Although the toddler months continue to offer the medical challenges of colds, cuts, bruises, and other minor emergencies, you'll also find yourself dealing with an emerging personality and increasing conflicts. The new ability to walk means your child can now become independent of you - and he or she might like to flaunt it at every opportunity! If you continue your vigilance in the areas of safety and discipline, this can be a joyous year for the entire family.

When Will We See the Doctor?

Some doctors have their own schedule for well-child visits, but most will generally see children four times during this stage, typically at 12, 15, 18, and 24 months. If your toddler has missed any immunizations, or if a problem has been detected that needs special attention, additional visits may be scheduled during this time.

What Will Happen During the Office Visit?

The well-child visits during your child's second year are similar to the ones that have taken place so far, although your discussions with your child's doctor about behavior and habits may become more detailed as your toddler grows.

You can expect these common procedures and questions:

• Measurement of your child's length, weight, and head circumference. Growth will be plotted on his or her own growth chart, and you will be advised of his or her progress. A physical examination checking for normal function of the eyes, ears, heart, lungs, abdomen, heart, hands and feet, etc. The doctor may look in your child's mouth for new teeth and signs for the appearance of others.
• A review of your toddler's physical and emotional development through both observation and your report of his progress. Is he or she trying or starting to walk? Can he or she recognize or even say his or her own name? By age 2, can he or she follow simple instructions? Can he or she say a few words? Can he or she combine two words by age 2? Your child's doctor may ask you these questions and others.
• You may be asked how you are doing with your child and how the rest of the family is functioning. Your child's doctor may go over safety questions with you: Have you childproofed your home? (You will need to review your babyproofing efforts now that your toddler can stand and reach.) Is he or she in an appropriate safety seat while riding in the car?
• A discussion of your child's eating habits. Is he or she eating more and more table foods? Is he or she interested in finger foods on the tray of his or her high chair? Can he or she use a cup? Is he or she being weaned from the breast or bottle? Most doctors advise a switch from bottle to cup by the first birthday to be sure the bottle doesn't interfere with normal tooth development, and to avoid a struggle with a determined toddler later on. Sleeping with a bottle of juice or milk will only lead to cavities now. Also, after their first birthday, most children can be given foods that were off-limits before, such as cow's milk, citrus fruits, and eggs. Your doctor can discuss these additions to your child's diet with you.
• Advice on what to expect in the coming months.
• Your child will receive immunizations during some visits (see below).

If he or she hasn't already, your child may undergo a tuberculin skin test, especially those at risk for tuberculosis. You'll be given instructions on how to monitor the test and report results to the doctor's office. Your child may also have a hemoglobin screen to check for anemia, and if you are in a high-risk area, a screen to check for lead poisoning.

Bring to your child's appointments any questions or concerns you may have at this time. Make sure to write down any specific instructions the doctor gives you regarding special care. Keep updating your child's permanent medical record, listing information on his or her growth and problems or illnesses.

What Immunizations Will My Child Receive?

If your child missed immunizations at previous visits because of illness or scheduling problems, he or she will be brought up-to-date by 18 months of age. Because your child is coming in contact with other children more often, you'll want to make sure his or her immunizations are given close to the recommended times. This is especially true if your child is going out of your home for child care.

Because more immunizations than ever (20 injections, or shots) are being given to children before the age of 2 years, doctors are spacing immunizations so your child will not need more than 3 to 4 shots per well-child visit.

From the Recommended Immunization Schedule of the American Academy of Pediatrics:

If your child did not receive them at his 12-month visit, the following vaccines will be given at 15 months:

• fourth Haemophilus influenzae type b (Hib) vaccine
• measles, mumps, rubella (MMR) vaccine
• fourth pneumococcal conjugate (PCV) vaccine

At his 18-month visit, if these haven't already been given, your child should receive:

• varicella (chicken pox) vaccine
• fourth diphtheria, tetanus, pertussis (DTaP) vaccine
• third hepatitis B vaccine (Hep B)
• third polio vaccine (IPV)

Discuss possible vaccine reactions with your doctor and get advice on when to call with unusual problems.

When Should I Call the Doctor?

By now you have probably called your doctor's office may times with questions and concerns about your child's health. Don't hesitate to notify your child's doctor if you suspect something is wrong - you know your child best. Be sure to call if your child is especially sluggish or irritable, has serious problems sleeping, is refusing all food or drink, is suffering from vomiting or diarrhea, or has a temperature over 104 degrees Fahrenheit.

There are also some developmental delays that should be reported to your child's doctor, although these delays may or may not signal a problem. By 18 months your child will probably be able to:

• walk on his or her own, with a regular heel-toe walking pattern
• speak about 15 words

By age 2 your toddler should be able to:

• put two words together to form a sentence
• follow simple directions
• imitate actions
• push and pull a toy

Again, signs of developmental delay should be brought to the doctor's attention, but they do not necessarily mean there is something wrong.

Updated and reviewed by: Barbara Homeier, MD
Date reviewed: January 2005
Originally reviewed by: Steve Dowshen, MD