Fifteen-Eighteen Month Visit

Development

This is the golden age for language development. Toddlers have an uncanny ability to absorb language. At this age most toddlers use about 4-10 words other than Mama and Dada. Speech may not be clear. By two years of age they will be putting two words together. There is tremendous variability. Some children will have an extensive vocabulary and others still are using Mama and Dada consistently and babbling.

Pointing is an important indicator of language/social skills; your child will start to recognize the names of people, objects and body parts.

Toddlers this age will walk, run, walk up steps holding on, and begin to kick and throw a ball. He/she will sit in a chair and feed him/herself with a spoon. Toddlers enjoy scribbles and learning to "draw."

Many toddlers this age will hit and bite especially if they are excited, frustrated or having difficulty communicating.

Activities

- Books, puzzles, building blocks, stacking toys.
- Dance to music, sing, and clap.
- READ! Kids love to look at books page by page. Point at pictures and start naming.
- Start "clean up" time to put away toys as part of playing. Start this habit early.
- Trips to the park, the library, the museum or walks in the neighborhood.
- TV and video are not recommended. Early screen time is not beneficial to development.

Sleep

Most children this age will take one nap per day.

When your child climbs out of crib it is time to move to a mattress on the floor or a toddler bed.

Safety

This is an especially challenging age. Don't let your child out of your sight. The toddler has the ability to move fast. Curiosity is increasing rapidly, but judgment lags behind. Be careful with irons, stovetops, hot drinks, knives and houseplants. Parking lots and homes near water are particularly hazardous situations.

Teach animal safety. Never let a toddler put his/her face next to a dog's face.

Use sunscreen.

When in the car, continue to use car seat in back seat. Never allow a child to "play" unaccompanied in the car.

Check your smoke detectors and fire extinguishers on a regular basis. Have a family fire exit plan with ladders in upstairs bedrooms.

Poisonings are common events. Lock up medicines, cleaners, detergents, & antifreeze. Syrup of Ipecac is no longer recommended for home treatment of poisoning by the American Academy of Pediatrics, although some experts continue to recommend its use in certain situations. In case of ingestion of poisons, call the Poison Control Center (1-800-222-1222) immediately prior to giving Ipecac.

Parenting

Exploring the boundaries established by your rules and your child's physical and developmental limits will occupy much of his/her time over the next few years. You are very important in showing him/her what is OK and what is not. She/he will check in with you frequently for reassurance, guidance and security. Rules and routines help a child feel secure, as they know what to expect.

Your child is self-centered at this age. It is difficult to share. Minimize the frustration when your child is playing with friends by having reasonable expectations.

Praise new skills whenever possible.

If your child does something that hurts another person, hurts property or is harmful to them, a firm verbal reprimands, brief and clear, is appropriate. Do not expect them to remember this when in the same situation again.

Model a calm communication style.

There are many approaches to discipline. Now is a great time to talk to all your children's caregivers and agree on consistent guidelines for handling difficult situations.

Nutrition

- Enjoy family meals without TV. Work to serve one meal for all. Model good nutrition. Minimize meal time battles.
- Offer dried cereal or fruit rather than crackers, cookies and fruit snacks. Offer food from all food groups. Avoid fast foods, fish sticks, chicken nuggets and other "kid foods" for as long as possible.
- Expect swings in appetite. A typical toddler eats one good meal a day and grazes the rest of the day. Your job is to offer healthy foods. Your child's job is to eat healthy foods when they are hungry. It is OK if they don't eat a balanced diet on a day-to-day basis, but they should balance out over the week. The amount of food your child needs decreases as your child's growth rate decreases.
- Avoid "choke" foods until age three, especially popcorn, nuts and raw vegetables. Grapes and hot dogs should be cut in small pieces.
- Serve small portions and let your child request more if desire.
- Avoid or limit juice to less than 4 oz of 100% fruit juice a day. Offer whole milk and water instead. Your child needs 16-24 oz of milk a day.
- Phase out bottle (and pacifier) as it will be more difficult as your child gets older.
- Ask for a fluoride vitamin if your child does not receive water with fluoride.
- Vitamins are not necessary but a multivitamin is OK if you are concerned about your child's diet.

Next Visit

Please schedule your next visit for when your child is 18 months or two years old.

Books/Resources

Positive Discipline for Preschoolers by Jane Nelsen, EdD et al
Raising an Emotionally Intelligent Child by John Gottman, PhD
1-2-3- Magic: Effective Discipline for Children 2-12 by Thomas Phelan, PhD
How to Talk so Kids with Listen and Listen so Kids Will Talk by Adele Daber and Elaine Mazlis
Normal Children Have Problems Too by Stanley Turecki, MD

The Difficult Child by Stanley Turecki, MD