Well Child Care, 15 Months

PHYSICAL DEVELOPMENT

The child at 15 months walks well, bends over, walks backwards, and creeps up the stairs. The child can build a tower of two blocks, feed self with fingers, and drink from a cup. The child can imitate scribbling.

EMOTIONAL DEVELOPMENT

At 15 months, children can indicate needs by gestures and may display frustration when they do not get what they want. Temper tantrums may begin.

SOCIAL DEVELOPMENT

The child imitates others and increases in independence.

MENTAL DEVELOPMENT

At 15 months, the child can understand simple commands. The child has a 4–6 word vocabulary and may make short sentences of 2 words. The child listens to a story and can point to at least one body part.

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. (The fourth dose of a 5-dose series should be obtained at age 15–18 months. The fourth dose may be obtained as early as 12 months if 6 months or more have passed since the third dose.)

  • 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. Children who have certain conditions, missed doses in the past, or obtained the 7-valent pneumococcal vaccine should obtain the vaccine as recommended.)

  • 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 health care provider may obtain laboratory tests based upon individual risk factors.

NUTRITION AND ORAL HEALTH

  • Breastfeeding is still encouraged.

  • Daily milk intake should be about 2–3 cups (500–750 mL) of whole-fat milk.

  • 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 a vitamin C containing juice. Encourage the child to drink water.

  • Provide a balanced diet, encouraging vegetables and fruits.

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

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

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

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

  • Avoid nuts, hard candies, popcorn, and chewing gum.

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

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

  • 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 daily and encourage your child to point to objects when named.

  • Choose books with interesting pictures.

  • Recite nursery rhymes and sing songs to your child.

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

  • Avoid using "baby talk."

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

  • Introduce your child to a second language, if used in the household.

TOILET TRAINING

Children generally are not developmentally ready for toilet training until about 24 months.

SLEEP

  • Most children still take 2 naps each day.

  • Use consistent nap and bedtime routines.

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

PARENTING TIPS

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

  • Recognize that your child has limited ability to understand consequences at this age. All adults should be consistent about setting limits. Consider time-out as a method of discipline.

  • Minimize television time. Children at this age need active play and social interaction. Any television should be viewed jointly with parents and should be less than one hour each day.

SAFETY

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

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

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

  • Use gates at the top of stairs to help prevent falls.

  • Use fences with self-latching gates around pools.

  • 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 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, heavy objects, and all cleaning supplies should be kept out of reach of children.

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

  • Make sure that furniture, bookshelves, and televisions are securely mounted so that they cannot fall over on a toddler.

  • Assure that windows are always locked so that a toddler cannot fall out of the window.

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

WHAT'S NEXT?

The next visit should be when your child is 18 months old.