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15 MONTH CHECK-UP

GROWTH

  • Most babies gain 1/4 - 1/2 lb. per month (about 6 lbs. per year).
  • Most babies grow about 1/4 inch per month (about 3-4 inches per year).

DEVELOPMENT

  • Most toddlers are walking and even running.
  • Can usually stoop and pick up objects.
  • Usually says about 4-6 words.
  • Can follow most directions.

NUTRITION

  • Should be on whole milk until 2 years of age. Should be using cup well and be off of bottle. Prolonged bottle feeding can lead to tooth decay. Encourage toddler to feed self and allow to use utensils. Appetites often decrease at this age. Don't be alarmed by decrease in food intake as long as their growth is normal. You can't make your child eat. All you can do is offer him/her nutritious foods, relax, and be reassured that this is normal.
  • We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.

TEMPER TANTRUMS

  • You may notice a dramatic increase in negativism and temper tantrums at this age. This is a normal and healthy response to the increasing independence of toddlers. We recommend ignoring tantrums - not giving any positive or negative attention to this behavior. Sometimes it is easier to avoid the places and situations that you know your child will not do well in - such as restaurants, malls and grocery stores. This behavior will not last forever!

TOYS/ACTIVITIES

  • Toddlers love imitative play such as sweeping, dusting, playing and caring for dolls, etc. Offer toys for reciprocal play - balls, cars, push-pull toys. May begin to enjoy water and sand play. They usually like to be read to at this age and this is an excellent way to increase language skills.

CHADIS-Child Health & Development Interactive System

  • Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
  • This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
  • The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

  1. Go online to http://www.chadis.com and register your child.
  2. The "invitation code" for our office is our phone number 3018692292. Create your password.
  3. For checkups, when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

Next check-up is at 18 months.


18 MONTH CHECK-UP

GROWTH

  • Average weight gain is about 1/4 -1/2 lb. per month.
  • Average height increase is about 1/4 inch per month.

DEVELOPMENT
Your child usually:

  • Can run, climb, and walk up and down stairs.
  • Throw a ball overhand, and turn pages in a book.
  • Has a vocabulary of 5-10 words.
  • Is able to follow a 2 step direction.

TOILET TRAINING

  • Most girls are 2-2 1/2 years and boys often 2 1/2-3 years before they are ready for toilet training. However, if your child expresses an interest (heightened awareness of wet or soiled diapers) you can get a "potty chair" and allow child to imitate parents. We encourage you to follow your child's lead and use positive reinforcement for successes and have a neutral attitude when accidents occur. Toilet training is usually very easy when your child is ready.

DISCIPLINE

  • You have probably already observed a change in your child's behavior such as temper tantrums and negativity. This is normal and expected behavior of an 18 month old. We recommend trying to "pick your battles" and try to make your house as baby-proof as possible so that you don't have to constantly say "no." Usually the best reaction to discipline problems is distraction or removing the child from the source of frustration, such as another child, the grocery store, etc. However, you may start to use a modified "time-out" for certain behaviors. Time-out is a discipline technique that is used to interrupt unacceptable behavior by removing the child from the scene to a boring place, such as a corner of a room, a certain chair, or the bedroom. Sometimes the child will have to be held on the parent's lap in order to introduce the concept. Time-outs should last about 1 minute per year of age and not last more than 5 minutes. Time-outs should be followed by "time-ins"-spend one-on-one time with child and praise child for the next episode of positive behavior that occurs.

TOYS/ACTIVITIES

  • Books, crayons and paper, playdough, sand and water play, simple puzzles, and push/pull toys are favorites. Children like pretend play, rough and tumble play, and to have assigned little chores to complete.

CHADIS-Child Health & Development Interactive System

  • Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
  • This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
  • The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

  1. Go online to http://www.chadis.com and register your child.
  2. The "invitation code" for our office is our phone number 3018692292. Create your password.
  3. For checkups, when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

Next check-up is at two years of age.


2 YEAR CHECK-UP

GROWTH

  • Child usually gains about 1/4 -1/2 lb. per month and increases about 1/4 inch per month in height.

DEVELOPMENT
Your child probably:

  • Uses some 2 word sentences with pronouns such as "I, you, or me."
  • Jumps in place with both feet off floor.
  • Assists with dressing/undressing.
  • Builds a tower of 6-8 blocks.

NUTRITION

  • Your child is probably handling spoon and cup well. You may change from whole milk to lowfat or skim milk now. Try not to get into mealtime battles; your child will probably win! Remember, most children will eat what and how much their body's need. Sometimes dinner time is their worst meal of the day because they may be tired or not hungry. Children should be drinking city tap water (for fluoride) on a daily basis-if child refuses water, dilute frozen concentrated juices with water. If child drinks well water, they usually need a fluoride supplement (ask your health care provider for a prescription). We recommend a daily multivitamin, to ensure adequate Vitamin D for your child.

DISCIPLINE

  • Time-out is a form of discipline that is used to interrupt unacceptable behavior by isolating the child in a boring place for a brief period of time (usually about a minute per year of age). Appropriate behaviors to use time-outs for include aggressive, harmful (safety issues), or disruptive behaviors that can not be ignored. Time-out is much more effective than spanking, threatening or shouting and can be used without parents losing control or feeling guilty. After the time-out is over, the child is given a "clean slate" and is praised for the next acceptable behavior that occurs.

TOILET TRAINING

  • By age 3, most children have become toilet-trained. We encourage you to take this process slowly and not push your child. Allow child to imitate you by sitting on his/her own potty chair. Praise the successes and portray a neutral attitude towards the inevitable failures. If your child seems to be resisting the process, back off totally from the training for at least a month and try again.

TOYS/ACTIVITIES

  • Children enjoy pull-able, and musical toys. Most 2 year olds participate in "parallel" play where child plays alongside another child and is completely aware of the other child's activities, but does not interact much with other child. It is important to provide opportunities for peer contacts and imaginative play.

CHADIS-Child Health & Development Interactive System

  • Our practice is pleased to announce that we are expanding our use of CHADIS, an interactive online system developed by Johns Hopkins University pediatric specialists, which screens for developmental, social, emotional and behavioral problems.
  • This system allows the child's caregivers to provide more in-depth observations of their child to the child's health care providers through the use of confidential online questionnaires. Done prior to the office visit, the information you provide will help in the early identification and treatment of these important issues.
  • The use of pre-visit questionnaires like CHADIS is supported by the American Academy of Pediatrics.

We are currently using the CHADIS system for all check-up visits and all behavior visits. For this tool to be successful, we need your help by completing these brief questionnaires a few days prior to your office visit. Please follow these instructions:

  1. Go online to http://www.chadis.com and register your child.
  2. The "invitation code" for our office is our phone number 3018692292. Create your password.
  3. For checkups, when asked visit type, choose "well child/checkup visit." You will see the age appropriate tests for your child. Select "begin" and complete all the questionnaires listed. It is normal for some of the questions to seem too mature for your child.

Your provider will discuss the results at the check-up or behavioral visit. We appreciate your participation as it helps us provide your child with the best care possible.

Next check-up is at 2 & 1/2 years old.


2 & 1/2 YEAR CHECK-UP 

Development
By 2 & ½ most toddlers can do the following:

  • speak with pronouns, such as I, me, you.
  • pull pants up and down with assistance.
  • jump in place.
  • throw a ball overhand.
  • match shapes and colors.
  • wash and dry hands.
  • begin to play with other children.

Nutrition

  • Don’t be surprised if your toddler skips meals occasionally, or loves something one day and won’t touch it the next week. Schedule three meals and two nutritious snacks daily. This does not include chips, cookies, and processed food. You are in charge of providing the healthy meals, but let your child be in charge of how much they eat. You should never force feed your child. Try to limit drinks to water, low fat or skim milk, and up to four ounces of juice per day. Eat meals as a family whenever possible.

Toilet Training
Many toddlers are ready for toilet training at this age. Your child may be ready if they are:

  • showing an interest in the potty.
  • staying dry for longer periods.
  • able to pull pants up and down with help.
  • communicating that diaper is wet or dry.

Read your child a book about toilet training (such as Potty by Leslie Patricelli.) Pick a convenient time to put your toddler in regular underwear and give it a try. Reward successes, but if your child isn’t ready, put the diaper back on and wait a month to try again. Continue to read the book with your child. Many children are ready to wear regular underwear at night once they are trained during the day.

Sleeping
Most kids this age get 11-14 hours per day. This often includes a nap.

Learning

  • Read to your child daily to encourage language development.
  • Limit screen time (TV, computer, cell phones) to 1-2 hours per day.
  • Keep TVs and other screens out of your child’s bedroom.
  • Try to have your child play outside daily. Of course, wear appropriate clothing during the winter.
  • Consider enrolling in preschool or other organized activities.
  • Play dates help build social skills.

Routine care

  • Brush teeth with a soft toothbrush and a small pea-sized amount of toothpaste twice daily. Your toddler should do this most of the time.
  • Have reasonable rules, such as bedtime at 7:30 or no more than three cups of milk daily. Try to be consistent. Use praise such as, “thank you for helping clean up your toys,” to encourage good behavior and calmly redirect such as, “don’t throw food on the floor. Put it on the tray.” Or, simply ignore it.
  • Give your child a sense of independence by offering two choices such as, “Would you like an apple or banana for a snack?” when choices are available.
  • Don’t spank. Children cannot make the connection between spanking and the bad behavior you are trying to correct. You can use a brief ‘time out’ to discipline your toddler.

Next check-up is at 3 years of age.

Contact Us

Pediatric & Adolescent Care, P.A.

(301) 869-2292
903 Russell Avenue, Suite 301 Gaithersburg, MD 20879