2 year old visit

The 2-Year-Old Checkup

Medical review policy, latest update:.

Medically reviewed to ensure accuracy.

The physical checkup

Developmental milestones, more about your toddler, 2-year-old vaccines, questions to ask your doctor.

Believe it or not, the time of frequent well-baby visits is coming to an end. After taking your child for another appointment around her half birthday (when she's 30 months old), you'll book a 3-year checkup . Trusted Source American Academy of Pediatrics AAP Schedule of Well-Child Care Visits See All Sources [3] From then on, it’s just a single yearly visit.

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Doctor Visits

Make the Most of Your Child’s Visit to the Doctor (Ages 1 to 4 Years)

Take Action

Young children need to go to the doctor or nurse for a “well-child visit” 7 times between ages 1 and 4.

A well-child visit is when you take your child to the doctor to make sure they’re healthy and developing normally. This is different from other visits for sickness or injury.

At a well-child visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask questions about things like your child’s behavior, eating habits, and sleeping habits.

Learn what to expect so you can make the most of each visit.

Well-Child Visits

How often do i need to take my child for well-child visits.

Young children grow quickly, so they need to visit the doctor or nurse regularly to make sure they’re healthy and developing normally.

Children ages 1 to 4 need to see the doctor or nurse when they’re:

• 12 months old
• 15 months old (1 year and 3 months)
• 18 months old (1 year and 6 months)
• 24 months old (2 years)
• 30 months old (2 years and 6 months)
• 3 years old
• 4 years old

If you’re worried about your child’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my child is growing and developing on schedule.

Your child’s doctor or nurse can help you understand how your child is developing and learning to do new things — like walk and talk. These are sometimes called  “developmental milestones.”

Every child grows and develops differently. For example, some children will take longer to start talking than others. Learn more about child development .

At each visit, the doctor or nurse will ask you how you’re doing as a parent and what new things your child is learning to do.

Ages 12 to 18 Months

By age 12 months, most kids:.

• Stand by holding on to something
• Walk with help, like by holding on to the furniture
• Call a parent "mama," "dada," or some other special name
• Look for a toy they've seen you hide

Check out this complete list of milestones for kids age 12 months .

By age 15 months, most kids:

• Follow simple directions, like "Pick up the toy"
• Show you a toy they like
• Try to use things they see you use, like a cup or a book
• Take a few steps on their own

Check out this complete list of milestones for kids age 15 months.

By age 18 months, most kids:

• Make scribbles with crayons
• Look at a few pages in a book with you
• Try to say 3 or more words besides “mama” or “dada”
• Point to show someone what they want
• Walk on their own
• Try to use a spoon

Check out this complete list of milestones for kids age 18 months . 

Ages 24 to 30 Months

By age 24 months (2 years), most kids:.

• Notice when others are hurt or upset
• Point to at least 2 body parts, like their nose, when asked
• Try to use knobs or buttons on a toy
• Kick a ball

Check out this complete list of milestones for kids age 24 months . 

By age 30 months, most kids:

• Name items in a picture book, like a cat or dog
• Play simple games with other kids, like tag
• Jump off the ground with both feet
• Take some clothes off by themselves, like loose pants or an open jacket

Check out this complete list of milestones for kids age 30 months .

Ages 3 to 4 Years

By age 3 years, most kids:.

• Calm down within 10 minutes after you leave them, like at a child care drop-off
• Draw a circle after you show them how
• Ask “who,” “what,” “where,” or “why” questions, like “Where is Daddy?”

Check out this complete list of milestones for kids age 3 years . 

By age 4 years, most kids:

• Avoid danger — for example, they don’t jump from tall heights at the playground
• Pretend to be something else during play, like a teacher, superhero, or dog
• Draw a person with 3 or more body parts
• Catch a large ball most of the time

Check out this complete list of milestones for kids age 4 years . 

Take these steps to help you and your child get the most out of well-child visits.

Gather important information.

Bring any medical records you have to the appointment, including a record of vaccines (shots) your child has received.

Make a list of any important changes in your child’s life since the last doctor’s visit, like a:

• New brother or sister
• Serious illness or death in the family
• Separation or divorce
• Change in child care

Use this tool to  keep track of your child’s family health history .

Ask other caregivers about your child.

Before you visit the doctor, talk with others who care for your child, like a grandparent, daycare provider, or babysitter. They may be able to help you think of questions to ask the doctor or nurse.

What about cost?

Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-child visits. Find a health center near you and ask about well-child visits.

To learn more, check out these resources:

• Free preventive care for children covered by the Affordable Care Act
• How the Affordable Care Act protects you and your family
• Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions you want to ask the doctor..

Before the well-child visit, write down 3 to 5 questions you have. This visit is a great time to ask the doctor or nurse any questions about:

• A health condition your child has (like asthma or an allergy)
• Changes in sleeping or eating habits
• How to help kids in the family get along

Here are some questions you may want to ask:

• Is my child up to date on vaccines?
• How can I make sure my child is getting enough physical activity?
• Is my child at a healthy weight?
• How can I help my child try different foods?
• What are appropriate ways to discipline my child?
• How much screen time is okay for young children?

Take a notepad, smartphone, or tablet and write down the answers so you remember them later.

Ask what to do if your child gets sick. 

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to get hold of the doctor on call — or if there's a nurse information service you can call at night or during the weekend. 

What to Expect

Know what to expect..

During each well-child visit, the doctor or nurse will ask you questions about your child, do a physical exam, and update your child's medical history. You'll also be able to ask your questions and discuss any problems you may be having.

The doctor or nurse will ask questions about your child.

The doctor or nurse may ask about:

• Behavior — Does your child have trouble following directions?
• Health — Does your child often complain of stomachaches or other kinds of pain?
• Activities — What types of pretend play does your child like?
• Eating habits — What does your child eat on a normal day?
• Family — Have there been any changes in your family since your last visit?

They may also ask questions about safety, like:

• Does your child always ride in a car seat in the back seat of the car? 
• Does anyone in your home have a gun? If so, is it unloaded and locked in a place where your child can’t get it?
• Is there a swimming pool or other water around your home?
• What steps have you taken to childproof your home? Do you have gates on stairs and latches on cabinets?

Your answers to questions like these will help the doctor or nurse make sure your child is healthy, safe, and developing normally.

Physical Exam

The doctor or nurse will also check your child’s body..

To check your child’s body, the doctor or nurse will:

• Measure your child’s height and weight
• Check your child’s blood pressure
• Check your child’s vision
• Check your child’s body parts (this is called a physical exam)
• Give your child shots they need

Learn more about your child’s health care:

• Find out how to get your child’s shots on schedule
• Learn how to take care of your child’s vision

Content last updated February 2, 2024

Reviewer Information

This information on well-child visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by: Sara Kinsman, M.D., Ph.D. Director, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

Bethany Miller, M.S.W. Chief, Adolescent Health Branch Maternal and Child Health Bureau Health Resources and Services Administration

Diane Pilkey, R.N., M.P.H. Nursing Consultant, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

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Ages & Stages

Your Child’s Checkups

​​ ​​Regular checkups​ are an important way to keep track of your child's health and development. Your health care team will take measurements, conduct a head-to-toe examination, update immunizations, and answer questions you may have. Be sure to share your successes and milestones, any concerns about your child's development, and challenges in daily routines. These visits are a chance to learn as much as you can about the best ways to help your child grow and thrive! ​

• 1st Week Checkup Checklist: 3 to 5 days old
• Checkup Checklist: 1 Month Old
• Checkup Checklist: 2 Months Old
• Checkup Checklist: 4 Months Old
• Checkup Checklist: 6 Months Old
• Checkup Checklist: 9 Months Old
• Checkup Checklist: First Birthday (12 Months Old)
• Your Checkup Checklist: 15 Months Old
• Your Checkup Checklist: 18 Months Old
• Your Checkup Checklist: 2 ½ Years Old (30 Months)
• Your Checkup Checklist: 24 Months (2 Years) Old
• Your Checkup Checklist: 3 Years Old
• Your Checkup Checklist: 4 Years Old
• Your Checkup Checklist: 5 Years Old
• Your Checkup Checklist: 6 Years Old
• Your Checkup Checklist: 7 Years Old
• Your Checkup Checklist: 8 Years Old

• Baby & Toddler
• Baby Health & Wellness
• Pediatrician

What to Know About Your Child's 2 Year Checkup

Can you believe your little one is already 2 years old? At this age your 24 month old is probably regularly exercising their independence (and throwing the occasional tantrum ), kicking balls, running around and saying more words than ever (many of which you may now clearly understand!). They may even be ready to potty train (a major milestone for both of you!). To ensure your kiddo’s development is on track, your pediatrician will want to bring them in for their 2-year-old checkup. Below, learn more about everything that happens at this appointment and how to best prepare.

Preparing Your Toddler for Their 2-Year-Old Check Up

You may notice your kiddo becomes fussy or nervous at the pediatrician’s office. “Some 2-year-olds are still very scared at this visit when they’re weighed and measured, and some are not,” says Lauren Crosby , MD, FAAP, a California-based pediatrician. To help prepare your tot for the appointment, she suggests reading books and using a toy doctor kit at home to role-play activities like checking the eyes, nose and mouth and listening to the lungs with a stethoscope. It may also be helpful to have an older sibling present, if possible. Your pediatrician can demonstrate on them first since they’re more likely to be cooperative, Crosby says. Comfort items such as snacks, milk, water, a pacifier, books and toys can also go a long way. “I have no problem if the child watches an educational video that they like to keep them relaxed while the parents and I speak,” Crosby adds. Rest assured, your child’s feelings and frustrations are developmentally normal and will fade with time.

Finally, don’t forget to bring any records of screenings, tests and immunizations from previous visits, as well as a list of questions to ask (more on this below).

What Happens at the Two-Year Check Up

Just like at your toddler’s past well visits, your pediatrician will measure their height, weight and head circumference and add these numbers to their growth chart , says Loretta Cody , MD, a Connecticut-based pediatrician. They’ll also calculate your child’s body mass index (BMI). According to the American Academy of Pediatrics , at the two-year checkup your provider will also check and screen for:

• Lead exposure
• Anemia (This is usually tested with a finger prick anytime there are concerns about diet and iron-rich food intake, Crosby says)
• Tuberculosis
• Blood pressure
• Vision (Crosby notes her office, and some others, use a handheld machine for the vision test)
• New and existing teeth that need another round of fluoride varnish (this helps strengthen tooth enamel)

Along with the physical workup, your pediatrician will observe your child during the appointment and make a verbal assessment of their overall development by asking about their milestones, nutrition, sleep and stool patterns, Crosby says.

Milestone assessment at 2 years old

According to the AAP, your pediatrician will want to hear all about your child’s behavior, cognitive and emotional development, language milestones and more. They may ask questions, such as :

• How does your child play and engage with others?
• Does your child play with multiple toys at a time?
• Dothey use toys with buttons, knobs and switches?
• Can they can kick a ball and/or jump?
• How well do they walk up and down stairs?
• How many blocks they can stack?
• Can they point to and identify two or more body parts or other familiar objects?
• How many words they can say?
• Can they form two-word phrases and or sentences?
• Do they help to dress and undress themselves?

Autism screening at 2 years old

As you did at the 18 month checkup , you’ll once again complete an autism spectrum disorder screening questionnaire—likely the Modified Checklist for Autism in Toddlers—Revised with Follow-Up (MCHAT-R/F). It’ll ask about baby’s speech development, behavioral habits and milestone progress, notes the AAP . It’s important to remember that these screenings are not diagnostic, as family history and other health factors also play roles in the development of autism spectrum disorders. Rather, this screening is meant to identify any early risk factors and possible next steps.

Dietary habits and nutrition check in at 2 years old

It’s important to make sure your toddler is eating enough and consuming nutrient-rich foods. While you’ll want to offer a variety of healthy foods, the AAP advises letting your child decide how much they want to eat—a task that can become challenging when you’re in the throes of their picky eating stage. With that in mind, Crosby says that your pediatrician will likely ask some questions, including:

• Does your child eat with a spoon or other utensils?
• Do they can drink from a cup?
• What kind of fluids do they drink daily?
• How much milk do they consume—and what type do they drink the most?
• What kinds of foods do you offer during meals and snacks?
• Does your child eat a variety of foods?
• How do you handle any picky habits?
• How often does your family eat together during mealtimes?

Your pediatrician may also ask whether your child has had their first dental visit , Cody says. They’ll inquire about potty training too, and walk you through some potential signs of readiness.

Sleeping habits check in at 2 years old

Your pediatrician will want to get a read on your child’s sleeping patterns and habits at 2 years old. Cody says they’ll inquire about:

• How well your child sleeps at night
• How many hours your child sleeps at night
• Whether they still take daytime naps
• How long any naps are

Child safety check in at 2 years old

As your tot becomes more active, there’s a ton of safety considerations to keep top of mind, notes the AAP, including:

• How often your child is around water or at the pool, and what precautions you take (like fencing, gates, pool alarms , etc.)
• Where cleaning products and medications are stored, and whether they’re accessible to your child
• How any home gym equipment is stored and secured
• Whether anyone in the home smokes
• Whether you feel safe in your home
• Other aspects of home, food and car seat safety

Do Toddlers Get Shots at a 2 Year Checkup?

The AAP notes that most toddlers will likely have received all of their early recommended vaccinations by the time they’re 2 years old. However, if there were any immunizations that were missed or delayed, your doctor will catch up on them at the two-year checkup. “During this visit, they [may] receive a second hepatitis B vaccine (if it hasn’t yet been given) and a flu shot, if it’s flu shot season,” Crosby says. Plus, your pediatrician may also go over any updated guidelines for the COVID-19 vaccine .

Questions to Ask at the Two-Year Check Up

This age of toddlerhood involves lots of key social and emotional development. Your little one is probably very curious, loves to explore and has a tough time with changes. Though this phase can be difficult at times, it’s important to know your kiddo is looking to you to learn how to positively deal with all their big feelings. “[They]want to be independent, but they also still must rely on adults,” says Crosby. “They may be frustrated because they’re unable to verbalize what they mean or what they want—or because they want to do more than they’re capable of. This can be hard for them and their parents, but it’s a normal developmental milestone.”

Below, some possible things to ask about at the two-year appointment:

• What type of milk is best for your child to drink
• How often they should brush their teeth and visit the dentist
• Screen time recommendations
• How to best handle tantrums and the “terrible twos”
• Positive approaches to toddler discipline (i.e. time-ins vs. time-outs)
• How to handle separation anxiety and clinginess
• Any questions or concerns around milestones
• When to transition to a toddler bed
• Potty training readiness signs and suggestions
• How to handle picky eating habits and sleep issues
• Switching from a rear-facing to a front-facing car seat
• Safety considerations on the playground

Moreover, if you see any potential red flags in your child’s development, bring them up to your pediatrician. Here are some behaviors to bring up, according to Cody and Crosby:

• A child who’s not mimicking actions
• If they’re not using two-word sentences
• They’re not saying at least 15 words
• They’re unable to follow simple commands
• Your toddler isn’t showing any displays of affection
• They don’t engage in pretend play
• They’re not using toys in a typical manner
• They don’t notice others around them
• They’re not running and climbing
• They don’t point to things and people
• They don’t feed themselves
• They’re not yet scribbling or stacking objects

Additionally, if there’s any regression in your child’s development, your pediatrician will want to know about it, Cody says. They’ll help figure out what the cause may be, and work with you to take steps for any necessary early interventions.

At 2 years old, your little one is becoming their own little person. They’re becoming increasingly independent, but will likely still want to keep you close for cuddles. The truth is, they’re grappling with lots of big feelings that they may not yet understand. As you help them through this transitional phase, it’s important to show them compassion, empathy and kindness (even when you’re at your wits end because they want Goldfish for dinner again ). Before you know it, you’ll be taking them to their next doctor’s appointment, which may occur at 30 months or 3 years, depending on your pediatrician’s practice.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

What to Expect at Your Toddler’s 15 Month Checkup

What to Expect at Your Toddler’s 18 Month Checkup

Toddler Age Range: When Does Toddlerhood Start and Stop?

Loretta Cody , MD, is a board-certified pediatrician based out of Connecticut. She received her medical degree from New York Medical College and completed her residency at Yale New Haven Children’s Hospital.

Lauren Crosby , MD, FAAP, is a pediatrician with La Peer Pediatrics in Beverly Hills, California, as well as a mom of two. She earned her medical degree from UCLA School of Medicine and completed her residency at Cedars-Sinai Medical Center. She currently serves as an official spokesperson for the American Academy of Pediatrics.

Healthy Children (American Academy of Pediatrics), Your Checkup Checklist: 24 Months (2 Years) Old , August 2022

Healthy Children (American Academy of Pediatrics), How Pediatricians Screen for Autism , December 2019

Learn how we ensure the accuracy of our content through our editorial and medical review process .

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Doctor visit: The two-year checkup

You can expect your child's doctor to:

• Weigh and measure your child to make sure she's growing at a healthy rate .
• Check her heart and breathing.
• Check her eyes and ears.
• Measure your toddler's head size to keep track of her brain growth.
• Give your child any immunizations she missed at her previous checkups.
• Address any concerns about your child's health, including how to spot symptoms of ear infections , colds , and the flu .
• Answer any questions you may have about toilet training , discipline, or, if your child has brothers or sisters, sibling rivalry .
• Offer insight into your child's development , temperament, and behavior.
• Screen for anemia and lead poisoning with a blood test if your child has any risk factors.
• Ask about plans for preschool or organized activities.
• Watch your child walk to check her gait and coordination.

Questions the doctor may ask:

• How is your child sleeping? Most kids this age sleep about 11 hours at night and nap for about two hours during the day. Some kids may have given up naps altogether, preferring instead to sleep in one long nighttime stretch. If your child has been waking up with nightmares, tell your doctor. Nightmares and night terrors are common at this stage, but your doctor may suggest ways you can comfort your child.
• How is your child eating? Until now you may have been able to limit the amount of sugary foods your child eats, but as he spends more time around other kids – in daycare or at playdates, for example – he's probably becoming more interested in sampling junk food. If you find yourself constantly battling his sweet tooth, speak to the doctor, who may have some healthy snack suggestions for you or may be able to ease your concerns about your child's diet.
• How is toilet training going? Most kids have started toilet training at this point, although many haven't mastered it yet. Your doctor may have some advice on easing the transition out of diapers.
• Have you noticed anything unusual about the way your child walks? Many children walk knock-kneed at this age because their legs are still developing, but the problem usually resolves itself around age 7.
• Is your child physically active? By now a toddler has more control over his arms and legs, and is better coordinated overall. He should be able to kick a ball effortlessly, build block towers, climb furniture, jump, and walk up and down stairs. Make sure he has plenty of opportunities to move and explore.
• What new words is he learning? Most kids this age have discovered the word "why." Sometimes all he wants is an explanation, and other times he's merely trying to continue his conversation with you. His vocabulary is expanding, and he'll be trying out new words every day. The doctor may test your child's language abilities by asking him questions. Two-year-olds typically have a vocabulary of 50 to 100 words and are starting to put two words together.
• Does he respond to two-step commands? Two-year-olds are usually mature enough to understand and follow two-step directions such as "Go to your room and grab your bear" or "Go to Daddy and give him a hug." If your child doesn't follow your commands, or appears not to hear you , tell the doctor.
• What games does he like to play? The activities your child enjoys give the doctor insight into how he's developing. Many kids this age enjoy putting together simple puzzles, scribbling on paper, sorting objects by color, and filling and emptying boxes.
• Have you noticed anything unusual about your child's eyes or the way he looks at things? Learn about eye examinations and how to spot potential problems.
• Has he seen a dentist? The American Academy of Pediatrics recommends that children see a dentist after their first birthday. If your child hasn't been to the dentist yet, now is the time.

What's next?

• Find out what's in store for you at the 30-month doctor visit .

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2-year checkup: your toddler at 2 years.

This visit will probably go more smoothly than the 18-month one because your 2-year-old will be more interested in the whole business. It's easier and more enjoyable for her to talk to the doctor or nurse who examines her.

At This Visit, Your Provider Will Probably:

Weigh and measure your child.

Provide insights into your child's physical and emotional development.

Answer any questions you may have about surviving the " terrible twos ."

Discuss toilet training, preschool, and child care.

Your Provider Will Want To Know:

Has your child seen another healthcare provider since the last visit? If so, why? What was the outcome of that visit, and were any medications or treatments prescribed?

How many words does your toddler know? Can she use two-word phrases?

Does she imitate you? Does she play with trucks or dolls?

Can she kick a ball? Can she walk up and down the stairs using both feet or one foot at a time?

Is she shy around strangers, at least at first?

Can she follow a story and name pictures in a book?

Can she follow a two-step command?

Is there a family history of heart attacks before age 50? If so, there may be some testing of your child's fat balance that needs to be done at this time.

Is she extremely fearful and/or does she have a hard time with other children?

Talk It Over

Although most 2-year-olds are not potty-trained (no matter what your mother or mother-in-law says), you may have started the training process. Keep in mind that you shouldn't rush toilet training. Forcing the matter usually ends up frustrating everyone, and doesn't get the diapers off any sooner.

Dental care is a big concern at this age. Ask for a referral to someone who works well with children. Ask about fluoride.

If you're having a hard time limiting TV or screen time or if you find yourself using it as a babysitter, ask for some help. Habits are shaped now.

If your child is extremely fearful and/or has a hard time with other children, ask for advice.

Major changes can stress you and affect your toddler. If you're moving, having a new baby, going back to work, or dealing with a loss or serious illness, your child may be affected. Your provider may also be able to suggest resources for you and your family to help with the situation.

There are many programs that can help you cope with the challenges you face with a growing child. Your provider can help you find one.

Your busy toddler will probably bruise his shins and bump his head. If you have any concerns about your child's injuries, tell your provider immediately. She or he can look at the bumps and bruises and tell you whether they appear to be from normal activities.

Also, Let Your Healthcare Provider Know if Your Child:

Isn't putting together two-word sentences or phrases.

Doesn't point at pictures in books and name at least some of the pictured objects.

Doesn't run or is very unsteady on his feet.

Doesn't understand two-step commands such as "Get your shoes and bring them to me."

Doesn't throw or kick a ball.

Can't stack more than two blocks.

Doesn't know how to scribble on paper with large crayons. Most kids can draw a crude circle at this age.

Still has trouble swallowing table food.

Can't be understood or get his message across to strangers half of the time.

Is very fearful generally, or in particular situations or with particular people.

Is doing anything that you think is odd or unusual.

Remember that all children develop and learn at their own pace, and try not to worry. Discuss any questions with your healthcare provider to ensure all is going well for your little one.

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KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551.

Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk in infancy. Pediatrics. 1992;89(6 pt 1):1105-1109.

Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426.

Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

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Bright Futures Information for Parents: 2 Year Visit

​Here are some suggestions from Bright Futures experts that may be of value to your family.​​

How Your Family Is Doing

Take time for yourself and your partner.

Stay in touch with friends.

Make time for family activities. Spend time with each child.

Teach your child not to hit, bite, or hurt other people. Be a role model.

If you feel unsafe in your home or have been hurt by someone, let your health care professional​ know. Hotlines and community resources can also provide confidential help.

Don’t smoke or use e-cigarettes. Keep your home and car smoke-free. Tobacco-free spaces keep children healthy.

Don’t use alcohol or drugs.

Accept help from family and friends.

If you are worried about your living or food situation, reach out for help. Community agencies and programs such as WIC and SNAP can provide information and assistance.

Your Child's Behavior

Praise your child when he does what you ask him to do.

Listen to and respect your child. Expect others to as well.

Help your child talk about his feelings.

Watch how he responds to new people or situations.

Read, talk, sing, and explore together. These activities are the best ways to help toddlers learn.

Limit TV, tablet, or smartphone use to no more than 1 hour of high-quality programs each day.

• It is better for toddlers to play than to watch TV.
• Encourage your child to play for up to 60 minutes a day.

Avoid TV during meals. ​Talk together instead.

Talking and Your Child

Use clear, simple language with your child. Don’t use baby talk.

Talk slowly and remember that it may take a while for your child to respond. Your child should be able to follow simple instructions.

Read to your child every day. Your child may love hearing the same story over and over.

Talk about and describe pictures in books.

Talk about the things you see and hear when you are together.

Ask your child to point to things as you read.

Stop a story to let your child make an animal sound or finish a part of the story.

Toilet Training

Begin toilet training when your child is ready. Signs of being ready for toilet training include

• Staying dry for 2 hours
• Knowing if she is wet or dry
• Can pull pants down and up
• Wanting to learn
• Can tell you if she is going to have a bowel movement

Plan for toilet breaks often. Children use the toilet as many as 10 times each day.

Teach your child to wash her hands after using the toilet.

Clean potty-chairs after every use.

Take the child to choose underwear when she feels ready to do so.

Make sure your child’s car safety seat is rear facing until he reaches the highest weight or height allowed by the car safety seat’s manufacturer. Once your child reaches these limits, it is time to switch the seat to the forward- facing position.

Make sure the car safety seat is installed correctly in the back seat. The harness straps should be snug against your child’s chest.

Children watch what you do. Everyone should wear a lap and shoulder seat belt in the car.

Never leave your child alone in your home or yard, especially near cars or machinery, without a responsible adult in charge.

When backing out of the garage or driving in the driveway, have another adult hold your child a safe distance away so he is not in the path of your car.

Have your child wear a helmet that fits properly when riding bikes and trikes.

If it is necessary to keep a gun in your home, store it unloaded and locked with the ammunition locked separately.

What to Expect at Your Child's 2.5 Year Visit

We will talk about:

• Creating family routines
• Supporting your talking child
• Getting along with other children
• Getting ready for preschool
• Keeping your child safe at home, outside, and in the car

Helpful Resources:

• National Domestic Violence Hotline: 800-799-7233
• Smoking Quit Line: 800-784-8669
• Information About Car Safety Seats: www.nhtsa.gov/parents-and-caregivers​
• Toll-free Auto Safety Hotline: 888-327-4236

Consistent with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition

The information contained in this webpage should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original handout included as part of the Bright Futures Tool and Resource Kit, 2nd Edition.

Inclusion in this webpage does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this webpage. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this handout and in no event shall the AAP be liable for any such changes.

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8 Questions to Ask at a Well-Child Visit With Your Pediatrician

A well-child visit is an important part of keeping your child healthy. From babyhood through the teen years, these routine checkups are a great time to talk to your doctor about your child’s growth, development and behavior.

Lauren Nguyen, MD, MPH , a pediatrician with Children’s Medical Group in Torrance, California, part of the  Children’s Hospital Los Angeles Care Network , shares eight key questions to ask your pediatrician during your appointment.

1. Are my child’s growth and weight healthy?

At each visit, your doctor will do basic measurements of your child, including height and weight (and head circumference for babies and toddlers).

“Children are in a rapid phase of growth, so we want to make sure they’re following their own growth curve,” Dr. Nguyen says. “If there are any dramatic changes or concerns about that growth, the pediatrician will address them.”

Growth and weight are important beyond the baby years. For older children and teens, gaining too much weight is a common issue. Other children may experience early puberty. Talk to your doctor about any concerns you have about your child’s growth.

2. Is my child on schedule for his/her vaccinations?

At the end of the visit, your child will receive any needed vaccinations. These shots are critical for protecting your child from a host of serious diseases, including whooping cough, polio, measles and more.

Your doctor should explain which vaccines your child is receiving and what they protect against. Ask which shots are coming up for the next visit as well.

“It’s extremely important for your child to not only get these vaccinations, but to also get them on schedule ,” Dr. Nguyen says. “It can sometimes take weeks or multiple doses of a vaccine before a child is fully protected. The schedule is carefully designed to make sure your child is protected at the right time.”

Children will receive most vaccinations before the age of 6 or after 10 years old. But don’t skip a well-child visit during this gap just because no shots are needed. These are key growing years, plus your child should receive the flu shot every year, so it’s important to still have regular checkups with your pediatrician.

3. What should my child eat (and not eat)?

Nutrition is a big part of a child’s growth and development. Talk to the doctor about your child’s diet. For babies and toddlers, you might have questions around breastfeeding, when to introduce solid foods and what to do if your child is a picky eater.

Ask your doctor which foods your child should eat—and which they should not. Dr. Nguyen tells her patients to avoid juices and sodas, for example. “You want to establish healthy behaviors at a young age,” she says. “It’s so much harder to change these habits later on.”

Be sure to also tell your doctor about any vitamins or supplements your child is taking. “Gummy vitamins have become very popular for young children, but they’re one of the biggest causes of childhood cavities,” Dr. Nguyen explains. “A multivitamin is fine, but it should be a chewable tablet.”

4. Which milestones should my child reach next?

Your doctor will want to know if your child is achieving the typical milestones for his or her age group. In the early years, these include smiling, walking, throwing, grabbing and talking. In addition, ask which milestones your child should reach by the next appointment.

“For example, at the 15-month checkup I’ll say, ‘By 18 months, I’d like your baby to be able to say 10 words, to be able to almost run, to scribble and color and use utensils,’” Dr. Nguyen explains. “That lets parents know what to look for in their baby’s development.”

5. How can I keep my child safe?

For babies and toddlers, safety questions can cover car seats, child-proofing your home, sun exposure and more. For older children, questions might include: When can my child graduate from a booster seat? How much screen time is appropriate?

For adolescents and teens, safety conversations often center around social media use, drugs and alcohol, and sex. Your pediatrician may want to talk one-on-one with your teen about these issues. Talk to your doctor about what you are comfortable with.

6. What about my child’s mental health?

Mental health is important at every age, but this is a particular focus for adolescents. Is your child depressed or anxious? Struggling in school? Having trouble making friends?

“There is a significant increase of depression and anxiety right now among children and adolescents,” Dr. Nguyen says. “The earlier you can identify a mental health issue, the earlier you can treat it. Don’t be afraid to bring up these issues.”

7. Is it normal that my child … ?

This can be anything you’re concerned about—from a recurring rash or a strange bump to weight gain, picky eating or trouble making friends.

Tip: Write down your questions before the appointment. Put the most important ones at the top of the list. If a question comes up after your appointment, call and ask.

“Parents know their child best,” Dr. Nguyen says. “If you feel something is off, definitely ask your pediatrician. There might be an issue we need to address. Fortunately, most of the time your doctor can reassure you that your child is fine.”

8. When is my next appointment?

Before you head home, don’t forget to book your next well-child visit.

“Many parents don’t schedule that next visit, and then it’s easy to start falling behind,” Dr. Nguyen says. “You can always change the date later if you need to. Making the appointment while you’re still at the office is the best way to ensure you’ll stay on track.”

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Child Well-Visits: 8 Questions to Ask at Your Next Appointment

July 20, 2021

Whether you are a new parent or have older kids, there are always things to learn about your child’s development and health. That’s why it’s important for you to schedule child-well visits with a pediatrician. Pediatricians are highly trained in the conditions of childhood, so they have a wealth of information you can use to keep your child healthy and happy.

When you take your child to the doctor for an illness or injury, it’s easy to keep track of what you want to talk about with the pediatrician. However, at a well-visit, your child’s overall health is the focus, so it can be hard to keep track of what you want to discuss with the doctor. In order to make sure you get the most out of your next appointment for a child well-visit, make a list of questions to ask using these eight suggestions as a starting point.

1. Is my child meeting milestones for growth and development?

Every child is different, so they do not always hit the same milestones at the same exact age. However, your pediatrician can discuss the age ranges certain developmental milestones should be met, especially in babies and toddlers. If your child is not meeting milestones for development or physical growth, then you and your doctor can discuss any steps you can take to help your child, like special diets for growth, speech therapy, or help with fine motor skills.

2. What vaccines does my child need now or in the near future? Can I get a copy of my child’s shot record?

Your child’s doctor will likely make sure you get reminders about needed vaccines, and yearly visits are a good way to keep up-to-date. The Centers for Disease Control and Prevention (CDC) also has a guide on the recommended child and adolescent immunization schedule . If the pediatrician does not give you information on what vaccines or boosters your child needs, make sure to ask so you can discuss what’s coming up and when your child needs certain shots.

3. What kind of seat should my child be using in the car?

You probably know the guidelines about what kind of car seat is safest for your child based on age, weight, and height, but you might still want to check in with their doctor to make sure you are using the safest option for your child. Plus, since your child will be weighed and measured during the well-visit, you will have the most up to date numbers.

4. Are there any infectious illnesses going around and how can I prevent my child from getting sick?

Ask your child’s doctor if they know of any illnesses affecting your area at the time. And if so, ask if there are steps you can take to protect your family from getting sick. While many contagious conditions can be vaccinated against, some things like stomach bugs, colds, and hand-foot-and-mouth disease cannot be prevented with vaccines. The pediatrician can give you tips on avoiding these conditions.

Also, some communities are still vulnerable to illnesses that have vaccines because a percentage of the population has chosen not to vaccinate, harming herd immunity. Outbreaks of measles, mumps, chickenpox, and other preventable diseases have occurred in several areas in recent years. So, make sure your child is up to date on vaccines and boosters they need.

5. When should my child go to the dentist?

Generally, pediatricians and pediatric dentists recommend that your child start seeing the dentist by their first birthday, if not as soon as their first teeth come in. However, if you want more guidance in your child’s case, then ask the pediatrician when your child should start having check-ups and when they need to move on to get regular cleanings. Also, if you have questions about when the right time is for your child to switch from training toothpaste to a toothpaste with fluoride.

6. Questions about any specific concerns you have about your child’s health or behavior.

No two children are the same, so if you have specific concerns about your child, make sure to bring them up with the pediatrician. They can be pretty thorough, but they cannot cover every possible issue. So, if your child is exhibiting unusual behavior or physical symptoms, put those questions on the list of things to be addressed. Possible topics might include:

• Vision problems (squinting, not being able to see the board at school, sitting too close to the TV)
• Behavioral issues (acting out of anger, difficulty paying attention, hyperactivity)
• Sleep issues or unusual fatigue
• Allergies and food sensitivities
• Breathing issues/asthma

7. Can you give me a referral for a specialist?

If your child has a problem that the pediatrician is not equipped to treat, like vision issues, your pediatrician is a good resource for recommendations on good providers. Many pediatricians have working relationships with doctors who specialize in pediatric dentistry, optometry/ophthalmology, allergies, or dermatology. They may also be able to provide you with options for counselors or mental health professionals if you have concerns about behavioral or emotional health.

8. When do I need to bring my child back?

Make sure you are familiar with the recommended schedule of well-visits. The American Academy of Pediatrics’ website for parents, healthychildren.org has a summary of the recommended schedule. Well-visits should be more frequent for babies and toddlers and then become yearly around age 3. Of course, you should make sure your child sees the pediatrician in cases of illness and injury, as well as for vaccinations.

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Holly Springs Pediatrics is a family-oriented practice with two healthcare providers serving the Holly Springs area. We aim to create a safe and comfortable medical home for children and parents and believe in having an open and collaborative relationship with each patient. If you have questions or concerns about your child’s health or want to schedule a child well-visit, call (919) 249-4700. You can also request an appointment online .

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What questions should I ask at my 2-year-old well visit?

You asked and you shall now receive. It’s only fair for us to share all of this stored up knowledge about a toddlers and what happens when they start toddling (and talking)! We now will answer, in a very public forum, all of those burning questions about children in their second year. Each Wednesday, we will tackle a commonly-asked-question from the point of view of a parent with a toddler. Chiming in to give her feedback will be an expert who has been there and done that. Earmark, share and add your own input to today’s question; it’s good karma.

Toddlers grow in many ways so when you go into his well visit here are some areas to discuss:

First and foremost ask about any health concerns. Mention the things you notice about your toddler so the pediatrician can get a more accurate picture of what you are seeing at home. This needs to include your impressions of your toddler socially, emotionally and physically. If you are worried about something raise it no matter how small or silly you think it sounds. This information helps a doctor get a fuller picture of your child.

Ask your doctor to explain some of the next major milestones that will be coming up for your toddler and ways to support his health physically and emotionally along the way.

If you have a long list ask the Dr if she would prefer to have you email some of them ahead of time so she can be prepared to answer all of your questions especially since your two year old may not want to be in the room for any lengthy discussions.

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2 Year Online Milestone Checklist

How your child plays, learns, speaks, acts, and moves offers important clues about your child’s development. Developmental milestones are things most children (75% or more) can do by a certain age.  Check the milestones your child has reached by the end of 2 years by completing the checklist below.  Share it with your child’s doctor, teacher, and other providers, and be sure to talk about the milestones your child has reached and what to expect next.

Checking children’s development regularly is important.  CDC’s free  Milestone Tracker  app  is also available to complete the checklists, with reminders and helpful tips on the go!  Available on the  AppStore external icon  and  GooglePlay external icon .

Your Child at 2 Years

Milestones matter! Check the milestones your child has reached by age 2 by completing the checklist below.

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What Most Babies Do by this Age:

Social/Emotional

Language/Communication

Cognitive (learning, thinking, problem-solving)

Movement/Physical Development

Selected “not sure”? Watch for these milestones over the next week or two. Try some things with your child that gives him/her the chance to show the milestone. If you’re still not seeing the milestone, see the steps below.

Selected “not yet” or have other concerns or questions about your child’s development? Talk with your child’s doctor, teacher and/or another trusted provider. Share the checklist and any questions or concerns you might have. Ask about developmental screening. It’s recommended for all children. If you, the doctor, teacher, or other provider is still concerned after screening, ask to be connected with (1) a specialist who can learn more about your child AND (2) with services and other supports that may help. Visit www.cdc.gov/Concerned for more information.

Notices when others are hurt or upset, like pausing or looking sad when someone is crying

Points to things in a book when you ask, like “Where is the bear?”

Says at least two words together, like “More milk.”

Points to at least two body parts when you ask him to show you

Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes

Holds something in one hand while using the other hand; for example, holding a container and taking the lid off

Tries to use switches, knobs, or buttons on a toy

Plays with more than one toy at the same time, like putting toy food on a toy plate

Kicks a ball

Walks (not climbs) up a few stairs with or without help

Eats with a spoon

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Police: Suspect fled after fatally shooting man, wounding child at Prince George’s Co. youth football game

Dana Sukontarak | [email protected]

June 15, 2024, 7:55 PM

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Police in Prince George’s County, Maryland, say they are actively investigating a shooting Saturday morning at a youth football game at Potomac High School in Oxon Hill.

At a press conference late Saturday afternoon, Prince George’s County Police Chief Malik Aziz said the department has “promising leads” in the shooting that killed a man and wounded a child.

At approximately 11:20 a.m., officers responded to the school for a shooting and found a man in the bleachers suffering from a gunshot wound. Police said the man was pronounced dead after being transported to the hospital.

Aziz said the suspect and the victim were watching the football game when a dispute happened.

Police said the second victim, a 5-year-old child, was also found with a gunshot wound and was taken to the hospital with non-life-threatening injuries.

The suspect fled after the shooting, police said.

“Prince George’s County is a safe place to live. We have our challenges and we have our issues, but this is where it comes into play that community and police work together to resolve these issues,” Aziz said. “We can’t do anything without the intelligence and information of our greater community who want to see an end to senseless violence.”

Aziz said the department wants to “bring some resolution to an affected family on Father’s Day weekend.”

Police ask anyone with information about the suspect or possible motives to contact 1-866-411-8477.

A map showing the area of the shooting is below.

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© 2024 WTOP. All Rights Reserved. This website is not intended for users located within the European Economic Area.

Dana Sukontarak is a Digital Writer/Editor for WTOP.com. She loves haiku poetry, short sci-fi stories and word games. She grew up in Prince George’s County, Maryland, and currently lives in Silver Spring.

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Blog The Education Hub

https://educationhub.blog.gov.uk/2024/05/03/how-to-claim-15-hours-free-childcare-code/

Thousands of parents of 9-month-olds can now apply for 15 hours free childcare - here's how

We’re making the  biggest investment  by a UK government into childcare in history, doubling the amount we expect to spend over the next few years from around £4 billion to around £8 billion each year.

We've already started to rollout the expansion. Hundreds of thousands of families have been able to access 15 hours of government-funded childcare for their 2-year-olds since April 2024.

And on 12 May, applications opened for eligible working parents to access 15 hours of government-funded childcare for children who are aged between 9-months and 23-months-old. We explain more about exactly who’s eligible below.

The rollout of support is part of our plan to help families – freeing thousands of parents from having to choose between having a family and a career.

• Currently, eligible working parents of 3- and 4-year-olds can access  30 hours of childcare  support.
• Eligible working parents of 2-year-olds are also now able to access 15 hours  childcare  support.
• From  September 2024 , 15 hours childcare support will be extended to eligible working parents with a child from 9-months-old. Applications are now open.
• From  September 2025 , support will reach 30 hours for eligible working parents with a child from 9-months-old up to school age.

It's worth noting that some providers may ask for charges in addition to the government funded childcare. Visit childcarechoices.gov.uk  for further information.

When can I apply and how do I get my code? 

Applications are now open for eligible working parents whose children will be 2 or older by the 31 August to receive 15 hours childcare, starting from September 2024.

And since 12 May, eligible working parents whose children will be aged between 9- and 23-months old on 31 August can now apply to receive 15 hours childcare starting from September 2024.

When you apply, you’ll receive a code to give to your childcare provider.

It’s important to remember that codes need to be renewed every three months, so parents who apply before 1 June will need to make sure they renew their code before the offer starting in September.

You can claim your place the term after your child turns the relevant age. This gives local authorities and childcare providers enough time to prepare.

There is no limit on the number of codes available, so you don’t have to apply on the day applications open.

However, if you’re applying for childcare to start in September 2024, we recommend that you reach out to your preferred provider now to check when they will need your code by, and apply for your code before the start of the school summer holidays.

How do I apply?  

You apply online here on gov.uk  once you have checked our  eligibility criteria .

You’ll need to make sure you have the following information to hand before starting the application:

• your national insurance number (or unique taxpayer reference if you are self-employed)
• the date you started or are due to start work
• details of any government support or benefits you receive
• the UK birth certificate reference number (if you have one) for your child.

You may find out if you’re eligible straight away, but it can take up to 7 days.

Once your application has been approved, you’ll get a code to give to your childcare provider.

Eligible parents are also able to access Tax-Free Childcare through the same application system. You can apply for Tax-Free Childcare at any time. However, you don't need to apply for Tax-Free Childcare to be eligible to apply for the 15 hours childcare scheme.

Can I apply for government-funded childcare if I’m on parental leave?

Yes, you can.

If you’re applying for childcare for an older child, who is not the reason for your parental leave, you can continue to apply in the usual way.

For parents applying for free childcare for the child who is the reason for your parental leave, we have extended the period where a parent starting a new job or returning to a job after parental leave, including maternity leave, can apply for government-funded childcare.

Previously, there was a 31-day window in which new parents could apply for childcare before returning to work.

Now, as long as a parent plans return to work from parental leave or start a new job by the end of September 2024, they can apply for a free childcare code from 12 May at the same time as everyone else, giving them plenty of time to secure a place.

Parents on parental leave will need to apply online. They will then receive a letter in the post within 1 to 2 weeks so they can access their childcare entitlement.

Parents   starting a new job can call HMRC on 0300 123 4097 to receive a code.  

What if I receive an error message when I apply?

A small minority of parents on parental leave are receiving an error message on the online application system that incorrectly says they are ineligible.    

Parents returning to work before the end of September can ignore this message. They will still receive a letter in the post from HMRC within 2 weeks of applying, allowing them to access their entitlement code.  

HMRC is working to correct the message .  

What if I’m on parental leave and returning to work after 1  October 2024?  

Parents who plan to start or return to work between 1 October 2024 and 31 January 2025 will be able to apply for a code from 1 September 2024 to use from 1 January 2025.  

After 1 October 2024, the following dates will apply:   

It is important to remember that i f a parent is applying for childcare for an older child, who is not the reason for your parental leave, they can apply regardless of their return to work date.  

What happens once I receive my code? 

Once you receive your code, you’ll need to take it to your childcare provider, along with your National Insurance number and your child’s date of birth.

Your childcare provider will process the code to provide your place.

Places will be available for September in every area of the country, but a significant minority of settings hold waiting lists of over six months. If you have a preferred nursery for September, you should reach out now to secure a place for your child ahead of receiving your code.

Your local authority can provide support for finding a government-funded place in your area.

What if I’m already registered for Tax Free Childcare? 

If you have an existing Tax-Free Childcare account, you will be asked to reconfirm your eligibility every 3 months to ensure your code remains valid. The new offer of 15 hours government-funded childcare goes live on 12 May, and we know that some parents will not be able to apply for codes at this time due to the timing of their reconfirmation windows.

To ensure that every parent can obtain a code and give it to their provider in good time, we will be issuing temporary codes via letter to those whose reconfirmation windows open on or after 9 June. This means that no eligible parent should miss out regardless of when your reconfirmation window opens. You will receive your code in the post from HMRC by 24 May.

If I receive a code in a letter from HMRC, does this make my code on my Childcare Account invalid? 

No. Both codes will be valid.

If you have two codes, one from your letter beginning with 11 and one from the website beginning with 50, please give your provider the code from the website, as this is your permanent digital code for your child.

If you only have one code (beginning with 11) then you can use this code to start using your government-funded hours.

Please remember that once your reconfirmation window opens, you will still need to reconfirm your eligibility through your Childcare Account and share the digital code you receive  with your provider.

Do I need to wait for my reconfirmation window to add another child to my account? 

A parent who is already using the childcare service for another child can add a new child to their account at any time.

Your reconfirmation cycle for your current Tax-Free Childcare will not affect this.

How are you making sure there will be enough childcare places for eligible parents? 

Parents that have a preferred place for September should reach out now to their local provider to secure a physical place for their child ahead of time.

To make sure there are enough places available, we’re investing over £400 million in 2024-25 to increase the hourly rates paid to local authorities.

The Institute for Fiscal Studies has independently reported that the average funding rates for two-year-olds and under 2s paid by government from April 2024 are projected to be substantially higher than the market rate paid by parents last year, and we have committed to further increases to provider rates for the next two years.

We have also committed to increasing hourly funding rates over the next two years by an estimated £500 million, to make sure providers can increase places at each phase of the rollout.

You may also be interested in:

• Budget 2023: Everything you need to know about childcare support
• Before and after school childcare: Everything you need to know about wraparound care
• Free childcare: How we are tackling the cost of childcare

Tags: 15 hours free childcare , Applying for 15 hours free childcare , Childcare , Free childcare 2024 , Free childcare eligibility , tax-free childcare , When to apply for 15 hour free childcare

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Declared dead at nursing home, 74-year-old was alive at funeral home 2 hours later

A 74-year-old woman declared dead at a nursing home was found alive two hours later by funeral home employees attending to what they believed were her remains, a Nebraska sheriff's official said.

The employees of the Lincoln funeral home called 911, and the woman was taken to a hospital alive, where she remained Monday, Lancaster County Chief Sheriff’s Deputy Ben Houchin said at a news conference.

The woman's condition was unavailable. Houchin identified her as Constance Glantz.

“This is a very unusual case. I’ve been doing this 31 years, and nothing like this has ever gotten to this point before," Houchin said.

Houchin said a Lincoln-area nursing home where Glantz was receiving end-of-life care declared her dead about 9:44 a.m., with a doctor prepared to sign her death certificate. It wasn't clear whether that happened.

She was taken to the funeral home, where employees called 911 about 11:43 a.m., a Lincoln Fire & Rescue spokeswoman said.

Houchin described the scene as workers at the funeral home discovered the woman was alive.

"Employee was placing Constance Glantz onto a table to start their process," he said. "An employee noticed that she was still breathing."

He said that an investigation was underway but that so far there are no indications that the nursing home acted with malice in declaring Glantz dead.

"At this point, we have not been able to find any criminal intent by the nursing home, but the investigation is ongoing," he said.

Dennis Romero is a breaking news reporter for NBC News Digital. 

A 12,000-year-old hidden forest was unearthed in Manitowoc County. Here's what to know about it.

Did you know that Manitowoc County is home to a 12,000-year-old hidden forest on the shores of Lake Michigan ?

The Two Creeks Buried Forest State Natural Area is located about 30 miles southeast of Green Bay. Once encapsulated under silt and clay deposited during Wisconsin's glacial period, the ancient forest now provides a "unique, precise record of the multiple glacial advances and retreats in this area during the Wisconsinan stage of glaciation," the Wisconsin Department of Natural Resources says.

Today, natural erosion of the shoreline has exposed logs and other remains of the once-buried forest, spilling them onto the beach among modern driftwood, said Scott Schaefer, interim director of UW-Oshkosh Fox Cities' Weis Earth Science Museum . Layers of clay, silt, sand and the buried forest are visible on a steep bluff along the lakeshore, providing scientists and nature lovers alike with an illuminating look into our geological past.

Here's what to know about this unique natural area:

How old is the Two Creeks Buried Forest?

According to the Wisconsin DNR, unearthed wood at the site has been radiocarbon-dated at 11,850 years old.

In April, a small group of geologists and a landowner found two wood fragments that could be about 13,500 years old. Differences in color, texture and most notably density characteristics clued in geologists that the wood was not from recent times.

These specimens will be on display at the Weis Museum (1478 Midway Rd., Menasha) during Menasha's 150th anniversary celebration on Tuesday, June 25. Schaefer will conduct free tours from 3 to 7 p.m.

How did the Two Creeks Buried Forest form?

Wisconsin is well-known for its glacial landforms, created when glaciers spread across the state over the course of 20,000 years — from about 32,000 to about 12,000 years ago, Schaefer said. Scientists call this the "Wisconsin glacial episode," a cold climate period in the most recent ice age.

After the glaciers reached their maximum extent around 20,000 years ago, the climate started to change, and the glaciers retreated. The climate was warming but in inconsistent patterns, varying between warmer and colder conditions, each lasting hundreds to a few thousands of years.

During a warm phase about 14,000 years ago, a "mature boreal-like forest of black and white spruce, hemlock, pine, various mosses and other plants developed in the Two Creeks area near Lake Michigan," the DNR says.

Shortly after, an advancing glacier blocked the northern Lake Michigan drainage way. This caused lake levels to rise, flooding the forest and covering the ground with silt and clay, preventing the forest from decomposing. Later, when the southern end of the glacier reached the area, it flattened the forest, leaving behind another clay layer embedded with logs and other debris, the DNR says.

These layers are now visible from the bluff at Two Creeks Buried Forest and contain long-buried branches, logs, and stumps of spruce, pine and hemlock trees. Conifer needles, cones, mosses and terrestrial snails are also present in the layers.

The site provides evidence that periods between substage glacial advances were long enough for forests to develop, the DNR says. The forest is a unit of the Ice Age National Scientific Reserve and a popular study site for geologists, botanists, glacial ecologists and climatologists.

Can I visit the Two Creeks Buried Forest?

Yes, the Two Creeks Buried Forest is owned by the DNR and was designated a State Natural Area in 1967.

There's a historical marker at the location, and visitors can park in the northwest corner of the site and walk freely on the grounds. The DNR strictly prohibits the removal of any material from the site.

Where is the Two Creeks Buried Forest?

The Two Creeks Buried Forest State Natural Area is located off State 42 in Two Rivers.

The forest is about 100 miles north of Milwaukee and 30 miles southeast of Green Bay.

Longtime Old Town Scottsdale happy hour haunt is closing after 17 years: 'My heart sank'

Geisha A Go Go restaurant at the corner of Sixth Avenue and Scottsdale Road in Old Town Scottsdale is closing after 17 years.

The sushi restaurant was a popular after work destination for happy hour and karaoke. The team announced the closure in a June 13 Facebook post , citing the end of their lease as the reason for closing.

"We want to thank everyone that has made Geisha a 17yr success serving sushi and singing karaoke in Old Town Scottsdale!! To all our staff past n present that have been the family of Geisha we can not thank you enough for being part of the history here! "Sushi is in our soul and we will return soon!! Arigato!!"

Fans expressed shock and disappointment

"14years ive been going there! It was my 1st ever sushi as new transplant from Wisconsin and so mannny memories! It was my favorite place ever!!!" wrote Goondy Bermudez.

"My heart sank finding out this news," wrote Amy Quint.

"Noooo!!!! Best sushi Happy Hour handsdown…Now where will I take out of town guests and also find delicious crab mozzarella sticks at?!?!" wrote Chimere Lawshe.

The restaurant's last day of service is on June 16.

Did they get it right?: These are the 5 best sushi restaurants in Phoenix, per Yelp

Reach the reporter at  [email protected] . Follow  @banooshahr  on X, formerly Twitter.

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'It depends on what you mean by oldest': 10 things to do in historic Nacogdoches, Texas

NACOGDOCHES — Now that I've brushed the soft red dust of East Texas from my garb, it's time to revisit the perennial question: Is Nacogdoches really the oldest town in Texas?

In 2016, this small, undeniably historic city of 32,000 souls celebrated its tricentennial. Clearly, civic leaders were harking back to the start of the nearby Nuestra Señora de Guadalupe de los Nacogdoches Mission in 1716, not the founding of a municipality around a Spanish-style square by Don Antonio Gil Y'Barbo in 1779.

Either way, the place is old. As a wise local historian once quipped when asked the same question: "It depends on what you mean by 'oldest' and what you mean by 'town.'"

I recently spent the better part of five days in Nacogdoches, which rests on sandstone-ribbed hills under pines, oaks, pecans and magnolias above Lanana and Bonita creeks.

It was named for a local band of the Caddo tribe. Traces of ceremonial Caddo mounds can be found in the middle of town.

More: 'We're home': 140 years after forced exile, the Tonkawa reclaim a sacred part of Texas

The people I encountered in Nacogdoches proved to be uniformly open and helpful — more on that subject in a future column about places where the community meets to eat and drink. Two of the sites that I visited — Caddo Mounds State Historic Site and the upper reaches of El Camino Real de los Tejas — were so charismatic that I plan to write individual columns on them in the future.

Meanwhile, make way for 10 reasons to visit Nacogdoches:

1. Caddo Mounds State Historic Site

Waco boasts the Waco Mammoth National Monument, and Lubbock is rightly proud of the Lubbock Lake National Historic Landmark. Add to these priceless Texas prehistoric stops Caddo Mounds State Historic Site (1649 Texas 21, Alto), recently reopened and located 30 minutes west of Nacogdoches.

While I will describe my late May visit to the site in greater detail during the coming weeks, suffice it to say that it has healed from an April 13, 2019, tornado that severely damaged the interpretive center and other elements on this prairie above the Neches River. In fact, the new light-filled interpretive center, shaped like a Caddo grass house, is more inviting and instructive than the previous one.

More: San Antonio to Salado: 5 cool history day trips that won't take you too far from Austin

Do visit the historically minded garden, the three grass-covered Caddo mounds — ceremonial, burial and social — as well as an area devoted to the Spanish El Camino Real. While in the neighborhood, visit Mission Tejas State Park, which includes a CCC-era version of a mission church, and Weeping Mary, the post-emancipation freedom colony with an unforgettable name that grew up next to the mounds.

2. Fredonia Hotel

One of the best hotels in Texas, the redone Fredonia (200 N. Fredonia St.) has elevated tourism and the local social life in Nacogdoches. Built in 1955 in high midcentury modern style, it includes a six-story tower of luxurious rooms, a central swimming pool enclosed by a curving set of cabanas and a matching café. An events center provides a stylish space for gatherings, such as the Nacogdoches Heritage Festival, which populated the hotel with tuxes and gowns during our stay.

The Fredonia hosts three restaurants, the centerpiece 1st City Café, along with the 9 Flags Bar & Grill (a handy saloon with food from the café's kitchen) and the Republic Steakhouse (a cozy, high-end restaurant open on the weekends). Naturally, the hotel's soundtrack is often set to the Frank Sinatra channel.

More: All aboard for Nacogdoches, the 'oldest town in Texas'

Two quick anecdotes: On our first night, a "derecho" storm hit downtown with high winds and horizontal rains that scattered the heritage street festival below our fourth-floor window and turned the Fredonia lobby into a community refuge.

On the next day, we looked down from the same window to see a crowd cheering a newly engaged couple, Alana Culpepper and Van Robertson, who popped the question in the middle of Hospital Street.

"We first kissed in the middle of a street," Robertson later explained. What did Culpepper think of the surprise party, which drifted into the hotel lobby and poolside? She joked: "I thought he was cheating on me."

3. Historic City Center

Few Texas historic downtowns combine so much deep history with plenty of up-to-the-minute liveliness. The first thing the visitor notices are the red-brick streets. Then one begins to visualize all the traffic that has passed this way since the 18th century, as well as the city's role in three significant rebellions before the Texas Revolution.

On closer inspection, the town square was laid out on the Spanish pattern. In the middle of this square is the Charles Bright Visitors Center (200 E. Main St.), a big, welcoming and informative place that nevertheless disguises the square's original function as an open space.

More: What happened to the roof garden? Stephen F. Austin Hotel turns 100: What you should know.

We spent hours walking these streets because the buildings are filled with classy restaurants, shops and other businesses, such as the Red House Winery and, not far off, Fredonia Brewery. On North Street (Business U.S. 59) we found a handy used-book store, which helped with our local historical research. Directly downtown, we encountered an old opera house (329 E. Main St) — with anecdotal ties to the Marx Brothers from their early touring days — that now serves as a modern gallery for SFA's art school.

4. Stephen F. Austin University campus

The campus of SFA (1936 North St.), which recently joined the University of Texas System, has changed dramatically over the past few decades. In a good way. New or renovated buildings hold classrooms, a STEM center, dormitories and a performing arts complex. Pines and other greenery shade the open spaces between old and new structures.

We spent the most time at the Micky Elliott School of Fine Arts, where our friend Professor Scott Shattuck teaches in the school of theater and dance. The labyrinth of first class studios, labs, classrooms, performance venues and community spaces rivals that of UT in Austin, this for a university of perhaps 9,000 students.

More: Go inside revitalized Austin's Paggi House, where pre-Civil War complex finds new life

Why did the UT System acquire SFA? More than one Nacogdoches faculty member mentioned the school's forestry program, which adds a missing card to UT's always strong hand. The merger is a good deal all around, I think, because the system can open doors to donors and research money while SFA continues to define itself for the 21st century as one of the premier schools in East Texas.

5. Zion Hill Baptist Church and Sterne-Hoya House

Surely, Nacogdoches competes for the title of "most historic buildings per capita" in the state. We were offered plenty of choices to explore these places during our five days there.

Our first stop was at Zion Hill Baptist Church (324 N. Lanana St.), the Gothic and Victorian miracle that German immigrant Diedrich Anton Wilhelm Rulfs designed in 1914 for the town's African American community. It is built in an "opera house" style with a curved balcony supported by thin columns and a raked set of pews downstairs. Zion Hill, beautifully restored, now serves as an events center, including for gatherings of the congregation that moved to another structure when Zion Hill was in bad repair.

More: Can you eat Texas wild grapes? Sure, go wild. Here are the types that grow in the state.

Just blocks away is the Sterne-Hoya House (211 S. Lanana St.), built circa 1830 by Adolphus Sterne, immigrant, colonist, merchant, legislator and financier of the Texas Revolution. His personal accounts of early Texas are among the most valuable sources for that period. (Just now, I am rereading "Hurrah for Texas: The Diary of Adolphus Sterne, 1838-1851," edited by Archie P. McDonald. Every page is a Texas history lesson.)

One place to find a large number of old buildings at one time is Millard's Crossing Historic Village (6020 North St.), an independent museum put together by late U.S. Rep. Lera Millard Thomas, a Nacogdoches native and widow of longtime U.S. Rep. Albert Thomas, an LBJ ally. She collected about a dozen structures, several of them related to her family's history, filled them with period objects and decor, and strung them along two rows. It serves as an invitation to children to explore, or for planners to imagine an evocative background for their events. It could use a good deal more context.

6. Old Nacogdoches University

For me, this architectural artifact was an unexpected find: The main building of a public university (515 N. Mound St.) chartered by the Republic of Texas on Feb. 3, 1845, more than 75 years before SFA got its start in 1923. That makes it likely the first nonsectarian institution of higher learning in Texas. The impressive Greek Revival structure for Old Nacogdoches University (515 N. Mound St.) was built by local hands just before the Civil War to serve white male and female students.

During the war, parts of the campus were turned into a hospital and then were occupied by federal troops. It later became a private university, at one point run by the Congregation of Ursulines of the Agonizing Heart of Jesus. It closed as a college in 1895.

More: Twice wiped out by hurricanes, Indianola lives on in the romance of Texas history

Strangely situated away from current street fronts, it is found on a campus of the public school district, but is operated as a museum, recently refurbished, by a local chapter of the Federated Women's Clubs. The lower floor, where male and female students were separated, is decorated in period styles. The upper level includes some private quarters, but the main section holds exhibits, especially about historical education and health, that could use more analysis and interpretation.

7. Oak Grove, Old North Church and other cemeteries

You might figure that a historic city like Nacogdoches would know how to handle old cemeteries. You would be right. The main cemetery, Oak Grove (North Lanana St.), is in great condition under ancient shade trees above Lanana Creek. It holds the remains of several major figures of the Texas Revolution, including Thomas Jefferson Rusk, a soldier and statesman involved in just about every aspect of the Texas Republic. A short distance away from Oak Grove is the Zion Hill Cemetery, segregated for African Americans.

A different sort of Black graveyard can be found attached to the Old North Baptist Church (332 County Road 205). Its two cemeteries are generally segregated, and the one for enslaved African Americans and their descendants is undergoing an astonishing renaissance. About three years ago, neighbor Wyatt Ordway noticed that Old North Church Afro-American Cemetery was in severe disrepair and that many graves were simply unmarked. He organized volunteers and class groups to document the gravesites and honor them respectfully.

More: New funds for Bethany Cemetery help Austin's first Black cemetery write its next chapter

8. Pineywoods Native Plant Center and other oases

It rained every day during our visit to East Texas. According to some locals, it might rain throughout the month of June. So compared to much of Texas, this land is a vast garden that can quickly turn into a jungle.

To learn about the local flora, visit the Pineywoods Native Plant Center (2900 Raguet St.), where we ran into SFA Professor Emeritus David Creech. He explained the serious scientific work of the center, including propagation of multiple varieties of Japanese maple. The center is home to a tribute garden named for Lady Bird Johnson as well as fairly well-tended asphalt trails through wetlands above Lanana Creek.

A note to any potential UT System donor who wants to make an immediate improvement to SFA: Consider replacing the deteriorated interpretive signs that identify for the public which native plants we are seeing.

My road-trip companion and I did some light birding in other local green spots, including the Mize Azalea Gardens, Oak Grove Cemetery and Old North Baptist Church Cemetery. Mostly cardinals, crows, chickadees, etc., but we did hear a pileated woodpecker, one of the largest birds on the continent. (I've seen only one, in Davy Crockett National Forest).

More: Texas history museum dissects treaty that ended Mexican American War and changed the world

9. Stone Fort Museum

This is a building you want to celebrate. Yet it is important to know what is real and what isn't about the Old Stone Fort. The original building held down one corner of the old Spanish square in downtown Nacogdoches, right on the lip of El Camino Real de Los Tejas. It served as a trading post, fortification, government office and home to founder Dón Antonio Gil Ybarbo (1729–1809), whose statue rises nobly next to the Visitors Center.

Eventually, however, the stone structure stood in the way of roadway progress, and locals were less than enthusiastic about preserving what had become a saloon. While some of the sandstone blocks from the fort, demolished in 1902, were used for a monument and fences, others were transported to the SFA campus (808 Alumni Drive North), where a nice-looking museum on local history was formed. (It was closed because of a lack of personnel each time we tried to visit the museum.)

More: 'An Echo of Belonging': Ebenezer Baptist Church commences 150th year of faith in Austin

This would be a good time to explain the "Nine Flags Over Nacogdoches" theme, which one encounters all over town. Besides the traditional six flags of Texas (Spanish, French, Mexican, Republic of Texas, U.S., Confederate) — a false reduction that leaves out the Native American nations that actually controlled the region until the mid-19th century — locals here recognize three brief East Texas freebooting entities.

They would be the Gutiérrez-Magee Expedition (1812-1813), the Dr. James Long Expedition (1819-1821) and the Fredonia Rebellion (1826-1827), all of which attempted to take advantage of Nacogdoches' remoteness from Spanish or Mexican authorities to set up independent polities in the region.

10. El Camino Real de los Tejas

Again, I'll return to this subject in a future column, but the area around Nacogdoches is a target-rich environment for the Spanish royal road that grew out of Native American trails more than 300 years ago.

Nacogdoches sits on the northeastern end of the road from Mexico City, about 100 miles from its terminus at Natchitoches, Louisiana. One can spot signs that identify the route on Texas 21 and other highways and byways. But look closer.

SFA Professor Chris Talbot took us on a tour of sites east of Nacogdoches that included "swales," rutted evidence of the camino's track. Outside nearby St. Augustine, we explored the tiny park owned and operated by the El Camino Real de Los Tejas National Trail Association, for which Talbot formerly served as board president.

It is open to the public, and if you are a "rut nut," you will be astounded by the profound physical remains of this road that connected communities across a wide swath of Texas for centuries.

More: Margaret Howard altered Texas archaeology

Michael Barnes writes about the people, places, culture and history of Austin and Texas. He can be reached at [email protected]. Sign up for the free weekly digital newsletter, Think, Texas, at statesman.com/newsletters, or at the newsletter page of your local USA Today Network paper.