12 Month Well-Child Visit

Congratulations! Your baby is now a full year old, and has graduated from the infant to toddler stage. You have seen incredible growth and development in the past year, with much more to come. What can you expect at this visit with the Pediatrician?

Vitals – Heart rate and respiratory rate will be counted, temperature is taken.

Growth measurements – Children grow more slowly from 1 to 5 years of age compared to the first year. Length, weight, and head circumference are updated at the twelve month visit. These are plotted on a growth chart that is specific to your child’s gender and will be compared to the previous measurements to make sure growth occurs appropriately and proportionally. Remember, the goal is for your child to grow consistently on the curve. Growth curves are measured in “percentiles” where 50th percentile is the average measurement for age and gender. Children who fall above the 50th percentile are “above average” for that measurement, while those who fall below the 50th percentile are “below average.” Keep in mind that many factors affect where your child falls on the curve – genetics, feeding patterns, prematurity.

Development –

• Social: They wave bye-bye and clap hands. Social and separation anxiety continue to develop. They will look for objects that are hidden and start to imitate other’s actions. 
• Speech & Language: They say “dada” or “mama” specifically. They may have one other word as well. They follow commands such as “sit down.”
• Gross (large) motor: They cruise along furniture while holding on, and may start to have independent steps. They can stand without support.  
• Fine motor: They use a pincer grasp with a thumb and one finger, will feed self and drop objects in a cup. 

Questions from the Pediatrician – your baby’s doctor will ask questions about feeding, sleeping, voiding (urination) and stooling (bowel movements), and development.

Nutrition – at 12 months the transition is made from a primarily milk-based diet to a primarily solid-based diet. Continue to breastfeed, if desired, but avoid nursing to sleep or nursing during the night to prevent cavities. If not breastfeeding, transition to whole milk in a sippy cup and discontinue use of bottles. Offer your toddler a variety of fruits, vegetables, proteins, dairy, fats, and carbohydrates. Transition to family meal times with snacks. Allow your toddler to decide how much to eat at once. 

Exam – your toddler will have a head-to-toe exam at every well-child visit. 

Testing – a small sample of blood will be collected to check your child’s lead level, if you live in a high risk area or meet screening criteria. This is usually collected from a finger or a toe. 

Vaccinations – The CDC recommended vaccination schedule continues between 12-24 months of age, though the timing of vaccines is more of a range rather than specific dates. Your Pediatrician will discuss these in detail with you at your visit. Most offices will give the first MMR (Measles, Mumps, Rubella) and Hepatitis A vaccines at this visit. Your baby may also receive Varicella (Chicken Pox) or a Pneumococcal booster vaccine. I discuss toddler vaccines in depth in another post if you would like more detailed information. 

Questions from you – as your child interacts more with the environment and people around them, you will likely have more questions about proper developmental milestones, nutrition, sleep habits, and more. Bring your questions to the visit so you don’t forget them!

Safety information – part of every well-child visit is discussion of safety that is appropriate for age. For toddlers, this includes:

• sleep practices – toddlers should continue to sleep in the crib, with the mattress dropped down to the lowest setting to prevent them from climbing out. Avoid using bottles or sippy cups at bedtime. 
• car seat instructions – toddlers should continue to be in their car seats, in the back seat, facing backwards. If they meet weight requirements, they can transfer to a convertible upright carseat instead of the infant bucket seat. Never leave your child in the car alone. 
• water safety – toddlers should never be left alone in the water, even if it is only a few inches or only for a short amount of time. Drowning occurs quickly. 
• fall risks – Use baby gates to block stairs. 
• choking – toddlers will not always chew foods well so make sure foods are cut into tiny pieces. Avoid contact with small objects and plastic bags. 
• baby proofing – make sure all cleaning supplies, medications, and chemicals are up high or locked away. Check your floors and lower cabinets/shelves for small objects. Use outlet covers and hide electrical cords. Place barriers around space heaters and fireplaces. 
• sun exposure – avoid direct exposure during the middle of the day as much as possible. Use hats and long sleeves. Use sunscreen with a high SPF. 

Next visit: 15 months

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