Well-Child Checkup: 18 Months

Development and milestones

The healthcare provider will ask questions about your child. They will observe your toddler to get an idea of the child’s development. By this visit, most children are doing these:

• Pointing to show you something interesting

• Puts hands out for you to wash them

• Tries saying 3 or more words other than "mama" or "dada"

• Tries to use a spoon

• Drinking from a cup without a lid (may spill sometimes)

• Following 1-step commands (such as "please bring me a toy")

• Walking without holding on to anyone or anything

• Scribbles

• Copies you doing chores, like sweeping with a broom

• Looks at a few pages in a book with you

Feeding tips

You may have noticed your child becoming pickier about food. This is normal. How much your child eats at one meal or in one day is less important than the pattern over a few days or weeks. It’s also normal for a child of this age to thin out and look leaner, as long as they aren't losing weight. If you have concerns about your child’s weight or eating habits, bring these up with the healthcare provider. Here are some tips for feeding your child:

• Keep serving a variety of finger foods at meals. Don't give up on offering new foods. It often takes several tries before a child starts to like a new taste.

• If your child is hungry between meals, offer healthy foods. Cut-up vegetables and fruit, cheese, peanut butter, and crackers are good choices. Save snack foods, such as chips or cookies, for a special treat.

• Your child may prefer to eat small amounts often throughout the day instead of sitting down for a full meal. This is normal.

• Don’t force your child to eat. A child of this age will eat when hungry. They will likely eat more some days than others.

• Your child should drink less of whole milk each day. Most calories should be from solid foods.

• Besides drinking milk, water is best. Limit fruit juice. It should be 100% juice. You can also add water to the juice. And don’t give your toddler soda.

• Don’t let your child walk around with food or bottles. This is a choking risk and can also lead to overeating as your child gets older.

Hygiene tips

• Brush your child’s teeth at least once a day. Twice a day is ideal, such as after breakfast and before bed. Use a small amount of fluoride toothpaste, no larger than a grain of rice. Use a baby’s toothbrush with soft bristles.

• Ask the healthcare provider when your child should have their first dental visit. Most pediatric dentists recommend that the first dental visit happen within 6 months after the first tooth erupts above the gums, but no later than the child's first birthday. 

• Some children will begin to show readiness for toilet training as early as 18 to 24 months. Signs of readiness include:

  • Able to walk on their own

  • Staying dry longer (increased bladder and bowel control)

  • More discomfort with a soiled diaper

  • Able to tell you they need to eliminate

  • Able to follow simple commands (closer to 24 months)

Sleeping tips

By 18 months of age, your child may be down to 1 nap and is likely sleeping about 10 to 12 hours at night. If they sleep more or less than this but seems healthy, it’s not a concern. To help your child sleep:

• See that your child gets enough physical activity during the day. This helps your child sleep well. Talk with the healthcare provider if you need ideas for active types of play.

• Follow a bedtime routine each night, such as brushing teeth followed by reading a book. Try to stick to the same bedtime each night.

• Don't put your child to bed with anything to drink.

• If getting your child to sleep through the night is a problem, ask the healthcare provider for tips.

Safety tips

Put latches on cabinet doors to help keep your child safe.

Recommendations for keeping your child safe include: 

• Don’t let your child play outdoors without supervision. Teach caution around cars. Your child should always hold an adult’s hand when crossing the street or in a parking lot.

• Protect your toddler from falls with sturdy screens on windows and gates at the tops and bottoms of staircases. Supervise the child on the stairs.

• If you have a swimming pool, it should be fenced. Gates or doors leading to the pool should be closed and locked. Never leave your child unattended near any body of water. This includes the bathtub or a bucket of water.

• At this age, children are very curious. They are likely to get into items that can be dangerous. Keep latches on cabinets. Keep products like cleansers and medicines in locked cabinets, out of sight and reach. Cover unused outlets. Secure all furniture.

• Watch out for items that are small enough to choke on. As a rule, an item small enough to fit inside a toilet paper tube can cause a child to choke.

• In the car, always put your child in a car seat in the back seat. Babies and toddlers should ride in a rear-facing car safety seat for as long as possible. That means until they reach the top weight or height allowed by their seat. Check your safety seat instructions. Most convertible safety seats have height and weight limits that will allow children to ride rear-facing for 2 years or more.

• Teach your child to be gentle and cautious with dogs, cats, and other animals. Always supervise your child around animals, even familiar family pets.

• Keep your child away from hot objects. Don’t leave hot liquids on tables that your child can reach or with tablecloths that your child might pull down.

• If you have a gun, always store it in a locked location, unloaded, and out of reach of your child.

• Keep this Poison Control phone number in an easy-to-see place, such as on the refrigerator: 800-222-1222.

• Limit screen time. Screen time (TV, tablets, phones) is not recommended for children younger than 2 years. Limit screen time to video calls with loved ones. 

Vaccines

Based on recommendations from the CDC, at this visit your child may receive the following vaccines:

• Diphtheria, tetanus, and pertussis

• Hepatitis A

• Hepatitis B

• Influenza (flu)

• Polio

• COVID-19

Get ready for the “terrible twos”

You’ve probably heard stories about the “terrible twos.” Many children become fussier and harder to handle at around age 2. In fact, you may have started to notice behavior changes already. Here’s some of what you can expect, and tips for coping:

• Your child will become more independent and more stubborn. It’s common to test limits, to see just how much they can get away with. You may hear the word “no” a lot, even when the child seems to mean yes! Be clear and consistent. Keep in mind that you’re the parent, and you make the rules. Remember, you're the adult, so try to maintain a calm temper even when your child is having a tantrum.

• This is an age when children often don’t have the words to ask for what they want. Instead, they may respond with frustration. Your child may whine, cry, scream, kick, bite, or hit. Depending on the child’s personality, tantrums may be rare or often. Tantrums happen less as children learn how to express themselves with words. Most tantrums last only a few minutes. If your child’s tantrums last much longer than this, talk to the healthcare provider.

• Do your best to ignore a tantrum. See that the child is in a safe place and keep an eye on them. But don’t interact until the tantrum is over. This teaches the child that throwing a tantrum is not the way to get attention. Often moving your child to a private area away from the attention of others will help resolve the tantrum. 

• Keep your cool and try not to get angry. Remember, you’re the adult. Set a good example of how to behave when frustrated. Never hit or yell at your child during or after a tantrum.

• When you want your child to stop what they are doing, try distracting them with a new activity or object. You could also pick up the child and move them to another place.

• Choose your battles. Not everything is worth a fight. An issue is most important if the health or safety of your child or another child is at risk.

• Talk with the healthcare provider for other tips on dealing with your child’s behavior.