15 and 18 Month Visit

15 and 18 Month Well Child Visit

Immunizations Today:

__ DtaP (diphtheria, tetanus, and pertussis vaccine)

___ IPV (injectable polio vaccine)

___ Prevnar (pneumococcal vaccine)

___ Hib (Haemophilus Influenza type B vaccine)

___ Hepatatis A

___ Influenza

Next visit:

__ at 18 months of age

__ at 2 years of age

INJURY AND ILLNESS PREVENTION

¨ Check for hazards at toddler’s walking level.

¨ Re-examine the home to ensure it is child proof: locked medicine cabinet, kitchen and bathroom cabinet latches, window and stair guards, heating element precautions, and garage door safety devises.

¨ Make sure that the poison control number (275-3232 or 1-800-222-1222) is in any location where your child spends much time. Always call the poison control to obtain advice about the need to administer ipecac prior to giving.

¨ Use toddler car seat in the vehicle’s rear seat. The center is the safest.

¨ Check home water temperature – should be on lowest setting, below 120 degrees.

¨ Lower crib mattress. If your child is climbing out of the crib, consider moving him/her to a toddler bed.

¨ Ensure water safety around swimming pools, hot tubs, spas and bathtubs.

¨ Maintain a smoke free environment.

¨ Check smoke and carbon monoxide detectors; check fire extinguishers.

¨ Begin teaching your child to use a bike helmet.

¨ Use sunscreen of at least SPF 15. Avoid peak times (10:00 – 3:00) in the sun. Insect repellent should contain less than 10% DEET.

¨ Supervise closely – especially near dogs, lawnmowers, driveways and streets.

¨ Be sure that any guns in the home are securely locked and stored separately from the ammunition. Gun safety locks should be in place on every gun.

¨ Be familiar with first-aid steps for choking. Consider taking a pediatric CPR course.

NUTRITION

¨ Eat meals as a family. Our children learn by watching us, so be a model of good eating habits!

¨ Allow toddlers to self feed and drink from a cup, not a bottle. Chronic bottle use can cause tooth decay.

¨ Provide a variety of healthy food choices, allow experimentation and do not force eating. Respect your child’s ability to know when he/she is not hungry.

¨ Offer three meals and 2-3 nutritious snacks daily at regular times. Avoid foods that could cause choking, such as nuts, popcorn, hard raw vegetables and fruits, and foods cut in round pieces. Limit sugar.

ORAL HEALTH

¨ Brush teeth after meals and at bedtime.

¨ Water should be fluoridated. If it isn’t, ask about supplemental fluoride.

SLEEP

¨ Establish a regular bedtime routine and encourage your child to fall asleep on his/her own. Recognize that each child has different sleep requirements.

HEALTHY HABITS

¨ This is the age of developing autonomy and independence. Toddlers experiment with new powers as they learn the rules.

¨ Encourage language development. Talk, sing songs, and read interactively. Limit TV.

¨ Give individual attention and create opportunities for exploration and physical activity. Encourage playing by self as well as with siblings, playmates and parents.

¨ Limit number of rules, but consistently enforce them. Define “boundaries”. Allow no hitting, biting, or aggressive behavior. Do not expect toddlers to share all toys.

¨ Time Out should not be used as punishment, but rather as a method of self-quieting.

¨ Discipline should be respectful to the child and parent, should not be punitive, and should be related to the deed (“logical consequence”). Keep discipline brief and offer reassurance once the negative behavior has stopped.

¨ Toddlers are acquiring many new skills and this can be very frustrating, resulting in temper tantrums. Recognize warning signs of a developing meltdown and encourage self-quieting strategies. Use comfort object such as a stuffed animal or blanket.

¨ Encourage self-care, self-expression and choices within toddler’s ability.

¨ Most children are not ready for toilet training at this age. Let your child direct his/her course at this age. Expect natural curiosity about genitals.

¨ Help toddler express feeling: joy, anger, frustration, sadness and fear. Feelings are neither good or bad, right or wrong; they are real and they exist. Show affection.

¨ Serve as a role model for healthy habits.