WHAT YOU NEED TO KNOW:

What is a well child visit? A well child visit is when your child sees a healthcare provider to prevent health problems. Well child visits are used to track your child's growth and development. It is also a time for you to ask questions and to get information on how to keep your child safe. Write down your questions so you remember to ask them. Your child should have regular well child visits from birth to 17 years.

What milestones of development may my child reach by 18 months? Each child develops at his own pace. Your child might have already reached the following milestones, or he may reach them later:

• Say up to 20 words
  
  
• Point to at least 1 body part, such as his ear or nose
  
  
• Climb stairs if someone holds his hand
  
  
• Run for short distances
  
  
• Throw a ball or play with another person
  
  
• Take off more clothes, such as his shirt
  
  
• Feed himself with a spoon, and use a cup
  
  
• Pretend to feed a doll or help around the house
  
  
• Stack 2 to 3 small blocks

What can I do to keep my child safe in the car?

• Always place your child in a rear-facing car seat. Choose a seat that meets the Federal Motor Vehicle Safety Standard 213. Make sure the child safety seat has a harness and clip. Also make sure that the harness and clips fit snugly against your child. There should be no more than a finger width of space between the strap and your child's chest. Ask your healthcare provider for more information on car safety seats.
  
  
• Always put your child's car seat in the back seat. Never put your child's car seat in the front. This will help prevent him from being injured if you get into an accident.

What can I do to make my home safe for my child?

• Place gates at the top and bottom of stairs. Always make sure that the gate is closed and locked. Gates will help protect your child from injury. Go up and down stairs with your child to make sure he stays safe on the stairs.
  
  
• Place guards over windows on the second floor or higher. This will prevent your child from falling out of the window. Keep furniture away from windows. Use cordless window shades, or get cords that do not have loops. You can also cut the loops. A child's head can fall through a looped cord, and the cord can become wrapped around his neck.
  
  
• Secure heavy or large items. This includes bookshelves, TVs, dressers, cabinets, and lamps. Make sure these items are held in place or nailed into the wall.
  
  
• Keep all medicines, car supplies, lawn supplies, and cleaning supplies out of your child's reach. Keep these items in a locked cabinet or closet. Call Poison Help (1-800-222-1222) if your child eats anything that could be harmful.
  
  
• Keep hot items away from your child. Turn pot handles toward the back on the stove. Keep hot food and liquid out of your child's reach. Do not hold your child while you have a hot item in your hand or are near a lit stove. Do not leave curling irons or similar items on a counter. Your child may grab for the item and burn his hand.
  
  
• Store and lock all guns and weapons. Make sure all guns are unloaded before you store them. Make sure your child cannot reach or find where weapons are kept. Never leave a loaded gun unattended.

What can I do to keep my child safe in the sun and near water?

• Always keep your child within reach near water. This includes any time you are near ponds, lakes, pools, the ocean, or the bathtub. Never leave your child alone in the bathtub or sink. A child can drown in less than 1 inch of water.
  
  
• Put sunscreen on your child. Ask your healthcare provider which sunscreen is safe for your child. Do not apply sunscreen to your child's eyes, mouth, or hands.

What are other ways I can keep my child safe?

• Follow directions on the medicine label when you give your child medicine. Ask your child's healthcare provider for directions if you do not know how to give the medicine. If your child misses a dose, do not double the next dose. Ask how to make up the missed dose. Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen.
  
  
• Keep plastic bags, latex balloons, and small objects away from your child. This includes marbles or small toys. These items can cause choking or suffocation. Regularly check the floor for these objects.
  
  
• Do not let your child use a walker. Walkers are not safe for your child. Walkers do not help your child learn to walk. Your child can roll down the stairs. Walkers also allow your child to reach higher. They can reach for hot drinks, grab pot handles off the stove, or reach for medicines or other unsafe items.
  
  
• Never leave your child in a room alone. Make sure there is always a responsible adult with your child.

What do I need to know about nutrition for my child?

• Give your child plenty of healthy foods. Healthy foods include fruits, vegetables, lean meats, and whole grains. Cut all foods into small pieces. Ask your healthcare provider how much of each type of food your child needs. The following are examples of healthy foods:
  • Whole grains such as bread, hot or cold cereal, and cooked pasta or rice
    
    
  • Protein from lean meats, chicken, fish, beans, or eggs
    
    
  • Dairy such as whole milk, cheese, or yogurt
    
    
  • Vegetables such as carrots, broccoli, or spinach
    
    
  • Fruits such as strawberries, oranges, apples, or tomatoes
  
  
• Give your child whole milk until he is 2 years old. Give your child no more than 2 to 3 cups of whole milk each day. His body needs the extra fat in whole milk to help him grow. After he turns 2, he can drink skim or low-fat milk (such as 1% or 2% milk). Your child's healthcare provider may recommend low-fat milk if your child is overweight.
  
  
• Limit foods high in fat and sugar. These foods do not have the nutrients your child needs to be healthy. Food high in fat and sugar include snack foods (potato chips, candy, and other sweets), juice, fruit drinks, and soda. If your child eats these foods often, he may eat fewer healthy foods during meals. He may gain too much weight.
  
  
• Do not give your child foods that could cause him to choke. Examples include nuts, popcorn, and hard, raw vegetables. Cut round or hard foods into thin slices. Grapes and hotdogs are examples of round foods. Carrots are an example of hard foods.
  
  
• Give your child 3 meals and 2 to 3 snacks per day. Cut all food into small pieces. Examples of healthy snacks include applesauce, bananas, crackers, and cheese.
  
  
• Encourage your child to feed himself. Give your child a cup to drink from and spoon to eat with. Be patient with your child. Food may end up on the floor or on your child instead of in his mouth. It will take time for him to learn how to use a spoon to feed himself.
  
  
• Have your child eat with other family members. This gives your child the opportunity to watch and learn how others eat.
  
  
• Let your child decide how much to eat. Give your child small portions. Let him have another serving if he asks for one. Your child will be very hungry on some days and want to eat more. For example, he may want to eat more on days when he is more active. He may also eat more if he is going through a growth spurt. There may be days when he eats less than usual.
  
  
• Know that picky eating is a normal behavior in children under 4 years of age. Your child may like a certain food on one day and then decide he does not like it the next day. He may eat only 1 or 2 foods for a whole week or longer. Your child may not like mixed foods, or he may not want different foods on his plate to touch. These eating habits are all normal. Continue to offer 2 or 3 different foods at each meal, even if your child is going through this phase.
  
  
• Offer new foods several times. At 18 months, your child may mouth or touch foods to try them. Offer foods with different textures and flavors. You may need to offer a new food a few times before your child will like it.

What can I do to keep my child's teeth healthy?

• A child younger than 2 years needs to have his teeth brushed twice a day. Brush your child's teeth with a children's toothbrush and water. Your child's healthcare provider may recommend that you brush his teeth with a small smear of toothpaste with fluoride. Make sure your child spits all of the toothpaste out. Before your child's teeth come in, clean his gums and mouth with a soft cloth or infant toothbrush once a day.
  
  
• Thumb sucking or pacifier use can affect your child's tooth development. Talk to your child's healthcare provider if your child sucks his thumb or uses a pacifier regularly.
  
  
• Take your child to the dentist regularly. A dentist can make sure your child's teeth and gums are developing properly. Your child may be given a fluoride treatment to prevent cavities. Ask your child's dentist how often he needs to visit.

What can I do to create routines for my child?

• Have your child take at least 1 nap each day. Plan the nap early enough in the day so your child is still tired at bedtime. Your child needs between 12 to 14 hours of sleep every night.
  
  
• Create a bedtime routine. This may include 1 hour of calm and quiet activities before bed. You can read to your child or listen to music. Brush your child's teeth during his bedtime routine.
  
  
• Plan for family time. Start family traditions such as going for a walk, listening to music, or playing games. Do not watch TV during family time. Have your child play with other family members during family time. Limit time away from home to an hour or less. Your child may become tired if an activity is longer than an hour. He may act out or have a tantrum if he becomes too tired.

What do I need to know about toilet training? Toilet training can start between 18 and 24 months of age. Your child will need to be able to stay dry for about 2 hours at a time before you can start toilet training. He will also need to know wet and dry, and when he needs to have a bowel movement. You can help your child get ready for toilet training. Read books with your child about how to use the toilet. Take him into the bathroom with a parent or older brother or sister. Let him practice sitting on the toilet with his clothes on.

What else can I do to support my child?

• Do not punish your child with hitting, spanking, or yelling. Never shake your child. Tell your child "no." Give your child short and simple rules. Do not allow your child to hit, kick, or bite another person. Put your child in time-out for 1 to 2 minutes in his crib or playpen. You can distract your child with a new activity when he behaves badly. Make sure everyone who cares for your child disciplines him the same way.
  
  
• Be firm and consistent with tantrums. Temper tantrums are normal at 18 months. Your child may cry, yell, kick, or refuse to do what he is told. Stay calm and be firm. Reward your child for good behavior. This will encourage your child to behave well.
  
  
• Read to your child. This will comfort your child and help his brain develop. Point to pictures as you read. This will help your child make connections between pictures and words. Have other family members or caregivers read to your child. Your child may want to hear the same book over and over. This is normal at 18 months.
  
  
• Play with your child. This will help your child develop social skills, motor skills, and speech.
  
  
• Take your child to play groups or activities. Let your child play with other children. This will help him grow and develop. Your child might not be willing to share his toys.
  
  
• Respect your child's fear of strangers. It is normal for your child to be afraid of strangers at this age. Do not force your child to talk or play with people he does not know. Your child will start to become more independent at 18 months, but he may also cling to you around strangers.
  
  
• Limit your child's TV time as directed. Your child's brain will develop best through interaction with other people. TV time may not be appropriate for children younger than 2 years. Talk to your child's healthcare provider if you want to let your child watch TV. He can help you find programs that will be educational. He can also help you set appropriate time limits.

What do I need to know about my child's next well child visit? Your child's healthcare provider will tell you when to bring him in again. The next well child visit is usually at 2 years (24 months). Contact your child's healthcare provider if you have questions or concerns about his health or care before the next visit. Your child may need the hepatitis A vaccine at his next visit. He may need catch-up doses of the hepatitis B, DTaP, HiB, pneumococcal, polio, MMR, or chickenpox vaccine. Remember to take your child in for a yearly flu vaccine.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.