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YOUR ENERGETIC EIGHTEEN MONTH OLD
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If they haven’t surfaced already, behavioral issues will come to attention during these middle months of the second year. If it is not already a part of your routine, discipline in the form of guidance, protection and limit setting/boundary establishment must enter your child’s world as an expected response and interaction between he/she and you the parents. At this juncture, it may become important to look inwardly and ask yourselves “why do I want my child to be good, disciplined, in self-control and productive?” Although it is OK at this age to invoke the concept of absolute authority (“because I said so”), this answer will eventually lose its satisfaction to your child and perhaps yourself. Why are you good/disciplined/in self-control/and productive? If you are not, why not? These are more difficult to answer than they appear, but your intellectual and eventual behavioral response to them will be the most vital force in the development of your child’s character, morals and value system.
Impressions made even at this early age stick deeply, and children learn and emulate what they see lived in the home, not said. Issues that may put you to the test in this area include temper tantrums, negativism, aggressiveness, high activity or withdrawal, sleep problems, separation anxiety, and other activities. If you find difficulties in these or other areas, discuss them at your next visit. Continue the discipline principles previously outlined (clear, gentle, non-repetitive instruction followed by swift removal if instructions aren’t heeded – ignore negative responses and reward good responses). Consistent limit-setting without guilt is vital! (The “time-out” chair will come a little later but you can use a playpen without toys to act as a self calming area). Remember, the only behaviors needing discipline are those that are dangerous, disobedient, or defiant! (The 3-Ds of discipline).
Gross motor development smoothes out old skills but results in lots of jerky running, falls, bumps and bruises. Energy seems boundless; lugging, tugging, pulling, dumping, pushing, and pounding are new more complex skills that may be practiced and perfected. Gait may still be broad based, but hands are down, and walking backwards is now possible. He/she may climb stairs while holding a hand, climb onto chairs and more dangerous objects, kick a ball and throw with one hand. Intoeing, out-toeing and bowleggedness are common. Discuss any concerns at a visit. Some babies seem swaybacked or pot-bellied at this stage. This is probably normal. Hand use and fine motor development progress to better spoon use, early fork use, disrobing, holding and drinking adequately from a cup, stacking three or more blocks, turning single pages in books, imitation of crayon strokes, and ring stacking on a cone. He/she may spontaneously dump or replace objects from containers.
Speech and language gains continue their striking acceleration. Vocabulary increases to 10-20 words or more, and words are occasionally linked in two word combinations. Pronouns are used without discrimination (“me do”), and consonants are left off the end of words (“boo” for “book”). Several body parts can be pointed out, and directions are more easily understood and fulfilled. Completion words such as “all gone” and “thank-you” are favorites. He/she may voice two or more wants of his/her own. Pictures are named selectively in books, but imitation still makes up the bulk of vocabulary rather than spontaneous words. Jargon may get quite forceful and elaborate. Animal sounds are common, and two part commands can be followed.
Socially and cognitively, a real personality is beginning to show. Separateness and independence foster this development, but may paradoxically increase clinginess and anxiety. Each child “lets go” at a different rate and degrees. Any unusual attachment problems should be discussed.
Play should continue to be parent interactive, as more sensory motor skills result in more complex play. Use your and the child’s imagination to guide new autonomy and initiative. More “apart” play will start with you in eye or earshot. Explorative play may find the child suddenly alone or frightened of a new skill. Types of toys should  continue to include challenging (but not frustrating), versatile, and manipulatable ones. Do not expect sharing! (Provide enough for all sibs or playmates). Ability to chase, hide, run, jump, throw, kick, pull, push and carry should be incorporated into the playroom. Simple household chores (e.g., dusting) can be assigned, children should helping in toy pick-up (unless you have the “cat-in-the-hat” at home!). As before TV/screen/video time should be as close to zero minutes as possible. Never put a TV or computer or video game in a child’s bedroom! Provide a toothbrush for practice. Regular reading times are crucial, as are regular times alone for each caretaker.
Naptime adjustments may need to be made. Again, try to avoid their potential for interference with a good night’s sleep. Continue structured, brief, but soothing bedtime rituals.
Lack of eating interest will continue; hopefully eating times are routine, and the family gathers together for at least one meal. Try to avoid discussions about food around the table, rather allow each person to share some “air-time”. Caloric intake is still about 1,300 kcal a day. Snacking is an almost necessary “evil”, but it’s better to incorporate snack foods as part of regular meal times than to run a fast food restaurant. We “oversnack” as a society! Hence, consider serving veggies with cottage cheese or yogurt based dip, celery spread with peanut butter sprinkled with raisins or shredded carrot, bananas dipped in yogurt or spread with peanut butter. Serve apples dipped in a conglomeration of peanut butter, cream cheese, honey, raisins and coconut mixed together. Make whole grain veggied up muffins (carrots, zucchini, pumpkin, etc.). Pitas are great fun and nutritious as is garnished gelatin or yogurt, fruit, and granola parfaits. Whole milk and water should be the only drinks in general. Be creative! Limit total mealtime, continue to be a good nutritional example. Use food TV web sites for veggie ideas. Introduce whole grains for all carbohydrates and cook grains you never have heard of (bulgar, millet, etc…) Try new things. Brush and floss as much as practical (twice a day is a minimum). Wean that final bottle if not done yet! Fluoride may still be necessary. Explain to children early why certain foods are important. Cut foods to proper size. Watch food temperatures. Watch improperly cut hot dogs (cylinders), candy, nuts, grapes, raw carrots, corn and peas as possible aspiration items. One large meal a day may be enough to sustain your child on certain days, so don’t be alarmed with big appetite swings. Remember, it is unknown if reduced fat, cholesterol, sodium, diets are safe for growing children – so your intake must be more strictly watched than your child’s in these areas! Even in nutritional realms, children are not little adults.
Skin and diaper concerns are as before – remember sunscreens (30 SPF or more). Shoes should be sturdy, roomy, flexible, breathable, and non-skid. A potty seat can be purchased and early introduction made if the child seems interested – otherwise wait a while longer.
At this age, vaccines are usually given again in accordance with the American Academy of Pediatrics recommendations. Some “catch-up” may be necessary. It’s helpful in some children to pre- and post- medicate with normal acetaminophen doses. Serious vaccine reactions remain rare, and preservatives are not currently a part of pediatric vaccines in any significant way. Vaccines do not cause Autism.
Do not let up your safety guard! Now is the time to: refresh your choking first-aid (and possibly CPR) maneuvers, review crib safety, keep balloons, plastic bags, powders and small hard objects out of reach, check toy safety, avoid hot liquid carrying and smoking in the house or car, check the water heater, fire escape plan and equipment, check outlets and cords for fraying, keep the child out the of the kitchen while cooking, barricade fireplaces and heaters as well as steps, lock basement and other doors/upper floor windows, check furniture stability, put coffee table away if still out. Keep outdoor play equipment in good repair and replace soft surfaces under the equipment as needed. Your child may be ready for transfer to a low bed. Continue to keep medicines, chemicals, cleaners, and vitamins out of reach and in original containers. Check the poison control number; use safety caps. Don’t leave child alone with pets. Keep sharp tools and objects out of reach, also power tools. Use back stove burners, keep matches and lighters away. Continue perpetual proper car seat use – never leave your child unattended in a vehicle or tub. Parents, wear seat belts; don’t ride children on tractors, mowers, ATV’s. Use proper bike and helmet precaution. Fence and supervise outside play areas. Keep pool barricades functioning and never leave child in or around any standing water. Lock away firearms. The leading cause of acute medical interaction in this age group is INJURY! USE DEET TO AVOID INSECT BITES! (It is safe when properly used). Children still do not understand DANGER at this age.
Other issues you may desire to discuss such as thumb-sucking, pacifier use, use of favorite toys or objects to handle tension, proper day care choice, self-stimulation, pica, behavior or speech problems should be freely addressed.
Now is a good age for parents to step back and see if they are “in tune” with toddler. Are you generally confidant, consistent, affectionate, and excited about new gains? Are you able to set limits and not take responses personally? If stress of any kind is inhibiting these responses or causing you to be distant, overindulgent, rigid or anxious – stop and regroup (perhaps with pediatric, friend, counselor or clergy help). Focus on catching your child being “good” (remember to define why you think a behavior is “good” to yourself). Reinforce self-expression as it fits into your limit setting. Take time to be goofy with your child and delight in the wonderment of development You are succeeding!
“Yesterday shows another day is here.” -- Ruth Krauss
Prepared by David L. Ragonesi, M.D., F.A.A.P.
Revised 3/07
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