18 Month Well-Child Visit

Though many people think of the “terrible twos” being the start of tantrums and behavior outbursts, these often actually start closer to 18 months of age. A strong desire for independence clashes with a lack of language and communication abilities, leading to frustration for your young toddler. Be patient, encourage language development through reading with your child, and give him or her options to choose from when possible.  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 eighteen 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 like to play with others, help get dressed and undressed, and point to pictures in books. Social and separation anxiety may start to ease up. 
• Speech & Language: They have approximately 10-15 words and can identify a few body parts by pointing.
• Gross (large) motor: They are starting to walk up stairs, slowly and with help. Can carry something while walking. They climb furniture.  
• Fine motor: They scribble easily and without prompting. Can throw a ball overhand. 

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

Nutrition – Continue to offer your toddler a variety of fruits, vegetables, proteins, dairy, fats, and carbohydrates. Promote family meal times with snacks in between. Allow your toddler to decide how much to eat at once.  Avoid fruit juices or other sweetened beverages. 

Healthy Teeth – brushing your toddler’s teeth before bed should be an important part of the nighttime routine. Clean teeth and avoidance of any bottles or sippy cups before bedtime can help prevent cavities even in very young children. It is recommended that children by seen by a dentist before their second birthday. 

Exam – your toddler will have a head-to-toe exam at every well-child visit. The exam at this age is one of the most difficult for Pediatricians, so do not be surprised if your child screams, tries to get away, or throws a tantrum. Your child’s doctor will work with and around them to get the exam done.

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. Your toddler will likely receive DTaP (Diphtheria, Tetanus, acellular Pertussis) and Hepatitis A booster vaccines at 18 months. I discuss toddler vaccines in depth in another post if you would like more detailed information. 

Questions from you – you will likely have questions about proper developmental milestones, nutrition, sleep habits, and behavior. Bring your questions to the visit and never hesitate to ask your child’s Pediatrician about your concerns. We are here to help you navigate through the toddler years!

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 the baby 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. 
• firearms – remove all firearms from the home, if possible. Otherwise, ensure they are locked in a safe and stored unloaded. 

Next visit: 24 months

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