IMMUNIZATIONS & SCREENINGS

 

Your child will receive Pentacel and Prevnar boosters today and any other vaccines if behind.
Your child will also have blood work done today to screen for anemia and lead exposure.  Anemia at this age is not uncommon and is usually due to a lack of dietary iron.  If your child’s hemoglobin is less than 11, we will start an iron supplement and recheck labs in 1 month.

Lead exposure can occur from a variety of sources.  If your child’s lead level is >3.3, we will further discuss possible sources and may recheck their level in the future.

 

DIET

 

Your child’s diet at this age should be made up of a good variety of table foods and whole milk. Your child may be very messy when eating. Allow use of fingers or a spoon and sippy cups or a regular cup with assistance. Your child should be off the bottle and pacifier now. Toddlers grow more slowly so you may notice a drop in appetite as well as a large variation in appetite from day to day. This is very typical for toddlers. Don’t force your child to eat.  Offer small servings of a variety of foods from each of the four food groups. Avoid resorting to the same few favorites at every meal. Healthy children will eat appropriate amounts for them and we will continue to monitor weight gain and growth closely. Be sure to provide food from each of the four food groups.

Your child may show strong and frequently changing likes and dislikes. S/he may refuse to eat a certain food for days at a time or refuse to eat at all for some meals. Just try to keep the diet balanced from week to week. Continue using whole cow’s milk, but not more than 24 ounces a day. Be cautious to not let your child fill up on milk instead of eating. This can lead to nutritional deficiencies.

Snacks are okay if they are healthy foods. Remember that your child may eat less at mealtime if s/he has had a snack. Do not give your child whole grapes, whole olives, whole or sliced hot dogs or peanuts or popcorn. These foods present a high risk for choking as they can easily get caught in the wind pipe.

 

HEALTH

Teeth: Brush teeth twice daily.  Use a soft bristle toothbrush and allow child to “play” with his/her own toothbrush, though you will need to do the actual brushing until 5-6 years of age. Do not let your child run/walk with toothbrush in hands or mouth. We encourage establishing care with a dentist at this time if you haven’t already done so.

Sleep: Children vary in the number of hours of sleep needed. Establish a consistent routine for bedtimes and 1-2 naps per day. Try to keep a regular schedule. Your child will likely be more negative when he or she is tired.

Elimination: Although there may be some regularity to pooping by now, it is too early to consider toilet training.  Don’t feel pressured by family or friends.

 

PLAY

Your child will enjoy simple games and playing with adults. S/he is too young to play with another toddler for very long. Your child may like to “help you” with housework or yard work. S/he will like pouring, dumping, stacking, and filling activities. Provide toys and opportunities that allow this type of play.

Reading continues to be very important to your child.  Nursery rhymes and songs also help with language development and provide interaction between you and your child. TV is not recommended before age two.

 

BEHAVIOR

The second year of life is a great time for exploring and learning about the world. Distraction or redirection is the best form of discipline right now. Spanking is not appropriate. Pick your child up and take him/her to another room or outside when s/he is about to “get into trouble”. Children need discipline (not necessarily punishment). If you state consequences for wrong doing, you need to follow through with them or your child will distrust you and continue to disobey. Remember that what you want most is for your child to feel good about being him/herself and to trust you as the parent!

Offer forced choices, like “Which do you want to do first-put on your coat or your shoes?” This gives your child some sense of control without him or her having full control. Also, tell your child what needs to be done but not why. S/he will not understand this type of logic yet.

Your child may display some fears at this age such as fear of strangers, clowns, Santa Claus, etc. Do not make fun of these fears or force your child to “face his or her fears”. Just be very reassuring and allow avoidance as able.

 

SAFETY

 

• Continue to use a car seat when in a moving vehicle.  Always place car seat in the back seat and away from air bags.

• Begin to teach your child road safety and the dangers of cars.

• Keep all poisonous materials out of reach of your toddler. Be sure to check the garage for anything that might be in his/her reach.

• Keep the poison control number near the phone.  1-800-222-1222.

• Because your toddler can walk, creep up stairs, and climb, s/he needs constant supervision.  Be sure someone responsible is watching your child at all times.

• Remember to keep hot liquids away from your child, as well as cords that lead to pots and pans filled with hot liquids.

• Be “water cautious”. Children can drown in as little as 1 inch of water.

• Remember SUNSCREEN and protective clothing (hats, long sleeves, sunglasses).

 

DEVELOPMENT

PHYSICAL

Physical build and stature is slowly transitioning from “baby” to “child”, but many characteristics at this age are still classically “toddler” in appearance.

 

• chest is thin, belly sticks out

• bowed legs/flat feet (your child will outgrow these physical features without treatment)

• average weight gain of 1-2 oz per week

 

SOCIAL

Your child is becoming much more like a “little person” and learning to do a lot for him/herself. Encourage that as long as he or she is safe.

• begins to use spoon

• removes clothes

• walks well

• likes to throw things

• imitates house or yard work

 

LANGUAGE

Encourage the use of words to ask for things and answer simple questions. Read to your child daily.

• advancing vocabulary, should use about 6 words regularly

• indicates wants with pointing

• understands simple commands

 

Next appointment is at 18 months of age!