All About the 18-Month Well-Child Checkup
The 18-month checkup, along with all of your child’s wellness appointments, is an important part of your child’s healthcare. Your toddler may be due for some immunizations, and you might have lots of questions about things like sleep, discipline, and development milestones. Discover what typically happens at the 18-month well-child check and how to prepare so that you and your toddler get the most out of the session.
Growth Check and Physical Exam During the 18-month check, your provider will examine your toddler and check on his growth and development. Here are some of the physical checks that may take place:
- Your toddler’s height, weight, and head circumference will be measured and recorded on standard growth charts your provider uses. These growth charts help track your toddler’s development over time.
- Your little one’s eyes and ears may be checked.
- Your toddler’s provider might look inside his mouth to check on the gums and teeth.
- A stethoscope may be used to listen to the heart and lungs
- Your toddler may also be asked to walk a little, so your provider can check that his legs and feet move properly.
Screening Tests at the 18-Month Checkup
If your toddler has certain risk factors or is showing signs of a problem, your healthcare provider may recommend screening tests for things like
- lead poisoning
- hearing issues
- vision problems
- developmental delays.
Your provider will talk you through which screening tests may be recommended and why, as well as what the next steps may be based on the results.
Given at the 18-Month Checkup Your toddler may get these shots at the 18-month checkup, or at a separate visit:
- The fourth dose of the DTaP vaccine
- The third dose of the polio vaccine
- The fourth dose of Hib
- The fourth dose of pneumococcus
- The second hepatitis A vaccine (if the first dose was given 6 months earlier).
Your toddler may also be given other immunizations if any were missed over the past few months. Your healthcare provider may also recommend a flu shot if your toddler hasn’t gotten one in the past year.
Topics That May Come Up at the 18-Month Visit
Your provider will use this visit to assess how your toddler is developing, and give you the information you need so that you feel more empowered as a parent. Your provider will be familiar with you and your family by now, and will tailor these discussions to your specific needs.
These are just some of the important topics that may come up at the 18-month visit:
Your provider may ask what and how much your child is eating these days. If you think your child is such a finicky eater that he isn’t getting proper nutrition, talk it over with your provider. You might like to ask whether your toddler needs any vitamin or fluoride supplements. At this visit, you might also like to ask about healthy snack ideas, pick up some tips on getting your 18-month-old to try new foods, and find out how to feed your toddler if he prefers wriggling and playing to eating. You might be asked if your toddler can use a spoon and drink from a cup, and whether your toddler is still taking a bottle. If you are still breastfeeding but would like to stop soon, your provider can also offer tips on weaning.
Your healthcare provider may ask how well your child is sleeping at night and whether he is having one or two daytime naps. It might help to keep a diary of your child’s sleeping patterns for a few days and bring it to the visit. If it’s needed, your healthcare provider can offer some guidance on how to improve your little one’s sleep routine, and how to settle your little one if he wakes at night.
Potty Training Readiness
Your healthcare provider might ask you about whether you’re seeing any signs of readiness for potty training, and may offer advice on when and how to introduce the potty. Let the provider know if your child has diarrhea or is constipated, and feel free to bring up any concerns you may have.
How your child plays and behaves gives your healthcare provider lots of information about how he’s progressing. Having this information helps your provider recommend additional support or steps to help ensure your toddler’s healthy development. Each visit is unique, and your provider knows your family best, but these are some examples of questions your healthcare provider may ask about your toddler’s development: How are your child’s walking and climbing skills? Can your toddler say several single words, and shake his head as if to say “no”? Does he understand one-step commands such as “Get your shoes” or “Bring me a diaper”? Can he point to the right body part when asked? Does he imitate you in things you often do, such as by feeding a doll or holding a phone to the side of his head? How does he play? Can he pull a toy along the ground? Does he scribble? Does he point to show what he wants or to get your attention? Does he like to hand objects to people? Is he afraid of strangers, but shows affection to people he knows well? Remember, your toddler is unique and develops at his own pace. He may reach some milestones earlier or later than other children. It’s important that your provider get an accurate picture of where your child is at now in order to support healthy development.
Your healthcare provider may ask you about your toddler’s behavior and about your discipline strategies—what works and what doesn’t. Your toddler’s growing sense of independence could be leading to him acting out and misbehaving in various ways. “No” might be your toddler’s favorite word. Let your provider know if you’re facing any challenges. Your provider has lots of experience and will be able to give you some pointers on how to set up age-appropriate rules and boundaries, and how to handle issues that could arise as your toddler approaches the “terrible twos,” which are just around the corner.
Recent Health Issues
Your healthcare provider may want to know if your child has seen another healthcare provider since the last visit. The provider may ask about any outcomes of that visit, and if any medications or treatments were prescribed. Your provider may also ask if you have any other current concerns about your toddler’s health.
Your Healthcare Provider Might Talk to You About Your toddler’s healthcare provider knows your situation and might raise several other topics that could be relevant to you at this stage. Generally speaking, here are some other things that may come up at the 18-month check:
- How to choose a preschool
- Dealing with separation anxiety
- Oral hygiene and how to care for your toddler’s teeth and gums
- Any infections that are making the rounds in your area now
- Safety tips, especially as your toddler becomes more mobile, curious, and independent
- Any outside support or resources that may be available to you and your family to help ensure the happy and healthy development of your toddler
- Introducing your toddler to your new baby, if you are pregnant again, or dealing with sibling rivalry if you already have more than one child.
Ask Any Questions You Have
From time to time you might have questions that aren’t necessarily urgent. Write these down as you go and have them with you at this well-child visit. Here are some of things you may be curious about, for example:
- What’s an effective way to discipline an 18-month-old?
- How much and what kind of screen time can your 18-month-old have?
- Are there certain foods to avoid serving? (For example, you may be worried about an allergic reaction to something specific.)
- What to do if you are struggling to wean your little one from the breast or bottle?
- What should you do if you need to toilet train your little one by age 2 (for example, if your chosen preschool requires it)?
- Should you be stopping the morning nap soon?
- Is it OK if your 18-month-old doesn’t want to nap at all?
- Is it OK if your little one is shy around other toddlers?
- How can you encourage your toddler’s language development?
- How can you make the daycare drop-off easier?
- Can the provider recommend a great pediatric dentist in the area (if you don’t already have one)?
Let Your Healthcare Provider Know If…
- Your child can’t walk yet or is always walking on her toes
- Your child doesn’t mimic the way you use familiar household objects like the phone or cup
- Your child can’t say several words
- Your child doesn’t show affection to close family members
- Your child doesn’t seem to notice when you or any other caregiver leaves or returns
- Your child loses a skill she once had
- You have any other issues, questions, or concerns about your toddler’s development or your life as a parent.
Tips for the Visit
You probably know now from experience what works for you for these visits, but here are some general tips:
- Ensure your toddler isn’t over-tired or hungry
- Dress your toddler in a two-piece outfit that comes off easily for the physical exam
- Pack some snacks
- Pack a toy or two to keep her entertained
- Take any medical documents your provider doesn’t have, and write down any questions or observations you have so you don’t forget anything
- Plan to go with someone, if you can. It might help you to focus on your conversation with your provider if your partner, a grandparent, or a friend is there with your little one.
- Make the visit a treat. For example, you might like to follow the visit with an ice cream cone or a trip to the playground so that your little one associates something fun with the visit as well.
Baby’s 18-Month Checkup: What to Expect
By now, your toddler can probably say about 10 to 20 words, walk, point to body parts, and follow simple instructions, including “no” — but that doesn’t mean they’ll always listen! It’s normal if your child tries to push limits. Be sure to be consistent with discipline and talk about any concerns that you may have with your pediatrician.
Here’s what to expect at your toddler’s 18-month checkup.
You Can Expect Your Pediatrician to:
- Weigh and measure your child
- Perform a physical exam of your child
- Catch up on any vaccines, including a flu shot in the fall/winter
- Ask you to complete a developmental screening about your child
Questions Your Pediatrician May Ask
- Has your child been having temper tantrums?
- Is your child talking a lot? Pointing? Scribbling?
- Are they sleeping and napping well?
- Do they appear to understand what you are saying?
- Have they had a dentist appointment?
- Are they still taking a bottle?
Questions You May Have About Naps
- My child doesn’t want to nap. What can I do?
- How can I keep afternoon naps from causing problems at bedtime?
- Try soft music or a sound machine to ease your child into naptime.
- Stick to a routine so your child knows what to expect.
- Starting naps earlier and limiting them to less than 3 hours may help nighttime sleep.
- Expect to wean down to one nap per day.
Questions You May Have About Toilet Training
My child seems interested in potty training. Is it too early to start?
Toilet Training Tips
- Many kids are physically ready between 18 months and 2 years old.
- Girls are usually ready sooner than boys.
- If your child shows interest in the potty or stops an activity to “go,” they may be ready.
- Your child needs to be able to understand instructions about the potty and control the muscles involved, and needs to be able to remove their pants and underwear.
- Set up a potty chair in the bathroom and let them come in with you when you go. This will spike their interest!
- Some parents use training pants to transition from diapers to underwear. Or you can go “cold turkey” if you are okay with some messes as they learn.
- It can take a long time for a child to stay dry at night, so you might want to keep them in training pants at night for a while.
- Celebrate and congratulate your child if they use the potty — even if nothing happened.
- If it doesn’t seem to be working, don’t worry. Just try again a few months later.
- Remember, your child may be enthusiastic at first. But then they may start finding their own activity too interesting to break away from to go to the potty.
Questions You May Have About Talking
- How can I encourage my child to speak and learn words?
- Read to your child often. TV and videos (even the educational kind) can’t compete with you reading or talking to your child.
- Read the same book over and over if your child asks. Repetition helps them learn.
- Read interactively. Ask questions abut characters. Ask your child to point to characters or objects, or ask them to tell you where characters or objects are. Ask them to tell you what the characters are doing.
- If your child can’t sit still long, keep reading when they are playing or moving around.
- Pick books with lots of pictures about activities like bedtime or bath.
- Music also helps with language development.
- Expose your child to all kinds of music, not just children’s songs.
- Make up songs to daily activities, like brushing teeth.
- Talk to them throughout the day. Explain to them what you are doing such as folding laundry or cooking dinner.
Talk to the pediatrician if your child:
- Prefers to use gestures to communicate Has trouble imitating sounds
- Doesn’t understand simple instructions such as “get your book” Isn’t walking
- Remember that TV and media need to be limited. This time will go fast and you want to use the precious moments to stimulate their brain. TV will take this time away. Music, reading, and interactive play are wonderful ways to help their developing brain.
Well-Child Checkup: 18 Months
At the 18-month checkup, your healthcare provider will examine your child and ask how it’s going at home. This sheet describes some of what you can expect.
Development and milestones
- The healthcare provider will ask questions about your child. He or she will observe your toddler to get an idea of the child’s development. By this visit, your child is likely doing some of the following:
- Pointing at things so you know what he or she wants.
- Shaking head to mean “no” Using a spoon
- Drinking from a cup
- Following 1-step commands (such as “please bring me a toy”)
- Walking alone; may be running
- Becoming more stubborn (for example, crying for no apparent reason, getting angry, or acting out)
- Being afraid of strangers
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 he or she isn’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. Be persistent with 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. He or she 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.
- 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)and a baby’s toothbrush with soft bristles.
- Ask the healthcare provider when your child should have his or her 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.
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 he or she sleeps more or less than this but seems healthy, it’s not a concern. To help your child sleep:
- Make sure your child gets enough physical activity during the day. This helps your child sleep well. Talk to 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.
- Do not 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.
Recommendations for keeping your child safe include the following:
- 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.
- At this age, children are very curious. They are likely to get into items that can be dangerous. Keep latches on cabinets and make sure products like cleansers and medicines are out of reach.
- 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. Infants and toddlers should ride in a rear-facing car safety seat for as long as possible, until they reach the highest 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 this Poison Control phone number in an easy-to-see place, such as on the refrigerator: 800-222-1222.
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)
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 he or she 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 frequent. 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. Make sure the child is in a safe place and keep an eye on him or her, 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 avoid getting 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 he or she is doing, try distracting him or her with a new activity or object. You could also pick up the child and move him or her 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 to the healthcare provider for other tips on dealing with your child’s behavior.
18-Month Well Child Visit
What to expect during your child’s 18-month well child exam
Now that your child is more than a year old, you may have questions about discipline, social growth, and how to adjust to a child that feels more like a toddler than a baby now. At this well child checkup, your provider will not only answer your concerns, but make sure he is healthy and well.
Below are some of the things your doctor may do at your child’s 18-month checkup.
What your pediatrician may do during your child’s 18-month checkup Address any concerns of the new parent or caretaker
- Do you have a list of questions we can go over together?
- Has anything come up since our last visit?
- Observe the overall development of your child
- Do you have any new concerns about your baby’s development?
- Has your child reached some of the common project developmental milestones for this age?
- Can your child try to run or walk up stairs?
Complete physical examinations to ensure proper growth
- How is your child’s weight and height looking or compare on a growth chart?
- How often is your child eating, how much, and does it feel he has less of an appetite?
- Is your child sleeping through the night and getting a sufficient nap?
- How do your baby’s eyes and ears look? How is your baby’s heart and breathing?
Perform recommended laboratory screenings and immunizations
- Do you plan for your child to get the CDC recommended vaccines for DTaP, Hib, and Flu?
- Are you interested or want to know more about immunizations?
- Discuss the overall life of the child and give general guidance or medical recommendations Is your child showing signs of affection?
- Can your child listen to a story or turn the pages of a book?
- Is your child starting to imitate you or the words you say?
- Does your child enjoy singing time, being social with others or following simple commands?
Baby’s 18-Month Checkup?
What should I expect at my toddler’s 18-month doctor’s appointment?
At your child’s 18-month checkup, his pediatrician will likely take all the usual measurements — height, weight and head circumference — to make sure he’s growing on the right track. As long as your child appears to be growing along a steady curve, everything’s just fine. If not, the doctor may ask you questions about your child’s nutrition and eating habits to be sure there aren’t any causes for concern. She’ll also do the usual physical exam, checking baby head to toe to see that his eyes, ears, nose, mouth, genitals — and everything else — look healthy.
Believe it or not, the doctor might have your child roam around the exam room to be sure his walking looks normal. She’ll probably also ask you a ton of questions about your child’s development.
Expect questions about how baby uses language. There’s a wide range, at this age, of what’s normal. Some 18-month-olds are putting two-word phrases together. Others are just saying “mama” and “dada” and a few other things (and yes, saying “ba” for bottle counts as a word). Your child should understand just about everything you tell him — well, everything important, that is. He should have an understanding of the world around him, such as that the broom goes in the broom closet and that the baby doll gets pushed in the stroller.
To understand how your toddler makes sense of his environment, the pediatrician may want to know how your toddler plays. Does he know how to manipulate doorknobs and know that a square block will fit into a square-shaped hole? Does he have the fine motor skills to stack blocks without them tipping over?
At this age, it’s normal for children to be interested in other kids, but not really talk to them (and instead look at them like they’re aliens!). But to gauge your child’s social development, the doctor may ask if there’s some adult (other than you and your partner) whom your child is attached to, such as a grandparent or day care teacher.
The American Academy of Pediatrics recommends a test for autism, called the M-CHAT, or another autism screening at the 18-month and two-year appointments. The test will be a series of questions about your child’s behavior, such as: Does he get easily startled by loud noises? Does he seem to hear and understand you? And does he make strange movements (like arm flapping)? The doctor may also be observing your child for signs of autism, such as not making eye contact or not interacting with a parent.
Depending on the vaccine schedule you and your doctor have chosen for baby, he may get one or two shots this visit. Your child’s pediatrician may also counsel you, giving you tips on how to get your toddler to eat veggies, how to prevent tantrums and how to make sure he’s been weaned off the bottle. She may let you know about common choking hazards (always be sure he’s _sitting down _while eating) and other dangers. And hopefully, she’ll reassure you that whatever you’re doing is working. Your child is growing and developing. Keep doing what you’re doing, mama.
Doctor visit: The 18-month checkup
You can expect your child’s doctor to:
- Weigh and measure your child to make sure he’s growing at a healthy rate.
- Check her heart and breathing.
- Check his eyes and ears.
- Measure your toddler’s head size to keep track of her brain growth.
- Give your child another round of immunizations (including DTaP, hep A, and any others he missed at previous appointments).
- Address any concerns about your child’s health, including how to spot symptoms of ear infections, colds, and the flu.
- Answer any questions you may have about toilet training or discipline.
- Offer insight into your toddler’s development, temperament, and behavior.
- Screen for anemia and lead poisoning with a blood test if your child has any risk factors.
Questions the doctor may ask:
How is your child sleeping? Most toddlers this age sleep about 11 hours at night and nap for about two hours during the day. Bedtime is usually a battle, though, since children this age prefer being active and on the go. Your child may also fight sleep because she’s afraid of the dark and of being alone. How is your child eating?
The doctor will ask this question to find out whether your child is getting a balanced and varied diet. He may suggest some healthy snacks to serve or ways to get your busy child to sit long enough to eat, since most 18-month-olds resent being buckled into a highchair for mealtimes. Is your child showing any signs of toilet training readiness?
Many toddlers develop the physical and cognitive skills necessary for toilet training, such as being able to pull their pants up and down easily, between 18 and 24 months of age, but some aren’t ready to start until they’re as old as 4. Is your child walking? By now, your toddler should have taken her first steps. Children learn to walk between 9 and 18 months.
If she’s walking on her toes or lists to one side, mention this to the doctor so he can evaluate her motor skills. Has he been saying “no” a lot or throwing temper tantrums? Most 18-month-olds have discovered the joy of saying “no,” and they like wielding this powerful word. It’s a sign of independence and language development.
Is your child talking a lot? By this time, most toddlers know and use at least six words – “mama” or “dada” among them. A few tots can even string two words together to form a basic sentence, such as “Mama go” or “Carry me.” The doctor can also give you tips on how to encourage your child’s language development.
Does she respond to simple commands? Eighteen-month-olds are usually mature enough to understand and follow simple directions such as “Please pass me the ball” or “Bring me your shoes,” so if she doesn’t follow basic commands, or doesn’t appear to hear you, tell the doctor.
What games does he like to play?
The activities your child enjoys give the doctor insight into how he’s developing. Many toddlers this age love peekaboo, a sign that they’re developing mental skills, and playing with balls, which helps them become better coordinated.
Do you clean her teeth and gums?
Your child may still be waiting for her molars to come in, but as soon as she has any teeth, good oral hygiene becomes important. Your doctor may also recommend fluoride drops. If he doesn’t bring them up, ask about them.
Have you noticed anything unusual about your toddler’s eyes or the way he looks at things? Learn more about eye examinations and how to spot potential problems.
All About the 18-Month Well-Child Checkup
Baby’s 18-Month Checkup: What to Expect
The 18-Month Well-Baby Visit
Your Child’s Checkup: 1.5 Years (18 Months)
Well-Child Checkup: 18 Months
18-Month Well Child Visit
Baby’s 18-Month Checkup?
Doctor visit: The 18-month checkup