Well-Child Visit: 1.5 Years (18 Months)

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child's weight, length, and head circumference and plot the measurements on a growth chart.

2. Do a screening test that helps identify developmental delays or autism.

3. Ask questions, address concerns, and provide guidance about how your toddler is:

Eating.Feed your toddler 3 meals and 2–3 scheduled healthy snacks a day. Growth slows in the second year so don't be surprised if your child's appetite decreases. Your child can drink from a cup and use a spoon but probably prefers to finger-feed.

Peeing and pooping. Your child's diapers might stay dryer for longer periods, but most children do better with toilet training when they're a little older, usually between 2–3 years. Let your doctor know if your child has diarrhea, is constipated, or has poop that's hard to pass.

Sleeping. There's a wide range of normal, but generally toddlers need about 12–14 hours of sleep a day, including naps. By 18 months, most toddlers have given up their morning nap.

Developing. By 18 months, most toddlers:

• try to say 3 or more words besides “mama” or “dada”
• follow 1-step directions without a gesture
• point to show you something interesting
• help with dressing by pushing their arms through sleeves or lifting their feet
• copy you doing chores
• try to use a spoon
• scribble with a crayon
• play with toys in a simple way, like pushing a car
• walk without holding onto anyone or anything
• climb on and off the couch or a chair without help

Talk to your doctor if your toddler is not meeting one or more milestones, or you notice that your toddler had skills but has lost them.

4. Do an exam with your child undressed while you are present. This will include an eye exam, tooth exam, listening to the heart and lungs, and paying attention to your toddler's motor skills and behavior.

5. Update immunizations.Immunizations can protect kids from serious childhood illnesses, so it's important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may test for lead or anemia, if needed.

Looking Ahead

Here are some things to keep in mind until your child's next checkup at 2 years:

Feeding

1. Give your child whole milk (not low-fat or skim milk, unless the doctor says to) until your child is 2 years old.
2. Serve milk and 100% juice in a cup and limit juice to no more than 4 ounces (120 ml) a day. Avoid sugary drinks like soda.
3. Avoid foods that are high in sugar, salt, and fat and low in nutrients.
4. Continue serving a variety of healthy foods. Offer iron-rich foods like beans and meat, vegetables, and fruit. Let your child decide what to eat and when they've had enough.
5. Avoid foods that may cause choking, such as hot dogs, whole grapes, raw veggies, nuts, and hard fruits or candy.

Learning

1. Toddlers learn best by interacting with people and exploring their environment. Make time to talk, read, sing, and play with your child every day.
2. Limit your child's screen time (time spent with TV, computers, phones, and tablets) to less than 1 hour a day.  Choose quality programs to watch with your child. Video chatting is OK.
3. Have a safe play area and allow plenty of time for exploring and active play.

Routine Care & Safety

1. Watch for signs that your toddler is ready to start potty training, including showing interest in the toilet, staying dry for longer periods, and pulling pants up and down.
2. Set up a potty chair and let your child come in the bathroom with you.
3. Brush your child's teeth with a soft toothbrush and a tiny bit of toothpaste (about the size of a grain of rice). If you haven't already, schedule a dentist visit. To help prevent cavities, the doctor or dentist may brush fluoride varnish on your child’s teeth 2–4 times a year.
4. Toddlers look for independence and will test limits. Be sure to set reasonable and consistent rules.
5. Tantrums are common at this age, and tend to be worse when kids are tired or hungry. Try to head off tantrums before they happen — find a distraction or remove your child from frustrating situations.
6. Don't spank your child. Children don't make the connection between spanking and the behavior you're trying to correct. You can use a brief time-out to discipline your toddler.
7. Have a calm bedtime routine. If your child wakes up at night and doesn't settle back down, offer reassurance that you're there, but keep interactions brief.
8. Keep your child in a rear-facing car seat in the back seat until your child reaches the highest weight or height limit allowed by the car-seat manufacturer.
9. Apply sunscreen of SPF 30 or higher on your child's skin at least 15 minutes before going outside to play and reapply about every 2 hours.
10. Protect your child from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful.
11. Make sure your home is safe for your curious toddler:
    • Keep out of reach: choking hazards; cords; hot, sharp, and breakable items; and toxic substances (lock away medicine and household chemicals).
    • Keep emergency numbers, including the Poison Control Help Line number at 1-800-222-1222, near the phone.
    • Use safety gates and watch your toddler closely when on stairs.
    • To prevent drowning, close bathroom doors, keep toilet seats down, and always supervise your child around water (including baths).
    • Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids can't get to the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.