What to Expect the Toddler Years (8 page)

A Mantoux tuberculin test (a simple skin test) for children at high risk for TB, such as those who have 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; communicating with 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 your child shows any signs of illness (see page 569).

“Our year-old daughter can barely stay on her feet for five minutes at a time without falling. Is something wrong with her coordination?”

A toddler is an accident waiting to happen . . . and happen . . . and happen again. Surefootedness is not characteristic of new walkers (which is why, of course, they are called toddlers); most fledgling toddlers can’t even make it across a room without taking a flop.

Part of the problem is a lack of experience with balance and coordination, which take a lot of practice to perfect. (If you’ve learned to ice-skate or ride a bike as an adult, you have an inkling of what learning to walk must be like.) Another factor is farsightedness; most children this age can’t clearly 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 her than where she’s going. And since toddlers are rarely able to concentrate on more than one thing at a time, collisions and spills are the typical result.

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

A pair of soft, wide, elasticized pony-tail holders or wrist bands that fit comfortably (never snugly) around the ankles of sleepers will keep floppy feet from slipping up a toddler.

Meanwhile, since you can’t always prevent her from falling, the best you can do is work toward preventing falls and minimizing injury when she does fall. It makes sense to have your child do most of her walking on carpeted surfaces (obviously this is not feasible if your home isn’t carpeted), and to keep her away from such extra-hard surfaces as slate, ceramic tile, stone, and brick. Check any areas she frequents for sharp corners and other protuberances and cover or remove them (see page 626). Keep drawers, furniture doors, and appliances (especially dishwashers) closed when she’s around; eliminate or tape down dangling electric cords; and temporarily remove rickety chairs or tables (which she might grab onto for support). Areas where falls could be particularly dangerous, such as stairs and bathrooms, should be made completely inaccessible (see page 620).

Protective clothing can help, too. When practical opt for long pants instead of shorts or dresses. Heavy corduroy and quilted fabrics cushion falls more effectively than do thin cotton knits. And while you’re outfitting her, make sure your toddler’s footwear isn’t contributing to the trouble she’s having staying upright. Floor temperature permitting, bare feet are best indoors; if socks or slippers are necessary, they should be nonslip. When only shoes will do, make certain that the soles provide enough traction to prevent slipups and that the shoes fit correctly. (Shoes that are too big or too small can trip up a toddler. See page 8 for more on toddler shoes.)

If your toddler is a climber, putting some cushions or soft mats at the base of her favorite “mountains” can make for a happier landing should she lose her footing. Remove or bracket to the wall any furniture (including freestanding bookcases) that could topple if she climbed on it.

After taking appropriate safety measures, relax. A toddler’s body is built to take the falls. It’s close to the ground and usually still well-cushioned with baby fat. The skull is flexible because the soft spot (or fontanel) hasn’t closed completely (it doesn’t generally close fully until somewhere around eighteen months), so a toddler can generally take slight bumps to the head without damage. Overprotecting your toddler in order
to prevent falls (penning her up in a playyard for hours at a time, for example) is unwise. A toddler has to take some falls in order to master staying on her feet.

Overprotecting your toddler and overreacting when she does fall (“Oh, my poor baby!”) may also inhibit her natural drive to explore, slow her gross motor development (walking, jumping, climbing), and make her needlessly fearful.

“My son constantly bumps into things—tables, chairs, people. Could something be wrong with his eyesight?”

Probably not. Typically, the one-year-old is somewhat farsighted and possesses limited depth perception, so judging distances at this age can be tricky. By age two, normal vision improves to about 20–60; by three to about 20–40. It’s not until roughly age ten that normal 20–20 vision is attained. (See page 478 for possible signs of vision problems.)

Even if a toddler did possess perfect vision, chances are he still couldn’t see his way clear of collisions. That’s because he rarely looks where he’s going. Preoccupied with the mechanics of walking, he often looks at his feet (to make sure one’s still going in front of the other) instead of at where they’re taking him. Or he focuses his attention on the person or object he’s trying to reach—the stuffed giraffe that’s lying on the sofa, a parent beckoning from across the room with outstretched arms, the fascinating dials of the television set—and not on the obstacles that may be lying in his path. It’s not surprising that he careens into the floor lamp, barrels into the coffee table, or stumbles over the dump truck he’s left in the middle of the floor. And even if he does spy a roadblock at the last minute, he may not possess the ability necessary to go around it or stop short of it, especially if he’s picked up some speed.

Fortunately, both vision and coordination sharpen with time. Around his third birthday, you can expect your toddler to begin navigating his world more steadily and more safely. True grace, however, will probably elude him until the age of eight or nine—at the earliest.

Until then, you can protect him from some of life’s little bumps by making his environment safe (see page 622).

“Our little girl was the last one in her play group to roll over and to sit up. Now even though she’s a year old, she still hasn’t pulled up to standing. Everything else
(speech, hand coordination, and all) seems normal. The doctor says ‘don’t worry,’ which is easy for her to say. . . .”

Just about every parent worries sometimes—it’s part of the job description. And usually, being told not to worry—even by your child’s doctor—isn’t enough to calm parental concerns completely. If, in spite of the doctor’s reassurances, your gut feeling tells you to pursue the matter further, explain that you would be more comfortable if your baby had an assessment to rule out any problems. The doctor is likely to agree, if only to set your mind at ease. It may well turn out that your daughter’s gross-motor development (the development of the large muscles of the body that are involved in crawling, sitting, standing, climbing) is just on the slow side of normal and that she’ll gradually catch up with her playmates on her own. In that case, you may be able to help speed the process along in the ways recommended below. Rarely, such tests uncover a motor problem that would benefit from extra attention. When poor muscle tone is at the root of slow motor development, physical therapy can be very beneficial, especially if started at an early age. In fact, with appropriate intervention (usually consisting of a variety of do-at-home physical-therapy exercises) many children with gross-motor delays eventually catch up and do just fine.

“I really thought that by now my son would have started walking. But he hasn’t even tried yet.”

The fact that your son hasn’t yet started training for the toddler Olympics doesn’t mean he isn’t destined to perform great feats on two feet. After all, the average baby doesn’t take those first momentous steps until he’s somewhere between thirteen and fifteen months of age. And though a few begin toddling around as early as seven or eight months, many completely normal youngsters don’t step out on their own until sixteen months or even later.

Where your child falls within this very wide range of normal development doesn’t tell you anything about his intelligence or his future athletic ability. Just like most slow talkers, most slow walkers catch up quickly once they get started—often breaking into a run just weeks after they’ve attempted their first tentative steps.

But while you shouldn’t worry about or rush him, you should give your toddler plenty of opportunities to practice his prewalking skills. Encourage him to pull himself up by holding onto your hands, your shins, the bars of the crib, or the coffee table. Help him to cruise from your knees to your partner’s, from chair to chair, around the crib. If he doesn’t seem inclined to practice on his own—content instead to sit or crawl—play pull-up games with him so he can get the hang of standing on his own two feet while exercising his leg muscles. Be sure your toddler doesn’t spend most of his day confined to a high chair, stroller, or playpen. Allow him to go barefoot at home or put slip-proof socks on him when floors are cold. Beware of stiff shoes as they can hamper learning to walk. And avoid using a walker. Not only are walkers associated with frequent accidents, but babies who become “walker-dependent” often take longer to learn to walk independently. If your baby has been using a walker, chuck it out now.

If your toddler isn’t pulling himself up or trying to stand on his own, odds are he’s just waiting until he’s good and ready to walk. You should, nevertheless, check with his doctor at the next checkup.