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Quick reference medical handouts used by Pediatric offices


Growth Milestones - EIGHTEEN MONTHS


"Mr. No!"

Your sweet little baby has grown up into a toddler, entering a world of boundless energy, curiosity, independence and negativism. Having a toddler brings new challenges to you and your partner as parents. The following comments are designed to help you enjoy your 18-month-old son or daughter. This information not intended as a substitute for well-baby visits by your newborn's pediatrician. Never hesitate to ask your child's physician for guidance concerning specific problems. This is the reason for regular well-baby checkups.
Parenting and Behavioral
  • The 18-month-old child gets around easier and will soon be running. It is easy to except too much of our toddler. He or she looks so different from the crawling baby of a few months ago, and many parents think their youngster is no longer a baby.
  • Keep rules to a minimum. Long speeches of explanation are completely useless. "Because I said so!" should be enough.
  • Be firm and consistent, but loving and understanding with discipline. Praise your toddler for his or her good behavior and accomplishments.
  • Encourage your toddler to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt.") Never ask a toddler an open question ("Do you want to take a bath?") unless you are willing to accept the answer.
  • Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). Keep time-out to no more than two minutes per child's age, and be consistent. When disciplining, try to make a verbal separation between the child and his or her behavior ("I love you, but I do not like it when you touch the VCR." Pick-up your toddler, hold him or her, or remove her from dangerous situations. Reassure the toddler once the negative behavior has stopped.
  • Provide alternatives. "No, you cannot play with the telephone, but you can play with these blocks."
  • Avoid power struggles with your toddler. No one wins! The toddler uses a powerful weapon against the parents: the temper tantrum! These occur when the toddler is angry, tired, frustrated, or does not get his or her way. Most of the time, what happens during the tantrum is fairly predictable. Occasionally a child this age my get so angry he or she will hold his or her breath and pass out. Not to worry - once they do, the body's reflexes take over and your child will start breathing again on his or her own. Again, handle temper tantrums with the two I's of discipline - ignore or isolate (time out!).
  • Reinforce self-care and self-expression. Praise what the child does for himself (putting his hand in a sleeve, putting meat on a fork, washing his hands, etc.) Parents should say "...and you did that all by yourself!" The 18-month old child is highly pleased by parental approval.
  • Show affection in the family. Be a good role model by using seat belts, avoiding tobacco and showing respect for others. The toddler is a great imitator.
  • Do not expect the toddler to share toys, wait for his or her food in a restaurant, or be patient while you try on clothes at the store or go food shopping.
  • Early toilet training does not mean your child is super smart. Pushing the toddler will only make him or her rebel and be in diapers even longer. Signs that a child might be ready are dry for periods of about two hours, knows the difference between wet and dry, can pull his or her pants up and down, wants to learn, and can give a signal when he or she is about to have a bowel movement. If you insist on toilet training when your child is not ready, a battle will develop ... and it is a battle you cannot win! Discuss toilet training with your child's pediatrician to get his or her views.
  • Remember that aggressive behaviors - hitting and biting - are common at this age. They are, of course, not acceptable behaviors. How parents respond to them determines if the behavior will continue.
  • Do not discourage your child from using a security object - a stuffed animal, favorite blanket, etc. These are important for a toddler and the child will give it up when he or she is ready. (They usually do not take them to high school!)
  • Despite your child's desire to become independent, you will find the 18-month-old will still cling to a parent.
  • Read simple stories to the child regularly, especially at bedtime, to enrich his verbal expression and increase his interest in the spoken language and his listening skills.
  • Limit television viewing and do not use it as a substitute for interaction with the child. Watch children's programs with the child when possible.
  • The principal caregiver should be encouraged to arrange time for himself/herself. Raising a toddler can often be demanding.
  • Praise the child when they are behaving well, and always show affection
Development
  • Walks fast, walks up stairs with one hand held, kicks a ball.
  • Uses a vocabulary of four to 10 words and may combine two-word phrases.
  • Understands simple directions.
  • Points to some body parts correctly.
  • Shows affection by kissing parents.
  • Feeds himself or herself, drinks from a cup adequately and uses a spoon.
  • Imitates a crayon stroke on paper.
  • Holds and "loves" a doll or stuffed animal; may use a household-type toy (for example, a toy telephone) appropriately.
  • Will sit for a short time and look at pictures in a book. Turns single pages in book or magazine
Oral Health
  • Begin brushing your child's teeth with a tiny, pea-size amount of toothpaste.
  • To protect your toddler's teeth, do not put him or her to bed with a bottle or prop it in his or her mouth.
  • Continue to give your child fluoride supplements as recommended by the pediatrician based on the level of fluoride in the toddler's drinking water.
  • Discontinue pacifier use except, perhaps, at nap time and bedtime.
  • Ask your child's doctor when you should make the youngster's first dental appointment.
Feeding
  • Your baby's appetite is going to continue decreasing during the toddler years. Don't make a "big deal" out of it if your child refuses to eat. No one ever starved with a refrigerator full of food. The toddler's caloric needs are down and he or she is trying to show independence. Develop a "take it or leave it" attitude and do not engage in battles over eating. You cannot win, so why fight? Children this age will determine the amount of food they need. Mealtime should not be a battle.
  • Your toddler probably did not grow much since his or her last checkup. Maybe two inches and a few pounds, but that's all.
  • Share meals as a family whenever possible. This helps your baby learn Make mealtimes pleasant and encourage conversation. Avoid using snacks between meals because the toddler has "not eaten all day."
  • The toddler should be drinking only from a cup and using utensils pretty well to feed himself or herself.
Sleep
  • Encourage your child to console himself or herself by putting them to bed awake.
  • Prepare strategies to deal with night awakening, night fears, nightmares and night terrors.
  • Children this age frequently resist going to sleep. They will usually give you a "test" cry to see if you will return. While it is important to let the toddler know you are there, it is also important to let him or her know that the day is over.
  • Your toddler may start to give up at least one nap. This is sometimes an awkward stage when one nap is not enough and two naps are too many.
  • Never put your child to bed with a bottle. He or she should be off all bottles at this age!
Immunizations
Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
  • Normally, no immunizations are given at this checkup unless your child's doctor follows another approved schedule or the child is behind in the immunization schedule.
  • By this age, most children have received the following immunizations
3 doses of Hepatitis B vaccine
4 doses of DTaP vaccine
4 doses of HIB vaccine
1 dose of the MMR vaccine
1 dose of the Chickenpox vaccine
4 doses of the Pneumococcal  vaccine
3 doses of the Inactivated Polio Vaccine
Kidsgrowth Vaccine Guide
What Immunizations should my child have had
by 18 months?
The Vaccines and the Diseases they Prevent
Keep a record of your child's immunizations.
(Click to download an immunization record)
 
Toilet Training
  • Some children show readiness for toilet training between 18 and 24 months. When toddlers report to their parents that they have wet or soiled their diaper, they are beginning to be aware that they prefer dryness. This is a good sign and parents should praise their child. Other signs of readiness include long periods of dryness, ability to pull pants up and down, can signal when he or she is about to have a bowel movement and knows the difference between wet and dry.
  • Toddlers are naturally curious about the use of the bathroom by other people, so let them watch you or other family members use the toilet.
  • Starting toilet training before the child is ready will only cause the toddler to rebel and still be in diapers at 3 and 4 years of age. It is important not to put too many demands of a child or shame them during toilet training.
Safety
  • Use car restraints consistently.
  • Ensure stair and window safety.
  • All play outside should be supervised. Toddlers do not understand danger and cannot remember "no."
  • Knowing how to "swim" does not make a child water-safe at this age. Supervise the toddler constantly whenever he or she is in or around water, buckets, the toilet or the bathtub. Continue to empty buckets, tubs or small pools immediately after use. Ensure that swimming pools have a four-sided fence with a self-closing, self-latching gate.
  • If your home uses gas appliances, install and maintain carbon monoxide detectors.
  • Put sun screen on the toddler before going outside to play or swim. Be particularly careful during the hours between 10 a.m. and 3 p.m. when the sun is most dangerous.
  • Continue to keep your toddler's environment free of smoke. Keep the home and car nonsmoking zones.
  • Ensure electric wires, outlets and appliances are inaccessible or protected.
  • Keep medicines, cigarettes, lighters, matches, alcohol, firearms and electrical tools locked up and/or out of the toddler's sight and reach.
  • Always walk behind your car before you back out the driveway.
  • Remember, almost anything in your home can be poisonous.
  • Keep Syrup of Ipecac in the home to be used as directed by the poison control center or the health professional. Keep the number of the poison control center near the telephone.
  • Do not expect your older children to supervise the toddler (e.g., in the house, apartment, playground, or yard).
  • Keep the toddler away from moving machinery, lawn mowers, overhead garage doors, driveways and streets.
  • Ensure that a toddler riding in a seat on an adult's bicycle is wearing a helmet and wear a helmet yourself.
  • Teach the child to use caution when approaching dogs, especially if the dogs are unknown or eating.
  • Keep plastic bags and balloons, and small hard objects out of reach. Cut food into small pieces.
  • Know how to save a choking child.
  • Store toys in a chest without a dropping lid

Illnesses
  • Your toddler might have many colds and other respiratory infections during this time. Children who are in day care will experience more infections than those home with a parent or grandparent.
  • There will be times when you will think you "live" at your pediatricians office, since many viral infections at this age come one after the other.
Check your child's progress with our Growth Charts.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.. Updated 05-08-07

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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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