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.

Woman backing up car while another woman stands safely nearby holding toddler girl.

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; may be running

  • Becoming more stubborn (for example, crying for no apparent reason, getting angry, or acting out)

  • Being afraid of strangers

Feeding tips

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. Be persistent with 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.

Hygiene tips

  • Brush your child’s teeth at least once a day. Twice a day is ideal (such as after breakfast and before bed). Use water and 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 should occur soon after the first tooth erupts above the gums.

Sleeping tips

By 18 months of age, your child may be down to 1 nap and is likely sleeping about 10 hours 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:

  • Make sure your child gets enough physical activity during the day. This helps your child sleep well. Talk to the health care 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.

  • Do not put your child to bed with anything to drink.

  • Be aware that your child no longer needs nighttime feedings. If the child wakes during the night, it’s OK to let him or her cry for a while. Talk with your child’s healthcare provider about how long he or she should cry.

  • If getting your child to sleep through the night is a problem, ask the healthcare provider for tips.

Safety tips

  • 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 and make sure products like cleansers and medications are 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 the child in a rear-facing child safety car seat in the back seat. Be sure to check the weight and height limits of your child’s seat to ensure proper use. Ask the healthcare provider if you have questions.

  • 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.

Vaccinations

Based on recommendations from the CDC, at this visit your child may receive the following vaccinations:

  • Diphtheria, tetanus, and pertussis

  • Hepatitis A

  • Hepatitis B

  • Influenza (flu)

  • Polio

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. 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 frequent. 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 healthcare provider.)

  • Do your best to ignore a tantrum. Make sure 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 avoid getting 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 to the healthcare provider for other tips on dealing with your child’s behavior.

 

Next checkup at: _______________________________

 

PARENT NOTES:



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