Your Baby at Twelve Months
Twelve months have passed. Your baby has grown quickly and is continuing to keep the family looking forward to the next step or word. She has done wonderfully, thanks to your family’s love and guidance. Your baby has probably now tripled her birthweight and has grown by about 50 percent. The next few years involve toddlerhood, a challenging and gratifying period for the family.
Your baby is now learning self-confidence and independence. If he is not walking yet, he soon will be. He should be at least pulling himself up to stand, and perhaps even walking hanging onto support. Encourage him to walk by holding his hands and leading him around. The toddler moves quickly but has little appreciation of impending danger. As his curiosity grows, your job involves more supervision as well as more education. You may find your toddler likes to explore away from you in familiar surroundings, but is fearful and clings in unfamiliar settings. Children must be protected and taught by action. He should be allowed to play and explore freely without a lot of hand slapping and a stream of “NO! NO!” This is tiring and difficult, but a child must be removed from danger repeatedly. Remove him from situations whenever possible rather than always repeating "no, no." This is a time of testing limits, and it will take many repetitions for him to learn. Do not expect him to remember after being told a few times. Parenting is successful with persistence and consistence.
In the area of language development, the most helpful thing you can do to add to her vocabulary of two or three words, is to talk about the things you are doing: eating, changing diapers, cleaning, etc. Name body parts while you bathe or dress her. Introduce her to books - the type with cardboard or cloth pages may be best right now. Having a pacifier in her mouth at all times may retard her language development.
As the toddler explores his body, he will also discover and play with his sex organs. Do not treat this any differently from when he discovers the other parts of his body. Teach him the name of all of his body parts. Remember your toddler will repeat everything you say and do. If you use vulgar language in front of him; he, too, will use it.
Most children develop the habit of a "security blanket" or favorite toy about this age. These can be helpful transition objects at bedtime. It is best if this object is not the bottle, so this is a good age to get the baby off the bottle. Never allow the baby to have the bottle in bed. Your child may enjoy push-pull toys, sponge and floating toys for the bath, books with textures and objects, books with rhymes and big pictures, simple take apart toys, large balls, and large puzzles.
In order to better screen for developmental concerns, you will be getting a questionnaire to answer. Please fill this questionnaire out and give to the front desk upon check out. We will contact you if there is any concern based on your answers. If at any time you have concerns regarding your child’s development, feel free to discuss this with your provider. If we are unable to fully address these issues, feel free to contact the Early Intervention Program at 1-800-323-GROW for a free evaluation.
Most children are eating table foods by this age. It is okay for him to have most types of foods. Eggs, dairy, fish, peanut butter, shellfish, and citrus foods are less likely to cause allergenic problems at this age, however, if there is a family member with food allergies, a more restricted program regarding food introduction may be recommended by your provider or your allergist. Remember to continue to avoid the choking foods (whole hot dogs, popcorn, nuts, raw carrots and celery, hard candies, whole grapes, etc.). Use common sense in deciding what is an appropriate food for your toddler.
It is now the time to change from formula to milk. The type of milk will be discussed at your visit with your provider. If your wish to continue to breast-feed, please do so. Between 16 and 24 ounces of milk per day is enough milk to meet your child's daily calcium requirement. Juice is not recommended at this age. It is responsible for multiple problems such as obesity, tooth decay, and failing to thrive to name a few.
Encourage your child to feed himself. Many children of this age exert their independence in this area and resist being fed anyway. 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, try to continue to keep mealtimes pleasant and ignore the eating behavior. Offer your child a well balanced diet and put small portions on her plate. Start with one tablespoonful as a serving. 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. The vast majority of toddlers will eat when they are 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. Stopping the bottle and avoiding juice (even watered-down juice) will also help with mealtime struggles. Do not become a short-order cook and continue to fix foods for that meal with the hope that she will eat them.
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.
- Until 24 months it is recommended that the baby ride in a car seat facing backwards every time the car is moving.
- She must be in a carseat until 40 pounds and a booster seat until 57 inches tall.
- Place gates at stairways to keep babies or toddlers from playing and falling on stairs.
- Place screens or bars on high windows to prevent falls.
- Use safety restraints when baby is in infant seat, high chair, stroller, car seat, etc.
- Keep crib sides in "up" position when baby is in crib.
- Put medicines away in a child-proof place after use and keep bathroom door closed at all times.
- Post the phone number to the Poison Control Center next to the phone (1-800-222-1222).
- Place detergents, cleaning fluids, razor blades, matches, medicines, etc. in a locked cabinet.
- Plug all empty electrical outlets with plastic plugs designed for this purpose.
- Keep matches, lighters, and electrical cords out of the reach of small children.
- Place the high chair and playpen well away from stove and kitchen counters.
- Turn pot and pan handles toward the back of the stove.
- Have smoke and carbon monoxide alarms installed in your home. Fire extinguishers are also recommended.
- Teach the word "hot" and keep children away from hot oven, iron, vent, fireplace, and woodstove.
- Move large sofa or chair in front of electrical outlets with cords plugged in.
- Place crib well away from cords to blinds and drapes and remove mobiles from crib now.
- Never leave pre-school children unattended in bathtub or wading pool.
- Never tie toys to crib or playpen - baby may get entangled and strangle.
- Be sure the baby's toys are too big to swallow. If they fit in a toilet paper roll, they are too small.
- Keep small objects (pins, buttons, coins, etc.) out of the reach of infants and toddlers.
- Install childproof latches on all cabinets and drawers containing dangerous items.
- Crawl through the house on hands and knees to spot enticing hazards that must be remedied.
- Lock or latch doors that lead to danger for a toddler.
- Remove small tables or other furnishings that are not sturdy or that have sharp corners.
- Constantly check toys for sharp edges or small broken pieces.
- Do not hang tablecloth off a table with a small child nearby.
- Do not smoke. While in the process of quitting, go outdoors and never smoke in the car. Smoking is associated with increased ear infections, pneumonia, colds, and increased risk of crib death. For assistance contact the Smoking Cessation Hotline at 1-866-QUIT-YES.
- Never shake or hit your baby. If you are angry or feel out of control, place your baby down safely and take the time to regain control. Contact the FUSSY BABY NETWORK at 1-888-431-BABY if you feel your baby’s crying or needs are overwhelming you. This is a free service.
Your physician will decide if fluoride or vitamins are necessary for your child. If you are still breast-feeding, please continue your child’s vitamin drops and your prenatal vitamins and iron.
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 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.
At the 12-month visit your baby should be getting: Prevnar #4 (prevents most pneumococcal meningitis), MMR #1 (prevents measles, mumps, and rubella), and Varavax #1 (prevents chicken pox). Also, any child who is not up to date with immunizations will be caught up. Fever from the Prevnar is usually within 2 days of the vaccine, while fever from the MMR shows up about 7-10 days after the vaccine. Use acetaminophen or ibuprofen for fever control or discomfort as needed. Proper dosing for these medications can be found in The Baby Book: Infant and Pediatric Care. Screening for anemia at this age is now routinely done, and you should get your results before you leave the office. 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. If you are planning on traveling to these locations, it is recommended to get the Hepatitis A vaccine as well.
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.
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.
Please schedule your baby's next appointment for 15 months of age 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 infant if necessary. We appreciate your understanding. Please bring the immunization record to every visit so we can update it.