Well-Child Checkup: 18 Months
Well-Child Checkup: 18 Months
At the 18-month checkup, your
healthcare provider will examine your child and ask how it’s going at home. This sheet
describes some of what you can expect.
Development and milestones
The healthcare provider will ask
questions about your child. They will observe your toddler to get an idea of the child’s
development. By this visit, most children are doing these:
Pointing to show you
Puts hands out for you to
- Tries saying 3 or more words other than "mama" or "dada"
Tries to use a spoon
Drinking from a cup without a
lid (may spill sometimes)
Following 1-step commands
(such as "please bring me a toy")
Walking without holding on to
anyone or anything
Copies you doing chores, like sweeping with a broom
Looks at a few pages in a book with you
You may have noticed your child
becoming pickier about food. This is normal. How much your child eats at one meal
one day is less important than the pattern over a few days or weeks. It’s also normal
for a child of this age to thin out and look leaner, as long as they aren't losing
weight. If you have concerns about your child’s weight or eating habits, bring these
with the healthcare provider. Here are some tips for feeding your child:
Keep serving a variety of
finger foods at meals. Don't give up on offering new foods. It often takes several
tries before a child starts to like a new taste.
If your child is hungry
between meals, offer healthy foods. Cut-up vegetables and fruit, cheese, peanut
butter, and crackers are good choices. Save snack foods, such as chips or cookies,
for a special treat.
Your child may prefer to eat
small amounts often throughout the day instead of sitting down for a full meal.
This is normal.
Don’t force your child to
eat. A child of this age will eat when hungry. They will likely eat more some days
Your child should drink less
of whole milk each day. Most calories should be from solid foods.
Besides drinking milk, water
is best. Limit fruit juice. It should be 100% juice. You can also add water to the
juice. And don’t give your toddler soda.
Don’t let your child walk
around with food or bottles. This is a choking risk and can also lead to
overeating as your child gets older.
Brush your child’s teeth at
least once a day. Twice a day is ideal, such as after breakfast and before bed.
Use a small amount of fluoride toothpaste, no larger than a grain of rice. Use a
baby’s toothbrush with soft bristles.
Ask the healthcare provider
when your child should have their first dental visit. Most pediatric dentists
recommend that the first dental visit happen within 6 months after the first tooth
erupts above the gums, but no later than the child's first birthday.
Some children will begin to
show readiness for toilet training as early as 18 to 24 months. Signs of readiness
Able to walk on their own
Staying dry longer (increased
bladder and bowel control)
More discomfort with a soiled
Able to tell you they need to
Able to follow simple
commands (closer to 24 months)
By 18 months of age, your child may
be down to 1 nap and is likely sleeping about 10 to 12 hours at night. If they sleep
more or less than this but seems healthy, it’s not a concern. To help your child
See that your child gets
enough physical activity during the day. This helps your child sleep well. Talk
with the healthcare provider if you need ideas for active types of play.
Follow a bedtime routine each
night, such as brushing teeth followed by reading a book. Try to stick to the same
bedtime each night.
Don't put your child to bed
with anything to drink.
If getting your child to
sleep through the night is a problem, ask the healthcare provider for tips.
Recommendations for keeping your
child safe include:
Don’t let your child play
outdoors without supervision. Teach caution around cars. Your child should always
hold an adult’s hand when crossing the street or in a parking lot.
Protect your toddler from
falls with sturdy screens on windows and gates at the tops and bottoms of
staircases. Supervise the child on the stairs.
If you have a swimming pool,
it should be fenced. Gates or doors leading to the pool should be closed and
locked. Never leave your child unattended near any body of water. This includes
the bathtub or a bucket of water.
At this age, children are
very curious. They are likely to get into items that can be dangerous. Keep
latches on cabinets. Keep products like cleansers and medicines in locked
cabinets, out of sight and reach. Cover unused outlets. Secure all furniture.
Watch out for items that are
small enough to choke on. As a rule, an item small enough to fit inside a toilet
paper tube can cause a child to choke.
In the car, always put your
child in a car seat in the back seat. Babies and toddlers should ride in a
rear-facing car safety seat for as long as possible. That means until they reach
the top weight or height allowed by their seat. Check your safety seat
instructions. Most convertible safety seats have height and weight limits that
will allow children to ride rear-facing for 2 years or more.
Teach your child to be gentle
and cautious with dogs, cats, and other animals. Always supervise your child
around animals, even familiar family pets.
- Keep your child away from hot objects. Don’t leave hot liquids
on tables that your child can reach or with tablecloths that your child might pull
- If you have a gun, always store it in a locked location,
unloaded, and out of reach of your child.
Keep this Poison Control
phone number in an easy-to-see place, such as on the refrigerator:
- Limit screen time. Screen time (TV, tablets, phones) is not
recommended for children younger than 2 years. Limit screen time to video calls with
Based on recommendations from the
CDC, at this visit your child may receive the following vaccines:
Get ready for the “terrible twos”
You’ve probably heard stories about
the “terrible twos.” Many children become fussier and harder to handle at around age
In fact, you may have started to notice behavior changes already. Here’s some of what
you can expect, and tips for coping:
Your child will become more
independent and more stubborn. It’s common to test limits, to see just how much
they can get away with. You may hear the word “no” a lot, even when the child
seems to mean yes! Be clear and consistent. Keep in mind that you’re the parent,
and you make the rules. Remember, you're the adult, so try to maintain a calm
temper even when your child is having a tantrum.
This is an age when children
often don’t have the words to ask for what they want. Instead, they may respond
with frustration. Your child may whine, cry, scream, kick, bite, or hit. Depending
on the child’s personality, tantrums may be rare or often. Tantrums happen less as
children learn how to express themselves with words. Most tantrums last only a few
minutes. If your child’s tantrums last much longer than this, talk to the
Do your best to ignore a
tantrum. See that the child is in a safe place and keep an eye on them. But don’t
interact until the tantrum is over. This teaches the child that throwing a tantrum
is not the way to get attention. Often moving your child to a private area away
from the attention of others will help resolve the tantrum.
Keep your cool and try not to
get angry. Remember, you’re the adult. Set a good example of how to behave when
frustrated. Never hit or yell at your child during or after a tantrum.
When you want your child to
stop what they are doing, try distracting them with a new activity or object. You
could also pick up the child and move them to another place.
Choose your battles. Not
everything is worth a fight. An issue is most important if the health or safety of
your child or another child is at risk.
Talk with the healthcare
provider for other tips on dealing with your child’s behavior.
Online Medical Reviewer: Liora C Adler MD
Online Medical Reviewer: Amy Finke RN BSN
Online Medical Reviewer: Stacey Wojcik MBA BSN RN
Date Last Reviewed:
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