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Well Child Visit Handout - 12 Months

TWELVE MONTHS
 
Date of Visit:  ___________
Weight:           ___________
Height:            ___________
HC:                 ___________
 
NORMAL DEVELOPMENT:    
The first year of infancy is over and your child is now a toddler.  Toddlerhood, ages 1-3, is a time when physical growth is slower than during the first year, but development continues at a rapid pace.  The following are characteristics of toddlers 12-15 months, but remember each child grows and develops at his/her own unique pace.
PHYSICAL:
•  Stands alone.
•  Begins walking.
•  Climbs up and down stairs.
•  Climbs into parents’ laps.
•  Lowers to sitting position.
•  Shows a preference for one hand.
•  May undress without assistance.
•  May have 2-8 teeth.
•  Builds tower of 2-3 blocks.
•  Birth weight has tripled.
SOCIAL & EMOTIONAL:
•  Suspicious of strangers and strange places.
•  May have difficulty separating from parents.
•  Developing sense of humor.
•  Shows affection.
•  May become more negative.
•  Remembers events.
•  Imitates behavior of others.
•  Loves an audience and applause.
LANGUAGE:  
•  Says 2-8 words.
•  Listens to new words.
•  Likes to sing and likes repetitive sounds.
•  Jabbers excessively.
 
DIET:
•  The major achievement of walking will probably interfere with the interest in eating as your toddler is experiencing new independence.  Definite likes and dislikes may become apparent and meals may be refused.  One good meal per day with 4-5 foods eaten is typical.
•  Your child should be able to feed him-/herself finger foods.  Participation by parents may cause a negative reaction.
•  AVOID foods that are easily choked on: hot dog rounds, raw carrots, popcorn, peanuts, and hard candies.
•  Encourage the use of a cup and spoon.
•  Continue to wean your child from the bottle.
•  You may now give your child whole milk (not skim or 2%).
•  Fresh citrus fruits and juices and egg whites may now be introduced.
•  Expect messiness—this is how your child learns.
 
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.
•  Don’t start toilet training.  Your baby is too young to toilet train (necessary muscle control is lacking).
 
SAFETY:
•  Use a car safety seat appropriate for toddlers every time your child is in a car.  Place the child safety  
seat in the back seat.  The car seat can now face forward if the child weighs at least 20 lbs.
•  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.
•  Childproof the house of dangling cords, hanging tablecloths, hot irons, curling irons, or space heaters.
•  Cover electrical outlets with safety caps.
•  Place safety gates at the top and bottom of stairs.  Be sure all windows have screens.
•  Install smoke alarms on every floor and change batteries twice a year.
•  Place all heavy or sharp objects out of your baby’s reach.
•  Check electrical cords so your baby cannot pull appliances or lamps over onto him-/herself.
•  Keep cigarettes and hot beverages out of his/her reach.
•  Do not leave your baby alone in the bathtub or near a pool or bucket of water even for a minute.  Children drown even in shallow water.  Even with swimming lessons, your child is never drownproof.
•  Keep your baby away from the stove and turn pot handles away from the edge of the stove.
•  Set the hot water heater thermostat to less than 120 degrees Fahrenheit.  Fence a space heater so your child cannot get to it.
•  Toys should be carefully inspected for small loose parts that might be swallowed or inhaled.  Children under age 4 years should not be given toys with parts smaller than a ping pong ball.
•  Keep household plants out of your baby’s reach—many are poisonous.
•  Do not leave your child alone or with a young sibling.
•  Watch your child carefully when visiting friends and relatives, and keep visitors’ purses out of your toddler’s reach.
 
STIMULATION:
•  Talk and sing to your baby as much as possible so your baby can begin to imitate your speech sounds.
•  Board books with colorful pictures are good choices to read with your baby—it is never too early to read to your child.  
•  Babies at this age love to play “Patty-Cake” and “Peek-a-Boo.”
•  Supply your baby with pots, pans, and wooden spoons for a “kitchen orchestra.”  You baby will love creating and manipulating sounds.
 •  Brightly colored balls of all sizes are fun for your baby to chase, clutch, and roll around.
•  Stacking blocks, rings, and push-pull toys are also fun at this age.
•  Age appropriate busy boxes encourage various kinds of manipulation and aid development of dexterity.
•  Your baby will continue to love huggable dolls and stuffed animals and may want to sleep with one.
•  Colorful, sturdy cars and trucks are also fun.
 
HEALTH MAINTENANCE:
•  IMMUNIZATIONS:  MMR, Varicella, PCV, HEP A (see vaccine information sheets).
•  ACETAMINOPHEN DOSAGE:  Acetaminophen (i.e., Tylenol, Tempra) can be given for fever every 4-6 hours (See Tylenol Dosing Handout).  Tylenol is dosed according to your baby’s weight.
•  A blood sample will be taken to measure your child’s blood lead level for lead poisoning and    to measure hemoglobin to screen for anemia.  Any abnormal results will be discussed (see Lead
Poisoning Handout).
 
ANTICIPATORY GUIDANCE:  (Information credited to Brazelton’s Touchpoints)
 •  Temper Tantrums:  Tantrums can be expected in the second year of life.  The best way to manage these tantrums is to first ignore the behavior while keeping the child safe.  After the tantrum is over, give the child the warm support that he/she needs.
 •  Toilet Training:  It is too soon to train but not to discuss this topic.  Physically and emotionally children are usually ready between 18 months and 2 years of age.
 •  Aggression:  Toddlers may scratch, bite, or hit especially when the exciting world is overloaded with new people and objects.  These initial aggressive behaviors should be limited calmly without too much overt attention given to them.