Eighteen Months
By Dr. Brown
The eighteen month old is truly a study in contradictions and extremes. One minute they insist on their independence, the next minute they’re clinging on to you. They run away, but look back to make sure you’re watching. They want to be tickled, but pretend to run away from the tickling. In many cases they seem to be testing their parents all the time. Referred to as “limit testing”, toddlers are finding out how things (and their parents) work. “Negativism” typically reaches a peak at this age. The negativism and defiance of this age are a child’s attempts to assert her emerging identity. Parents have to adapt to this exciting time and appreciate this behavior as part of their child’s “experiential” learning. Children at this age learn through experience. The famous developmental psychologist Piaget called this the “Sensor-Motor Period”. And that explains it all – kids are all about exploring by touching, tasting, hearing, shaking, kicking, jumping, pushing, banging, etc, etc. Patience and choosing your battles are critical survival tools for parents.
Eighteen month olds are proud of their many new capabilities and tend to do the same things over and over again. Developmental psychologists call these repeated cause and effect experiments secondary and tertiary circular reactions. This repetition may be exasperating to a parent, but this is really how children learn.
DEVELOPMENTAL PLAY
Your child should be walking by now. Soon she can walk backwards and run. Once she begins to run, everything seems to have an urgency to get to! Have your child think about her walking by telling her to march (like a soldier) lifting her legs up and stomping her feet on the ground. This sensory input is helpful to refine her gross motor movement.
Children should be able to understand commands pretty well by know. Although some children may not say many words, make sure that your child can understand. Begin to work on “two-step” commands at this age: “get the cup (step one) and bring it to daddy (step two)”. This helps with your child’s memory and sequencing.
Speech really begins to escalate at this time. Talk to your child (of course), but, don’t just talk at your child; don’t just narrate what you are doing. If your child picks up or shows interest in an object – that’s what you want to talk about. Your role is not to push words into your child’s ears, your role is to notice what’s coming from your child and respond accordingly.
Children are beginning to make distinctions among like objects. Test and exercise this emerging capability by asking your child to “go get the Elmo book” or :”get daddy’s shoes”. He’ll have to go where the books are and find the correct book, or find which shoes are daddy’s amongst the pile.
Continue to read to your child with simple picture books, pointing out and identifying the various objects. Be sure to expound on what you see in the book, don’t just read the words. If there is a dog in the book you are reading, stop and say something like “it’s a big doggie like grandma’s dog Rover”. Ask questions about what your child can see on the page. Reading and Learning specialists call this dialogic (as in dialogue not monologue) reading. Your child should “point to show” to share an “interest” with you. Encourage this joint attention by showing him objects (doggies, balloons, etc.) and responding to any similar gesture your child makes
Perhaps the most important advice I can give to you and your child’s play is to PLAY THE WAY YOUR CHILD WANTS TO PLAY. All too often, with good intention, we parents want to direct a child’s play to show them the right way, teach them, whatever. However, good intention doesn’t necessarily yield good results. Developmental specialists strongly suggest “following your child’s lead”. Don’t worry about finishing that book you’re reading – maybe your child wants to turn the pages to quick get to the end to find the doggie picture he saw on the previous page!
Social play continues to evolve at this time. Your child will want to interact with you and engage you in their play at this age. They are very observant - it’s great to see them mimic what you do: talk on the phone, brush hair, put shoes on feet, etc. If they are not doing this pretend play, try to encourage her to do so. Being silly is a great way to get a child’s attention.
Children like to just manipulate objects (Piaget’s Sensori-Motor Period): opening, closing, putting things in, taking things out – all day long! It’s a good time to work with simple puzzles at this time including shape sorters to help their dexterity. In the bathtub, children like to empty and fill containers – enabling them to experiment with volume, weight, capacity, gravity at the same time they are refining their motor control.
Larger toys like chairs, rocking chairs, and “ride-em” toys are great for children this age as they sharpen their gross motor skills. Playground and climbing equipment are terrific.
Go to the section "Child Development" on our website to get more info.
FEEDING
Your child should be completely on table foods by now and whole milk or substitute if appropriate (at least 16 ozs per day). You can continue to give your child jar foods to make up for any deficiencies she may have. Continue to avoid nuts, or other things she may choke on. If you haven’t gotten rid of that bottle, now is a good time! Most children do not need extra vitamins if they eat a fairly balanced diet.
You’ve probably seen some sort of “Toddler Appetite Slump” by now, if not – you’re lucky (look at the discussion for 15 month olds).
Mealtime should still be with the family and involve a lot of socialization. Children can learn a lot at mealtime. Comment on everything that’s going on: what she’s eating, the color, is it hot, did it fall off the spoon, etc.
SLEEP
Bedtime can be difficult – toddlers often resist calling it quits for the day. However, you know better – your child needs sleep. Please try to be consistent with this. If your child sees you wavering, they can use it to their advantage.
Your child should be sleeping through the night. That means 10-12 hours at night. This is the transition time where she may go down to one nap (sorry!). Follow your child’s lead on this. Your child should not be having anything to eat or drink in the middle of the night. Most children are down to only one nap (sorry!)
SELF-HELP SKILLS
Allow your child to attempt to dress / undress themselves, open things, or at least assist you with these duties. It’s a time killer, but pays off in the end and provides other benefits like a “can-do” attitude. Allowing a child to build self esteem and a “can-do” sense is very beneficial for children. You want your child to try and tackle new challenges, right?
A cautious word about praise: Sure, praise is good, but too much can lead your child down a dangerous path (more about this later – or see the book “Nurture Shock” in our recommended book section). When you praise your child, make sure to praise the “effort” or the “initiative”. Be specific: “you helped mommy carry all those cans – what a good girl”.
SAFETY
As usual, watch out for choking and poisonings. Children at this age are learning to open and close bottles - which opens a bigger array of possible poisonings. Poison Control telephone number is: 1-800/222-1222
It’s a good time to get down on your hands and knees to see the world as your toddler does. Check under furniture for any items that your exploring child may find and choke on. Gate stairs and other hazards. Its also a good idea to turn your hot water heater down to 120 degrees to avoid scalding. Close the bathroom door so your exploring child won't play in the toilet!
Be careful when holding hot liquids. Your mobile child may sneak up on you!
Kids like to climb at this age. Watch out for objects that they may climb on and tip over.
Soon your child will learn to pull a chair over to climb on to get at something higher. That’s when the fun really starts!
Please see our page on "Babyproofing" Your Home / Safety Checklist on our website.
COMMON PROBLEMS
Toddler Appetite Slump
As mentioned above, your child may start having all sorts of changes with her appetite. Some suggestions about eating if your child is having a slump:
Teach your child to feed herself as soon as possible. Don't expect your child to finish her portion and don't put food into her mouth because it is open.
Put your child in charge of how much she eats.
Don't give her more than two snacks per day and limit juice intake.
Serve smaller amounts than your child may want to eat. Let her ask for more.
Avoid conversation about what your child eats; neither praise or criticize.
Make mealtimes pleasant.
Don't make your child sit at the dinner table after everyone has left so that she can finish her meal.
Temper Tantrums
Temper tantrums commonly start showing up when your child becomes more independent and wants to make her own decisions. A lot of this independence starts when she begins to walk and move to where she wants to go. Telling your child “no” will commonly precipitate these protests or tantrums. During this curious time, try to not to use the word “no” very often. Instead, use tone of voice, call your child’s name, say “uh-oh”, or some other variation to stop your child from whatever. Re-direction is essential for these persistent ones. This may be a good time to utilize the “Time-Out” technique, depending on your parenting philosophy. See “Recommended Books – Discipline” on our website for several different books on “discipline”. Choose the book that seems to best fit with your tendency.
Sleep Disturbances
Many children who had been great sleepers may begin to wake up in the middle of the night. Some of this may be attributed to teething, but also many children tend to go through another stage of separation anxiety wherein they need to check-in with a parent. Use whatever approach that you feel most comfortable with – reassuring your child is a good plan, but try not to be too friendly. Give your child a clear message that he should be sleeping.
Refusal to go to sleep is common at this age. Try to be consistent with your message and your routine.
WHAT TO EXPECT
Doctors Office Visits
Now that your child is older, she may start finally realizing what goes on at the doctors office. For the next year or so, the office visits may not go so well, as she protests being examined. Your child will take “cues” from you – try to not let him see that you think the doctor is scary. Has your child had his nap, or will the visit be during his naptime?
Exploring
Your curious toddler will want to get into everything. Baby proof the house and be prepared!
Language
Stimulate your child's language development as much as possible. See some of the above suggestions.
Social
Soon your child should start seeing other children on a frequent basis. Although they don't play together interactively, children engage in what's called "parallel play"; they watch the others, especially older children and begin to mimic their play. This is a great way for children to learn how to accomplish new developmental milestones. Other children are a great stimulus for your child.
Start using the term “turn” as in turn-taking. Mom and dad should also incorporate the word “turn” in their conversations with each other so that the child can hear and see that the whole world has to take turns!
Remember: PLAY THE WAY YOUR CHILD WANTS TO PLAY!!!!!
COVER TEST FOR VISION
Whenever you can think of it, try this test to see if your child's vision seems to be equal from both eyes:
When she's looking intently at an object, cover one eye with your hand, then cover the other. What you're doing is checking to see if she protests consistently. For example, if your child has a "weak" right eye, she'll probably allow you to cover that eye because she can still see well from the left eye. If you now cover her left or "good" eye, she may protest or push your hand away because things may appear blurry out of the right or "weak" eye. It's very likely that she'll protest whenever you do either eye, but if she consistently allows you to cover one eye and not the other, there may be a problem.
DENTAL
You should be wiping or brushing your child’s teeth. Use just plain water, a fluoride-free toothpaste, or less than a pea-sized bit of regular toothpaste. A great way to get your child involved is to have him watch you in your daily ritual, then one day offer him his very own brush. Likely, he will try to mimic you. After a while tell him, now mommy’s turn, so that he knows from the start that mommy has to finish the job! If your child drinks water, its best to have it supplemented with fluoride.
No bottles to bed (but you already knew that)!
AUTISM
If you have any concerns, please see the section below "Special Topics" - Autism. There is also a checklist on our website under the Autism Section – you can download the checklist “Developmental Screen for 15-18 month old children” and the MCHAT and bring them into the office for review.
The eighteen month old is truly a study in contradictions and extremes. One minute they insist on their independence, the next minute they’re clinging on to you. They run away, but look back to make sure you’re watching. They want to be tickled, but pretend to run away from the tickling. In many cases they seem to be testing their parents all the time. Referred to as “limit testing”, toddlers are finding out how things (and their parents) work. “Negativism” typically reaches a peak at this age. The negativism and defiance of this age are a child’s attempts to assert her emerging identity. Parents have to adapt to this exciting time and appreciate this behavior as part of their child’s “experiential” learning. Children at this age learn through experience. The famous developmental psychologist Piaget called this the “Sensor-Motor Period”. And that explains it all – kids are all about exploring by touching, tasting, hearing, shaking, kicking, jumping, pushing, banging, etc, etc. Patience and choosing your battles are critical survival tools for parents.
Eighteen month olds are proud of their many new capabilities and tend to do the same things over and over again. Developmental psychologists call these repeated cause and effect experiments secondary and tertiary circular reactions. This repetition may be exasperating to a parent, but this is really how children learn.
DEVELOPMENTAL PLAY
Your child should be walking by now. Soon she can walk backwards and run. Once she begins to run, everything seems to have an urgency to get to! Have your child think about her walking by telling her to march (like a soldier) lifting her legs up and stomping her feet on the ground. This sensory input is helpful to refine her gross motor movement.
Children should be able to understand commands pretty well by know. Although some children may not say many words, make sure that your child can understand. Begin to work on “two-step” commands at this age: “get the cup (step one) and bring it to daddy (step two)”. This helps with your child’s memory and sequencing.
Speech really begins to escalate at this time. Talk to your child (of course), but, don’t just talk at your child; don’t just narrate what you are doing. If your child picks up or shows interest in an object – that’s what you want to talk about. Your role is not to push words into your child’s ears, your role is to notice what’s coming from your child and respond accordingly.
Children are beginning to make distinctions among like objects. Test and exercise this emerging capability by asking your child to “go get the Elmo book” or :”get daddy’s shoes”. He’ll have to go where the books are and find the correct book, or find which shoes are daddy’s amongst the pile.
Continue to read to your child with simple picture books, pointing out and identifying the various objects. Be sure to expound on what you see in the book, don’t just read the words. If there is a dog in the book you are reading, stop and say something like “it’s a big doggie like grandma’s dog Rover”. Ask questions about what your child can see on the page. Reading and Learning specialists call this dialogic (as in dialogue not monologue) reading. Your child should “point to show” to share an “interest” with you. Encourage this joint attention by showing him objects (doggies, balloons, etc.) and responding to any similar gesture your child makes
Perhaps the most important advice I can give to you and your child’s play is to PLAY THE WAY YOUR CHILD WANTS TO PLAY. All too often, with good intention, we parents want to direct a child’s play to show them the right way, teach them, whatever. However, good intention doesn’t necessarily yield good results. Developmental specialists strongly suggest “following your child’s lead”. Don’t worry about finishing that book you’re reading – maybe your child wants to turn the pages to quick get to the end to find the doggie picture he saw on the previous page!
Social play continues to evolve at this time. Your child will want to interact with you and engage you in their play at this age. They are very observant - it’s great to see them mimic what you do: talk on the phone, brush hair, put shoes on feet, etc. If they are not doing this pretend play, try to encourage her to do so. Being silly is a great way to get a child’s attention.
Children like to just manipulate objects (Piaget’s Sensori-Motor Period): opening, closing, putting things in, taking things out – all day long! It’s a good time to work with simple puzzles at this time including shape sorters to help their dexterity. In the bathtub, children like to empty and fill containers – enabling them to experiment with volume, weight, capacity, gravity at the same time they are refining their motor control.
Larger toys like chairs, rocking chairs, and “ride-em” toys are great for children this age as they sharpen their gross motor skills. Playground and climbing equipment are terrific.
Go to the section "Child Development" on our website to get more info.
FEEDING
Your child should be completely on table foods by now and whole milk or substitute if appropriate (at least 16 ozs per day). You can continue to give your child jar foods to make up for any deficiencies she may have. Continue to avoid nuts, or other things she may choke on. If you haven’t gotten rid of that bottle, now is a good time! Most children do not need extra vitamins if they eat a fairly balanced diet.
You’ve probably seen some sort of “Toddler Appetite Slump” by now, if not – you’re lucky (look at the discussion for 15 month olds).
Mealtime should still be with the family and involve a lot of socialization. Children can learn a lot at mealtime. Comment on everything that’s going on: what she’s eating, the color, is it hot, did it fall off the spoon, etc.
SLEEP
Bedtime can be difficult – toddlers often resist calling it quits for the day. However, you know better – your child needs sleep. Please try to be consistent with this. If your child sees you wavering, they can use it to their advantage.
Your child should be sleeping through the night. That means 10-12 hours at night. This is the transition time where she may go down to one nap (sorry!). Follow your child’s lead on this. Your child should not be having anything to eat or drink in the middle of the night. Most children are down to only one nap (sorry!)
SELF-HELP SKILLS
Allow your child to attempt to dress / undress themselves, open things, or at least assist you with these duties. It’s a time killer, but pays off in the end and provides other benefits like a “can-do” attitude. Allowing a child to build self esteem and a “can-do” sense is very beneficial for children. You want your child to try and tackle new challenges, right?
A cautious word about praise: Sure, praise is good, but too much can lead your child down a dangerous path (more about this later – or see the book “Nurture Shock” in our recommended book section). When you praise your child, make sure to praise the “effort” or the “initiative”. Be specific: “you helped mommy carry all those cans – what a good girl”.
SAFETY
As usual, watch out for choking and poisonings. Children at this age are learning to open and close bottles - which opens a bigger array of possible poisonings. Poison Control telephone number is: 1-800/222-1222
It’s a good time to get down on your hands and knees to see the world as your toddler does. Check under furniture for any items that your exploring child may find and choke on. Gate stairs and other hazards. Its also a good idea to turn your hot water heater down to 120 degrees to avoid scalding. Close the bathroom door so your exploring child won't play in the toilet!
Be careful when holding hot liquids. Your mobile child may sneak up on you!
Kids like to climb at this age. Watch out for objects that they may climb on and tip over.
Soon your child will learn to pull a chair over to climb on to get at something higher. That’s when the fun really starts!
Please see our page on "Babyproofing" Your Home / Safety Checklist on our website.
COMMON PROBLEMS
Toddler Appetite Slump
As mentioned above, your child may start having all sorts of changes with her appetite. Some suggestions about eating if your child is having a slump:
Teach your child to feed herself as soon as possible. Don't expect your child to finish her portion and don't put food into her mouth because it is open.
Put your child in charge of how much she eats.
Don't give her more than two snacks per day and limit juice intake.
Serve smaller amounts than your child may want to eat. Let her ask for more.
Avoid conversation about what your child eats; neither praise or criticize.
Make mealtimes pleasant.
Don't make your child sit at the dinner table after everyone has left so that she can finish her meal.
Temper Tantrums
Temper tantrums commonly start showing up when your child becomes more independent and wants to make her own decisions. A lot of this independence starts when she begins to walk and move to where she wants to go. Telling your child “no” will commonly precipitate these protests or tantrums. During this curious time, try to not to use the word “no” very often. Instead, use tone of voice, call your child’s name, say “uh-oh”, or some other variation to stop your child from whatever. Re-direction is essential for these persistent ones. This may be a good time to utilize the “Time-Out” technique, depending on your parenting philosophy. See “Recommended Books – Discipline” on our website for several different books on “discipline”. Choose the book that seems to best fit with your tendency.
Sleep Disturbances
Many children who had been great sleepers may begin to wake up in the middle of the night. Some of this may be attributed to teething, but also many children tend to go through another stage of separation anxiety wherein they need to check-in with a parent. Use whatever approach that you feel most comfortable with – reassuring your child is a good plan, but try not to be too friendly. Give your child a clear message that he should be sleeping.
Refusal to go to sleep is common at this age. Try to be consistent with your message and your routine.
WHAT TO EXPECT
Doctors Office Visits
Now that your child is older, she may start finally realizing what goes on at the doctors office. For the next year or so, the office visits may not go so well, as she protests being examined. Your child will take “cues” from you – try to not let him see that you think the doctor is scary. Has your child had his nap, or will the visit be during his naptime?
Exploring
Your curious toddler will want to get into everything. Baby proof the house and be prepared!
Language
Stimulate your child's language development as much as possible. See some of the above suggestions.
Social
Soon your child should start seeing other children on a frequent basis. Although they don't play together interactively, children engage in what's called "parallel play"; they watch the others, especially older children and begin to mimic their play. This is a great way for children to learn how to accomplish new developmental milestones. Other children are a great stimulus for your child.
Start using the term “turn” as in turn-taking. Mom and dad should also incorporate the word “turn” in their conversations with each other so that the child can hear and see that the whole world has to take turns!
Remember: PLAY THE WAY YOUR CHILD WANTS TO PLAY!!!!!
COVER TEST FOR VISION
Whenever you can think of it, try this test to see if your child's vision seems to be equal from both eyes:
When she's looking intently at an object, cover one eye with your hand, then cover the other. What you're doing is checking to see if she protests consistently. For example, if your child has a "weak" right eye, she'll probably allow you to cover that eye because she can still see well from the left eye. If you now cover her left or "good" eye, she may protest or push your hand away because things may appear blurry out of the right or "weak" eye. It's very likely that she'll protest whenever you do either eye, but if she consistently allows you to cover one eye and not the other, there may be a problem.
DENTAL
You should be wiping or brushing your child’s teeth. Use just plain water, a fluoride-free toothpaste, or less than a pea-sized bit of regular toothpaste. A great way to get your child involved is to have him watch you in your daily ritual, then one day offer him his very own brush. Likely, he will try to mimic you. After a while tell him, now mommy’s turn, so that he knows from the start that mommy has to finish the job! If your child drinks water, its best to have it supplemented with fluoride.
No bottles to bed (but you already knew that)!
AUTISM
If you have any concerns, please see the section below "Special Topics" - Autism. There is also a checklist on our website under the Autism Section – you can download the checklist “Developmental Screen for 15-18 month old children” and the MCHAT and bring them into the office for review.