What to Expect as Your Child Grows:
Well Child Care at 18 Months

Nutrition Family meals are important for your baby. Let your child eat with you. This helps her learn that eating is a time to be together and talk with others. Don’t make mealtime a battle. Let your baby feed herself. Your child should use a spoon and drink from a cup now. 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 have many different feelings and behaviors such as pleasure, anger, joy, curiosity, warmth, and assertiveness. It is important at this age to praise your child for doing things that you like.

Toilet Training

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

Behavior and Discipline

• Toddlers sometimes seem out of control, or too stubborn or demanding. At this age, children often say “no” or refuse to help.
• Divert and substitute. If a child is playing with something you do not want her to have, replace it with another object or toy that she enjoys. This approach avoids a fight and does not place a child in a place where she will 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 one 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 do not stay in your car seat, the car does not go. If you throw your food, you do not get any more and may be hungry.
• Be consistent with discipline. Do not make threats that you cannot carry out. If you say you are 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 cannot do that. The rule is ______.” Then repeat the rule.
• Praise your child for behaving well.

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 the action and activity. Make sure the books have happy, clear-cut endings.

Dental Care

After meals and before bedtime, clean your toddler’s teeth with a clean cloth or very soft toothbrush. It is now recommended that you make your child's first dental appointment.

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 so.
• Choking and Suffocation
  - Keep plastic bags, balloons, and small hard objects out of reach.
  - Store toys in a chest without a dropping lid.
  - Cut foods into small pieces. Avoid foods on which a child might choke (popcorn, peanuts, hot dogs, or chewing gum).
• Fires and Burns
  - Keep hot appliances and cords out of reach.
  - Don’t cook with your child playing at your feet.
  - Keep hot foods and liquids out of reach.
  - Turn the water heater down to 120° Fahrenheit.
• Falls
  - Make sure that drawers, furniture, and lamps cannot be tipped over.
  - Do not place furniture (on which children can climb) near windows or on balconies.
  - Install window guards on windows above the first floor (unless against your local fire code).
  - Make sure that 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 on to your child when you are around traffic.
  - Provide a play area where balls and riding toys cannot roll near 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 lids of toilets down. Never leave water in an unattended bucket. Store buckets upside-down.
• Poisoning
  - Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
  - Put the poison center number on all cell 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 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.

Immunizations

• At the eighteen-month visit, your child will usually receive a Hepatitis A vaccine.
• Children over the age of six months should receive an annual flu shot.
• We will attempt to check your child’s hearing and vision. Early detection is the key to correcting problems and avoiding lifelong impairment.

What to Expect as Your Child Grows:
Well Child Care at 15 Months

Nutrition Do not use food as a reward. Children should be using a cup only. If your child is still using a bottle, start weaning to a sippy cup. Never let a baby take a bottle to bed. Development Show your child how to use words. Use words to describe your child’s feelings. Describe your child’s gestures with words. Toddlers are very curious and want to be the boss. This is normal. If it is safe, this is a time to let your child explore new things. As long as you are there to protect your child, let her satisfy her curiosity. Stuffed animals, toys for pounding, pots, pans, measuring cups, empty boxes, and Nerf balls are some examples of toys your child may enjoy. Toddlers want to imitate what you are doing. Sweeping, dusting, or washing play dishes can be fun choices for children. There is quite a bit of anxiety around new or unfamiliar people at this age.

Discipline and Temper Tantrums

• Toddlers start to have temper tantrums around this age. Trying to reason with or punish your child may actually make the tantrum last longer. It is best to make sure your child is in a safe place and then ignore the tantrum. You can best ignore it by not looking directly at your child and not speaking to her.
• Use diversion and substitution whenever you can.
• Praise your child for behaving well.
• Let your child choose between two good options when deciding between different foods, books, or games.

Reading and Electronic Media

• Reading to your child should be a part of every day. Choose books with interesting pictures and colors. Children at this age may ask to read the same book over and over. This repetition is a natural part of learning.
• Children this age get no benefit from watching television.

Dental Care

• After meals and before bedtime, clean your toddler’s teeth.
• You may want to make an appointment for your child to see the dentist for the first time.

Safety Tips

• Choking and Suffocation
  - Keep plastic bags, balloons, and small hard objects out of reach.
  - Use only unbreakable toys without sharp edges or small parts that can come loose.
  - Cut foods into small pieces. Avoid foods on which a child might choke (popcorn, peanuts, hot dogs, or chewing gum).
• Fires and Burns
  - Keep lighters and matches out of reach.
  - Don’t let your child play near the stove.
  - Use the back burners on the stove with the pan handles out of reach.
  - Turn the water heater down to 120° Fahrenheit.
• 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 on to your child when you are around traffic.
  - Supervise outside play areas.
• 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 lids of toilets down. Never leave water in an unattended bucket. Store buckets upside-down.
• Poisoning
  - Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
  - Put the poison center number on all cell phones.
  - Buy medicines in containers with safety caps.
  - Do not store poisons/chemicals in drink bottles, glasses, or jars.

Smoking

• Children who live in a house where someone smokes have more respiratory infections. Their symptoms are 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.

What to Expect at This Visit

• At this visit, most children will receive DTaP, IPV, and Hib. It is usually given in a combination vaccine.
• Children over 6 months of age should receive an annual flu shot.
• We will attempt to check your child’s vision and hearing. Early detection and prompt treatment is the key to correcting problems and avoiding lifelong impairment.

What to Expect as Your Child Grows:
Well Child Care at 9 Months

Feeding

• Your baby should continue to have breast milk or formula until he is one year old. Most babies now take 6 to 8 ounces of formula 4 times a day. Encourage your child to drink from a cup now. This is a good time to start preparing for weaning from the bottle at a year of age.
• Do not let your baby keep the bottle between meal times.
• You can begin adding table food to your child’s diet. Talk to your doctor about what’s appropriate for your child.
• Avoid honey until one year of age.

Development

• Babies are starting to pull themselves up to stand.
• Soon, they may start to say “dada” and “mama.”
• An important part of discipline now is teaching your child what behaviors you expect. Your primary role at this age is protector for the infant's natural curiosity. During this time, examples you set are much more important than words you may say to your child. Therefore, set an example of the behaviors you expect of your child. Use a description of desired behavior as often as possible, i.e. "Time to sit", instead of "Don't stand."
• At this age, babies learn what "no" means. A critical step in establishing discipline is to limit "no" to the most important issues. Then, when an important issue comes up (such as your baby reaching for the stove), saying, "NO, hot, don't touch" and removing the baby will have real meaning for him.
• Give your baby a choice of toys. Talk to him about the toy he chooses and what he is doing with the toy. Peek-a-boo is a favorite game.
• Avoid the use of TV, computers, and videos.

Sleep

• A regular bedtime hour and routine are important.
• Babies enjoy looking at picture books. You may want to read one regularly with your child before bed. A favorite blanket or stuffed animal may help your baby feel secure at bedtime.
• NEVER put your baby in bed with a bottle.
• Put your baby to bed awake, but drowsy. If your baby wakes up a lot at night, ask your doctor or nurse for advice.

Dental Care

By now, many children have 2 or more teeth. After meals and before bedtime, try to wash off the teeth with a clean cloth. As your child gets more teeth, discuss brushing habits with your doctor.

Safety Tips

• Childproof your home.
• Remove or pad furniture with sharp corners. Keep sharp objects out of reach.
• Store toys on a chest without a dropping lid.
• Check your smoke detector periodically to make sure it's working. Consider using a carbon monoxide detector.
• Put plastic covers in unused electrical outlets.
• Keep hot appliances (such as curling irons) and their cords out of reach and turned off when not in use. Keep all electrical appliances unplugged and out of reach, especially in the bathroom.
• Don't cook with your child at your feet. Use the back burners on the stove with the pan handles out of reach.
• Turn your hot water heater down to 120° F.
• Make sure windows are closed or have screens that cannot be pushed out.
• Don't underestimate your child's ability to climb.
• Check the sticker on your child's car seat for its capacity. It may be time to switch to a rear-facing convertible car seat. Follow the manufacturer's guidelines for installation.
• NEVER leave your child in a car alone. Remember to lock car doors when the car is parked at home.
• NEVER leave your child unattended in a bathtub.
• Continuously supervise your baby around any water, including toilets and buckets. Empty all water and store buckets turned over.
• If you or anyone you visit regularly has a pool, now is a good time to have a fence installed. There is no substitute for this precaution.
• Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away and out of reach. Dispose of them properly. Do not keep expired medicines in the house.
• Put safety latches on cabinets.
• Keep your Poison Control number programmed on all phones. The number from anywhere in the U.S. is 1-800-222-1222.

What to Expect at This Visit

• Development and Anticipatory Guidance.
• Children over 6 months of age should receive an annual flu shot.

Next Visit

Your child’s next visit should be at the age of 12 months.

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