Fifteen-Month Checkup

Date ______________________________________

A.  MEASUREMENTS                   

Length _________________ in     (         %tile) 

Weight ___________ lb ___ oz    (          %tile) 

Head Size ______________ cm    (         % tile)

B.  IMMUNIZATIONS

Your child will receive the following:                               

Although most infants do fine with these immunizations, some may experience fever or fussiness.  This should subside within 48 hours.  You can give acetaminophen if your child develops a fever.

C.  LABORATORY STUDIES AND PROCEDURES

 No routine tests are performed today.

D.  FEEDING

Your child will be learning to feed herself.  She will use her fingers and perhaps a spoon.  This is important for your child’s development, even though it is messy!  Remember to cut the food into small pieces to prevent choking, and avoid foods that are easy to choke on, such as popcorn, peanuts, hot dogs, chewing gum, and hard candy.  Provide well-balanced meals and allow her to eat what she wants.  Offer three meals and up to two snacks per day.  Remember that constant between-meal snacking or “grazing” is unhealthy.  If you do provide a snack, offer nutritious foods such as cheese, fruit, or vegetables instead of cookies, cereal, or other sugary or salty snacks.  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 need 2% milk, rather than whole or skim milk.    Limit total milk intake to not more than 16 ounces a day.  Your child should already be weaned from the bottle.  Continuing to offer a bottle greatly increases the risk of tooth decay and ear infections.

Toddlers do not grow as quickly during the second year of life, so it is common to see their appetite decrease.  Do not force her to eat if she doesn’t seem hungry. 

E.  DEVELOPMENT AND BEHAVIOR

Toddlers are very curious and enjoy exploring new things.  Keep the environment around your child safe, so that he can satisfy his curiosity.  In addition to toys, your child may enjoy stuffed animals, pots, pans, measuring cups, and empty boxes.  He may also enjoy imitating what you are doing, for example sweeping, vacuuming, or drying dishes.  Reading to your toddler is a very important daily activity.  Children who have books read to them learn more quickly.  Talk to your child often to help his language develop.

Many toddlers start to have temper tantrums around this age.  Attempting to reason with or even punishing your child may worsen the tantrum.  The best approach is to make certain your child is in a safe place, and then ignore the tantrum by not looking directly at him and by not speaking to him.  Giving in to your toddler’s tantrum only teaches him that is the way to get whatever it is he wants.

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.  Your child can now be turned around in the car seat as long as she is at least 20 pounds.  Children are required by law to remain in a car seat until they are 4 years old AND at least 40 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)  PEDESTRIAN SAFETY:  Hold onto your toddler whenever you are around traffic, such as going on walks or in parking lots.  Constantly supervise outdoor play to be certain your child does not wander towards the street.  Do not allow your child to play around or in parked cars.

(3)  CHOKING HAZARDS:  As you transition to more table foods, remember to avoid 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.

(4)  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 you can dial 911.  We no longer recommend the use of Syrup of Ipecac.

(5) FIRES AND BURNS:  Be sure to check smoke detectors monthly.  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 toddler in your arms or at your feet.  Be especially careful to keep hot beverages well out of reach of your child.  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).

(6)  WATER SAFETY:  Never leave your 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.

 (7)  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.

(8)  SUN EXPOSURE:  Avoid direct sun exposure whenever possible.  If your child 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.

(9)  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.  Do not use 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 18 months of age.  Although your child will not likely receive any immunizations at that visit, be sure to bring the immunization record so we can be certain all required vaccines are up to date.

Last modified: Monday February 16, 2015