A Newsletter for Parents Next Visit

18 Month Check Up years2 of age Well Child Appointments can be made online at AustinRegionalClinic.com.

Your baby’s length, weight, size, along with health screens and immunizations performed will be in the After Visit Summary (AVS) that your baby’s provider or nurse will give you at the end of the visit. You can also view this information on MyChartARC.com

your child’s development, but as parents NUTRITION we need to avoid falling into a pattern Remember this year is an important of offering only what the child “likes” time when your child develops food or offering less nutritious alternative preferences that may predict their foods because your child refuses what is Online Access: Day or Night eating preferences for life. As early as offered to them. ▪ View your child’s medical records 12 months, your toddler’s diet begins ▪ mirroring some of the unhealthy eating 3. One way to remember how to give your ▪▪ Print your child’s shot records any time child nutritious, healthful choices is to patterns seen in older children and ▪▪ Book your child’s next appointment adults, including eating limited fruits utilize the MyPlate visual diagram to ▪▪ Review your child’s After Visit Summary and vegetables and consuming too include all 5 food groups in meals and much sugar and fat. It is important snacks. For the 3 meals of the day try to that as parents we provide a variety of make half their plate fruits and vegeta- — Enroll Today — healthy, nutritious foods at mealtime bles. Remember: it can take up to 12–15 Visit MyChartARC.com and snack-time to avoid developing times of presenting a vegetable before a an unhealthy eating pattern for your child will eat it. Never force a child to eat child. Families have a tremendous a vegetable—this will just create a battle DEVELOPMENT influence on developing their children’s and control issue—and try not to reward food preferences, so please model the a child eating their vegetables with Social/Emotional healthiest eating habits you can. dessert. Remember: the child decides Successful parenting of an 18 month how much to eat. Parents decide to old requires patience, consistent limits, Here are a few tips: keep offering it to them.For more and daily routines. Communication and 1. Children thrive with structure and information and tips please visit www. social skills are developing rapidly in predictability. This fosters a sense of ChooseMyPlate.gov. most 18 month olds. Despite this rapid security for your child. A set schedule 4. Snacks: Today, the most popular snack development, most 18 month olds still of 3 meals and 2–3 snacks per day choices among toddlers and preschool- have limited communication skills and should be part of your child’s diet. With ers are crackers, cookies, and candy. But tend to get frustrated easily. The defiance set times for meals and snacks you can children’s stomachs are small and they and negativism of children this age reflect avoid your child grazing throughout the will not eat very much at each meal, so a desire for choice and independence. day. Grazing can lead to unhealthy snacks should be thought of as “mini- At the same time, children need to have eating. Your child may not be hungry meals.” Fruits, vegetables, and protein are strong emotional ties and feel loved by every meal. Many children this age only better choices for snack times to keep parents. To venture out into the world and eat 1-2 meals per day, since their rate of your child’s diet healthy. Sweets can be test independence, a child must know that growth is slowing down. part of a healthy diet, but they should be they have a safe and emotionally secure 2. “Parents provide and the child thought of as an occasional treat and not place at home. decides.” This is an important, easy-to- offered everyday. remember expression for us as parents. As a parent, our job is to provide optimal nutrition for our child. Parents are responsible for what the family eats, when the family eats, and where the family eats. Your child’s job is to decide how much of the correct portion to eat. Children are responsible for whether they eat what For more information on how to encour- is offered or wait until the next meal/ age healthy habits for children 0–5 years of snack. Picky eating and food refusal (or age, please visit: www.healthychildren.org/ “food jags”—liking something one day growinghealthy and not the next) are normal parts of 17.0823 1 09012016 To help with emotional and social Respond to nonverbal communication with development, allow your child to make the appropriate word or phrase, “Look at the simple choices, such as which fruit for snack- doggie!” Soon your toddler will add “dog” or time or what book at nap time. Praise your “doggie” as they point to the puppy. Developmental Concerns? child when you see them being cooperative Most 18 month old children say 10–25 If you believe that your child is delayed or has a condition that could and friendly. Comfort your child when they words. Soon after 18 months, language have fears or are afraid. Reassure your child lead to delays, please ask your doctor abilities explode. By 2 years most children to refer you. that you are there. can say at least 50 words. Reading at least You may also call 1-800-628-5115 While your child may engage you in play, 30 minutes a day to your child will help or visit the ECI website at children don’t generally involve other speech and language development. The dars.state.tx.us/ecis children in their imaginary play until around more words your child hears, the more for the ECI program closest to you. 2 ½ years. However, children this age often words the child will learn. enjoy having another child around during Talk to you child, and ask questions about play. They watch each other and learn from the pictures and stories as you read. There each other by imitation. It is not expected are many apps or shows for kids that aim to that your child will share at this age. improve their development, but your voice CARE OF YOUR CHILD Around 18 months, children begin explaining their world around them is more developing a sense of self awareness. They helpful than any product. Dental are learning that they are individuals with Children benefit from learning two their own feelings, thoughts, likes, and languages at the same time. This is a dislikes. Next, they realize that other people wonderful opportunity for your child and have their own feelings, thoughts, and is a way to bond with their community and preferences as well. This helps children learn culture. Don’t worry when you hear some empathy. They start to imagine how another language mixing. Eventually they will sort person feels. To help your child develop out the words. empathy: Talk about other’s feelings. “Susie is sad because you took her doll. Let’s give Now we know that dental caries (“cavities” Susie her doll back and we can find you or tooth decay) are an infectious disease another one.” Demonstrate empathy: “Oh transmitted from other people. Babies no, Johnny hurt his knee. Let’s bring him usually pick up the germs that cause cavities some ice.” from family members. Not sharing spoons, forks and drinks with your baby will help Learning reduce cavities. For the same reason, do not Children this age enjoy imaginary play clean your toddler’s pacifier with your mouth and will eventually involve other people and put it back in their mouth. This will share in their pretend play. Provide toys that your mouth germs and cause more cavities encourage imaginary play such as simple for them. dolls, toy phone, cars, musical instruments, Brush your child’s teeth twice daily with play kitchens, and dress-up clothes. Join small amount (smear) of fluoride-containing in the fun if your child wants you to play. Movement skills toothpaste. You can play puppy, wear a silly hat, or Your child’s ability to move about and let your child serve you “food.” Enjoy such effectively use their arms and legs is rapidly Eliminate all bottle use. It is time for the “cold moments. improving. Most 18 month olds run well, turkey” approach if your child is still using a bottle. Bottle use at this age, especially This is also an age when children become can throw objects while standing up, and during the night, causes cavities. Breast- problem-solvers. You will see your child seat themselves in a small chair. Over the feeding during the night also causes cavities. filling and dumping, opening and closing, next few months your toddler will start shaking and throwing, as they explore and carrying large objects, squatting while Make healthy food choices throughout the try to make sense of their world. Three playing and going up stairs placing both day. Frequent sweets, including fruit juices, and four piece puzzles or blocks also help feet on each step. increase tooth decay. Dentists recommend develop problem solving skills. that your toddler drink their milk (or juices) Hand and finger skills at meal-time and drink only water between Talking skills Your child’s ability to use their hands and meals to get less cavities. fingers are rapidly improving. By this age, Communication skills should be rapidly For more information about dental care look your child should be able to use a spoon improving at this age. Nonverbal at the pediatric dentistry website, www. and cup without spilling all of the time, communication is starting to be supported aapd.org. For patients insured by Medicaid, stack 2 or 3 blocks, and may even imitate by language. Your child should be pointing you can find a dental provider for your child scribbling with a crayon. and starting to use words to indicate needs www.tmhp.com, or calling the THSteps and show you items of interest. Squeals of Hotline at 877-847-8377. laughter and pointing at a puppy is a happy example of nonverbal communication.

17.0823 2 09012016 Training Discipline ▪▪ Because most parents do not want to spank, they are less likely to be consistent. Most children are ready to toilet train between 2 and 3 years of age. On occasion ▪▪ Spanking increases aggression and anger children less than 2 years are ready to instead of teaching responsibility. toilet train; however; many children are not ▪▪ Parents may intend to stay calm, but often ready until age 3. The normal age range for do not. They then regret their actions later. is quite large. ▪▪ Spanking can lead to physical struggles Signs of being ready to toilet train: and even grow to the point of harming 1. Your child is dry for two hours or dry your child. after naps. Praise your child when they are behaving 2. Your child shows an interest in toilet well. A way to think about this is “catch them SAFETY training. being good.” Give specific praise about the Children need constant supervision at this Preparing your child for toilet training: behavior, “You wiped the table clean!” rather age. Rapidly improving motor skills along than general comments such as “You are so with very little judgment is a combination 1. Read books about using the toilet to good.” Rewards and praise are better than that results in lots of accidents. Parents and your child. punishments when trying to promote the other caretakers have to be vigilant. Also, 2. Have a parent or sibling of the same behavior you would like to see in your child. watch more videos on how to protect your sex take your child to the . Testing limits is normal toddler child on the YouTube channel SafeKidsAustin 3. Take your child with you to buy a floor development. It is not unusual for parents and www.safekids.org. level potty chair. Make it clear that this is to deal with challenging behavior by their Car Safety a special chair. At first let your child keep toddler every 5–10 minutes. Toddlers try Most injuries and deaths caused by car the chair in the play area and let your different behaviors and see what reaction crashes can be prevented by the use of car child sit on it fully clothed. Help your they get. If you are having an adult seats every time your child is in the car. child develop good feelings about the conversation, give your child brief attention potty chair. every 2-3 minutes before the misbehavior ▪▪ Keep your child in a rear-facing car seat happens. This might be a quick smile, eye until at least 2 years of age and, even Sleep contact or a light touch to their shoulder. better, until they reach the highest weight or height allowed for your car seat when it’s Set limits that are important to you and ask facing toward the rear. others to enforce the same limits with your toddler. Be clear about the rules. A toddler’s ▪▪ Never place your child’s car seat in the front memory is still developing so they need seat. Children less than 13 years of age many reminders. They remember actions should sit properly restrained in the back seat. even better than words. For example, put the toy they just threw into time out for ▪▪ Questions about how to install your car seat the rest of the day (out of their reach), to should be answered by a certified Child prevent them from throwing toys. Passenger Safety Technician. You can find a Child Safety Technician closest to you by Be specific. For example, say “please put checking the Child Safety Seat Inspection Most children this age need between 11-14 your blocks in the box” instead of “clean up Station Locator: www.seatcheck.org or hours of sleep per day (including naps). They your toys.” Use simple words and a nice tone 866-seatcheck (866-732-8243). are often taking one nap or in the process of when you tell your child what to do. Staying transitioning from two naps to one. calm will teach your child self-control. Do not leave your child alone in the car. Death from excess heat may occur quickly Having regular times for bedtime and Change your child’s focus to another toy in warm weather. naptime is very important to your child or activity if they are getting too upset. and your family. Predictable schedules Distract them before they melt down. Before backing up, always walk behind your car to be sure that your child is not are comforting to children and help them Be consistent. Use the same consequences there. You may not see a small child if you develop normal day-night patterns. Your for misbehavior. For example, every time only rely on your rear view mirror. child should not wake at night, for milk or your child hurts themselves or someone comfort, on a regular basis. else, they might have time-out in a playpen Gun Safety If you want to read more about sleep or highchair. Keep time-outs brief, no more It is best to keep guns out of your home. problems, we recommend Solve Your than a minute or two. Homes with guns in them have more Child’s Sleep Problems by Richard Ferber, Spanking is not recommended by your accidents than homes without them. Your Healthy Sleep Habits, Happy Child by Marc child’s physician or the American Academy child is in more danger of being shot by Weissbluth, or Sleep: What Every Parent of Pediatrics. Although many Americans yourself, a friend, or a family member than Needs to Know by the American Academy were spanked as children, there are several being shot by an intruder. If your family of Pediatrics. important reasons not to spank: chooses to keep a gun, it should be stored ▪▪ Even though spanking may seem to “work” unloaded and in a locked place, with at first, it loses its impact after a while. ammunition stored separately.

17.0823 3 09012016 while cooking. Safe places for your child while you are cooking include the playpen, RESOURCES crib, stationary activity center, or buckled into a high chair. Books Never carry your child and hot liquids or food Caring for Your Baby and Young at the same time. You can’t handle both. Child: Birth to Age 5, from The American To protect your child from tap water Academy of Pediatrics. burns, set your water heater to no more Poisonings than 120 degrees. Your Baby and Child: From Birth Children continue to explore their world by to Age 5, by Penelope Leach If your child does get burned, immediately putting everything in their mouths, even if it put cold water on the burn and keep the Toddler 411: Clear Answers and doesn’t taste good. burned area in cold water (not iced cold) for Smart Advice for Your Toddler, You must use safety caps on all medicines a few minutes to cool it off. Then cover the by Ari Brown, Denise Fields and toxic household products. burn with a dry bandage or clean cloth. ▪ Be sure and keep all household products Websites ▪ Make sure that you have a working smoke www.healthychildren.org and medicines completely out of sight and alarm on every level of your home. Test A parenting website developed reach. Keep all products in their original the alarms monthly. It is best to use smoke by the American Academy of containers. alarms that use long-life batteries, but if Pediatrics. Now available in Spanish. you do not, change the batteries at least ▪▪ Liquid laundry and dishwasher packets can www. healthychildren.org/ be deadly to your toddler. Keep them up, once a year. growinghealthy out of your child’s reach. Drowning Dynamic interactive website to ▪▪ Liquid nicotine found in e-cigarettes or vapes help encourage healthy habits can also easily poison your child. Just touching for children 0-5 years of age. liquid nicotine can be poisonous. E-cigarettes www.vaccineinformation.org are also dangerous because there are small Answers to questions about vaccines. parts and are easily opened by small hands. www.seatcheck.org Keep them away from your child. Information about car safety for all ages If your child does have contact with a but check the page on car seats for a possible poison, call the Universal Poison listing of local car seat checks available. Control Number, 1-800-222-1222. www.mychildrensteeth.org Information on caring for your Choking Never leave your child alone in or near a child’s teeth from the American Many food related choking deaths can be bathtub, pail of water, wading or swimming Academy of Pediatric Dentistry. prevented by making sure food is always pool, or any other water—even for a Also check out www.ilikemyteeth. cut into small pieces and having your child moment. Stay within an arm’s length of your org for information on how fluoride eat while sitting down. Don’t feed your child child around water. protects your child’s teeth. hard pieces of food. Remember: no chips, If you have a swimming pool, fence it on all www.cdc.gov/parents/essentials popcorn, or nuts until your child can grind Frustrated with discipline? them with their back teeth after four years sides with a fence at least 4 feet high, and be sure the gates are self-latching. Most This resource gives great how- old. Circular foods can block your baby’s to modules on parenting. airway and cause choking. Cut grapes and children drown when they wander out of hot dogs into small pieces and smash beans the house and fall into a pool that is not www.zerotothree.org/parenting- resources until your child is 4 years old. fenced off from the house. This is another parenting resource Watch carefully to be sure that small objects that discusses common parent are kept out of your child’s reach. Some struggles and solutions. 24-Hr Appointment Scheduling of the more worrisome choking risks are www.babybuffer.org balloons, magnets, and button (circle) visit MyChartARC.com or Parenting website with email batteries. ARCappointments.com updates for your child’s age. Still have questions about how to keep your Same-Day & After Hours Care Make Safe Happen child safe? Check out www.redcross.org/ call your ARC clinic and press “1” An app available for iPhone and take-a-class/first-aid for more information. 24-Hr Phone Nurse Android, that gives a room-by-room Burns call your ARC clinic and press “4” checklist of how to keep your child safe. The kitchen is a dangerous place for your child during meal preparation time. It is best to keep your child out of the kitchen

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