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Toddlers are children ages 1 to 3 years.

CHILD DEVELOPMENT THEORIES

Cognitive (thought) development skills typical for toddlers include:

• Early use of instruments or tools
• Following visual (then later, invisible) displacement (moving from one place to another) of objects
• Understanding that objects and people are there, even if you can't see them (object and people permanence)

Personal and social development in this age focuses on the child learning to adjust to society's demands. At this stage, children try to maintain independence and a sense of self.

These milestones are typical of children in the toddler stages. There can be some variations. Talk to your health care provider if you have questions about your child's development.

PHYSICAL DEVELOPMENT

The following are signs of expected physical development in a toddler.

GROSS MOTOR SKILLS (use of large muscles in the legs and arms)

• Stands alone well by 12 months.
• Walks well by 12 to 15 months. (If a child is not walking by 18 months, talk to a provider.)
• Learns to walk backwards and up steps with help at about 16 to 18 months.
• Jumps in place by about 24 months.
• Rides a tricycle and stands briefly on one foot by about 36 months.

FINE MOTOR SKILLS (use of small muscles in hands and fingers)

• Makes tower of four cubes by around 24 months
• Scribbles by 15 to 18 months
• Can use spoon by 24 months
• Can copy a circle by 24 months

LANGUAGE DEVELOPMENT

• Uses 2 to 3 words (other than mama or dada) at 12 to 15 months
• Understands and follows simple commands (such as "bring to mommy") at 14 to 16 months
• Names pictures of items and animals at 18 to 24 months
• Points to named body parts at 18 to 24 months
• Begins to answer when called by name at 15 months
• Combines 2 words at 16 to 24 months (There is a range of ages at which children are first able to combine words into sentences. Talk to your child's provider if the toddler cannot make sentences by 24 months.)
• Knows sex and age by 36 months

SOCIAL DEVELOPMENT

• Indicates some needs by pointing at 12 to 15 months
• Looks for help when in trouble by 18 months
• Helps to undress and put things away by 18 to 24 months
• Listens to stories when shown pictures and can tell about recent experiences by 24 months
• Can take part in pretend play and simple games by 24 to 36 months

BEHAVIOR

Toddlers are always trying to be more independent. You may have safety concerns as well as discipline challenges. Teach your child the limits of appropriate vs. inappropriate behavior.

When toddlers try out new activities, they can get frustrated and angry. Breath-holding, crying, screaming, and temper tantrums may often occur.

It is important for a child at this stage to:

• Learn from experiences
• Rely on boundaries between acceptable and unacceptable behaviors

SAFETY

Toddler safety is very important.

• Be aware that the child can now walk, run, climb, jump, and explore. Child-proofing the home is very important at this new stage. Install window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features to keep the child safe.
• Put the toddler in car seat when riding in a car.
• Do not leave a toddler alone for even short periods of time. Remember, more accidents occur during the toddler years than at any other stage of childhood.
• Make clear rules about not playing in streets or crossing without an adult.
• Falls are a major cause of injury. Keep gates or doors to stairways closed. Use guards for all windows above the ground floor. Do not leave chairs or ladders in areas that are likely to tempt the toddler. They may try to climb up to explore new heights. Use corner guards on furniture in areas where the toddler is likely to walk, play, or run.
• Poisoning is a common cause of toddler illness and death. Keep all medicines in a locked cabinet. Keep all toxic household products (polishes, acids, cleaning solutions, chlorine bleach, lighter fluid, insecticides, or poisons) in a locked cabinet or closet. Many household and garden plants, such as toad stools, may cause serious illness or death if eaten. Ask your child's provider for a list of common poisonous plants.
• If there is a firearm in the house, keep it unloaded and locked in a secure place.
• Keep toddlers away from the kitchen with a safety gate. Place them in a playpen or high chair while you work. This will eliminate the danger of burns.
• Never leave a child unattended near a pool, open toilet, or bathtub. A toddler may drown, even in shallow water in a bathtub. Parent-child swimming lessons can be a safe and enjoyable way for toddlers to play in water. Toddlers cannot learn how to swim by themselves and should not be on their own near water.

PARENTING TIPS

• Toddlers need to learn accepted rules of behavior. Be regular both in modeling behavior (behaving the way you want your child to behave) and in pointing out inappropriate behavior in the child. Reward good behavior. Give them time-outs for bad behavior, or for going beyond the set limits.
• The toddler's favorite word may seem to be "No!!!" Do not fall into a pattern of bad behavior. Do not use yelling, spanking, and threats to discipline the child.
• Teach children the proper names of body parts.
• Stress the unique, individual qualities of the child.
• Teach the concepts of please, thank you, and sharing with others.
• Read to the child regularly. This will help develop verbal skills.
• Regularity is the key. Major changes in their routine are hard for them. Let them have regular nap, bed, snack, and meal times.
• Toddlers should not be allowed to eat many snacks throughout the day. Too many snacks can take away the desire to eat regular nutritious meals.
• Traveling with a toddler or having guests at the house can disrupt the child's routine. This may make the child more irritable. In these situations, reassure the child and try to get back to a routine in a calm way.

References

Beck BM, Nwora C. Development, behavior, and developmental disability. In: Anderson CC, Kapoor S, Mark TE, eds. Harriet Lane Handbook, The. 23rd ed. Philadelphia, PA: Elsevier; 2024:chap 9.

Carter RG, Feigelman S. The second year. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 24.

Centers for Disease Control and Prevention website. Learn the signs. Act early. Important milestones: your child by two years. www.cdc.gov/ncbddd/actearly/milestones/milestones-2yr.html. Updated June 6, 2023. Accessed February 22, 2024.

Chaves-Gnecco D, Feldman HM. Developmental/behavioral pediatrics. In: Zitelli, BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 3.

Goode R, Lawrence A, Reimschisel T. Global developmental delay and regression. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 8.

Hazen EP, Abrams AN, Muriel AC. Child, adolescent, and adult development. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Elsevier; 2016:chap 5.

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