Well Child Care at 18 Months

Nutrition

Family meals are important for your baby. Let him eat with you. This helps him learn that eating is a time to be together and talk with others. Don't make mealtime a battle. Let your baby feed himself. Your child should use a spoon and drink from an open-rimmed cup (not a sippy-cup).

Development

Children at this age should be learning many new words. You can help your child's vocabulary grow by showing and naming lots of things. Children at this age can engage in pretend play. They will look where you point and will try to get your attention when they want to point something out to you. Children have many different feelings and behaviors such as pleasure, anger, joy, curiosity, warmth, and assertiveness. Praise your child for doing things that you like.

Toilet Training

At 18 months, most toddlers are not yet showing signs that they are ready for toilet training. When toddlers report to parents that they have wet or soiled their diaper, they are starting to be aware that they prefer dryness. This is a good sign and you should praise your child. Toddlers are naturally curious about the use of the bathroom by other people. Let them watch you or other family members use the toilet. It is important not to put too many demands on a child or shame the child during toilet training.

Behavior Control

Toddlers sometimes seem out of control, or too stubborn or demanding. At this age, children often say "no". To help children learn about rules:

• Divert and substitute. If a child is playing with something you don't want him to have, replace it with another object or toy that he enjoys. This approach avoids a fight and does not place children in a situation where they'll say "no."
• Teach and lead. Have as few rules as necessary and enforce them. Make rules for the child's safety. If a rule is broken, after a short, clear, and gentle explanation, immediately find a place for your child to sit alone for 1 minute. It is very important that a "time-out" comes right after a rule is broken.
• Make consequences as logical as possible. For example, if you don't stay in your car seat, the car doesn't go. If you throw your food, you don't get any more and may be hungry.
• Be consistent with discipline. Don't make threats that you cannot carry out. If you say you're going to do it, do it.
• Be warm and positive. Children like to please their parents. Give lots of praise and be enthusiastic. When children misbehave, stay calm and say "We can't do that. The rule is ________." Then repeat the rule.
• Most toddlers at this age are not yet ready for time-outs.

Reading and Electronic Media

Toddlers have short attention spans, so stories should always be short, simple, and have lots of pictures. The best choices are large-format books that develop one main character through action and activity. Make sure the books have happy, clear-cut endings.

It is best if children under two years of age do not watch television. Talking, playing, singing, and reading books help your child to develop.

Dental Care

After meals and before bedtime, clean your toddler's teeth with a clean cloth or very soft toothbrush.

Safety Tips

Child-proof the home. Go through every room in your house and remove anything that is valuable, dangerous, or messy. Preventive child-proofing will stop many possible discipline problems. Don't expect a child not to get into things just because you say no. Remove guns from the home. If you have a gun, store it unloaded and locked. Store the ammunition in a separate place that is also locked.

Choking and Suffocation

• Keep plastic bags, balloons, and small hard objects out of reach.
• Cut foods into small pieces.
• Store toys in a chest without a dropping lid.

Fires and Burns

• Keep hot appliances and cords out of reach.
• Don't cook with your child at your feet.
• Keep hot foods and liquids out of reach.
• Keep matches and lighters out of reach.
• Turn your water heater down to 120°F (50°C).

Falls

• Make sure that drawers, furniture, and lamps cannot be tipped over. Do not place furniture (on which children may climb) near windows or on balconies.
• Use stair gates.
• Install window guards on windows above the first floor (unless this is against your local fire codes.)
• Make sure windows are closed or have screens that cannot be pushed out.
• Don't underestimate your child's ability to climb.

Car Safety

• Never leave your child alone in the car.
• Use an approved toddler car seat correctly and wear your seat belt.

Pedestrian Safety

• Hold onto your child when you are near traffic.
• Provide a play area where balls and riding toys cannot roll into the street.

Water Safety

• Never leave an infant or toddler in a bathtub alone — NEVER.
• Continuously watch your child around any water, including toilets and buckets. Keep the lids of toilets down. Never leave water in an unattended bucket and store buckets upside down.

Poisoning

• Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
• Put the poison center number on all phones.
• Buy medicines in containers with safety caps.
• Do not store poisons in drink bottles, glasses, or jars.

Smoking

• Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
• If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

At the 18-month visit, your baby may receive shots. Children during the first 2 years of life should get a total of 3 flu shots. Ask your healthcare provider about influenza shots if you have questions about them.

Your baby may run a fever and be irritable for about 1 day after the shots. Your baby may also have some soreness, redness, and swelling in the area where the shots were given.

You may give your child acetaminophen drops in the appropriate dose to prevent fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed for comfort.

Call your child's healthcare provider if:

• Your child has a rash or any reaction to the shots other than fever and mild irritability.
• Your child has a fever that lasts more than 36 hours.

Next Visit

Your child's next visit should be at the age of 2 years. Bring your child's shot card to all visits.