Well-Child Checkups

Eighteen-Month Visit

Department of Pediatrics
University of Iowa Children's Hospital

Peer Review Status: Internally Peer Reviewed
First Published: September 2002
Last Revised: September 2002

Immunizations
(see sections on Immunizations and Fever Management)

  • Your child may receive the booster for DTP and polio today, if they have not already been given.

Feeding Your Toddler

  • Your child should be eating three meals and two snacks a day
  • Eating more often promotes poor eating habits
  • Meals and snacks should consist of table foods from the four food groups (approximate serving size):
    1. Breads (1/2 slice), cereals--ready-to-eat or cooked (1/4 cup), rice or pasta (1/3 cup), pancake (1/20), crackers (1-2)
    2. Vegetables or fruits (4-6 Tbsp), 3-6 ounces fruit juice--4-6 servings per day
    3. Milk (1 1/2 cup), yogurt and cheese (1 1/2 ounces)--2 servings of milk and 2 other servings
    4. Meat, poultry, fish (2-4 Tbsp), dry beans (1/2 cup), egg (1)--3 servings per day
  • Offer health snacks between meals
  • Your child should be drinking juices and white milk from a cup

Physical Development

Every child develops at his own rate and with his own style. This is not a strict timetable, but rather, a guideline of things to expect between now and the two-year visit.

What your toddler is learning to do:
  • Walk fast, backwards, and up stairs with help
  • Climb into chairs
  • Kick a ball
  • Throw a ball
  • Feed himself with a spoon, but messy when eating
  • Drink from a cup by himself
  • Pull toys
  • Dump objects from containers
  • Draw stroke with crayon
  • Hold and love favorite doll or stuffed animal
  • Stack blocks or rings
  • May begin to run

    Using play to help your toddler learn:

  • Provide push and pull toys
  • Supply toys with different textures and surfaces for your toddler to feel
  • Allow to scribble and draw with crayons and paper
  • Play ball
  • Provide toys that fit inside each other
  • Furnish stacking blocks and toys to build towers
  • Provide toys that can be banged together

Language Development

What your toddler is learning to do:
  • Look at pictures and name objects
  • Read books in his own language
  • Use four to 10 words
  • Use two word phrases
  • Voice wants
  • Follow simple directions

    Using play to help your toddler learn:

  • Read books
  • Look at pictures
  • "Talk" to grandma and grandpa on the phone
  • Repeat newly learned words
  • Praise when he follows directions
  • Visit zoo and listen to animal sounds

Social Development

What you can expect from your toddler:
  • Shy around strangers
  • Mimic adult's behaviors
  • Play beside other children or with adults
  • Become more independent from parent
  • Explore farther away from parent
  • Test limits

    What you can do:

  • Give lots of hugs and kisses
  • Reassure your toddler of your love
  • Allows him to help with chores
  • Make a game of picking up toys
  • Provide play time with other children
  • Create times to explore the environment--your home, the yard or the park

Discipline

  • Your toddler does not understand why he cannot do what he wants to do
  • Help him follow the rules by
    1. Helping him put away his toys
    2. make "clean up" a game
  • Structure the environment to eliminate objects or situations that cause problems (put breakable objects up)
  • Distract from temptation by diverting your toddler's attention to another activity or objects like a toy
  • Set limits, but not too many--remember your toddler is still very young
  • Show your toddler what you want him to do if he is misbehaving (like where he can throw the ball instead of against the window)
  • Remove your child from the situation
  • Use temporary time out--one to two minutes in a playpen

Temper Tantrums

  • A temper tantrum is a child's immature way of expressing anger
  • Your child is eager to be independent and take control
  • He wants to make his own choices, but has not learned how to solve problems
  • H is unable to cope when he is disappointed or restrained
  • He acts out this frustration and anger by:
    crying, screaming, and whining
    thrashing and head banging
    breath holding
    being mean by hitting, biting, and spitting
  • As parents you should recognize that temper tantrums are a normal and expected part of growing up
  • Breath holding is not dangerous--your child will start breathing if he holds his breath long enough
  • Hunger, tiredness, and illness can contribute to temper tantrums
  • When your child acts this way:
    • remain calm
    • do not get angry or upset with him
    • be loving but firm
    • be very clear about the rules and limits that are important to you
    • tell him what you want him to do
    • be consistent--respond the same way every time your child breaks the rules
    • do not hit or spank your child unless his behavior is life threatening. Do not give in or offer rewards.
    • ignore behavior as long as your toddler stays in one place, is not too disruptive, and is safe
  • Make sure that all adults who care for your child (grandparents and baby-sitters) follow the same rules consistently and discipline your child the same way
  • The behavior of some temper tantrums is too violent to ignore:
    • hitting or kicking parents
    • throwing things
    • continued screaming and yelling
    • having tantrums in public places
  • Move your child away from the scene of the tantrum to another room when this happens--stay with him

Toilet Training

  • There is no set age when toilet training should begin--do not rush your toddler
  • Your child needs to be physically mature enough to control urination and bowel movements before toilet training can be successful (this probably will not happen for several more months)
  • Watch for any of the following signs that your child may be ready:
    • remains dry at least to hours at a time during the day
    • bowel movements before it happens
    • follows simple verbal instructions
    • knows the words you will use for bowel movements and urination
    • walks to and from the bathroom
    • undresses and then dresses himself again
  • Some children do not care for soiled diapers and want to be changed
  • Your child may ask t use the toilet or potty chair


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