Well Child Care, 12 Months

PHYSICAL DEVELOPMENT

At the age of 12 months, children should be able to sit without assistance, pull themselves to a stand, creep on hands and knees, cruise around the furniture, and take a few steps alone. Children should be able to bang 2 blocks together, feed themselves with their fingers, and drink from a cup. At this age, they should have a precise pincer grasp.

EMOTIONAL DEVELOPMENT

At 12 months, children should be able to indicate needs by gestures. They may become anxious or cry when parents leave or when they are around strangers. Children at this age prefer their parents over all other caregivers.

SOCIAL DEVELOPMENT

  • Your child may imitate others and wave "bye-bye" and play peek-a-boo.

  • Your child should begin to test parental responses to actions (such as throwing food when eating).

  • Discipline your child's bad behavior with "time-outs" and praise your child's good behavior.

MENTAL DEVELOPMENT

At 12 months, your child should be able to imitate sounds and say "mama" and "dada" and often a few other words. Your child should be able to find a hidden object and respond to a parent who says no.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (The third dose of a 3-dose series should be obtained at age 6–18 months. The third dose should be obtained no earlier than age 24 weeks and at least 16 weeks after the first dose and 8 weeks after the second dose. A fourth dose is recommended when a combination vaccine is received after the birth dose. If needed, the fourth dose should be obtained no earlier than age 24 weeks.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Doses only obtained if needed to catch up on missed doses in the past.)

  • Haemophilus influenzae type b (Hib) booster. (One booster dose should be obtained at age 12–15 months. Children who have certain high-risk conditions or have missed doses of Hib vaccine in the past should obtain the Hib vaccine.)

  • Pneumococcal conjugate (PCV13) vaccine. (The fourth dose of a 4-dose series should be obtained at age 12–15 months. The fourth dose should be obtained no earlier than 8 weeks after the third dose.)

  • Inactivated poliovirus vaccine. (The third dose of a 4-dose series should be obtained at age 6–18 months.)

  • Influenza vaccine. (Starting at age 6 months, all children should obtain influenza vaccine every year. Infants and children between the ages of 6 months and 8 years who are receiving influenza vaccine for the first time should receive a second dose at least 4 weeks after the first dose. Thereafter, only a single annual dose is recommended.)

  • Measles, mumps, and rubella (MMR) vaccine. (The first dose of a 2-dose series should be obtained at age 12–15 months.)

  • Varicella vaccine. (The first dose of a 2-dose series should be obtained at age 12–15 months.)

  • Hepatitis A virus vaccine. (The first dose of a 2-dose series should be obtained at age 12–23 months. The second dose of the 2-dose series should be obtained 6–18 months after the first dose.)

  • Meningococcal conjugate vaccine. (Children who have certain high-risk conditions, are present during an outbreak, or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

TESTING

The caregiver should screen for anemia by checking hemoglobin or hematocrit levels. Lead testing and tuberculosis (TB) testing may be performed, based upon individual risk factors.

NUTRITION AND ORAL HEALTH

  • Breastfed children can continue breastfeeding.

  • Children may stop using infant formula and begin drinking whole-fat milk at 12 months. Daily milk intake should be about 2–3 cups (700–950 mL).

  • Provide all beverages in a cup and not a bottle to prevent tooth decay.

  • Limit juice to 4–6 ounces (120–180 mL) each day of juice that contains vitamin C and encourage your child to drink water.

  • Provide a balanced diet, and encourage your child to eat vegetables and fruits.

  • Provide 3 small meals and 2–3 nutritious snacks each day.

  • Cut all objects into small pieces to minimize the risk of choking.

  • Make sure that your child avoids foods high in fat, salt, or sugar. Transition your child to the family diet and away from baby foods.

  • Provide a high chair at table level and engage the child in social interaction at meal time.

  • Do not force your child to eat or to finish everything on the plate.

  • Avoid giving your child nuts, hard candies, popcorn, and chewing gum because these are choking hazards.

  • Allow your child to feed himself or herself with a cup and a spoon.

  • Your child's teeth should be brushed after meals and before bedtime.

  • Take your child to a dentist to discuss oral health.

  • Give fluoride supplements as directed by your child's health care provider.

  • Allow fluoride varnish applications to your child's teeth as directed by your child's health care provider.

DEVELOPMENT

  • Read books to your child daily and encourage your child to point to objects when they are named.

  • Choose books with interesting pictures, colors, and textures.

  • Recite nursery rhymes and sing songs to your child.

  • Name objects consistently and describe what you are doing while your child is bathing, eating, dressing, and playing.

  • Use imaginative play with dolls, blocks, or common household objects.

  • Children generally are not developmentally ready for toilet training until 18–24 months.

  • Most children still take 2 naps each day. Establish a routine at naps and bedtime.

  • Your child should sleep in his or her own bed.

PARENTING TIPS

  • Spend some one-on-one time with each child daily.

  • Recognize that your child has limited ability to understand consequences at this age. Set consistent limits.

  • Minimize television time to 1 hour each day. Children at this age need active play and social interaction.

SAFETY

  • Make sure that your home is a safe environment for your child. Keep home water heater set at 120° F (49° C).

  • Secure any furniture that may tip over if climbed on.

  • Avoid dangling electrical cords, window blind cords, or phone cords.

  • Provide a tobacco-free and drug-free environment for your child.

  • Use fences with self-latching gates around pools.

  • Never shake a child.

  • To decrease the risk of your child choking, make sure all of your child's toys are larger than your child's mouth.

  • Make sure all of your child's toys are nontoxic.

  • Small children can drown in a small amount of water. Never leave your child unattended in water.

  • Keep small objects, toys with loops, strings, and cords away from your child.

  • Keep night lights away from curtains and bedding to decrease fire risk.

  • Never tie a pacifier around your child's hand or neck.

  • The pacifier shield (the plastic piece between the ring and nipple) should be at least 1½ inches (3.8 cm) wide to prevent choking.

  • Check all of your child's toys for sharp edges and loose parts that could be swallowed or choked on.

  • Your child should always be restrained in an appropriate child safety seat in the middle of the back seat of the vehicle and never in the front seat of a vehicle with front-seat air bags. Rear-facing car seats should be used until your child is 2 years old or your child has outgrown the height and weight limits of the rear-facing seat.

  • Equip your home with smoke detectors and change the batteries regularly.

  • Keep medications and poisons capped and out of reach. Keep all chemicals and cleaning products out of the reach of your child. If firearms are kept in the home, both guns and ammunition should be locked separately.

  • Be careful with hot liquids. Make sure that handles on the stove are turned inward rather than out over the edge of the stove to prevent little hands from pulling on them. Knives and heavy objects should be kept out of reach of children.

  • Always provide direct supervision of your child, including bath time.

  • Assure that windows are always locked so that your child cannot fall out.

  • Children should be protected from sun exposure. You can protect them by dressing them in clothing, hats, and other coverings. Avoid taking your child outdoors during peak sun hours. Sunburns can lead to more serious skin trouble later in life. Make sure that your child always wears sunscreen which protects against UVA and UVB when out in the sun to minimize early sunburning.

  • Know the number for the poison control center in your area and keep it by the phone or on your refrigerator.

WHAT'S NEXT?

Your next visit should be when your child is 15 months old.