Dosage of Fever/Pain Medications

Date______Weight ______Height ______OFC ______

DOSAGE OF FEVER/PAIN MEDICATIONS

Tylenol Children’s Suspension (160 mg/5 ml) - ____ teaspoons every 4 hours

Or Tylenol Children’s Chewable (80 mg) - ______tablets every 4 hours

Or Motrin Children’s Suspension (100 mg/5 ml) - ______teaspoons every 6 hours

Or Motrin Junior Chewable (100 mg) - _____tablets every 6 hours

Next well-child check-up______

TWELVE TO EIGHTEEN MONTH CHECKUP

FEEDING: Healthy children of this age group frequently demonstrate decreasing appetite, due to normally slowed growth and developing food preferences. Offering a balanced diet at regular meal and snack-times teaches the child that a variety of foods taste good and satisfy hunger. Typically, a toddler eats one good meal a day or eats well one day but not the next. Forcing a child to eat, or frequently making special favorite meals can lead to later problems. Restricting food you do not want your child to eat will be more effective in developing proper nutritional habits. Continuing to periodically offer foods a child has previously refused may result in eventual acceptance. Finger foods will be popular now, but choking hazards are abundant. Pay special attention to avoid peanuts, hot dogs, popcorn, grapes, raisins, candy and chewing gum for the next several years. Also, be sure a child has already swallowed what is in her mouth before adding more. Food safety can also be promoted with the avoidance of unpasteurized juice and milk, processed meats (e.g. ham, bacon, hot dogs), unwashed fruits and vegetables, and deli meats and soft cheeses (e.g. blue cheese).

Whole milk provides calcium, protein and healthy fat to the diet. Toddlers need 2-3 servings of milk and milk products a day. More than that may be associated with constipation and anemia. Less than that suggests the need for a calcium and vitamin D supplement (500 milligrams of elemental calcium/400 I.U. of vitamin D per day). Juice should be limited to 8 ounces or less per day. If milk intake is deficient, 6 – 8 ounces of calcium and vitamin D fortified orange juice would be beneficial. Juice is high in sugar and should not be allowed to become a “fast food” for toddlers. Offer water periodically throughout the day. If the water is not fluoridated, please request a prescription fluoride supplement. This will be continued until age 13. Otherwise, vitamins are usually not needed. This is a good time to wean an infant from the bottle or breast. If this is proving difficult, please let us know. Learning to use the cup, fork and spoon is messy but fun at this time of growing independence. Brushing teeth twice daily and after sticky food presents similar challenges. Dentists generally recommend parents brush the child’s teeth daily.

DEVELOPMENT: Toddlers love to play and learn many new skills and behaviors. Early in this time, they initiate play, demand attention and begin to accept limits. Later they learn to play games, understand the use of objects (such as a comb for her doll’s hair) and enjoy social interaction and new experiences.

Naming common objects, talking about what you are seeing and doing, and especially READING will build language skills. These skills progress from a few words and imitating vocalizations at 12 months, to using 10-30 words, mimicking even more words, following commands and starting to use phrases at 18-24 months.

Toys that your child can push/pull, empty/fill, open/close and put together/take apart as well as soft balls and riding toys will help develop motor skills. Walking, climbing, running, and kicking and throwing a ball are mastered in this second year. Crayons, washable markers and puzzles are popular after 15-18 months when children are less commonly exploring objects with their mouths.

Give attention to encouraging both quiet and active play as well as playing alone and with a parent or sibling. Play that imitates your actions will evolve into pretend play. Giving small chores such as folding towels and dusting (to “help out”) promotes learning and self-esteem.

Music and dance are great fun now. They can substitute for TV, video, and computer time which should be limited to thirty mintues a day. Please let us know if you feel your child’s development is not progressing normally, or if you have concerns about their vision or hearing.

DISCIPLINE: A growing sense of self and independence, as well as a natural curiosity, lead to self-confidence. Teaching discipline during this time requires consistency, clear limits, avoiding meaningless threats, and lots of praise for good behavior. Parents and caregivers should openly discuss their child-rearing ideas and support each other’s actions. As an example, a child who throws himself down in the store aisle kicking and screaming in frustration that he didn’t receive the cookie he demanded, would be best moved to a safe place and ignored from a short distance away, or removed from the store altogether. When he is calm, he should be praised for regaining control but not rewarded with the cookie. A threat to never again bring the child to the store or give him a cookie would be difficult to carry out and undermine credibility and trust. A threat of delayed punishment is often forgotten by the adult or the “crime” forgotten by the child and again ruins credibility. Distraction and avoidance of conflict situations are the best techniques for this age group. Brief time-outs can be useful, also. Behavior problems are often complicated. We are happy to discuss them with parents but ask you to recognize that a special appointment may be necessary to give the appropriate time and attention to your concerns. It is sometimes helpful to schedule a conference where the child is left with a sitter, to reduce distraction.

SAFTEY: Accident and poison prevention are very challenging in this age group. Child-proofing and poison-proofing should be updated as the child’s skills grow. Special concerns at this age include:

 Guarding against fall (e.g. stairs, windows, countertops)  Close supervision near water  Preventing burns and scalds  Avoiding plastic bags and balloons  Close supervision near streets and driveways  Lowering the crib mattress  Keeping Ipecac and poison control numbers in every home (1-800- 392-9111 or 614-772-5200)  Using safety caps on medicines  Keeping hazardous material out of reach even to a climbing child  Avoiding machinery, tractors, ATV’s mowers  Use approved car seat-forward facing after 2 years of age

Booster sears are recommended from 40 inches until 57 inches in height.

ILLNESS: Management of fever, colds and vomiting and diarrhea are similar to what you have read in past pamphlets. More detailed information is available upon request from our office. In general, over-the-counter medicines (other than fever control medicines) are still to be avoided. This is a good time to begin teaching and continue demonstrating good hand washing techniques. Teaching the child to sing a brief song may help achieve the goal of scrubbing 30 seconds. Regular exposure to cigarette smoke is harmful. Smokers should not smoke in the house or car but should step outside to smoke. The American Cancer Society can provide information on stop- smoking programs.

SLEEP: Toddlers benefit from a predictable bedtime routine. It is best to put the child into bed while awake but tired, rather than waiting until they fall sleep and then carry them to bed. They favor “transitional objects” such as a favorite blanket to comfort themselves. This can help with bedtime avoidance and night waking. Naps occur less frequently during this second year. As with discipline concerns, sleep problems can be complex. Please schedule a separate appointment if your family is having major sleep problems so we may give your concerns all the time they require.

IMMUNIZATIONS: Vaccines to protect against measles, mumps, rubella and chicken pox (MMR and VZV) and hepatitis A (HAV) are due after the first birthday. Booster doses of other vaccines including acellular DPT (Whooping cough, tetanus, diphtheria) HIB (meningitis), HBV (hepatitis), IPV (polio) and Prevnar (meningitis, pneumonia, blood stream infections, and some ear infections) will be due at this time period. “Flu” shots, given in November, are now recommended annually.

OFFICE CALLS: When calling for advice, please have your questions organized with a pencil and paper handy, If the baby is ill, please take the rectal temperature before calling (do not add or subtract to the actual reading). Routine calls should be made during regular weekday office hours when records are available. Many routine questions can be answered evenings and weekends by the “Answer Line” at 1-800-678-KIDS. Emergency calls may be placed to the office number at any time.

RECOMMENDED READING MATERIAL: An excellent resource for parents is the book, Your Child’s Health, by Barton D. Schmitt, M.D. Another excellent, comprehensive resource is The Children’s Hospital Guide to Your Child’s Health and Development, from the Children’s Hospital of Boston. Other resources for parents include Solve Your Child’s Sleep Problems by R. Ferber, nutrition books by Ellyn Sater, and American Academy of Pediatrics parenting books (Caring for Your Baby and Guide to Your Child’s Sleep). St. Louis Children’s Hospital’s web site now contains protocols that parents can access when they have a sick child. You can take a look by logging on to www.stlouischildrens.org and clicking on “Health Resources” then “Health Information.” The American Academy of Pediatrics website is also an excellent source for up-to-date information at www.aap.org.

APPOINTMENTS: Preventive care visits (well child checkups) are an essential part of your baby’s care. In addition to complete physical exams, preventive care visits are an opportunity to discuss changes and concerns about diet, sleep, developing skills, safety and immunizations issues. This year, visits are recommended at 12, 15, 18 months and two years. Immunizations are recommended at 12, 15, & 18 months. Preventive care visits are usually best scheduled at least 4 weeks in advance.

REGULAR OFFICE HOURS: Routine Phone Calls are Welcome Monday – Friday 8:30 a.m. - 5:00 p.m. Saturday 8:30 a.m. - 11:00 p.m. Sunday 9:00 a.m. - 10:30 a.m.

AFTER HOURS URGENT CALLS: 1-877-599-8962 This line should be used for emergency and urgent medical concerns whenever our office is closed.

THE ANSWER LINE (St. Louis Children’s Hospital): 1-800-678-KIDS (5437) General pediatric information is provided by specially trained nurses until 11 p.m. This line is not for emergencies.

POISON CONTROL 1-800-392-9111 OR 614-772-5200

PHYSICIAN VISITS: By Appointment Only Monday – Friday 9:30 a.m. – 4:00 p.m.

“WALK-IN” VISITS: Monday – Friday 8:00 a.m. – 8:45 a.m.

Children with urgent conditions which should not wait for regular hours or with brief uncomplicated illnesses may be seen by the doctor on call without an appointment. This clinic has limited capacity, and your child is not likely to be seen by his own doctor. Whenever possible, please call for a regular appointment.

WEEKEND AND HOLIDAY VISITS: 9:00 – 11:00 a.m. Children and urgent conditions that might otherwise need to be seen in the emergency room may be seen by the doctor on call weekend and holiday mornings. Please call as early as possible so your child may be seen while the office is open.

NURSE VISITS: Monday – Friday 10:00 a.m. – 11:00 a.m. 2:00 p.m. – 4:00 p.m.

Immunizations, weight checks, and other minor procedures which do not require being seen by the physician can be done at this time.

EMERGENCY ROOM: We continue to be available to our patients on weekends and holidays because we strongly believe we provide higher quality and more consistent care than urgent care clinics. If you must use another after-hours provider, please send us a copy of your visit records.