Eighteen-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

Unless we have previously checked your child’s lead level, we will obtain blood by finger stick which we will send off to the state lab for processing.  We usually get results back within three weeks and notify parents only if the levels are elevated.

D.  FEEDING

Your child will prefer to feed himself with his fingers and perhaps a spoon or a fork.  This is important for your child’s development, even though it is messy!  Continue 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.  Do your best to sit down to eat as a family.  Provide well-balanced meals.  Offer three meals and up to two snacks per day.  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.  

Toddlers do not grow as quickly during the second year of life, so it is common to see their appetite decrease.  Do not force him to eat if he doesn’t seem hungry.   Frequently, toddlers enter a “picky” eating phase in which they refuse to try new foods, or decide they no longer like foods they used to enjoy.  They may also go on “jags” of wanting the same food at each meal.  Should your toddler do this, do not feel you must become a short-order cook in an attempt to satisfy your child’s picky behavior.  Simply offer well-balanced meals that include at least one item you think your toddler might eat.  Do not allow mealtime to become a battle.  We will let you know if we have any concerns over your toddler’s growth.

E.  DEVELOPMENT AND BEHAVIOR

Toddlers are learning many new words.  You can help grow your child’s vocabulary by showing and naming lots of things around you both in the home and when you are on errands, such as grocery shopping.  Toddlers are naturally very curious and enjoy exploring new things.  Keep the environment around your child safe, and allow her to satisfy her curiosity.  We cannot over-emphasize the importance of daily reading to your child.

Toddlers often seem out of control, demanding, and stubborn.  They often say “no” and refuse to do what you want.  There are some things you can do to help this situation.  First, child-proof the entire home and put away anything that is valuable, dangerous, or messy.  This will keep you from constantly telling your naturally inquisitive toddler “no.”  If your toddler is playing with something you don’t want her to have, replace the item with an object or toy she enjoys.  Give your child attention when she is behaving well and playing nicely to reinforce that behavior.  Discipline consistently.  If your child breaks a rule, do not give a warning, but rather place her in time-out for one minute per year of age.  In general, ignore unwanted behavior since even negative attention can increase a behavior.

F.  SLEEP

Keep a regular bedtime routine and bedtime hour.  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.

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.  For more information, visit http://www.buckleupnc.org/.  Children are required by law to remain in a car seat until they are 4 years old AND at least 40 pounds.  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:  Stay away from 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

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The next checkup is at 2 years 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