Well Child Care, 18 Months

PHYSICAL DEVELOPMENT

The child at 18 months can walk quickly, is beginning to run, and can walk on steps one step at a time. The child can scribble with a crayon, builds a tower of two or three blocks, throw objects, and can use a spoon and cup. The child can dump an object out of a bottle or container.

EMOTIONAL DEVELOPMENT

At 18 months, children develop independence and may seem to become more negative. Children are likely to experience extreme separation anxiety.

SOCIAL DEVELOPMENT

The child demonstrates affection, can give kisses, and enjoys playing with familiar toys. Children play in the presence of others, but do not really play with other children.

MENTAL DEVELOPMENT

At 18 months, the child can follow simple directions. The child has a 15-20 word vocabulary and may make short sentences of 2 words. The child listens to a story, names some objects, and points to several body parts.

IMMUNIZATIONS

At this visit, the health care provider may give either the 1st or 2nd dose of Hepatitis A vaccine; a 4th dose of DTaP (diphtheria, tetanus, and pertussis-whooping cough); or a 3rd dose of the inactivated polio virus (IPV), if not given previously. Annual influenza or "flu" vaccination is suggested during flu season.

TESTING

The health care provider should screen the 18 month old for developmental problems and autism and may also screen for anemia, lead poisoning, or tuberculosis, depending upon risk factors.

NUTRITION AND ORAL HEALTH

  • Breastfeeding is encouraged.

  • Daily milk intake should be about 2-3 cups (16-24 ounces) of whole fat milk.

  • Provide all beverages in a cup and not a bottle.

  • Limit juice to 4-6 ounces per day of a vitamin C containing juice and 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 highchair 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 the child to feed themselves with cup and spoon.

  • Brushing teeth after meals and before bedtime should be encouraged.

  • If toothpaste is used, it should not contain fluoride.

  • Continue fluoride supplements if recommended by your health care provider.

DEVELOPMENT

  • Read books daily and encourage the child to point to objects when named.

  • Recite nursery rhymes and sing songs with your child.

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

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

  • Some of the child's speech may be difficult to understand.

  • Avoid using "baby talk."

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

TOILET TRAINING

While children may have longer intervals with a dry diaper, they generally are not developmentally ready for toilet training until about 24 months.

SLEEP

  • Most children still take 2 naps per day.

  • Use consistent nap-time and bed-time routines.

  • Encourage children to sleep in their own beds.

PARENTING TIPS

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

  • Avoid situations when may cause the child to develop a "temper tantrum," such as shopping trips.

  • Recognize that the 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.

  • Offer limited choices when possible.

  • 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 per 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.

  • The 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 with air bags.

  • Equip your home with smoke detectors!

  • 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 can not fall over on a toddler.

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

  • Make sure that your child always wears sunscreen which protects against UV-A and UV-B and is at least sun protection factor of 15 (SPF-15) or higher when out in the sun to minimize early sun burning. This can lead to more serious skin trouble later in life. Avoid going outdoors during peak sun hours.

  • Know the number for poison control 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 24 months old.