15 and 18 Month Visit

15 and 18 Month Well Child Visit

Immunizations Today:

___ Pentacel (diphtheria, tetanus, pertussis, Haemophilus Influenza type B, and polio vaccines)

___ Prevnar (pneumococcal 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.

Vitamin D: 400 IU is the recommended daily requirement. Because a child would need to drink 32 oz. of milk a day to meet this requirement, we recommend a children's multivitamin daily.

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.