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Well-baby visit: 18 months-2 years. All about toddler development, child growth, emotional growth

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By Ricky Richardson & Suzanne Dixon BSc, MBBS, FRCP, FRCPCH & MD, MPH

Dr Ricky Richardson was brought up in Spain, educated in the United Kingdom at Eton College, and took his first Degree with Honours in Cell Biology and Immunology at the University of London. He then proceeded to study clinical medicine at the Middlesex Hospital Medical School, qualifying in 1973. Following three years as an intern and then resident in Internal Medicine, he turned to Paediatrics and he has remained in this field ever since.

Most of his paediatric career has been based at The Great Ormond Street Hospital for Children in London, but a considerable period of time has been spent overseas on specific assignments in Africa, Central America, Southeast Asia and the Middle East.

He spent five years in Brunei to devise and implement a comprehensive integrated paediatric service at the request of the Government of Brunei. He also spent two years in Muscat in the Sultanate of Oman as Senior Paediatric Consultant and advisor to the Ministry of Health.

In addition to his academic role, he was appointed Honorary Consultant Physician at The Great Ormond Street Hospital for Children, a position which he still holds. He is also a Consultant Physician at the Portland Hospital for Women and Children. His clinical interest is in children with specific learning and behavioural difficulties. In 1990, he co-founded Whizz-Kidz, a children’s charity which has become the largest supplier of mobility aids and specialist services to disabled children outside the NHS.

Dr Richardson is an acknowledged authority on the emerging field of e-Health and Telemedicine. He lectures frequently on the subject and is Chairman of the UK Telemedicine Association. He is also involved in an European working group mandated to facilitate e-Health and telemedicine activities across the European Community.

Dr Richardson is a Fellow of the Royal College of Physicians (FRCP), a Fellow of the Royal College of Paediatrics and Child Health (FRCPCH), a Fellow of the Royal Society of Medicine and a Fellow of the Royal Society of Tropical Medicine.

Dr Richardson is married and has two sons.

"I love this job!" says Suzanne Dixon. "I believe I can bring the best of information to families by the thousands every day. I'm not shy about tapping my colleagues and friends all around the country so that we can get the latest, best, and most sensible advice on every issue."

Suzanne Dixon, MD, MPH, was born and raised in Minnesota and graduated from the University of Minnesota, School of Medicine. She did her paediatric training at Massachusetts General Hospital in Boston and then completed a fellowship in Child Development at Boston's Children's Hospital. Dr Dixon joined the faculty at the University of California, San Diego, and did patient care, teaching, and research for 20 years. She ran a large newborn service, performed research in early child development, and was involved in many community outreach activities in maternal child health. Throughout her entire professional life she has maintained an interest in cross-cultural activities, living and working in many parts of the world, including Mexico, India, Kenya, Indonesia, and several countries from the former USSR.

Dr. Dixon is the author of numerous research articles, review articles, and textbook chapters in paediatrics, child and family development, and public health. Her textbook, written with Dr. Martin Stein, Encounters With Children: Pediatric Behavior and Development, has become a classic in child health education andis just coming out in its third edition. She has served as an associate editor for Infant Mental Health and currently reviews for several major paediatric journals.

Dr Dixon is a fellow of the American Academy of Paediatrics and served in national positions in that organization. She is a member of the Society for Paediatric Research, the Society for Research in Child Development, the American Public Health Association, and the Society for Developmental and Behavioral Paediatrics.

Dr. Dixon continues to lecture and consult worldwide on aspects of maternal, child, and family health. She practices behavioral and developmental paediatrics in Montana and works with local advocacy groups on education and women's health. Dr Dixon has been married for 25 years and has three sons. She and her husband travel frequently and enjoy being amateur anthropologists.

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Eating, sleeping, and discipline are the usual hot topics at this visit. Meanwhile, fidgety toddlers may fuss and protest being examined. For tips on getting your little one to cooperate, read on!

Well-baby visit: 18 months-2 years

Your baby has come a long way and a well-baby visit can bring home just how far your toddler has progressed. They can also be a handful when what you really want them to do is stay still while they are checked over!

Dress your toddler in a two-piece outfit that comes off easily. Plan to keep them on your lap or near you for most of the examination. Take one or two familiar toys. Snacks will also help you get through this visit.

Early appointments are better than afternoon ones. Avoid naptime.


At this visit you may find:


Your child is weighed. Click here to see our child growth chart.
You are given insights into your toddler development and emotional growth.
Your toddler development is reviewed to make sure they're on track.
You can talk about discipline issues.
Your health professional can answer questions you may have about surviving the 'terrible twos'.
Discussion turns to toilet training, nursery school and childcare.


Other things that may be discussed:


Has your baby seen a GP since the last visit? If so, why? What was the outcome of that visit, and was any medication or treatment prescribed?
How are your baby's walking, running and climbing skills? Can they walk backwards?
How about language abilities? What are they saying?
Does your baby understand one-step commands such as 'Get your shoes' or Bring me a nappy'? Can they listen to and follow a simple story? Does your baby look at the pictures in a book?
How does your baby play? The type of play a child engages in tells us about cognitive abilities. Do they imitate you at household tasks? Can they stack blocks?
Is your baby starting to say 'no' and have temper tantrums? These are good signs of emotional growth and cognitive aspects of child growth.
Can they kick a ball? Can they walk up and down the stairs using both feet or one foot at a time?
Is your toddler shy around strangers, at least at first?
Can they follow a two-step command?

Exactly what you chat about from the list above will depend on your baby's age and toddler development stage.


Talk it over


Most parents are concerned about three things at this age: diet, discipline and getting their child to bed. These confusing and troublesome issues are all related to your baby's growing sense of independence. Other concerns may include how to manage temper tantrums, and how to get your child to eat

Diet. Let your health professional know what your child is eating these days. If you're giving your baby good food, their diet is probably fine. Weight gain will indicate if they're eating enough. Appetite and rate of child growth fall off in the toddler years.

Discipline. Let your health professional know if your toddler seems hard to control. Discuss the steps you take when you discipline your child - what works and what doesn't.

Sleep. Sleep issues are common at this age. Try keeping a diary of your child's sleeping patterns for at least three days and take it to the visit. Your health professional may be able to suggest solutions for you. Helping children settle down means developing good patterns. Don't allow bottles in bed.

If your child is extremely fearful and/or has a difficult time with other children - ask for advice.

You may want to say if your child doesn't know how to scribble on paper with large crayons. Most children can draw a rough circle at around this age.

Bringing up children can bring great joy, but as every parent knows, it is also very challenging. If you're feeling stressed out, talk it over with your health professional. Your emotions can influence emotional growth of your child. This is extremely important if you:
Feel out of control.
Hit them when you feel out of control.
Leave a mark or bruise on your child.

There are many programmes that can help you cope with the challenges you face with a growing child.

Speak up!

Your busy toddler will probably bruise their shins and bump their head. But you should ask your child about bruises anywhere on their body that can't be reasonably explained. If you have any concerns about your child's injuries, tell your health professional immediately. They can look at the bumps and bruises and tell you whether they appear to be from normal activities. Do this before you let any childminder or babysitter take care of your baby again.

Raise any concerns you may have. Such as:

if your baby has a wandering eye that still wanders, even once in a while
if your baby gets very close to things to see them better, especially if poor vision at early ages runs in the family
if your baby seems especially sensitive to light or sound
if your baby isn't walking yet, is walking on their toes, or limps or tilts to one side when they walk
if your baby seems to be using only one hand when they play, handle things or reach for objects. If your baby is already very right or left handed, they will use one hand more often when they eat and point. But they should use both hands equally when they play.
if they can't put two objects together in play - are still playing with one object at a time
if they don't take a spoon when you offer it to them
if they don't feed themselves
if they've lost skills they had before.
if they use no real words
if they show no affection

Click here to return to Well-baby introduction


 
 
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