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18 Month Check Up

FEEDING:   Your child should still consume 2-3 servings of dairy products or 16-24 ounces of milk each day for optimal calcium intake.  More milk than this can actually cause children to eat poorly if their stomachs are full of milk and can place them at risk for anemia (low iron).  Most pediatricians recommend whole milk as the best choice between 1 and 2 years, because babies need the added fat for good growth and brain development, but 2% milk is acceptable as well.   Optimally your child should be off the bottle by now.  If your child likes to carry a cup around during day, fill the cup with water instead of juice to decrease the chance of cavities in the teeth and to prevent filling up on sugary drinks.  Children do not need juice every day—even if it is 100% juice—and they really can benefit if they learn to drink water early.  Limit juice to no more than 1 cup per day.  Continue to be careful of foods that your child could choke on, including anything that is hard or in large pieces, such as hot dogs, carrots, grapes, and popcorn.  Avoids nuts until age 3.  Many toddlers become much pickier about what they eat and will have some days when it seems they’re not eating much at all. Try to assure your child has at least one good meal a day by limiting snacks and extra drinks during the day.  Eat together as a family whenever possible and try to make mealtime pleasant.  As long as your child gets some variety in her diet and continues to grow well, she is probably eating enough.

DEVELOPMENT   Common milestones at eighteen months include walking well, stacking 4-10 blocks, and eating with a spoon.  Most eighteen month olds will be able to say around 10 words, although they usually understand much more than this.  Usually between 18 and 24 months children learn to put 2 word phrases together, such as “want cookie” or “go bye-bye.” In the next few months, your child will learn to open doors, climb steps alone, and scribble with a crayon, and his vocabulary will grow quickly.  Continue to talk and sing with your child often and to read books together.  Reading remains the most important activity to stimulate language development and build the foundation for good school performance later!

TEMPER TANTRUMS:   Most children at this age at least occasionally have temper tantrums, which are usually a sign of frustration and a cry for attention.  Try whenever possible to ignore bad behavior and praise good behavior and step in quickly if your child is starting to get upset or frustrated.  If your child has a tantrum in your house, try to leave the room and return only when he or she is quiet.  If this happens out in public, picking your child up and leaving together when possible is the best remedy.  Other strategies include distracting your child by giving him something to hold onto or allowing him to choose between two acceptable options.  Whenever possible tell your child what to do instead of what not to do.  (For example, if your child is reaching for things on the shelf in the grocery store, you could tell her to put her hands in her pockets instead of telling her to stop reaching.)  Try to avoid running errands when you or your child is tired or irritable and your patience is already low.  Make rules very simple so your child learns what is expected.  Time-outs can begin to be an effective tool for some children between 18 and 24 months when used consistently with the general rule being one minute of time-out for each year of age.  Remember that this will get better!

DENTAL CARE:  At this age it is very important regularly to clean your child’s teeth.  Use only training toothpaste without fluoride.  Even if your child tries to help at this age, it is important for you to go over all the teeth, especially the back teeth, to make sure all are cleaned.  Most pediatricians recommend the first visit to the dentist by age 3.

SAFETY:  Make sure your child always rides in a carseat in the backseat of the car.  Protect his skin with sunscreen with SPF greater than 15 when outdoors, and avoid sun between 10am and 3pm whenever possible.  Check smoke detectors regularly to assure they are working properly.  It is still important to make sure that all cabinets and drawers are childproofed, and all chemicals and medicines are locked away.  If your child ever accidentally swallows anything that might be dangerous (such as cleaning supplies, chemicals, or medications) do not give anything else by mouth and call Poison Control immediately.       POISON CONTROL 1-800-222-1222