Please click here to download the 18 month developmental assesment form that you will need to complete and bring with you to your child's appointment.

Nutrition

FEEDINGS

• Your child should be eating three balanced meals a day, but may still require nutritious between-meal snacks.
• Most children have enough teeth for chewing at this age, but caution against choking should continue. Remember, firm or airway sized food should be avoided such as hotdogs, peanuts, hard candy, raw carrots, grapes, popcorn, etc.
• Allow your toddler to eat with his hands and with a utensil, and to drink from a cup. If you haven't already, you must wean your child from the bottle now.
• Milk and dairy products are still required, but should be limited to 16 to 24 ounces per day as they are high in calories.
• Limit sweets and high fat snacks like sodas, kool-aid, candy, chips, etc.

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:

• Understand and follow simple directions or commands
• Sing, jump and dance
• Feed themselves
• Hold a regular cup or glass without help and drink from it without spilling much
• Locate body parts correctly
• Walk without support or help all the way across a large room without falling or wobbling much from side to side.
• Climb stairs
• Communicate with several simple words
• Identify sizes and shapes
• Put simple puzzles together (3 to 4 pieces)
• Help undress himself and put on some clothing

IMPORTANT SOCIAL AND LANGUAGE DEVELOPMENT QUESTIONS

Does your child:

• Use 6-10 words?
• Ever engage in pretend play? i.e. talking on phone, taking care of dolls
• Enjoy playing peak-a-boo or hide and seek?
• Key MCHAT questions-
  • Ever use index finger to point in order to indicate interest in something?
  • Take an interest in other children?
  • Ever bring objects over to you to show you something to share?
  • Does your child imitate you?
  • Does your child respond to their name?
  • If you point at a toy across the room, does your child look at it?

If your have further concerns, please fill out our MCHAT questionnaire and visit our web page on Autism.

Vaccinations

At this visit, your child is scheduled to receive Hepatitis A immunization. Please review the immunization 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.

COLDS

As your infant grows and is exposed to other children (particularly if in daycare), upper respiratory infections may be frequent. Treatment is discussed in our hand-out on "Colds and Congestion".

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

• Continually praise your toddler for good behavior.
• Consistency and structure in your child's day are very important. Decide what limits are important. Be specific when setting these limits and consistently enforce them
• Remember their mental development is ahead of what they can speak. They will get frustrated often because they can't communicate as well as they would like.
• When disciplining your toddler it is important that you speak in a firm, calm tone.
• The best discipline at this age 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.
• Toddlers should never be spanked. Spanking does not usually work and is not a good kind of punishment for a young child.
• Toddlers will sometimes get on your nerves. They are just learning about their world and not necessarily getting on your nerves on purpose.
• A "time-out" period is often effective if your toddler's behavior cannot or should not be ignored. Many times just 15-30 seconds is enough time to reinforce your point but never longer than 2 minutes.
• Encourage language development by talking about the things you are doing and seeing together, reading books, repeating words and phrases and singing
• Talk to your child by giving brief explanations. You will be surprised at how much they understands.
• Let your child practice their skills by giving them plenty of time to romp and play.

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

• Keep the Poison Control Center phone number by the phone
• Re-examine your home to be certain that it is childproofed. Ensure that electrical wires, outlets and appliances are inaccessible or protected
• Keep cigarettes, lighters, matches, alcohol and electrical tools locked up and/or out of sight and reach
• Continue to keep child's environment free of smoke, and keep the car and home nonsmoking areas
• Never leave a toddler alone in the car or in the house. Do not expect young children to supervise a toddler in the house or the yard
• Limit TV and make sure your toddler only watches shows made for his age
• Avoid foods that may cause choking including hard candy, gum, large pieces of meat or hotdogs, nuts, popcorn, raisins and raw vegetables
• Guns in the home are a danger to your family. If a gun is kept at home, the gun and the bullets should be locked up in separate places
• 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.

Next Well Child Visit

The next routine physical examination is at 2 years of life. Please review the 2 year old physical examination information on our website prior to your visit as well as the immunization information on the vaccines your child may receive.