Nutrition

FEEDINGS

Milk - Breast milk or formula may now be replaced by whole cow's milk (2% if your infant is chubby). One percent and skim milk are not recommended because children need extra fat at this age for their development. The volume taken will vary and may be supplemented with dairy products such as yogurt or cheese. If your child's milk intake decreases, do not be alarmed. Your child needs just 500 mg a day of calcium which is easy to achieve. Please see our calcium handout to make sure your child is receiving enough calcium. Milk intake should not exceed 20-24 ounces in a day as you transition to whole milk. Encourage use of a sipper cup and promote total weaning from the breast or bottle between 12 and 15 months.
Solids - Expect a decrease in appetite as your child's rate of growth slows. Maintain three meals a day on a regular schedule. Pureed or junior foods may be continued, and soft table foods gradually added as tolerated. Eating becomes interesting and very messy as finger foods are added. Your infant will become more opinionated about their diet. Do not worry. Keep trying but do not force them to eat. Variety is well tolerated and generally all foods may be given unless there is a strong family history of allergies to certain foods.
Choking is a major concern. Avoid firm airway-sized foods such as hotdogs, peanuts, candy, grapes, popcorn, etc.
Juices - Try to avoid excess amounts of sweet juices such as greater than 8 ounces (even natural fruit juices) and quench thirst with water.

VITAMINS

Formula fed infants receive adequate vitamin supplements from commercially prepared formula. Breast feeding mothers should continue their prenatal vitamins. You may continue vitamin supplements such as poly-vi-sol - one dropper a day if you would like or if your child is not getting a variety of foods.

FLOURIDE

Fluoride is very important for the development of your child's teeth and it is recommended to begin fluoride supplements at 6 months of life. Fluoride is not in formula or breast milk and must come through water or supplements. Although most municipal water supplies add fluoride, some do not. Let us know if your child needs fluoride. If you are uncertain or moved recently, then ask us or call your utility company.

Development

At this age most children can:

• Stands momentarily
• Pulls self up and walks holding onto furniture or may be walking alone. May fall frequently
• Gets into everything - especially cabinets and open closets
• Holds and drinks from a cup. May attempt to feed themselves (picks up food with his fingers)
• Babbles a lot and may say a few words such as "mama", "dada" or "baba".
• Begins to follow simple directions or commands such as please come here or drink your juice.
• Makes gestures such as pointing, imitative behavior or waves bye-bye.
• Presses buttons on phone or toys.
• Enjoys being read to
• Locates sounds by turning their head

Indicators for concern:

• Does not use single words like "Mama" or "Dada".
• No eye contact
• No pointing or other gestures such as waving "bye-bye"
• No babbling
• Difficulty crawling
• Needs to use hand to maintain sitting.

Vaccinations

At this visit, your child is scheduled to receive Varicella, Pneumococcal Conjugate, and Hepatitis A immunizations. Please review the immunizations your child will receive.

Common Issues and Concerns

MEDICATIONS

To see information on Acetaminophen (Infant Tylenol) dosage, click here. Remember to always dose based on the weight of your child.

SLEEP

(Helpful hints for preventing problems)

• Your child should be sleeping in his own bed and sleeping through the night.
• A bedtime ritual is important at this age. Children need a familiar routine. Both parents should hug and kiss the child "good night".
• Keep security objects, such as favorite stuffed animals, nearby.
• Complete the bedtime ritual before your child falls asleep.
• Once put in bed, your child should stay there.
• Overlook tantrums and protests and leave the room. It is important to enforce bedtime at this age.

DENTAL CARE

Brush your baby's teeth with a soft brush each day . Pleae see handout on Tooth Decay, Prevention.

BEHAVIOR AND DISCIPLINE

• To set limits and discipline toddlers - use distraction, gentle restraint, removal of object from toddler, or move toddler away and help him get interested in something else
• Use discipline as a means of teaching and protecting, not as punishing; toddlers should never be spanked
• Limit your toddler's TV time - you may sometimes let him watch a show developed for his age (Barney, Teletubbies, etc.)
• Do not allow hitting, biting or other harmful behavior
• Praise, sing songs and read; hug, cuddle, smile and talk to your child often
• Continue to play interactive games
• Reading books to your child helps him learn new words
• Your child is learning so much; encourage free play with blocks, toys and stuffed animals or dolls; Play both indoors and outside.

WALKING

• Legs, feet and shoes - See this handout on "What Parents Should Know".
• It is best to learn how to walk barefooted. Infant's shoes are needed to protect feet from hard or sharp objects, dirt and the cold. Shoes should be flexible, inexpensive and a good fit in both length and width. Rigid shoes should be avoided.

SAFETY

Your infant is becoming more mobile and constant supervision and safety precautions are critical. Please review the safety and TIPPS handouts.

RECOMMENDATIONS

• Watch your toddler closely, especially near dogs, lawnmowers, driveways, overhead garage doors and streets.
• Supervise toddler constantly when around water, buckets, toilets and bathtub.
• Use sunscreen but also limit your child's exposure to direct sunlight
• Keep all poisonous substances/hazards locked in a safe place, and out of toddler's sight and reach
• Keep cigarette lighters, matches and alcohol out of toddlers sight and reach
• Do not give toddlers plastic bags, latex balloons, or small objects such as marbles or coins
• Switch to a toddler car seat in the back seat; car safety seats may face the front beginning at age 1 and when the child weighs over 20 pounds
• Know CPR.
• Continue to keep toddler's environment free of smoke
• Recheck your house for safety.

Next Well Child Visit

The next routine physical examination is at 15 months of life. Please schedule the appointment today. Please review the 15 month physical examination information on our website prior to your visit as well as the immunization information on the vaccines your child will receive.