Friday, July 10, 2009

18 month guidelines


All pediatricians have their own set of guidelines, but a lot of people have been asking what their baby should be doing at 18 months or what the dr. might ask at the 18 month well baby check up. I got this packet from Bailey Alyse's pediatrician today and I just wanted to share some of the info out of it and hopefully it will help to clear things up. And I'm going to go ahead and apologize for all the spelling errors. I didn't realize there was so much to type but holy moly, there is!!!! My hands hurt after typing all of that so now it's time to fold laundry, haha. But, don't forget that just because these are my daughter's doctors guidelines, doesn't meant that your dr. has the same set of guidelines and parenting tips...It also doesn't meant that your child isn't right on track. Ask your child's pediatrician if you have any questions...

Mr./Miss "No!"

Your sweet little baby has grown up into a toddler, entering a world of boundless energy, curiosity, independence, and negativism. Having a toddler brings new challenges to you and your partner as parents. The following comments are designed to help you enjoy your 18-month-old son or daughter. Never hesitate to ask us for guidance concerning specific problems. This is the reason for regular well-baby checkups.

Parenting & Behavioral

* The 18-month-old child gets around easier and will soon be running. It is easy to expect too much of our toddler. He or she looks so different from the crawling baby of a few months ago, and many parents think their youngster is no longer a baby.

* Keep rules to a minimum. Long speeches of explanation are completely useless. "Because I said so!" should be enough.

* Be firm and consistent, but loving and understand with discipline. Praise your toddler for his or her good behavior and accomplishments.

* Encourage your toddler to make choices whenever possible, but the choices should be limited to those you can live with ("red shirt or green shirt") Never ask a toddler an open question ("Do you want to take a bath?") unless you are willing to accept the answer.

* Use the two "I's" of discipline (ignore or isolate) rather than the two "S's" (shouting or spanking). Keep time-out to no more than two minutes per childs age, and be consistent. When disciplining, try to make a verbal separation between the child and his or her behavior ("I love you, but I do not like it when you touch the VCR") Pick-up your toddler, hold him or her, or remove her from dangerous situations. Reassure the toddler once the nagative behavior has stopped.

* Provide alternatives. "No, you cannot play with the telephone, but you can play with these blocks."

* Avoid power struggles with your toddler. No one wins! The toddler uses a powerful wewapon against the parents: the temper tantrum! These occur when the toddler is angry, tired, frustrated, or does not get his or her way. Most of the time, what happens during the tantrum is fairly predictable. Occasionally a child this age may get so angry he or she will hold his or her breath and pass out. Not to worry - once they do, the body's reflexes take over and your child will start breathing again on his or her own. Again, handle temper tantrums with the two I's of descipline - ignore or isolate (time out!).

* Reinforce self-care and self-expression. Praise what the child does for him or herself (putting his/her hand in a sleeve, putting meat on a fork, washing his/her hands, etc.). Parents should say "...and you did that all by yourself!" The 18-mont old child is highly pleased by parental approval.

* Show affection in the family. Be a good role model by using seat belts, avoiding tobacco, and showing respect for others. The toddler is a great imitator.

* Do not expect the toddler to share toys, wait for his or her food in a restaurant, or be patient while you try on clothes at the store or go food shopping.

* Early toilet training does not mean your child is super smart. Pushing the toddler will only make him or her rebel and be in diapers even longer. Signs that a child might be ready are dry for periods of about two hours, knows the difference between wet and dry, can pull his or her pants up and down, wants to learn, and can give a signal when he or she is about to have a bowel movement. If you insist on toilet training when your child is not ready, a battle will develop...and it is a battle you cannot win! Discuss toilet training with your child's pediatrician to get his or her views.

* Remeber that aggressive behaviors - hitting and biting - are common at this age. They are, of course, not acceptable behaviors. How parents respond to them determines if the behavior will continue.

* Do not discourage your child from using a security object - a stuffed anima. favorite blanket, etc. These are important for a toddler and the child will give it up when he or she is ready. (They usually do not take them to high school!)

* Despite your child's desire to become independent, you will find the 19-month-old will still cling to a parent.

* Read simple stories to the child regularly, especially at bedtime, to enrich his or her verbal expression and increase his or her insterest in the spoken language and his or her listening skills.

* Limit television viewing and do not use it as a substitute for interaction with the child. Watch children's programs with the child when possible.

* The principal caregiver should be encouraged to arrange time for himself/herself. Raising a toddler can often be demanding.

* Praise the child when they are behaving well, and always show affection.

Development

* Walks fast, walks up stairs with one hand held, kicks a ball

* Uses a vocabulary of 4-10 words and may combine 2-word phrases.

* Understands simple directions

* Points to some body parts correctly

* Shows affection by kissing parents

* feeds himself or herself, drinks from a cup adequately and uses a spoon.

* Imitates a crayon stroke on paper

* Holds and "loves" a doll or stuffed animal; may use a household-type toy (for example, a toy telephone) appropriately.

*Will sit for a short time and look at pictures in a book. Turns single pages in a book or magazine.

Oral Health

* Brush you child's teeth twice daily with an age appropriate toothpaste

* To prtect your toddler's teeth, do not put him or her to bed with a sippy cup or prop it in his or her mouth.

* Discontinue pacifier use except, perhaps, at nap time and bedtime.

* Ask your child's doctor when you should make the youngster's first dental appointment. This is usually at 2 or 3 years of age.

Feeding

Your baby's appetite is going to continue decreasing during the toddler years. Don't make a "big deal" out of it if you child refuses to eat. No one ever starved with a refrigerator full of food. The toddler's caloric needs are down and he or she is trying to show independence. Develop a "take it or leave it" attitude and do not engage in battles over eating. You cannot win, so why fight? Children this age will determine the amount of food they need. Mealtime should not be a battle.

* Your toddler probably did not grow much since his or her last checkup. Maybe 2 inches and a few pounds, but that's all.

* Share meals as a family whenever possible. This helps your baby learn. Make mealtimes pleasant and encourage concersation. Avoid using snacks between meals because the toddler has "not eaten all day".

* The toddler should be drinking only from a cup (or a sippy cup) and using utensils pretty well to feed himself or herself.

Sleep

* Encourage your child to console himself or herself by putting them to bed awake.

* Prepare strategies to deal with night awakening, night fears, nightmares, and night terrors.

* Children this age frequently resist going to sleep. They will usually give a "test" cry to see if you will return. While it is important to let the toddler know you are there, it is also important to let him or her know that the day is over.

* Your toddler may start to give up at least one nap. This is sometimes an awkward stage when one nap is not enough and two naps are too many.

* Never put your child to bed with a bottle. He or she should be off all bottles at this age!

Immunizations

Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced, it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.

* Normally, no immunizations are given at this checkup unless your child's doctor follows another approved schedule or the child is behind in the immunization schedule.

* By this age, most children have received the following immunizations:

- 3 doses of Hepatitis B vaccine

- 4 doses of DTaP vaccine

- 4 doses of HIB vaccine

- 1 dose of the MMR vaccine

- 1 dose of the Chickenpox vaccine

- 4 doses of the Pneumococcal vaccine

- 3 doses of the Inactivated Polio vaccine

Toilet Training

Some children show readiness for toilet training between 18-24 months. When toddlers report to their parents that they have wet or soiled their diaper, they are beginning to be aware that they prefer dryness. this is a good sign and parents should praise their child. Other signs that a child might be ready are dry for periods of about two hours, knows the difference between wet and dry, can pull his or her pants up and down, wants to learn, and can give a signal when he or she is about to have a bowel movement.

* Toddlers are naturally curious about the use of the bathroom by other people, so let them watch you or other family members use the toilet.

* Starting toilet training before the child is ready will only cause the toddler to rebel and still be in diapers at 3 and 4 years of age. It is important not to put too many demands of a child or shame them during toilet training.

Safety

* Use car restraints consistently

* Ensure stair and window safety

* All play outside should be supervised. Toddlers do not understand danger and cannot remember "no".

* Knowing how to "swim" does not make a child water-safe at this age. Supervise the toddler constantly whenever he or she is in or around water, buckets, the toilet, or the bathtub. Continue to empty buckets, tubs, or small pools immediately after use. Ensure that swimming pools have a four-sided fence with a self-closing, self latching gate.

* If your home uses gas appliances, install and maintain carbon monoxide detectors.

* Put sun screen on the toddler before going outside to play or swim. Be particularly careful during the hours between 10am and 3pm whe nthe sun is most dangerous.

* Continue to keep your toddler's environment free of smoke. Keep the home and car nonsmoking zones.

* Ensure electric wires, outlets, and appliances are inaccessible or protected.

* Keep medicines, cigarettes, lighters, matches, alcohol, firearms, and electrical tools locked up and/or out of the toddler's sight and reach.

* Always walk behind your car before you back out the driveway.

* Remeber, almost anything in your home can be poisonour.

* Keep the number of the poison control center near the telephone.

* Do not expect your older children to supervise the toddler (e.g., in the house, apartment, playground, or yard.

* Keep the toddler away from moving machinery, lawn mowers, overhead garage doors, driveways, and streets.

* Ensure that a toddler riding in a seat on an adult's bicycle is wearing a helmet and wear a helmet yourself.

* Teach the child to use caution when approaching dogs, especially if the dogs are unknown or eating.

* Keep plastic bags and balloons, and small hard object out of reach. Cut food into small pieces.

* Know how to save a choking child.

* Store toys in a chest without a dropping lid.

Illness

* Your toddler might have many colds and other respiratory infections during this time. Children who are in day care will experience more infections than those home with a parent or grandparent.

* There will be times when you will think you "live" at your pediatricians office, since many viral infections at this age come one after the other.

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