Your Child’s Checkup: 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 the growth charts.

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 three meals and two or three scheduled nutritious 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. You may notice your child’s diapers are dryer for longer periods, but most children do better with toilet training when they’re a little bit older, usually between 2 and 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 to 14 hours of sleep a day, including one or two daytime naps. By 18 months, most toddlers have given up their morning nap.

Developing. By 18 months, it’s common for many toddlers to:

• say 10–20 words
• point to some body parts
• run
• walk up stairs with hand held
• throw a ball
• help with dressing and undressing
• scribble with a crayon
• engage in pretend play

4. Do a physical 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 exposure or anemia, if your child is at risk.

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 your doctor recommends it) until 2 years of age.
2. Serve milk and juice in a cup and limit juice to no more than 4 ounces (120 ml) a day. Avoid sugary drinks like soda.
3. 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 he or she has had enough.

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. Consider limiting your child’s screen time (TV, videos, phones, tablets, and other media). Less than 1 hour a day is best, and choose quality programs to watch with your child.
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.
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 normal 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 age 2 or whenever 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 cannot access the keys.

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