Well-Child Checkup: 18 Months
Well-Child Checkup: 18 Months
At the 18-month checkup, your
healthcare provider will examine your child and ask how it’s going at home. This sheet
describes some of what you can expect.
Development and milestones
The healthcare provider will ask questions about your child. He or she will observe your toddler to get an idea of the child’s development. By this visit, your child is likely doing some of the following:
Pointing at things so you know what he or she wants. Shaking head to mean "no"
Using a spoon
Drinking from a cup
Following 1-step commands (such as "please bring me a toy")
Walking alone, and may be
Becoming more stubborn. For
example, crying for no apparent reason, getting angry, or acting out.
Being afraid of strangers
You may have noticed your child becoming pickier about food. This is normal. How much your child eats at one meal or in one day is less important than the pattern over a few days or weeks. It’s also normal for a child of this age to thin out and look leaner, as long as he or she isn’t losing weight. If you have concerns about your child’s weight or eating habits, bring these up with the healthcare provider. Here are some tips for feeding your child:
Keep serving a variety of
finger foods at meals. Don't give up on offering new foods. It often takes
several tries before a child starts to like a new taste.
If your child is hungry between meals, offer healthy foods. Cut-up vegetables and fruit, cheese, peanut butter, and crackers are good choices. Save snack foods, such as chips or cookies, for a special treat.
Your child may prefer to eat small amounts often throughout the day instead of sitting down for a full meal. This is normal.
Don’t force your child to eat. A child of this age will eat when hungry. He or she will likely eat more some days than others.
Your child should drink less of whole milk each day. Most calories should be from solid foods.
Besides drinking milk, water is best. Limit fruit juice. It should be 100% juice. You can also add water to the juice. And, don’t give your toddler soda.
Don’t let your child walk around with food or bottles. This is a choking risk and can also lead to overeating as your child gets older.
Brush your child’s teeth at
least once a day. Twice a day is ideal, such as after breakfast and before bed.
Use a small amount of fluoride toothpaste, no larger than a grain of rice. Use a
baby’s toothbrush with soft bristles.
Ask the healthcare provider when your child should have his or her first dental visit. Most pediatric dentists recommend that the first dental visit happen within 6 months after the first tooth erupts above the gums, but no later than the child's first birthday.
By 18 months of age, your child may be down to 1 nap and is likely sleeping about 10 to 12 hours at night. If he or she sleeps more or less than this but seems healthy, it’s not a concern. To help your child sleep:
See that your child gets
enough physical activity during the day. This helps your child sleep well. Talk
with the healthcare provider if you need ideas for active types of play.
Follow a bedtime routine each night, such as brushing teeth followed by reading a book. Try to stick to the same bedtime each night.
Don't put your child to bed
with anything to drink.
If getting your child to sleep through the night is a problem, ask the healthcare provider for tips.
Recommendations for keeping your
child safe include:
Don’t let your child play outdoors without supervision. Teach caution around cars. Your child should always hold an adult’s hand when crossing the street or in a parking lot.
Protect your toddler from falls with sturdy screens on windows and gates at the tops and bottoms of staircases. Supervise the child on the stairs.
If you have a swimming pool, it should be fenced. Gates or doors leading to the pool should be closed and locked.
At this age, children are
very curious. They are likely to get into items that can be dangerous. Keep
latches on cabinets. Keep products like cleansers and medicines out of reach.
Watch out for items that are small enough to choke on. As a rule, an item small enough to fit inside a toilet paper tube can cause a child to choke.
In the car, always put your
child in a car seat in the back seat. Babies and toddlers should ride in a
rear-facing car safety seat for as long as possible. That mean until they reach
the top weight or height allowed by their seat. Check your safety seat
instructions. Most convertible safety seats have height and weight limits that
will allow children to ride rear-facing for 2 years or more.
Teach your child to be gentle and cautious with dogs, cats, and other animals. Always supervise your child around animals, even familiar family pets.
Keep this Poison Control phone number in an easy-to-see place, such as on the refrigerator: 800-222-1222.
Based on recommendations from the CDC, at this visit your child may receive the following vaccines:
Get ready for the “terrible twos”
You’ve probably heard stories about the “terrible twos.” Many children become fussier and harder to handle at around age 2. In fact, you may have started to notice behavior changes already. Here’s some of what you can expect, and tips for coping:
Your child will become more
independent and more stubborn. It’s common to test limits, to see just how much he
or she can get away with. You may hear the word “no” a lot, even when the child
seems to mean yes! Be clear and consistent. Keep in mind that you’re the parent,
and you make the rules. Remember, you're the adult, so try to maintain a calm
temper even when your child is having a tantrum.
This is an age when children
often don’t have the words to ask for what they want. Instead, they may respond
with frustration. Your child may whine, cry, scream, kick, bite, or hit. Depending
on the child’s personality, tantrums may be rare or often. Tantrums happen less as
children learn how to express themselves with words. Most tantrums last only a few
minutes. If your child’s tantrums last much longer than this, talk to the
Do your best to ignore a
tantrum. See that the child is in a safe place and keep an eye on him or her. But
don’t interact until the tantrum is over. This teaches the child that throwing a
tantrum is not the way to get attention. Often moving your child to a private area
away from the attention of others will help resolve the tantrum.
Keep your cool and try not to
get angry. Remember, you’re the adult. Set a good example of how to behave when
frustrated. Never hit or yell at your child during or after a tantrum.
When you want your child to stop what he or she is doing, try distracting him or her with a new activity or object. You could also pick up the child and move him or her to another place.
Choose your battles. Not everything is worth a fight. An issue is most important if the health or safety of your child or another child is at risk.
Talk with the healthcare
provider for other tips on dealing with your child’s behavior.
Online Medical Reviewer: Adler, Liora C., MD
Online Medical Reviewer: Dozier, Tennille, RN, BSN, RDMS
Date Last Reviewed:
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