Topic Overview

What kinds of growth and development occur during ages 12 to 24 months?

Your child's rapid brain development between the ages of 12 and 24 months causes amazing changes to happen—such as talking, walking, and remembering—as he or she enters the toddler years.

The changes that happen in this period are often grouped into five areas:

• Physical growth. Healthy growth is different for every child, and your child will grow at his or her own pace. Your child will continue to get new teeth and the first molars will appear.
• Cognitive development. This is your child's ability to think, learn, and remember. Your child will start to remember recent events and actions, understand symbols, imitate, imagine, and pretend.
• Emotional and social development. Toddlers form strong emotional attachments and often feel uneasy when they are separated from their loved ones. Around the same time, toddlers typically want to do things on their own or according to their own wishes. This sets the stage for conflict, confusion, and occasional breakdowns.
• Language development. At 15 to 18 months, a typical toddler understands 10 times more words than he or she can speak. By the second birthday, most toddlers can say at least 50 words.
• Sensory and motor development.
  Motor skills develop as your child's muscles and nerves work together. Toddlers gain control and coordination and become steady walkers. Climbing, running, and jumping soon follow.

Why are routine medical visits needed?

During a routine checkup, the doctor examines your child to find out whether he or she is growing as expected. In some areas, your child may see a public health nurse for routine checkups and immunizations. Your child will get any needed immunizations, and the health professional will ask you questions about the new things your child is doing, such as saying any words or walking. The health professional may also check your child for signs of developmental problems such as autism.

Schedule routine checkups for your child. Talk to your child's doctor or public health nurse about when to make these appointments.

When should I be concerned about my child's growth and development?

Talk to your doctor if your child is not reaching normal growth and development milestones. But keep in mind that every child develops at a different pace. A child who is slow to reach milestones in one area, such as talking, may be ahead in another area, such as walking. Usually it is of more concern when a child reaches developmental milestones but then loses those abilities.

See your doctor if your child makes repetitive motions or odd movements or has not bonded well with others, especially caregivers. Also, watch for signs of hearing problems, such as not reacting to people or loud noises.

Do not hesitate to talk to your doctor anytime you have concerns about your child, even if you are not sure exactly what worries you.

How can I help my child during this period?

You can help your child grow and develop by understanding a toddler's need for independence and allowing safe exploration. It helps your child become confident in trying new skills when you are patient and provide unconditional love. Also, recognize that your child can be easily overwhelmed by all the new things he or she is seeing, hearing, learning, and doing. Help your child to get plenty of rest and quiet time. Schedule routine checkups to keep track of your child's growth, development, and overall well-being.

What to Expect

General growth and development

Children usually progress in a natural, predictable sequence from one developmental milestone to the next. Children who are 12 to 24 months of age make gains in five major areas: physical growth, cognitive abilities, emotional and social development, language skills, and sensory and motor development.

• Physical growth, although slower than in the first year of life, continues at a steady pace. In the second year, toddlers gain an average of 1.5 kg (3 lb) to 2.5 kg (5 lb) and grow an average of 7.5 cm (3 in.) to 12.5 cm (5 in.). Healthy growth is different for every child, and your child will grow at his or her own pace. Your child's natural growth rate may be slower or faster. Also, teething continues with the eruption of the first molar teeth.
• Cognitive development is a child's increasing skill at thinking, learning, reasoning, and remembering. A toddler begins to recall past events, understand symbols, imitate, imagine, and pretend.
• Emotional and social development during the second year is characterized by strong emotional attachments to parents. Your child may feel uneasy and cry when he or she is separated from you. During this time, toddlers typically develop two conflicting feelings: wanting both independence and reassurance from their parents. Although their emotions change often, toddlers' personalities and temperament are becoming more defined.
• Language development rapidly progresses. At 12 months, many children can say a few words. And they jabber often. At 15 to 18 months, a typical toddler understands 10 times more than he or she can put into words. Speech begins with one- or two-syllable words, such as "mama." This progresses to short two-word sentences, such as "no peas" or "walk dog," sometime between 18 and 24 months. By 24 months, most toddlers can say at least 50 words.
• Sensory and motor skills advance as your toddler starts walking and moving around. Climbing, running, and hopping soon follow.

Although most children reach milestones, such as walking and talking, by a specific age, it is important to remember that development happens at an individual pace. Also, many children tend to make progress in one area, such as talking, while another skill, such as walking, levels off. If your child has a slight delay in an area, it does not always mean there is a problem. But be sure to talk to your doctor anytime you have a concern.

Milestones by age

By 12 months (1 year) of age many children are walking without help or by holding onto furniture ("cruising"). Most children will have a few teeth and like to put almost anything in their mouths that they can. And many children will say a few words and practice a lot of sounds. Your child may like to "flirt" with you and other caregivers.

By 18 months of age—look out!—most children are walking with ease and anything within reach is fair game. Your child may like to press buttons, move handles, and turn knobs. You may notice your child pretending to "feed" a toy or a similar act that he or she sees. Most children understand 10 times as many words as they can say, including the names of some people, body parts, and objects. Many children can often point to an object in a book when asked.

By 24 months (2 years) of age most children feel excited, confused, and scared about their emerging independence. Temper tantrums may start happening regularly. Children may start thinking in more complex ways, such as recalling events that happened days earlier. A child's make-believe world gets bigger as he or she may have play "events" rather than just one act. For example, he or she may pretend to be a mommy or daddy and care for a baby by changing a stuffed animal's diaper and feeding it a bottle. Most children say at least 50 words and use two-word phrases. Not only can most toddlers walk, but they also can run—and go up and down stairs.

Babies who were born early (premature)

Until age 2, a child born prematurely (3 or more weeks early) will have growth and development milestones adjusted based on gestational age. To figure out your baby's adjusted (corrected) age, doctors subtract the number of weeks your baby was born early from his or her current age. For example, the corrected age of a 17-month-old baby who was born premature at 30 weeks is between 14 and 15 months.

Common Concerns

Keeping track of your fast-moving 12- to 24-month-old child can be a challenge. Also, your child who was loving and well-mannered may suddenly start having "meltdowns" without warning. It is normal to be both excited and worried about your child's new mobility and unpredictable behaviour.

During ages 12 to 24 months, your toddler may:

• Rarely mind and may frustrate you. It is normal for toddlers to ignore you or protest when you ask them to do (or not do) something. Their resistance to your directions are expressions of the inner struggles they have while trying to become more independent. Toddlers do not understand when you try to reason with them. Try giving your child clues ahead of time about what you want and what is going to happen. For example, if you are going to leave grandma's house soon, start waving "bye-bye" to people and toys about 10 minutes before you go. Explain that you are going soon and repeat the waving every few minutes. This gives your toddler time to adjust to the idea of leaving.
• Have temper tantrums. During this second year, toddlers start to understand that they are individuals—a unique and separate person from their parents and everyone else. This awareness brings up many new issues, especially related to strong emotions and confusion about what they can and cannot control. A toddler wants to be the master of his or her universe. Toddlers become easily frustrated when they cannot do things they want to do. Although they may say some words and a few phrases, they cannot express themselves fully. This sets the stage for angry outbursts that can surprise and confuse parents. Don't take it personally when your child has a temper tantrum. This behaviour is normal. Try using methods to prevent temper tantrums, such as distracting your child, rather than just saying "no." (Realize, though, that sometimes nothing will work.) After a tantrum is in full swing, it may help to ignore it. Stay close, be supportive, and talk calmly. For more information, see the topic Temper Tantrums.
• Be a picky eater. Often, being picky about food happens because your child wants to assert his or her independence. Your child may also sometimes simply not be hungry. Eating patterns can change suddenly. Toddlers may eat well for a day or two, then eat very little for the next few days. As long as you adopt healthy eating strategies, such as by offering healthy foods and snacks, your child's unpredictable eating habits will likely not be a problem. For more information, see the topic Healthy Eating for Children.
• Nap less. Usually by around 18 months of age, sleeping patterns change and toddlers may try to abandon the morning nap. As a result, your child may have tired, cranky periods. Try to fit in an afternoon nap. Your child still needs rest. Adjust to changing nap patterns by planning quiet times to regroup. Also, stick to a nighttime routine with a regular bedtime. For example, give your child a bath, put on pyjamas, and read books in the same order each night.
  • Sleep: Helping Your Children—and Yourself—Sleep Well
• Make messes. Many toddlers find it great fun to open drawers and cupboards—and love even more to remove every item they find. Be careful what you store in your bedside table and other cupboards that are lower than your shoulder height. Many toddlers also like to "sweep" all the contents off any shelves they can. It may help to give your child his or her own cupboard or shelf to play with. Place soft toys on a shelf or plastic bowls, lids, and containers in a cupboard. Your child can then play freely and feel in control.
• Seek out danger. Your child may seem drawn to stairs, electrical outlets, and breakable objects. After your child is up and moving around, it is important to provide safe opportunities for exploration. Try to keep items that could cause choking out of reach. For more information on safety, see the topic Health and Safety, Birth to 2 Years.
• Show separation protest. Also called separation anxiety, this is an uneasiness or fear your child feels when you or another caregiver leaves. Most children's separation-protest phase peaks around 10 months of age, but in some children it lasts longer or happens again. Your child's temperament as well as your own personality affect how strongly your child reacts to your leaving. Some ways you can help manage your child's separation protests are to stay calm and positive about your leaving, make the first few times you leave very short, and set a routine you follow each time when you leave. If your child's uneasiness with your leaving does not improve after about 15 months of age, talk to your doctor.

Promoting Healthy Growth and Development

During ages 12 to 24 months, children learn and develop best in a caring and loving home from which they can safely explore and experience life. You can help nurture your child by knowing the challenges of toddlerhood, learning basic parenting techniques, and using behaviour management strategies.

Physical growth and development

Promote your child's physical growth and development by:

• Adopting healthy eating strategies. Although picky eating is common during this age, a simple and relaxed approach to eating usually helps your child to eat well. Offer healthy foods at regular times. It may also help to set a pattern by being together at the table for all main meals. For more information on helping your child to eat well, see the topic Healthy Eating for Children.
• Seeing your doctor or public health nurse for all routine checkups. During these visits, the health professional will measure your child's growth to make sure he or she is on track. The health professional will also give your child any needed immunizations.
• Teaching healthy habits to help reduce your child's risk of infections.

Thinking, reasoning, and memory skills

Promote your child's thinking, reasoning, and memory skills (cognitive development) by:

• Building with blocks. Help your child learn to stack blocks and knock them down.
• Scribbling on paper. You can find washable and thick crayons and pencils that are made for a toddler's fisted grip.
• Playing with balls and other moving toys. Toddlers love to watch a rolling ball. It helps them learn to track objects and fosters eye-hand coordination.
• Finding toys he or she can turn, sort, pound, push, and pull. Examples include knobs, sort-by-shape toys, and thick-paged books.

Social and emotional development

Promote your child's social and emotional development by:

• Spending time with him or her. Make an extra effort to sit and play, read, and talk to your child. Don't worry too much about having "play dates" and organized activities for your child between the first and second birthdays. Children this age don't interact much with each other. Rather, they tend to play alone but near each other, a behaviour called "parallel play." Your love and attention are the most important factors that help your child's social and emotional growth.
• Knowing about your child's individual temperament. Every child is different. Getting to know your child's personality helps you to predict and handle his or her reactions to everyday situations.
• Praising your child. When your child reacts well to a difficult situation, such as leaving the park without protest, tell him or her how proud you are. Although your child may not understand the exact meaning of your words, he or she will associate the positive behaviour with your approval.
• Not responding to angry outbursts. When you react to a child's temper tantrum or similar behaviour, it is more likely to continue. Unless your child's behaviour is dangerous, ignore it (but stay nearby and soothe your child as needed). After the outburst is over, you can talk to your child calmly and reassure him or her that everything is okay. It is very important that you do not get angry or threaten to spank or hurt your child. Staying calm can sometimes be difficult. Keep in mind that you are the model for your child's behaviour.

Sensory and motor skills

Promote your child's sensory and motor skills by:

• Providing safe opportunities for exploration. Play games that encourage walking and movement, and go outside when possible. For example, help your child walk around the yard with push toys, such as play lawn mowers or bubble poppers. Play chase and race in areas that allow "soft landings."
• Helping him or her to climb stairs. Keep a secure hold on your child as the two of you go up and down stairs together.
• Letting him or her feel different textures. Find items that let your child safely explore the concepts of soft, hard, fuzzy, wet, dry, cold, and warm.

Language development

Promote your child's language development by:

• Talking. Get face-to-face and eye-to-eye with your child as much as possible when interacting. Talk in slow and regular speech about the things your toddler can see, what you are doing together, or those things that are an important part of his or her world.
• Responding to your child's words. Repeat and expand on what he or she says.
• Asking your toddler to use words to express meaning. Teach words like "happy," "sad," "angry," "want," "like," and "don't like" so that the child can begin to associate words with feelings and wants.
• Reading to him or her every day. Also use songs, stories, games, and rhymes to engage your child in language. To help your child's brain develop, play or read together instead of letting your child watch TV, watch movies, or play games on a screen. For more information, see the topic Speech and Language Development.

Learning parenting skills

Because your child is growing and developing so quickly, in many ways you have to "get to know" him or her over and over again. Help create a strong, lasting, and loving relationship with your child by thinking about what you like and don't like about the relationship from time to time. It may help to think about:

• What do I like most about my child?
• What new skills has my child developed within the past 3 months? 2 months? 1 month?
• When am I happy about how I treat my child?
• What don't I like about some of our interactions? When do these episodes tend to happen?
• What could be triggering my child's challenging behaviours? Are any of these new triggers?
• What things can I encourage my child to do for himself or herself? How can I encourage him or her?

As a parent or caregiver of children, it is also important for you to:

• Learn and use effective parenting and discipline techniques and avoid the use of corporal punishment. Parenting classes are offered in most communities. Ask your doctor or call a nurse call line for more information.
• Learn healthy techniques to resolve conflicts and manage stress. For more information, see the topic Stress Management.
• Ask for help when you need it. Call a family member or friend to give you a break if you feel overwhelmed. Investigate community resources that are available to help you with child care or other needed services. Call a doctor or nurse advice line for a place to start. Some communities have respite care facilities for children, which provide temporary child care during times when you need a break.

When to Call a Doctor

Call
911
or other emergency services if you become so frustrated with your child that you are afraid you might cause your child physical harm.

Call your doctor if:

• You are having constant trouble managing your child and often become angry or frustrated. Your doctor can guide you to resources for help if you feel unable to properly care for your child for any reason.
• You are concerned that your child isn't growing adequately or isn't reaching major developmental milestones in any area.

It's also a good idea to call your doctor if your child:

• Shows delays in several developmental areas.
• Successfully reaches a developmental milestone but then loses the new ability.
• Displays behaviours that may be associated with autism. These may include not appearing to interact with or be attached to others, especially caregivers; acting in a repetitive manner, sometimes with odd gestures; or seeming to selectively tune out other people or noises.

When it comes to your child's growth and development, keep the big picture in mind. Each child varies in the exact timing that they achieve milestones. For example, a slight delay in one development area, such as talking, usually is not of concern by itself. As long as your child communicates well through gestures and regularly responds to your speech and that of others, using language usually soon follows.

It's generally of more concern if a child shows signs of a general communication problem, which may include delayed language development. This type of delay can be related to hearing impairment. A child with signs of a communication problem does not:

• Know a word other than "mama" and "dada" or can't point to a familiar object when instructed to at 12 months.
• Say a few words, seem to listen when you are talking, or point to what they want at 15 to 18 months.
• Say 5 or more words or understand more than 50 words at 18 months.
• Speak more than 50 words, put two words together, name or try to name objects, or use words to request things at 2 years.

Routine Checkups

Routine checkups usually are scheduled several times during ages 12 to 24 months. These visits allow your child's doctor to keep a close eye on your child's general health and development. You also can discuss any concerns you have during these visits. In some areas, your child may see a public health nurse for routine checkups and immunizations.

During the checkup, the health professional:

• Measures your child's weight and height and around his or her head (head circumference). These measurements are plotted on a growth chart to make sure your child is growing as expected.
• Physically examines your child. Usually this includes looking at your child's eyes and ears, listening to his or her heart and lungs, checking the belly, and looking at the genital area. The health professional may also observe the way your child walks and test your child's reflexes.
• Reviews your child's immunization record to make sure it is current. Your child generally receives one or more shots at routine checkups up to age 2. Bring your child's immunization record to each visit. It may help to learn some comforting techniques to help your child during immunizations.
  • Immunizations
  • Immunizations: Questions Parents Ask
• Talks with your child, asking simple questions to test hearing and language abilities. For example, the health professional may ask your child to name or point to a body part.
• Watches how your child interacts with you for clues about his or her emotional and social development. At ages 18 months and 24 months, the health professional may specifically check for signs of autism.

Routine checkups are a good time to ask any questions or to discuss growth and development issues. Also, talk about your child's new skills, such as walking, using a spoon, or combining words. It may help you to go to your child's checkup with a prepared list of questions .