Well-Child Checkup: 18 Months
At the 18-month checkup, the healthcare provider will examine the child and ask how it’s going at home. This sheet describes some of what you can expect.
When backing up your car, always be sure you know exactly where your child is and that she is safe.
Development and Milestones
The healthcare provider will ask questions about your child. And he or she will observe your toddler to get an idea of the child’s development. By this visit, your child is likely doing some of the following:
Talking, with up to 10-20 words (it's okay if your child is just starting to talk)
Using a spoon or fork
Letting you know his or her needs
Following 2-step commands (such as “go into the bedroom and bring me a toy”)
Running and climbing
Stacking or lining up toys or other items
Becoming more stubborn (for example, crying for no apparent reason, getting angry, or acting out)
Feeding Tips
You may have noticed your child becoming pickier about food. This is normal. How much your child eats at one meal or in one day is less important than the pattern over a few days or weeks. It’s also normal for a child of this age to thin out and look leaner, as long as he or she isn’t losing weight. If you have concerns about your child’s weight or eating habits, bring these up with the healthcare provider. Here are some tips for feeding your child:
Keep serving a variety of finger foods at meals. Be persistent with offering new foods. It often takes several tries before a child starts to like a new taste.
If your child is hungry between meals, offer healthy foods. Cut-up vegetables and fruit, cheese, peanut butter, and crackers are good choices. Save snack foods such as chips or cookies for a special treat.
Your child may prefer to eat small amounts often throughout the day instead of sitting down for a full meal. This is normal.
Don’t force your child to eat. A child of this age will eat when hungry. He or she will likely eat more some days than others.
Your child should drink about 15-20 ounces of whole milk per day. Drinking more milk than this can be unhealthy. Milk should not take the place of a meal.
Besides milk, water is best. Fruit juice should be limited to 4-6 ounces of 100% juice per day. Don’t give your toddler soda.
Don’t let your child walk around with food. This is a choking risk and can lead to overeating as the child gets older.
Hygiene Tips
Brush your child’s teeth at least once a day. Twice a day is ideal (such as after breakfast and before bed). Use water and a baby’s toothbrush with soft bristles.
Ask the healthcare provider when your child should have his or her first dental visit.
Sleeping Tips
By 18 months, your child may be down to 1 nap and is likely sleeping about 10-12 hours at night. If he or she sleeps more or less than this but seems healthy, it’s not a concern. To help your child sleep:
Make sure your child gets enough activity during the day. Remember, an active child is a tired child! Talk to the healthcare provider if you need ideas for active types of play.
Follow a bedtime routine each night, such as brushing teeth followed by reading a book. Try to stick to the same bedtime each night.
Do not put your child to bed with any drink other than water.
Be aware that your child no longer needs nighttime feedings. If the child wakes during the night, it’s okay to let him or her cry for a while.
If getting your child to sleep through the night is a problem, ask the healthcare provider for tips.
Safety Tips
Don’t let your child play outdoors without supervision. Teach caution around cars. Your child should always hold an adult’s hand when crossing the street or in a parking lot.
Protect your toddler from falls with sturdy screens on windows and gates at the tops and bottoms of staircases. Supervise the child on the stairs.
If you have a swimming pool, it should be fenced. Gates or doors leading to the pool should be closed and locked.
At this age children are very curious, and are likely to get into items that can be dangerous. Keep latches on cabinets and make sure products like cleansers and medications are out of reach.
Watch out for items that are small enough to choke on. As a rule, an item small enough to fit inside a toilet paper tube can cause a child to choke.
In the car, always put the child in a car seat in the back seat. It’s safest to face backward until age 2. Ask the healthcare provider if you have questions.
Teach your child to be gentle and cautious with dogs, cats, and other animals. Always supervise the child around animals, even familiar family pets.
Keep this Poison Control phone number in an easy-to-see place, such as on the refrigerator: 800-222-1222.
Vaccinations
Based on recommendations from the American Association of Pediatrics, at this visit your child may receive the following vaccinations:
Diphtheria, tetanus, and pertussis
Hepatitis B
Influenza (flu)
Measles, mumps, and rubella
Polio
Varicella (chickenpox)
Get Ready for the “Terrible Twos”
You’ve probably heard stories about the “terrible twos.” Many children become fussier and harder to handle at around age 2. In fact, you may have started to notice behavior changes already. Here’s some of what you can expect, and tips for coping:
Your child will become more independent and more stubborn. It’s common to test limits, to see just how much he or she can get away with. You may hear the word “no” a lot— even when the child seems to mean yes! Be clear and consistent. Keep in mind that you’re the parent, and you make the rules.
This is an age when children often don’t have the words to ask for what they want. Instead, they may respond with frustration. Your child may whine, cry, scream, kick, bite, or hit. Depending on the child’s personality, tantrums may be rare or frequent. Tantrums happen less as children learn how to express themselves with words. And most tantrums last only a few minutes. (If your child’s tantrums last much longer than this, talk to the healthcare provider.)
Do your best to ignore a tantrum. Make sure the child is in a safe place and keep an eye on him or her, but don’t interact until the tantrum is over. This teaches the child that throwing a tantrum is not the way to get attention.
Keep your cool and avoid getting angry. Remember, you’re the adult. Set a good example of how to behave when frustrated. Never hit or yell at your child during or after a tantrum.
When you want your child to stop what he or she is doing, try distracting him or her with a new activity or object. You could also pick up the child and move him or her to another place.
Choose your battles. Not everything is worth a fight. An issue is most important if the child’s or someone else’s health or safety is at risk.
Talk to the healthcare provider for other tips on dealing with your child’s behavior.
Next checkup at: _______________________________
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