12 Month Old Well Child Check

Nutrition

FEEDINGS

Milk - Commercially prepared formula may now be replaced by whole cow's milk (or two percent). One percent and skim milk are not recommended because children need extra fat at this age for their development. The volume taken will vary and may be supplemented with dairy products such as yogurt or cheese. If your child's milk intake decreases, do not be alarmed. Your child needs just 500 mg a day of calcium which is easy to achieve. Please see our calcium handout to make sure your child is receiving enough calcium. Milk intake should not exceed twenty to twenty-four ounces a day as you transition to whole milk. Encourage use of a sipper cup and promote total weaning from the bottle between twelve and fifteen months. Babies may continue to breastfeed for as long as is desired by mother and baby.

Solids - Expect a decrease in appetite as your child's rate of growth slows. Maintain three meals a day on a regular schedule. Pureed or junior foods may be continued, and soft table foods gradually added as tolerated. Eating becomes interesting and very messy as finger foods are added. Your infant will become more opinionated about their diet. Do not worry. Keep trying but do not force them to eat. Variety is well tolerated and generally all foods may be given unless there is a strong family history of allergies to certain foods.Choking is a major concern. Avoid firm airway-sized foods such as hotdogs, peanuts, candy, grapes, popcorn, etc.

Juices - Juices should not exceed eight ounces daily (even natural fruit juices); quench thirst with water.

VITAMINS

The American Academy of Pediatrics recommends supplementing exclusively breastfed babies with vitamin D. One such supplement, Poly-vi-sol, can be purchased over the counter; give one dropperful daily. Nursing mothers should continue their prenatal vitamins. Formula fed infants receive adequate vitamin supplement from commercially prepared formula.

FLUORIDE

Fluoride is very important for the development of your child's teeth and it is recommended to begin fluoride supplements at six months of life. Fluoride is not in formula or human milk and must come through water or supplements. Although most municipal water supplies add fluoride, some do not. If you are uncertain, you can check with your local utility company.

Development

At this age most children can:

Stand momentarily
Pull self up and walk holding onto furniture or may be walking alone. May fall frequently
Get into everything - especially cabinets and open closets
Hold and drink from a cup. May attempt to feed themselves (picks up food with his fingers)
Babble a lot and may say a few words such as "mama", "dada" or "baba".
Begin to follow simple directions or commands such as please come here or drink your juice.
Make gestures such as pointing, imitative behavior or waves bye-bye.
Press buttons on phone or toys.
Enjoy being read to
Locate sounds by turning their head

Indicators for concern:

Does not use single words like "mama" or "dada".
No eye contact
No pointing or other gestures such as waving "bye-bye"
No babbling
Difficulty crawling
Needs to use hand to maintain sitting.

Vaccinations

At this visit, your child is scheduled to receive Varicella, Pneumococcal Conjugate, and Hepatitis A immunizations

Common Issues and Concerns

MEDICATIONS

To see information on Acetaminophen (Infant Tylenol) dosage, click here. Remember to always dose based on the weight of your child.

SLEEP

(Helpful hints for preventing problems)

Your child should be sleeping in his own bed and sleeping through the night.
A bedtime ritual is important at this age. Children need a familiar routine. Both parents should hug and kiss the child "good night".
Keep security objects, such as favorite stuffed animals, nearby.
Complete the bedtime ritual before your child falls asleep.
Once put in bed, your child should stay there.
Overlook tantrums and protests and leave the room. It is important to enforce bedtime at this age.

DENTAL CARE

Brush your baby's teeth with a soft brush each day . Pleae see handout on Tooth Decay, Prevention.

BEHAVIOR AND DISCIPLINE

To set limits and discipline toddlers - use distraction, gentle restraint, removal of object from toddler, or move toddler away and help him get interested in something else
Use discipline as a means of teaching and protecting, not as punishing; toddlers should never be spanked
Limit your toddler's TV time - you may sometimes let him watch a show developed for his age (Sesame Street, etc.)
Do not allow hitting, biting or other harmful behavior
Praise, sing songs and read; hug, cuddle, smile and talk to your child often
Continue to play interactive games
Reading books to your child helps him learn new words
Your child is learning so much; encourage free play with blocks, toys and stuffed animals or dolls; Play both indoors and outside.

WALKING

Legs, feet and shoes - Please see A Guide to the Foot and Leg and the handout on shoes.
It is best to learn how to walk barefooted. Infant's shoes are needed to protect feet from hard or sharp objects, dirt and the cold. Shoes should be flexible, inexpensive and a good fit in both length and width. Rigid shoes should be avoided.

SAFETY

Your infant is becoming more mobile and constant supervision and safety precautions are critical. Please review the advice on Healthychildren.org.

RECOMMENDATIONS

Watch your toddler closely, especially near dogs, lawnmowers, driveways, overhead garage doors and streets.
Supervise toddler constantly when around water, buckets, toilets and bathtub.
Use sunscreen but also limit your child's exposure to direct sunlight
Keep all poisonous substances/hazards locked in a safe place, and out of toddler's sight and reach. Keep the phone number for the Poison Control Center near your phone or program it into your cell phone
Keep cigarette lighters, matches and alcohol out of toddlers sight and reach
Do not give toddlers plastic bags, latex balloons, or small objects such as marbles or coins
Switch to a toddler car seat in the back seat; car safety seats should remain rear facing until age 2 according to new AAP recommendations
Know CPR.
Continue to keep toddler's environment free of smoke
Recheck your house for safety.