn to climb out of cribs and playpens. Caution near water is another area of concern. Toddlers can drown in as little as an inch of water. Children under age five have the highest risk of drowning, with death rates of nearly 3 per 100,000 in 2010 according to the Centers for Disease Control (CDC). Swimming pools are the most common place where children under five drown each year. Car seat safety is also of critical importance.

Car Seat Safety

Car seat safety is of utmost importance. Many toddlers spend a considerable amount of time in a motor vehicle. According to the Centers for Disease Control (CDC, 2018), white children are more likely to be buckled up than black or Hispanic children. From 2001 to 2010, approximately 1 in 5 child passenger deaths in the United States involved drunk driving. Sixty-five percent of the time it was the child’s own driver that had been drinking (CDC, 2018). Restraint use among young children often depends upon the driver’s seat belt use. Almost 40% of children riding with unbelted drivers were themselves unrestrained. Child restraint systems are often used incorrectly. An estimated 46% of car and booster seats (59% of car seats and 20% of booster seats) are misused in a way that could reduce their effectiveness (CDC, 2018). Children should remain in rear-facing car seats until age 2 or when they reach the upper weight or height limit of that seat (CDC, 2018). All children 2 years old, or those younger than 2 years old who have outgrown the rear-facing weight or height limit for their car seat, should use a forward-facing car seat with a harness for as long as possible, up to the highest weight or height allowed by the manufacturer of their child safety seat (CDC, 2018). Car seat installation should be completed by a trained professional. Many local police and fire stations offer this service free of charge to help ensure that car seats are installed properly. Proper car seat installation significantly helps protect a child in the event of a motor vehicle accident.

Immunizations

Today, most children in the United States lead much healthier lives and parents live with much less anxiety and worry over infections during childhood. Immunizations are one of the success stories of modern medicine. Parents often wonder if vaccinations are worth putting their young child through the distress of receiving vaccinations or the potential side effects. The answer from the vast majority of medical experts is a resounding “yes.” The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend that healthy children get vaccinated against 14 diseases by age 2 (with boosters later for some), along with an annual inoculation against the flu. The government supports vaccines so strongly that any uninsured child can walk into a clinic and get his or her shots for free.

Despite doctors’ reassurances and mounting evidence that underscores the safety and value of vaccination, many educated, dedicated parents are still wary of vaccines or strongly opposed to them. Although the national immunization rate has remained stable over the past decade (76 percent of children ages 19 to 35 months were up to date on all of their shots in 2008), that’s still short of the government’s goal of 80 percent. In some parts of the United States, a rising number of parents are delaying shots for their children or skipping certain ones altogether, citing religious or philosophical exemptions from state laws that require children to be vaccinated in order to attend school. As a result, there have been recent outbreaks of serious diseases that vaccines had virtually wiped out in the U.S., including measles, mumps, pertussis (whooping cough), and haemophilus influenzae type b (Hib), which was once the most common cause of bacterial meningitis in children under 5 (CDC, 2023).

What scares parents most about inoculations is that there are some who believe that their child’s autism was caused by immunizations. Some believe that the increased number of vaccines are to blame for the rise in children with autism spectrum disorders (ASD). The idea first made headlines in 1998, when Andrew Wakefield, M.D., a British gastroenterologist, published a study of 12 children in The Lancet that linked the measles, mumps, and rubella (MMR) combination vaccine with intestinal problems that he believed led to autism. The following year, the American Academy of Pediatrics issued a warning about thimerosal, the mercury-containing preservative that was found in most vaccines. Though it didn’t mention autism specifically, it suggested that the use of vaccines with thimerosal could theoretically push an infant’s total exposure of mercury, a neurotoxin, above safe limits, and it recommended that the preservative be removed from shots. The vaccine-autism hypothesis was solidly in the mainstream by the time actress Jenny McCarthy went public with her belief that vaccines caused her son’s autism, describing in heartbreaking detail how “the soul left his eyes” on a 2007 segment of the The Oprah Show.

Caregivers can rest assured, however, since at least seven large studies in major medical journals have now found no association between the MMR vaccine and ASD and The Lancet officially retracted Dr. Wakefield’s original paper. In March, the U.S. Court of Federal Claims, Office of Special Masters, a group of judges appointed to handle cases of families who believe immunizations were responsible for their child’s autism, ruled that thimerosal in vaccines does not increase the risk of the disorder. Several demographic analyses have also found that autism rates continued to rise even after thimerosal was removed from all vaccines except some flu shots (AAP, 2018).

Any association of ASD characteristics emergence with the timing of vaccines is almost certainly coincidental. Children get their first dose of the MMR vaccine at 12 to 15 months, the age at which autism symptoms typically become noticeable. Some autism activists now believe that we shouldn’t even be performing more studies about a possible vaccine connection because they take attention and money away from important research that is investigating other potential causes of the disorder which has reached alarming numbers in the past decade.