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Your Baby at Eighteen Months

By Dr. Boettcher

Oh, the joys of parenthood!  Your toddler has continued to grow and develop, and he is challenging your endurance and occasionally your patience.  Your family is doing a terrific job rearing this little tyke.  Keep up the good work.

DEVELOPMENT:

Your toddler can now point to at least one body part when asked (hair, eyes, nose, mouth, etc.). He can also follow simple instructions, such as bring you his cup.  He is able to identify voices or sounds coming from another room and imitates new sounds.  His language has developed so that he is saying eight or more words.  Most children are able to give one word answers to simple instructions.  Even without a large vocabulary, he should be able to indicate his wants by pointing or pulling you rather than just crying.  Encourage him to talk by not talking for him.  Be sure to censor your language around your child, or he will soon be repeating your four-letter words.

She can walk across a large room, take off her shoes, and drink from a cup.  She should also become better at feeding herself with a fork or spoon.  In fact, she should be feeding herself almost everything. They are helpful and want to assist with housework, etc. 

Play at this age is often imitative, and you may be surprised to see your toddler re-enacting something you have done or said.  Do not be surprised if your child is not good at playing with others.  Often they do best to play alongside, but not directly with other toddlers.  Toys that your toddler may enjoy include: blocks, push and pull toys, motor vehicles and airplanes (for pulling and taking apart), trains (may be fastened together and taken apart), large beads that may be strung, pounding peg board, sand toys, riding toys, logs or bricks for building, carpet sweepers, seesaws, tricycles, wheelbarrow, climbing apparatus, drums and cymbals, dolls (lifelike, unbreakable heads, flexible rubber body), and books.

Many parents would like to initiate potty-training at this age.  There are some physical prerequisites to toilet training and they include a good vocabulary with a word for peeing and pooping (whichever words you teach), the ability to walk well and stoop down and stand easily, staying dry for extended periods during the day, having bowel movements at a regular time, knowing the sensation of a full bladder or urge to have bowel movement (comes after they start letting you know the diaper is wet or dirty), and the desire to please their parents.  If you purchase a potty chair, let your child get used to it first.  Let her sit on it (fully clothed at first) for short periods.  It is best for all of you if you wait until your child is actually ready to toilet train, and then they practically train themselves.  Generally, this is after 2 years of age.  Girls are usually trained before boys, and kids are usually dry during the day for about a year before becoming dry during the night.

At this visit, DuPage Medical Group does a developmental screen.  Please fill out the questionnaire and give it to the front desk upon check out.  If there are any concerns, we will contact you about the concerns and if necessary will refer your child to the appropriate place.  If at any time you are concerned about your child’s development, please discuss this with your provider.  If we are unable to fully address your concerns, feel free to contact the Early Intervention Program at 1-800-323-GROW.

DISCIPLINE:

Time- out basically involves placing your child in his playpen, corner, or chair for a short period of time following each occurrence of a negative behavior.  This procedure has been effective in reducing problem behaviors such as tantrums, hitting, and other aggressive acts.  Parents have found that this works much better than spanking, yelling, and threatening children.  It is most appropriate for children ages 15 months to 5 years.  A place for time- out should be selected.  This could be your child's playpen.  It needs to be a dull place, but not a dark, scary, or dangerous place.  The aim is to remove the child to a place where not much is happening, not to make the child afraid.  Discuss with your spouse which behaviors will result in time-out.  Consistency is vital, as is persistence.

Immediately following the negative behavior, say to the child, “No, don't”; no screaming, talking angrily, or nagging.  Carry the child to the playpen without talking to him.  When the child is in the playpen, wait until he has stopped crying for about 10-15 seconds or for a maximum of 2 minutes.  (We recommend a time limit of 1-2 minutes/age in years.)  Before your child has stopped crying, do not look at him, talk to him, or talk about him.  After he is finally quiet, just go over to the playpen, pick him up without saying a word, and set him on the floor near some of his toys.  Do not reprimand him.  Just mention what he did wrong and that this will happen each time that action occurs.  After each time out episode, the child should start with a “clean slate.”  No discussion, nagging, threatening, or reminding is necessary.  At the first opportunity, look for and praise positive behaviors.  "Catch'em being good."

Summary of the rules:

  • Decide which behaviors need time-out and discuss this with your spouse (target 3 of the most urgent).
  • Do not leave your child in time-out and forget about him.
  • Do not nag, scold, or talk to the child when he is in time out (all family members must follow this rule).
  • Remain calm, particularly when your child is being testy
  • Don't use time-out for every problem.
  • Remember – Time-Out only works if you also use Time-In (or “Catch 'em being good.”)
  • If you have any concerns about discipline or have not been successful with Time-Out, please call us for advice.

FEEDING:

Mealtime should be a pleasant family time.  Yet, most parents have problems at one time or another with their child's mealtime behavior.  This is the time to teach your child the kind of manners and behavior you want at mealtime.  Your child should learn one set of manners, appropriate at all meals - whether eating at home, with company, at a restaurant, or at someone else's house.  The following guidelines will help you teach your child appropriate mealtime behavior.  If you follow the guidelines consistently, mealtime hopefully will no longer be a problem.  You and your child will enjoy mealtime and will be able to look forward to it as a special time you have together.

1)       Establish sit-down, family-style meals, where everyone sits down together to eat.  Turn off the television.

2)       Set a reasonable time limit for each meal (for example. 15-25 minutes).  You may use a portable kitchen timer to indicate when the meal is over.

3)       Establish a set of mealtime rules for your child.  Some examples are:

  • You must remain seated.
  • Don't throw food.

The rules should be reasonable, based on the age of your child.  Don't expect a young child to learn all the rules quickly.  Start with two or three rules.  After your child has learned to follow them, add a few more rules at a time, until gradually you have introduced all the rules.  Tell your child the rules (using a nice tone of voice) once at the beginning of each meal until the child has learned to follow them consistently.  Do not nag your child about the rules.

Be sure to praise your child for appropriate behaviors (such as using utensils, sitting quietly, talking nicely) whenever they occur throughout the meal.  You cannot praise too often.  Praise is how you teach your child what behavior pleases you.  If your child breaks a rule, have the child practice the correct behavior.  The third time your child breaks any rule, use discipline.  Time-out is one good way to teach your child the rules at meals.  Put the child in time-out for misbehaviors as many times as necessary until the time limit for the meal is up.

Give your child small portions of preferred foods.  An amount you are sure the child will eat.  You can always give more.  At first, give a small amount your child must eat to succeed, and then praise your child for eating it.  Then gradually increase the quantity you require the child to eat and the types of food you want the child to try.  Do not make your child "clean the plate."

Do not carry on conversations with another adult for longer than a few minutes at a time.  Include your child in conversations and talk about things that you know interest your child.  Make sure you do not nag, threaten, or warn during mealtimes.  Use mealtime as an opportunity to praise your child for appropriate behaviors throughout the day and to teach your child how to behave in a social situation.

When the time for the meal is up, clear the table, regardless of whether your child is finished.  Do not say anything to your child beyond announcing that the meal is over. (Once your child is usually staying at the table and finishing the meals on time, you can stop using the timer.)  If your child did not finish the last meal (either because the child refused to eat or because the child was in time-out and ran out of time), do not offer dessert and do not allow your child to eat or drink anything except water until the next meal.  If your child whines and constantly asks for snacks, place the child in time-out.  Even under normal circumstances, limit snacks.  If you allow your child to fill up on snacks, the child will not be hungry at mealtimes.  Give snacks that have nutritional value (such as raisins, fruit) rather than junk food.  You will also be teaching your child good eating habits.

When your child has learned to follow your mealtime rules consistently, you no longer need to go over them at the beginning of each meal.  However, it is still a good idea to review the rules from time to time.  The best way to do this is to "catch 'em being good:" remind your child of a rule by praising the child for following it.

SAFETY:

By now, the home should be well childproofed.  You toddler is striving more and more for independence, but still does not have adult judgment and should be protected at all times.  He needs a safe place to play outside - in a fenced in yard under constant adult supervision.  Pools need fences and swimming lessons are encouraged at the appropriate age - but this does not make him drown proof, and he should never be allowed to play unsupervised near water.

If you do not have a fenced-in yard, be especially alert that your child does not play anywhere near a street.  If she has a tricycle, she needs to be supervised at all times to insure she does not ride out into the street.  It is not appropriate to allow or expect other young children to supervise your child.

Car seats are still recommended to be rear facing until 24 months of age.  Continue to use a car seat until your child reaches 40 pounds and a booster seat until 57 inches tall, usually 10-12 years of age.  Then be sure the restraints are used properly.

Keep the Poison Control number (1-800-222-1222) posted next to the phone.

VITAMINS:

Fluoride is not needed if your child is drinking fluoridated water.  Check with your local water department regarding your water supply.  If you only use bottled water, check to see if it has fluoride.  Inform us if you do not provide fluoridated water, and we will supplement your child's fluoride intake as needed.

ILLNESS:  

Many common childhood illnesses can be effectively managed at home.  Please use the provided booklet:  The Baby Book: Infant and Pediatric Care  for information on most common pediatric problems and illnesses.  For illnesses or concerns that are not responding to your care, please call your provider’s office to talk to the nurses for advice on managing these situations. Our nurses have an abundant amount of information regarding common childhood illnesses, diseases, behaviors, and home management tips for these.  If your child needs to be seen, they will make the appropriate appointment.  We are available 24 hours a day, including weekends and holidays.  If you have an urgent need after hours, please feel free to contact us, and the physician on-call will gladly assist you.

DuPage Medical Group Pediatrics has many office hours available after work and school. We have our Immediate Care Center, which is available seven days a week.  On the weekend afternoons and holidays, when most pediatric offices have closed, we have the Pediatric After Hours Care Clinic.  If your provider’s office is closed or does not have availability for you, please contact 1-888-MY-DMG-DR (693-6437).  As there are many available options to be seen conveniently at times outside of normal business hours, we hope to be able to decrease your use of the emergency rooms for non-emergent illnesses. This will provide a huge savings for your family, and help with the continuity of care as the visit is within DuPage Medical Group. Please use the emergency room for truly urgent or emergent illnesses.  Some insurance companies require physician approval prior to going to the emergency room, so if it is not a life-threatening problem, but you think your child needs to be seen urgently, please contact your provider who can assist you in that decision and provide the proper referral if needed.  For life-threatening problems, please call 911 for immediate assistance.

IMMUNIZATIONS:

Your child should have received all routine vaccines by this age and therefore should not need any vaccines (with the exception of the flu shot between September and June).  If your child has missed any vaccinations in the past, we will make the necessary arrangements to give those vaccines in a timely fashion.  The expected side effects are listed in the vaccine information sheets provided.  If you elect not to follow our recommendations of immunizations, we need to counsel you regarding the possible deleterious effect this may have on her and the community.  We will then request that you sign a Vaccine Refusal form indicating that we counseled you about these dangers.  If your child has had a severe or unusual reaction to shots in the past, please let us know before the immunizations are given.

Notify us if any problems occur, such as:

  • An unusual, high-pitched cry or crying without stopping for 3 hours or more.
  • Very high fever (over 105°F) or convulsions.
  • Other symptoms you think are serious.

From September to June, we recommend flu shots for infants 6 months and older, along with all family contacts.  Children less than 9 years will need two shots separated by at least one month the first time they receive the flu shot.  In most cases, your provider is able to offer  the entire family (parents, grandparents, and nannies too) the flu vaccine.  This program has made it more convenient for families and has really helped us see less influenza the last couple of years.

If mom, dad, or grandparents have not gotten the whooping cough vaccine (TdaP), which is recommended for all adult caregivers of infants, please let us know, as in most cases we are able to provide this service for them.

If we feel it is necessary, we may screen for lead poisoning at this age.  If you have traveled to areas with increased tuberculosis risk (Asia, Africa, Middle East, Central and South America, and Eastern Europe) we will recommend a TB skin test. 

MYCHART

DuPage Medical Group has become a leader in the area regarding electronic medical records.  With the expansion of the electronic medical record, we can now provide our families with access to much of the same medical information that we have through MyChart.  Immunization records, medication lists, allergies, lab and X-ray results, growth charts, and appointment reminders are all available through this wonderful program.  Also, the ability to communicate with your provider for non-urgent medical questions can be done via email with MyChart.  We encourage all our families to sign up for this secure and useful online medical record portal.  The opportunity to sign up will be given to you at check in.  If you have any questions regarding this program, please call or discuss with your provider.                                                                                                       

NEXT VISIT:

Your child’s next well child visit is at 2 years.  Please schedule your baby's next appointment at checkout.   Please try to arrive 5 -10 minutes before your appointment so the necessary paperwork can be done.  Unfortunately, sometimes unexpected or complicated problems will cause us to be slightly delayed and you may need to wait awhile. We would appreciate your understanding.  Please bring the immunization record to every visit so we can update it.


Topics and Subtopics: Children's Health & Infant Care

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