Your Child's 18-Month Checkup

Checkups are a way to make sure your child is growing properly and help you find out if there are any health problems. After the visit, make an appointment for your child's 2-year checkup.

• Offer 3 meals and 2–3 healthy snacks a day. Pull your child's high chair up to the table during meals and eat together as a family as often as possible.

• As long as your child does not have a food allergy, they can eat most soft foods. Include these in your child's diet:

  • fruits and vegetables (peeled and puréed or cooked until soft)

  • cereals, breads, rice, and pasta

  • iron-rich foods such as beef, pork, chicken, seafood, and tofu

  • whole cow's milk (about 16 ounces [480 ml] a day) and other calcium-rich foods, such as cheese and yogurt

• Limit foods and drinks that are high in sugar (such as candy and soda), salt, and fat (such as fried food).

• To help prevent choking:

  • Make sure your child is sitting while eating.

  • Avoid nuts, whole grapes and raisins, popcorn, hard candy, gum, thickly spread peanut butter, hard cheese, hard or raw fruits and vegetables, and hot dogs and sausages.

  • Cut all foods into small pieces (no bigger than ½ inch).

• You can offer a spoon for eating but your child will probably prefer to use their fingers to eat.

• It's normal for kids this age to eat a lot at some meals and less at others. Offer healthy food choices and let your child decide how much to eat.

• Help your child use a cup instead of a baby bottle.

• Kids don't need juice. It can lead to tooth decay and weight gain. If you do serve juice, give your child no more than 4 ounces (120 ml) of 100% fruit juice a day.

• Help your child get about 11–14 hours of sleep in a 24-hour period, including naps.

• Have a calm bedtime routine that includes a favorite toy, reading, and quiet singing.

• If your child is climbing out of the crib, talk to your health care provider about moving your child to a toddler bed or a bed with safety rails. Do not let your child sleep in bed with you or anyone else.

• Children this age learn best by talking and playing with others and touching things in their world. Video chatting is OK, but if your child has other screen time:

  • Choose educational programming and apps.

  • View/play together.

• Talk to and read with your child often. Help them use words to name objects, talk about pictures in books, and describe feelings.

• Help your child learn what you want them to do:

  • Give short and simple directions and explanations. Tell your child what to do rather than what not to do ("Use a quiet voice" instead of "Stop yelling").

  • Keep things that you don't want your child to touch out of reach.

  • Give choices when you can; for example, "Do you want to wear the red shirt or the blue shirt?"

  • Reward wanted behaviors with specific praise. For example, say, "I really like the way you put the blocks away" instead of "Good job."

  • When unwanted behaviors happen, be ready to help your child move on to a different activity.

  • Make your home and yard safe so you don't have to say "No" often.

  • Never hit or spank your child.

Toilet training:

• Watch for signs that your child is ready to learn to use the toilet, such as:

  • recognizing the need to go pee or poop

  • being able to tell you they need to go

  • being able to sit on the potty

• If your child seems ready:

  • Read books about toilet training with your child.

  • Set up a potty chair and let your child come into the bathroom with a parent or sibling.

  • Praise your child for sitting on the potty, even with clothes on.

  • Expect accidents and remember that it usually takes about 6 months for a child to be toilet trained.

In the car:

• Put your child in a rear-facing car seat in the back seat until they outgrow the height or weight limit allowed by the car seat manufacturer.

• Follow the manufacturer's instructions on installing and using the car seat, or go to a child safety seat check.

In your home:

• Put gates at the top and bottom of stairs.

• Lower the crib mattress to the bottom position.

• Put window guards on windows above the first floor.

• Keep blinds, drapes, and cords out of your child's reach.

• Keep out of reach:

  • small objects such as toys, button batteries, and coins

  • plastic bags

  • medicines (keep in a locked cabinet, if possible)

  • cleaning supplies

  • anything that is hot, sharp, or breakable

• Put smoke and carbon monoxide alarms near all sleeping areas and on every level of your home.

• Keep your child within reach if there is water nearby, including tubs, toilets, buckets, and pools. Empty water from tubs, buckets, and baby pools when done.

• Do not allow anyone to smoke around your child.

• A gun in the home increases the risk of accidents and injuries. If you do have a gun, keep it unloaded and locked up. Lock bullets separately from the gun.

• Only leave your child with responsible caregivers, and be sure to review safety information with them.

Prepare for emergencies:

• Take a first aid/CPR class. Be sure you know what to do if your child is choking.

• If you are ever worried that you will hurt your child, put your child in the crib or other safe space for a few minutes and call a friend, a relative, or your health care provider for help. Never shake your child — it can cause bleeding in the brain and even death.

• Call the Poison Help Line (1-800-222-1222) if you are worried about a poisoning.

• Get all immunizations and tests that your child's health care provider recommends.

• Take care of your child's teeth and gums:

  • Take your child to the dentist every 6 months.

  • Follow your health care provider's recommendations about using a fluoride coating (called a varnish) on your child's teeth.

  • If recommended, give fluoride drops at home.

  • Brush your child's teeth using a soft toothbrush with a smear of fluoride toothpaste (about the size of a grain of rice).

  • If your child is thirsty between meals or at night, give water only. Do not let your child sip juice or milk throughout the day or in the crib because this can cause tooth decay.

• In the sun, protect your child's skin with a water-resistant sunscreen with an SPF of at least 30, and re-apply every 2 hours or more often if swimming or sweating. It's best to keep your child in the shade, especially between 10 a.m. and 2 p.m.

• Your health care provider can tell you about help that is available in the community or through a social worker. Talk to your health care provider if you're worried that:

  • You don't have enough food for your child.

  • You don't have a safe place to live.

  • You don't have health insurance.

  • You have a problem with drugs or alcohol.

• Call your child's health care provider if you are worried about your child's health, growth, or development.