ALL patients are seen at our Portsmouth office on Saturday and Sunday for sick visits from 9-12 am




55 High Street
Suite 102
Hampton, NH 03842



330 Borthwick Avenue
Suite 101
Portsmouth, NH 03801

Well Child Visits

The 18 Month Visit

The eighteen month old may seem to be perpetually in motion. He runs stiffly, actively explores drawers, waste baskets and everything else in reach. He frequently walks up stairs with one hand held and may sit for brief times on small chairs. His fine motor skills continue to improve and by now he may be piling 2-3 cubes atop one another, probably imitate scribbling and usually enjoys emptying objects from containers, including milk from cups once his thirst is satisfied! The “average” 18 month old can say 10 words, though many say more and some haven’t started saying much of anything yet, except for jabbering in jargon meaningful only to them. Receptive language always develops faster than expressive ability and by this age most children understand much more than 10 words, including short sentences and commands. Your child may name pictures and identify one or more body parts. Learning is rapid, and reading to the child is often a favorite activity. To encourage speech, have your child fill in words of stories and rhymes, play naming games, read nursery rhymes. Books congaing pictures of animals and familiar objects are good for this age. Pull toys, wooden blocks, large balls, simple playground or climbing equipment, hammer boards; large “ride-em” toys, nursery-size table and chairs, clay, busy board, simple puzzles and sand toys are popular at this age.

The child often doesn’t care much about eating at this age, and from now until age 5, if your child eats one or two fair meals a day, you are doing about average. If you haven’t weaned him from the bottle, now is the time. It will never be any easier, and, IF ALLOWED TO CONTINUE, MAY CAUSE SERIOUS DENTAL DECAY. Protein foods, such as meats and high value foods (potatoes, dark bread, yogurt) are of the utmost importance to provide calories for your toddler’s high energy level. Don’t get your child in the habit of eating “junk foods” (sweets, cookies, soda) between meals. Snacks, when necessary, should be cheese, fruit, milk or water. Keep menus and seasoning simple; add new foods in small amounts. Your toddler should be completely on table foods. Avoid foods such as potato chips, coconut, nuts, peanuts, whole grapes, popcorn, whole kernel corn, hot dogs and raw carrots. They are difficult to chew and swallow and can cause choking or aspiration. Your child will still be clumsy with his spoon and cup, but let him feed himself anyway. Meals should be a pleasant, social occasion and not a time for discipline. Give no attention to rejected food. Do not offer food as a reward or withhold it as a punishment.
Early toilet training doesn’t mean your child is extra smart, so don’t push him too hard or he may rebel! However, the time has now come when you can help him gain bowel and bladder control. Put the training chair in the bathroom and allow your child to become comfortable with it.

(Attempt training if a regular pattern of bowel movement is established, if there is a connection of physical awareness of bowel movement and parental request to use the toilet (heads for the potty at the time of bowel movement), and if your toddler is willing to sit still on the toilet. Complete bladder control is usually not achieved before age 3.) When he awakens dry, and if he doesn’t object, place him gently on the chair and leave him. At first he will probably sit there for a few minutes, then stand up and wet all over the floor. Don’t be discouraged; this is a beginning.

Place him on the training chair for approximately 5 minutes 3-4 times a day. As he observes older children and/or parents going to the bathroom he will eventually “catch on” and be very proud of himself.  If, after sever days  of trying,  nothing is happening, wait and try again in 2-3 months.

At this age, your toddler sleeps 10- 12 hours, plus naps. A definite schedule and routine should be established. Bedtime rituals may become important to your child and provide security. Your child is now better able to block out stimulation around him, so he falls asleep more easily. He
 may enjoy talking to him self or may want a bedtime companion such as a teddy bear.
Night terrors. This is an age at which night terrors may begin. Your child may be frightened, screaming, or agitated and you cannot easily soothe him. Night terrors are an inherited disorder in which a child tends to have dreams during deep sleep from which it is difficult to awaken. They usually are not caused by psychological stress. Being overly tired can trigger night terrors, so be sure your child goes to bed at a reasonable time. Night terrors usually occur within a few hours of bedtime. They are harmless and will end of their own accord. You will not be able to awaken your child so don’t try to. To help, you can turn the lights on and make soothing comments such as: “You are all right. You are home in your own bed. You can rest now.” Speak slowly and repetitively. Hold your child only if it seems to help him feel better. Protect him against injury. Prepare babysitters for these episodes.

Special Concerns:

Discipline. As a child grows, his transition toward a more self-sufficient state should be a source of gratification to his parents. At the same time, great patience and understanding are called for, and parents must have sound disciplinary principals m mind as they guide their rapidly changing  child in the right direction.
By 18 months many children are starting to demonstrate the defiance and negativism that has earned the designation “the terrible twos”. Too often, we as parents respond to such behavior with reproach and an ever increasingly complex set of rules and punishment. At this age it is best to keep rules simple and few, to remove things when possible, rather than make issues about them. Long speeches of explanation or argument are completely useless at this developmental stage.
It is best not to try to reason with your child very much, but rather to guide him with your actions and attitudes. Praise him when he responds appropriately, but give him minimal attention when he decides to throw a tantrum Unacceptable behavior should be handled by distracting the child or moving him to another area. If he persists, a “time out” on a big easy chair or in his room may be effective; a timer set for 1-2 minutes, while he is sitting, will help you with consistency. In