Nutrition

FEEDINGS

• Your child should be eating three balanced meals a day, but may still require nutritious between-meal snacks.
• Encourage the toddler to feed himself, using a cup and letting him begin to use a spoon; during this learning phase expect a messy face and spilled food
• Soft food may still be required, and hard or airway-sized foods such as popcorn, grapes, hotdogs, candy, peanuts should be avoided because of the possibility of choking.
• Milk and dairy products continue to be a necessary part of your child's diet. 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.
• Don't add salt or sugar to your child's food.
• Your baby should be off the bottle or breast.
• Continue to wean your toddler from the bottle to a cup and avoid putting your toddler to bed with a bottle; both of these habits can cause damage to their teeth

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:

• Walk unassisted
• Kick and roll a ball. May try to catch and throw the ball
• Take some clothing off
• Follow simple directions and commands
• Understand some words and phrases
• Say 1- 3 words
• Respond to name
• Play hide-n-seek
• Try to name some common objects
• Try to communicate with simple words and actions

Indicators for concern:

• Does not use 1 -3 words
• No eye contact
• Does not respond to name
• No pointing or other gestures such as waving "bye-bye"
• Unusual repetitive movements
• Not attempting to cruise or walk

Vaccinations

At this visit, your child is scheduled to receive the DTaP, IPV, Hib and MMR 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

• Your child should be sleeping in their own bed and through the night. If not, review our sleep handouts.
• Bedtime should be enforced after a familiar routine is complete.
• If your child is climbing out of the crib, make sure to lower your toddler's crib mattress to the lowest rung. They can be placed in a toddler bed if they continue to climb out.
• Once your child is put to bed, he should not be allowed out of his bed or room.
• If your child comes out of his room, return him quietly without conversation, skip the hug and kiss. Hold the bedroom door closed for a few minutes if necessary. Consistency will prevail.

BEHAVIOR AND DISCIPLINE

• A daily routine is very helpful for a toddler. A regular bedtime is also important and toddlers still need a nap at least once a day
• Praise your child for good behavior. Parents should show immediate and enthusiastic responses to good behavior, giving more "yes" than "no" messages.
• The best discipline is to use redirection, distraction, gentle restraint, removal of object from toddler, or move the toddler away and help him get interested in something else. Use discipline as a means of teaching and protecting, not as punishing.
• Give your child consistent messages about what's right or wrong and reinforce them.
• Toddlers should never be spanked. Spanking does not usually work and is not a good kind of punishment for a young child.
• Discourage hitting, biting and harmful behavior
• Encourage language development by talking about the things you are doing and seeing together, reading books, repeating words and phrases and singing.
• Temper tantrums are common between 15 and 30 months, and are normal ways for young children to express
frustration. Use time out for tantrums that cannot be ignored and those that are harmful to another person or tear things up
• Remember, toddlers have not learned to share yet and sometimes do not play well with other toddlers
• It is best to wait until your child turns 2 before you begin toilet training

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.

DENTAL CARE

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

SAFETY

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

RECOMMENDATIONS

• Never underestimate the ability of a 15 month old to climb.
• Check for hazards at your toddler's level (stairs, cords, outlets, cabinets, windows)
• Continue using the toddler car seat on every outing in the car. Do not put the child in the front seat if an airbag is present
• Closely supervise your toddler especially near dogs, lawnmowers, driveways, streets and water
• The toddler's environment should be without cigarette smoke, alcohol or drugs
• Use sunscreen and limit exposure to the sun
• Your toddler may be able to tell you now in more obvious ways when they feel sick or something hurts. Watch for fever or changes in appetite, activity level or sleeping habits. Toddlers with ear infections often have fever and cold symptoms and usually don't present just "playing with their ears" as their only symptom.
• Limit your toddler's TV time. It's okay to occasionally watch a TV show designed for young children, but a toddler should watch less than 1 hour of TV a day.
• Remember your car seat and use it at all times, no exceptions.

Next Well Child Visit

The next routine physical examination is at 18 months of life. Please schedule the appointment today. Please review the 18 month physical examination information on our website prior to your visit as well as the immunization information on the vaccines your child may receive.