Well Child Visits
18 Month Visit
At this visit, your doctor will …
- Check baby’s weight, length and head circumference.
- Do a physical exam with your baby undressed while you are present.
- Discuss baby’s development.
- Address any concerns/questions you may have.
- Immunizations: 6 Month scheduled vaccines ( see Immunization Schedule)(consider giving baby Tylenol just before this check up – see Medication Dosing Chart)
- Continue giving your child cow’s milk rather than low fat or skim milk for the first 2 years.
- Serve iron-fortified cereal and iron-rich foods, including meat, poultry, well-cooked leafy greens, and beans.
- Offer your toddler 3 meals and 2-3 nutritious snacks a day.
- Growth slows down in the second year of life so don’t be surprised if your child’s appetite has decreased.
- Your child can drink from a cup and may be able to use a spoon but probably prefers to eat with his/her fingers.
- Serve juice in a cup and limit it to no more than 4 ounces (120 ml) a day.
- Avoid foods that are high in sugar and fat and low in nutrients including sugary drinks like soda.
- Avoid small, hard foods that can cause choking: nuts, popcorn, hot dogs, grapes, and raw veggies.
- As you introduce more foods and whole milk, the appearance and frequency of your child’s poopy diapers may change. Let your doctor know if your child has diarrhea, is constipated, or has poop that’s hard to pass.
- There’s a wide range of normal, but generally toddlers need about 12 to 14 hours of sleep a day, including one or two daytime naps. By 18 months, most toddlers will give up the morning nap.
- Make the hour before bedtime calm and comforting.
- Have a bedtime routine which involves reading, singing or both.
- Choose a bedtime for your child and stick to it. Earlier is better.
- Try to put your child to sleep while drowsy, but still awake.
- If your child wakes up at night, reassure, and give blanket or toy to hold. Keep interaction brief.
Routine Baby Care
- Keep Daily routines for baby; Continue feeding, sleeping, bathing and playing routines.
- Watch over baby as he/she explores inside and outside of the home.
- Create time for you and your family to be together.
- Keep outings with your toddler brief – 1 hour or less.
- Teach your child not to hit, bite or hurt other people or pets.
- Continue to brush your child’s teeth twice a day after breakfast and before bed with a soft toothbrush. Use a small smear of fluoride toothpaste (the size of a grain of rice) and water.
- Any concerns or problems with teeth should be examined by a dentist, but regular teeth cleanings are typically recommended at 3 years of age. Some dentists will schedule an exam (without cleaning) between 18 months – 2 years.
Tips for mom
Take care of yourself:
- Consider joining or starting a toddler playgroup.
- If you have more than one child, spend time with each.
- Make sure you are taking care of yourself.
- Always as us if you need help finding resources for your family.
- Toddlers learn best by interacting with you and other people.
- Show your child how to use words:
- Use words to describe your child’s feelings.
- Describe your child’s gestures with words.
- Use clear, simple phrases to talk to your child.
- When reading, use simple words to talk about pictures.
- Allow your child to choose between 2 good options. For example, he/she could choose which book to read or which fruit to have at snack time).
- Your child may be independent or clingy as they learn to navigate new situations. This is normal. Be patient.
- Play with and read to your child often.
- Play interactive games such as peekaboo and patty cake. Name baby’s features as you touch them (Ex. hand, nose, ears, mouth, etc).
- Limit screen time for your toddler (TV, videos, computers, phones). Less than one hour a day is best. Find quality programming to watch with your child.
By 18 months, it’s common for many babies to:
- Say 10-20 words
- point to some body parts
- walk up stairs with hand held
- throw a ball
- help with dressing and undressing
- scribble with a crayon
- engage in pretend play
* All babies develop at different rates, and meet developmental milestones differently.
Most children do better with toilet training when they’re a little bit older, usually between 2 and 3 years.
- Signs that your toddler is ready to begin toilet/potty training are:
- Dry diaper for 2 hours.
- Knows if he/she is wet or dry.
- Can pull pants down and up.
- Wants to learn.
- Can tell you if he/she is going to have a bowel movement.
Behavior and Discipline
- Keep rules for your child short and simple.
- Be consistent
- Do not expect your toddler to share.
- Use short time-outs for poor behavior, and tell your child what he/she did wrong.
- Help your toddler when he/she needs it.
- Tell your child he/she is doing a good job.
- Set limits and use discipline to teach and protect your child, not punish.
- Be patient with messy eating and play…your child is learning!
- Visit healthychildren.org for complete car seat guidelines provided by the American Academy of Pediatrics (AAP).
- Make sure car seat is installed correctly (the Fire Department will check car seats for correct installation)
- Make sure seat is rear-facing in the back seat, and never in the front seat with a passenger side airbag
- Never leave baby alone in the car
- Always wear a seat belt, and do not drive under the influence of alcohol or drugs
- Always use a car safety seat properly. Place the seat rear-facing in the back seat until your child is 2 years of
age or until he/she reaches the highest weight or height allowed by the car safety seat’s manufacturer. Never place the car safety seat in the front seat with a passenger airbag.
Child Safety Seat Inspection:
1-866-SEATCHECK (732-2432) or www.seatcheck.org
- Do not smoke/vape or allow others to smoke/vape around baby.
- Make sure places your child stays are safe.
- Do not leave baby unattended
- Never leave a baby alone with siblings or pets, in the bath, on a changing table, or any other raised surface.
- Keep small objects such as balloons, bags, toys from other children away from baby.
- Keep up with childproofing:
- Place gates on stairs, and close doors to rooms where your child might get hurt
- Lock up all cleaning cleaning supplies, medicine, and poisons. Call Poison Help if your baby eats them.
- To prevent drowning, close bathroom doors, keep toilet seats down, and always supervise around
water (including baths). Make sure to empty tubs, sinks and pools of water immediately.
- Don’t leave hot irons or hair care appliances plugged in.
- Lock away knives and scissors.
- Keep small objects such as balloons, bags, toys from other children away from your child.
- Watch child closely on stairs, and in any room where he/she may get hurt.
- Make sure places your child stays and plays are safe.
When to Call
- Fever: Rectal temperature below 96.8º or above 100.4º
- If you suspect baby is not acting normal for any reason
- Always follow the advice of your doctor when giving any medication.
- Use our Medication Dosing Chart as a guideline for the appropriate dose of Tylenol (acetaminophen) or Advil/Motrin (ibuprofen) to give baby.