18 Month Well-Child Visit

• Feeding: Your child should be completely off the bottle by now. She should be eating 3 meals and only 2-3 snacks per day. Use 2% or whole milk until age 2. Do not substitute juice for milk. To prevent the risks of choking, children should eat only when seated. The following foods remain a significant choking hazard: nuts, grapes, hot dogs, hard candy, raw vegetables, gum, and popcorn.
• Elimination: Toddlers are rarely ready to begin the potty training process until they are 24-30 months old. Children are ready to begin when they awake from naps with dry diapers, use words to signal that they have wet or dirty diapers, or when they begin to develop a routine of grunting or straining after a meal. Take advantage of her natural curiosity by explaining the process to her when she follows you into the bathroom. If you have a potty-chair, allow your child to explore it and use it as a chair. At this age it is more of a toy, but getting use to it will ease the process of “potty learning” later on.
• Sleep: This is a common age for bedtime resistance as well as nighttime awakenings. A consistent bedtime routine is very important and use of a transition object can help soothe your child to sleep initially. For nighttime awakenings it is equally important to be consistent. Don’t do anything to reward her for waking in the night – do not feed her, play with her, or bring her to your bed. Go to her bed to make sure she’s alright, and offer words of comfort. Don’t turn on the light, rock her, or walk with her. Rearrange the sheets, cover her with a favorite blanket, and offer verbal reassurance before leaving the room. If she continues to cry, wait five minutes before returning to her room to comfort her. Continue to return briefly every five to ten minutes until she’s asleep.

Development:

• Motor Skills: Children this age generally are able to walk backwards, walk up stairs with a helping hand, squat to pick up toys, help with dressing, and turn single pages of a book.
• Communication/Socialization: Your child is now able to follow simple commands. She has 7-20 words and knows 5-8 body parts. This is an appropriate time to begin teaching the words “please,” “thank you,” and “excuse me.”

Safety: Children this age explore the environment without fear. They are unable to differentiate actions that may be dangerous, and are unable to understand consequences. Close observation at all times is essential to keep your child safe.

• Continue to use a car safety seat. If you have a passenger side airbag, your child needs to remain in the back seat until age 10-12 years.  Children under the age of 2 should remain rear-facing until they reach the maximum height and weight recommended for that model or until their second birthday.
• Never leave your child alone in the car, tub, home, or yard.
• Make certain that the crib mattress is in the lowest position.
• Any guns in the home should be locked up with ammunition kept separately.
• Keep matches, lighters, and cigarettes in a high, latched cabinet. Never allow smoking in your home or car.
• Keep the Poison Control number by your phone (1-800-222-1222).
• Protect any open windows with secure screens or barriers.
• Remember to use gates at the top of all stairs to avoid dangerous falls.

Parenting: Separation anxiety is common. Encourage the use of a favorite toy or blanket for self-comforting. Discipline with love by using firm, consistent rules. Tantrums are common at this stage. Use distraction for unacceptable behavior and always generously praise your child for good behavior.

Play: Reading remains one of the most important activities that you can share with your child. Children this age also enjoy repetitive songs and poems, large puzzles, riding toys, toys that make noise, and sand box or water play. Children are typically engaging in pretend play at this age (i.e. pretending to feed or change a baby doll). Pretend play will become more complex over the next several months and your child may pick up a block or banana and pretend to be answering the phone.

Next visit is at 2 years of age.