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Well Child Visit Handout - 18 Months

 EIGHTEEN MONTHS
 
Date of Visit:  ___________
Weight:           ___________
Height:            ___________
HC:                 ___________
 
 
NORMAL DEVELOPMENT:  Your toddler . . .    
 
•  Runs stiffly.
•  Walks up stairs with one hand held.
•  Points to body parts.
•  Names a few objects.
•  Lowers to sitting position.
•  Seats him-/herself in small chairs.
•  Scribbles with crayons.
•  Pushes and pulls large objects.
•  Takes off shoes, socks, hats, and mittens.
•  Has occasional temper tantrums as frustration level is low
•  Wants to do things him-/herself.  Help by giving him/her a choice of two things such as, “Do you want to wear the red or blue shirt?” and not “What shirt do you want to wear?”
•  Says, “NO!” all the time, even if he/she does not mean it.
•  Wants to do things him-/herself, i.e. dress, eat, bathe—let him/her do what he/she is able do to with assistance and supervision.
•  May still need reassurance when you leave him/her even though he/she “understands” you will be back.
•  Learns by exploring—looking, touching, tasting, smelling, and listening.
 
DIET:
•  Your toddler will be using a spoon (and his/her fingers) to feed him-/herself.  You may try introducing a fork.
•  Table foods and finger foods are good at this age.  Many toddlers are picky eaters.
•  AVOID foods that are easily choked on: hot dog rounds, whole grapes, raw carrot sticks, popcorn, peanuts, and hard candies.
•  Should be weaned from bottle to cup.
 
HYGIENE:
•  Teeth may be cleaned with a soft child’s toothbrush and tooth and gum cleaner without fluoride.  A child’s fluoride toothpaste can be introduced at two years of age.
•  Use a mild soap for bathing such as Dove or Caress.
•  Daily toilet training is probably the best recommendation (see Handout).
 
SAFETY:
•  Use a car safety seat appropriate for toddlers every time your child is in a car.  Place the child safety seat in the backseat.
•  Move your child into a bed when he/she is tall enough to climb out of the crib (when his/her nipple line is even to the crib rail).
•  Install smoke alarms on every floor and change batteries twice a year.
•  Supervise all water activities constantly.
•  Start teaching street safety.  Never let your child go in the street unless holding hands with an adult.
•  Never leave your toddler alone in the car or in the house.
•  Do not expect young children to supervise your toddler at home or on the playground.
•  Keep all poisons, medicines, cleaners, vitamins, and iron supplements out of reach and with childproof caps where possible.  Keep the POISON CONTROL CENTER phone number handy (1-800-222-1222).  If your child ingests something harmful, call the Poison Control Center immediately.
 
STIMULATION:
•  Children at this age love music of all kinds.  Make a few songs part of his/her bedtime routine and when your child is fidgety in his/her car seat.  Singing helps hold a child’s attention and enhances his/her developing vocabulary.
•  Toddlers begin to enjoy “parallel play”—playing alongside, but not necessarily with, other children.  
•  The playground, sandbox, and baby wading pools are favorite places to play with supervision.
•  Limit television watching.
•  Read aloud to your child!
•  Riding toys (foot-powered), wagons, blocks, cars, rocking horses, sand toys, water toys, balls, doll carriages, and stuffed animals.
 
HEALTH MAINTENANCE:
•  IMMUNIZATIONS:  HEP A and Varicella.
 
ANTICIPATORY GUIDANCE:  (Information credited to Brazelton’s Touchpoints)
•  Temper tantrums:  If you have not experienced these yet, they are likely to happen in the near future.  It is important to keep your child safe but try to maintain consistency in your approach.  Try to ignore the behavior but provide warmth and care after the tantrum is over.
•  Safety:  Toddlers do not have internal controls to stop themselves from taking extreme risks.  He/she is also beginning to learn standards for his/her behavior.  It is important to be vigilant in guiding your toddler as he/she negotiates stairways, climbs out of cribs, and darts away as he/she walks down
the street.
•  Childhood:  The child and parents are experiencing the dramatic transition from infancy to childhood.  The willfulness, negativity, and fluctuations between dependence and independence can create difficult situations.  However, the development of the child’s sense of self, social understanding,
ability to use language, and more sophisticated play can be anticipated as outcomes of successful parenting.
•  Toilet training:  You can now look for and support signs of readiness for toilet training.  The beginning steps can include talking about what wet and dry mean and focusing on the ability to undress and dress in preparation for toileting.  It is appropriate to purchase a potty seat at this time.