Twelve-Month Checkup

Date ______________________________________

A.  MEASUREMENTS                   

Length _________________ in     (         %tile) 

Weight ___________ lb ___ oz    (          %tile) 

Head Size ______________ cm    (         % tile)

B.  IMMUNIZATIONS

Your child will receive the following:                       

About one-third of children receiving the MMR will develop a fever and a rash about 8-12 days after the vaccine.  Usually children act fine otherwise, and the symptoms subside within a few days.  This constitutes an expected side effect and not a true allergic reaction. 

C.  LABORATORY STUDIES AND PROCEDURES

A finger prick Complete Blood Count (CBC) will be performed to check for anemia, unless your child has already had a recent blood test during an illness. We will also ask questions to determine whether your child is at risk for lead poisoning, and if needed, we will obtain blood by finger stick (along with the CBC) which we will send off to the state lab for processing.  We usually get results back within four weeks and notify parents only if the levels are elevated.

If your child has risk factors for exposure to tuberculosis, we will place a test on her arm called an IPPD which we will need to read in 48 to 72 hours.  Should there be swelling beyond a certain amount we will need to perform further testing. 

D.  FEEDING

Now is the time to switch your baby to 2% milk.  Toddlers need 2% milk, rather than whole or skim milk.    Limit total milk intake to not more than 16 ounces a day.  Within the next month, you should wean your baby off the bottle.  One way to do this is to offer milk or juice in a cup, and only provide a small amount of water in the bottle.  Most babies will choose the cup over the bottle when given this choice.  Within a few weeks you can completely remove the bottle without much difficulty.

Switch from baby foods to table foods.  Continue to avoid larger pieces of foods, such as whole grapes, raw carrots or apples, or pieces of meat, which produce a choking hazard.  While some fish is part of a healthy diet, certain fish (shark, swordfish, king mackerel and tilefish) contain high levels of mercury, and should be avoided.  Offer three meals and up to two snacks per day.  Remember that constant between-meal snacking or “grazing” is unhealthy.  Juice, even when watered down, is very hard on the enamel of the teeth, and should only be offered once or twice a day. 

Toddlers do not grow as quickly during the second year of life, so your child may eat less.  Do not force him to eat since this will likely cause your child to refuse certain foods.  Trust his appetite.

E.  DEVELOPMENT AND BEHAVIOR

Different rates of development become more apparent by this age.  Some one-year-olds have learned to walk already while others continue to crawl.  Most understand and use words like “mama” and “dada.”  Help your child to learn words by pointing out objects as you say their name.  Allow your child to touch and manipulate objects when possible.  Reading to your toddler is a very important daily activity.  Children who have books read to them learn more quickly.  

At this age, toddlers learn the meaning of  “no.”  When your child breaks a rule, calmly tell her “no” and take away the item or remove her from the situation.  But remember that toddlers learn by exploring and interacting with their environment.  Do your best to keep the environment safe and remove breakables, so that you do not have to repeatedly tell her “no.”

Visit http://www.aap.org/family/2004PAFBrochure.pdf for a downloadable developmental checklist that covers ages three through fifteen months.

F.  SLEEP

Keep a regular bedtime routine and bedtime hour.  A security blanket or stuffed animal may help your toddler feel secure at bedtime.  If your child wakes up frequently at night, please ask us for advice.

G.  GENERAL INFORMATION AND SUGGESTIONS

(1) DENTAL CARE:  Clean your child’s teeth twice a day.  You may use a smear of fluoridated toothpaste when brushing.  Do not permit grazing or constant sipping of beverages and do not allow your toddler to take a cup to bed.  We are pleased to offer an optional Fluoride Varnishing Program to further protect your child’s teeth.

(2) VITAMINS, IRON, AND FLUORIDE: A supplemental vitamin such as Poly-Vi-Sol is now recommended.  Once a child is two years of age or older, he or she may take a chewable vitamin with close adult supervision.   We may recommend fluoride if you have a well water supply with little or no natural fluoride.

(3)  SHOES: The main purpose of shoes is to provide protection for your child’s feet while he is outside.  Hard soled shoes will not help him walk any better.  Inside the home it is perfectly fine for him to simply wear socks or go barefoot.  Do not fit your child with corrective shoes, except on the advice of an orthopedic surgeon.

H.   SAFETY TIPS

(1)  CAR SEAT SAFETY:  Motor vehicle accidents are the leading cause of death and serious injury after the first month of life.  Infants are required by law to remain in a rear-facing car seat in the back seat of a vehicle until they are BOTH one year of age AND at least 20 pounds.  For more information, visit http://www.buckleupnc.org/.  Carefully follow the manufacturer's recommendations to be certain the seat is properly installed in your vehicle. Remember, NEVER seat children in the front seat of cars with or without a passenger-side air bag.  For more information, call the National Highway Traffic Safety Administration at 1-800-424-9393, or visit their web site at http://www.nhtsa.dot.gov/. 

(2)  CHOKING HAZARDS:  As you transition to more table foods, remember not to give your child certain foods which may cause choking, such as hard candy, hot dogs, popcorn, and peanuts.  Cut foods into small pieces.  Do not allow your child to play with balloons or plastic bags.

(3) FIRES AND BURNS:  Be sure to check smoke detectors regularly.  Develop and practice a fire escape plan.  Place safety plugs in electrical outlets.  Keep hot appliances and cords out of reach, especially curling irons.  Keep all electrical appliances out of the bathroom to avoid electrical shock.  Do not cook with your baby in your arms or at your feet.  Get in the practice of using the back burners and keeping the pan handles turned inwards.  Turn your hot water heater down to 120 degrees F (50 C). 

(4)  WATER SAFETY:  Never leave an infant or toddler alone in a bathtub, even for a moment.  Supervise your child continuously around any kind of water, including toilets, buckets, wading pools, and even water standing in low-lying areas in the yard.

(5)  FALLS:  Keep windows closed or have screens that cannot be pushed out.  Restrict your toddler’s access to steps.  Do not underestimate your child’s ability to climb.

(6)  POISON PREVENTION:  Keep ALL medications, vitamins, cleaning solutions, and chemicals in locked cabinets.  High shelves are not good enough.  Should your child get into something you believe is poisonous, call the Poison Control Center immediately.  Their number is on the inside cover of your phone book or dial 911.  We no longer recommend the use of Syrup of Ipecac.

(7)  SUN EXPOSURE:  Avoid direct sun exposure whenever possible.  If your baby will be outside in direct sunlight for more than fifteen minutes, apply a sunscreen with SPF of 30 or higher thirty minutes before going outside.   If you visit the beach, avoid sun exposure in the hottest part of the day, from 11am to 3 pm, and remember to fit your child with sunglasses that block UV rays.

(8)  INSECT REPELLANTS:  During the time of year when mosquito bites are common, the AAP recommends that you protect your child with products that have 30% DEET as the active ingredient.  Other repellants simply do not work consistently or for long.  Avoid products that contain both sunscreen and repellant.  Apply the repellant with 30% DEET to exposed areas of skin, but avoid the nose, mouth, and eyes.  Wash the repellant off when you bring your child back inside.

For additional safety tips, visit http://www.aap.org/healthtopics/safety.cfm

* * * * * * * * *** * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

The next checkup is at 15 months of age.  Your child will be receiving more immunizations at that visit.

Last modified: Monday February 16, 2015