What to except during a 18 Month Old Physical?


  • Social Language and Self-Help
    • Engages with other to play
    • Helps dress and undress self
    • Points to pictures in book
    • Looks to adult if something new happens
    • Begins to scoop with spoon
    • Uses words to ask for help
  • Verbal Language
    • Identifies 2 body parts
    • Names 5 familiar objects
  • Gross Motor
    • Walks up steps with hand held
    • Sits in small chair
    • Carries toy while walking
  • Fine Motor
    • Scribbles spontaneously
    • Throws small ball while standing


  • 4Autism Spectrum Disorder Screening


  • 3Developmental Screening
  • 4Psychosocial/Behavioral Assessment


  • History
    • Initial/Interval
  • Measurements
    • Length/Height and Weight
    • Head Circumference
    • Weight for Length
    • 1Blood Pressure*
  • Sensory Screening
    • 2Vision*
    • Hearing*
  • 12Fluoride Supplementation*
  • 13Procedures
    • 8Anemia*
    • 9Lead*

7 Immunization

  • 2nd  Dose
    • Hepatitis A (HepA)
  • 3rd Dose 
    • Hepatitis B (HepB)
    • 1 Month   18 Month
    • Inactivated poliovirus (IPV)
    • 1 Month  18 Month
  • 4th Dose 
    • Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs)
    • 15 Month  18 Month
  • Annual vaccination
    • Influenza (IIV)
  • Recommended age for certain high-risk groups
    • Meningococcal (MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)
  • Recommended age for catch-up immunization
    • Haemophilus influenzae type b (Hib)
    • Pneumococcal conjugate (PCV13)
    • Measles, mumps, rubella (MMR)
    • Varicella (VAR)
  1. Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years. 7 //pediatrics.aappublications.org/content/140/3/e20171904).  
  2. Instrument-based  screening may be used to assess risk at ages 12 and 24 months //pediatrics.aappublications.org/content/137/1/e20153597
  3. See: //pediatrics.aappublications.org/content/118/1/405.full
  4. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver depression, and social determinants of health. //pediatrics.aappublications.org/content/135/2/384
  5. At each visit, age-appropriate physical examination is essential, with infant totally unclothed and older children undressed and suitably draped. The extent of the physical examination is determined by both the reason for the visit and diagnostic considerations raised during the taking of the history. //pediatrics.aappublications.org/content/127/5/991.full).
  6. Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. 
  7. For children at risk of lead exposure //pediatrics.aappublications.org/content/138/1/e20161493
  8. Recommend brushing with fluoride toothpaste in the proper dosage for age. //pediatrics.aappublications.org/content/134/6/1224
  9. Perform a risk assessment (//www2.aap.org/oralhealth/docs/ RiskAssessmentTool.pdf). See “Maintaining and Improving the Oral Health of  Young Children” (//pediatrics.aappublications.org/content/134/6/1224).
  10. Once teeth are present, fluoride varnish may be applied to all children every 3–6 months in the primary care or dental office. //pediatrics.aappublications.org/content/134/3/626
  11. If primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626

 range during which a service may be provided
* risk assessment to be performed with appropriate action to follow, if positive

18 Month Old Anticipatory Guidance

Temperament, development, toilet training, behavior, and discipline

◊ Anticipation of Return

◊ Separation Anxiety

◊ Managing Behavior with Consistent Limits

◊  Recognizing Signs of Toilet Training Readiness

◊ Parental Expectations

◊ New Sibling Planned or On The Way

  • Anticipate anxiety/clinging in new situations.
  • Spend time with child each day; plan ahead for difficult situations, and try new things to make them easier.
  • Be consistent with discipline /enforcing limits.
  • Wait until child is ready for toilet training (dry for periods of about 2 hours, knows wet and dry, can pull pants up/down, can indicate bowel movement).
  • Read books about using the potty; praise attempts to sit on the potty.
  • Prepare toddler for new sibling by reading books; avoid new developmental demands on toddler; take action to ensure own health.

Communication and social development

◊ Encouragement of Language

◊ Use of Simple Words and Phrases

◊ Engagement in Reading

◊ Playing ◊ Talking ◊ Singing

  • Encourage language development by reading and singing; talk about what you see.
  • Use words that describe feelings and emotions to help child learn about feelings.
  • Use simple language to give your child instructions.

TV viewing and digital media

◊ Promotion of Reading

◊ Physical Activity ◊ Safe Play 

  • Make time for technology-free play every day; use consistent bedtime routine of reading/songs, not media.
  • Use methods other than TV or other digital media for calming (distraction, removal from trigger, going outside, addressing hunger /tiredness).
  • Does your child watch TV or videos or use other Intern et-connected devices? If no, have you started to discuss a plan for media use when your child is older?
    • If you choose to introduce media now, choose high-quality programs/apps and use them together; limit viewing to less than 1 hour per day; be aware of own media use habits; discuss family media use plan (www.healthy children.org/MediaUsePlan); avoid TV during meals.

Healthy nutrition

 Nutritious Foods; water, milk, and juice

◊ Expressing Independence through Food Likes and Dislikes

  • Offer variety of healthy foods /snacks, especially vegetables/fruits /lean protein.
  • Provide 1 bigger meal, multiple small meals/snacks; trust child to decide how much to eat.
  • Provide 16 to 24 oz milk.
  • Juice is not a necessary drink. If you choose to give juice, limit to 4 oz daily and always serve it with a meal.
  • Continue to offer new foods; let toddler experiment by touching and mouthing.


◊ Car Safety Seats ◊ Parental Use of Seat Belts ◊ Poisoning ◊ Sun Protection ◊ Firearm Safety ◊ Safe Home Environment: burns, fires, and falls

  • Car Seats
    • Use rear-facing car safety seat until child is highest weight or height allowed by manufacturer 
    • Make necessary changes when switching seat to forward facing
    • Never place car safety seat in front seat of vehicle with passenger air bag; backseat is safest.
  • Does everyone use a seat belt, booster seat, or car safety seat?
    • Make sure everyone uses a seat belt.
  • Remove/lock up poisons/toxic household products
    • Poison Help number (800-222-1222) at each telephone, including cell.
  • Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
  • Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
  • Childproof home (medications, cleaning supplies, heaters, dangling cords, small/sharp objects, plastic bags); keep child away from heavy/hot objects.
  • Install smoke detector on every level; test monthly; change batteries annually; fire escape plan; keep child out of driveway when cars moving.

Goals For 18 months Check up:

  • Be gentle and patient
  • Get more sleep
  • Make a budget
  • Leave your work at the office
  • Focus on self-care
  • Meditate as a family
  • Find an outlet
  • “cell-free” zone
  • Spend more time with your partner
  • Take more baths
  • Have a girls’/boys’ night
  • Be more flexible
  • See your child for who they are
  • Teach your child to speak up
  • Help those less fortunate
  • Drink more water
  • Find 30 minutes a day of “me” time
  • Challenge yourself
  • Focus on experiences, not things
  • Make health a priority
  • Start—or finish—a degree
  • Inform yourself
  • Maintain balance
  • Laugh often
  • Cook dinner more frequently
  • Ask for help
  • Have designated “cheat” days
  • Stop having FOMO
  • Say “I love you” more often

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