HomeHealth Topics A to ZYour Baby at Fifteen Months
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Your Baby at Fifteen Months

By Dr. Boettcher

How time flies!  It seems as though just yesterday, you were waiting for your baby to roll over.  Now, your toddler has started to really develop into a little person.  Her personality is truly evident with all the little things that she does.  Your patience and endurance is tested quite frequently, but rest assured, your family is doing a terrific job.  Keep up the good work.

DEVELOPMENT:

Your toddler is now becoming more interactive.  He is starting to be able to follow simple instructions, such as bring you his cup.  He is able to imitate new sounds.  His language is developing, so that he is saying four or more words.  His utterances are more resembling words as he starts to evolve from babbling to jargoning.  Even without a large vocabulary, he should be starting to indicate his wants by pointing or pulling you rather than just crying.  Tantrums are a common experience at this time, due to communication dilemmas.  Encourage him to talk by not talking for him.  Try not to respond so quickly to the “Point and Grunt” and always speak to him during all interactions.  Censor your language around your child, as he may be increasing his vocabulary with unwanted words.

By now, most toddlers can walk across a large room.  Climbing onto furniture or up stairs is a new experience for her.   She will start to remove garments like socks or shoes.  She should also be adept at feeding herself finger foods and starting to use a fork or spoon.  Please encourage the use of crayons, but watch out that she doesn’t eat too many or scribble on the walls. 

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.  Sharing is not in the toddler mindset, but can be developed with continued reminders and praise.  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, wheelbarrow, climbing apparatus, drums and cymbals, dolls (lifelike, unbreakable heads, flexible rubber body), and books.

You will have a questionnaire that screens for any developmental concerns. If there were concerns revealed by this questionnaire, you will be notified and either a formal developmental evaluation will be recommended through the Early Intervention Program or a follow up screening questionnaire will be done at the next well visit. If you do not have concerns, but  develop concerns in the future, please let us know so we can address them.  If we are unable to fully address your developmental concerns, please contact the Early Intervention Program at 1-800-323-GROW.

DISCIPLINE:

“Time-out” basically involves placing your child in his playpen, a bench, or a 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, a bench, a chair, or even the bottom stair.  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.  Remember that “Time-out” only works if there is a “Time-in.” Also, too much “Time-out” will make it less effective.  Two good reference books for behavioral management are How to Say No to Your Toddler and S-O-S! Help for Parents.

Immediately following the negative behavior, say to the child, “No, don't”; no screaming, talking angrily, or nagging.  Carry the child to the Time-out place without talking to him.  When the child is in the Time-out place, wait until he has stopped crying for about 10-15 seconds or for a maximum of 2 minutes.  (We recommend a time-out 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:

Most children are eating table foods by this age.  Use common sense in deciding what is an appropriate food for your toddler.  Most foods are not restricted for intake, except for the choking hazards of nuts, popcorn, hard candy, raw vegetables, whole grapes, and hot dogs to name a few.  If your family has a history of food allergies, ask your provider regarding the proper timing of introduction of these foods – generally, not until 3 years of age.

By now you probably have changed from formula to cow’s milk.  If your wish to continue to breast-feed, please do so.  Your provider will be able to advise you as to which milk to be giving, whole, 2%, 1%, skim, or soy.  Between 16 and 24 ounces of milk per day is enough milk to meet your child's daily calcium requirement.  If your child needs soy or rice milk, make sure it is fortified with calcium and vitamin D.

Encourage your child to feed himself.  Many children of this age exert their independence in this area and resist being fed.  Once your child learns to feed himself, try not to feed him again.  When your child has had enough to eat, he will stop eating.  If he starts playing with his food, it is a good indication he has had enough.  Offer the cup after the meal or he may fill up on his drink and not be hungry for his food.

This is also the age when children sometimes become picky eaters.  If this describes your child, continue to keep mealtimes pleasant and ignore the eating behavior.  Offer your child a well balanced diet and put small portions on her plate (1 tablespoonful at a time).  She may skip meals here and there, but she will eat when she is hungry.  Her growth rate is not as rapid as it was during the first year, so she will seem to eat less.  Do not allow her to fill up on snacks, milk, or juice to make up the difference.  She will not starve herself and will eat when she is hungry.  Forcing her to eat by pleading, begging, or bribing does not help.  It only makes meals unpleasant for everyone.  Set reasonable time limits for each meal.  When the time is up, end the meal and clear the table.  If your toddler has not eaten, then she will probably eat better at the next meal.  Do not become a short-order cook and continue to fix foods for that meal with the hope that she will eat them.  Stopping the bottle and avoiding juice (even watered-down juice) will also help with mealtime struggles.  Snacks such as candy, crackers, and cookies should be infrequent and replaced by fruits and vegetables.

Mealtime should be a pleasant family time.  Yet, most parents have problems at one time or another with their child's mealtime behavior.  Mealtime 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 acknowledge 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.

SLEEPING:

A question many parents have at this age is about when to take the child out of the crib and put him in a regular bed.  Make sure the crib is set at its lowest level.  If your child climbs out of the crib, it is probably time to take him out of the crib.  Otherwise, if your child does not sleep through the night it is better to leave him in the crib so he does not wander around the house while you sleep.  Some also recommend changing from a crib at around 35 inches in length, about 18 months.

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.  If you do not have a fenced-in yard, be especially alert that your child does not play anywhere near a street.  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 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 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 ages 10-12 years.  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/LAB TESTS:

Your child is scheduled to receive DtaP#4, IPV#4, Hib#4 and Hepatitis A #1 vaccines today.  Most of these vaccines are combined and therefore results in fewer shots.  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.

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. 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 18 months.  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.  Bring toys and be prepared to feed your child if necessary.  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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