Well Child Care at 18 Months

Nutrition

Offer small portions of foods from all food groups at most meals. Cut food into small pieces and serve small amounts. Your child should use a spoon and drink from an open-rimmed cup (not a sippy cup). Your child should now be completely off a bottle.

Let your baby feed herself. Don't make mealtime a battle by insisting that your child eat everything on her plate.

Family meals are important for your baby. Let her eat with you. This helps your child learn that eating is a time to be together and talk with others. Don’t have the TV on during family meals.

Development

Children at this age are learning many new words. You can help your child's vocabulary grow by showing and naming lots of things. Your child will look where you point and then look back at you. She will try to get your attention when she wants to point something out to you. Your child will show many different feelings, such as pleasure, anger, affection, and assertiveness. She will be curious and enjoy pretend play. Praise your child for doing things that you like.

Reading and Technology

Talking, playing, singing, and reading books help your child to develop. Your toddler has a short attention span, so stories should always be short and simple and have lots of pictures. Big brightly colored books about kids or animals doing familiar things are best. Books about eating, playing, bedtime, baths, or pets are good choices.

Limit how much time your child spends with technology. Play games, read, or watch TV with your child and communicate with your child while you do. Children this age need to be active because it helps their brains and bodies to develop. Play and interact with your child, and be a role model by limiting your own use of technology.

Toilet Training

At 18 months, most toddlers are not yet showing signs that they are ready for toilet training. When your child tells you that she has wet or soiled diapers, it’s a sign that your child prefers to be dry.

Toddlers are naturally curious about the use of the bathroom by other people. Let your child watch you or other family members use the toilet.

Behavior Control

Toddlers sometimes seem out of control, stubborn, or demanding. At this age, children often say "no." A gentle but firm, consistent response is a good way to handle a stubborn toddler.

Here are some good ways to help your child learn about rules:

• Be warm and positive. Children like to please their parents. Give lots of praise and be enthusiastic.
• If your child is playing with something you don't want her to have, replace it with another object or toy that she enjoys. This approach avoids a fight and does not give your child a chance to say "no."
• Make simple rules and let your child know what will happen if she breaks a rule. Make consequences logical. For example, “If you don't stay in your car seat, the car doesn't go,” or “If you throw your toys, I will put them away.” When your child breaks a rule, follow through each time and do what you have said you would do. Your child will learn to trust that you mean what you say.
• Most toddlers at this age are not yet ready for time-outs. You can start time-outs when your child is about 2 years old. However, you may need to start earlier if your child has serious misbehavior, like hitting. Talk with your healthcare provider about this.

Dental Care

It’s important to take care of your child’s baby teeth because they help your child chew food and speak clearly. They also help save space for the permanent teeth that will come in later. You can help care for your child’s teeth by following these tips:

• Avoid sugary foods and limit juice to help prevent cavities. One cup of juice a day is enough.
• Brush your child’s teeth with water twice a day. Use a child-size toothbrush with soft bristles. Once your child learns how to spit out toothpaste, you can start using fluoride toothpaste.
• Start flossing your child’s teeth after all baby teeth are in.
• Talk with your healthcare provider or dentist if your child still sucks a finger or pacifier or still uses a sippy cup. These habits can cause dental problems.

Your child should see a dentist every 6 months or as often as the dentist recommends.

Safety Tips

Child-Proofing Your Home

• Go through every room in your house and remove valuables or anything that is dangerous for a child. Preventive child-proofing will stop many possible accidents, injuries, and discipline problems. Don't expect your child not to get into things just because you say no.
• Install safety gates to guard stairways.
• Lock doors that lead to dangerous areas like the basement or garage.
• Check drawers, tall furniture, and lamps to make sure they cannot fall over easily.
• Put safety latches on cabinets.
• Cover unused electrical outlets with outlet covers to keep your child from sticking things into the outlet.
• Keep cords out of reach, especially for coffee makers, irons, or other hot devices.
• Throw away cracked or frayed electrical cords.
• Keep all electrical devices in the bathroom unplugged and put away.
• It is recommended that you remove guns from the home. If you have a gun, store it unloaded and locked. Store the ammunition in a separate place that is also locked.

Choking and Suffocation

• Keep plastic bags, balloons, and small hard objects out of reach.
• Store toys on shelves or in a chest without a dropping lid. Small children can get trapped inside a toy chest.

Falls

• Make sure windows are closed or have screens that cannot be pushed out. Install window guards on windows above the first floor unless this is against your local fire codes.
• Don’t place furniture near windows or on balconies. Don't underestimate your child's ability to climb.
• Always buckle the safety belts or straps when your baby is in an infant carrier or shopping cart.

Car Safety

• Use an approved toddler car seat in the back seat with your child facing toward the back of the car.
• Never leave children alone in a parked car, even for a few minutes. Children are at risk for heat illness and injury when left alone. Always check to make sure your child is not still in the car when you leave your car.
• Always wear a seat belt yourself, and make a rule that the car doesn’t start moving until everyone is safely buckled in.

Traffic Safety

• Hold onto your child when you are near traffic.
• Provide a play area where balls and riding toys cannot roll into the street.
• Make sure an adult is watching your child during play outdoors.

Water Safety

• NEVER leave your toddler in a bathtub alone.
• Stay within arm’s reach of your child around any water, including toilets and buckets. Keep toilet lids down, never leave water in an unattended bucket, and store buckets upside down. Infants and toddlers who have completed swimming programs are still not safe from drowning.

Poisoning

• Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away. Dispose of them safely.
• Buy medicines in containers with safety caps.
• Do not store poisons in drink bottles, glasses, or jars or anywhere children can reach them.
• Put the poison center number on all phones.

Fires and Burns

• Keep matches and lighters out of reach.
• Keep hot foods and liquids out of reach.
• Use the back burners on the stove with the pan handles out of reach. Do not allow children to play on the kitchen floor while you are cooking or baking.
• Turn your water heater down to 120°F (49°C) or lower.
• Install smoke detectors. Check your smoke detectors as often as recommended by the manufacturer or at least once a month to make sure they work. For all detectors that use batteries, replace batteries at least once a year or when they are low.
• Keep a fire extinguisher in or near the kitchen.

Smoking

• Children who live in a house where someone smokes have more respiratory infections, like colds, flu, and throat infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
• If you smoke, set a quit date and stop. Ask your healthcare provider for help in quitting. If you cannot quit, do NOT smoke in the house, car, or near children. It helps keep your child healthy and sets a good example.

Immunizations

Immunizations protect your child against several serious, life-threatening diseases. At the 18-month visit, your child may need vaccines to catch-up for previously missed shots. Ask your healthcare provider what symptoms or problems you should watch for after your child gets a shot and what to do if your child has them.

Bring your child's shot record to all visits with your child’s healthcare provider.

Next Visit

Your child's next visit should be at the age of 2 years.