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Pediatric Health Maintenance 18 Months quick look
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This chart rates treatment options according to general effectiveness, ease of use,
side effects and safety.
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Check coordination and muscle strength, language, and social skills
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Not available
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Toddler should be able to stack 3-4 blocks, use a spoon and fork, and throw a ball. He/she should say10-20 single words and may have 2-word phrases. He/she should play pretend games and enjoy reading, naming pictures and making animal sounds.
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Full physical exam
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Not available
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Physician compares height to a growth chart to see if growth is normal. Physician should also focus on the child's walk to look for abnormalities.
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Full physical exam
Walking abnormalities that your pediatrician will watch for include improper heel-to-toe walking (ability to maintain balance while placing heel directly in front of toe with each step), ability to walk only on toes, limping, and other lopsided gaits/manner of walking. Many walking problems can be easily treated if they are detected early on.
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Lead screen if child is at risk. Blood count if at risk for iron deficiency
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Excellent
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Risks for lead poisoning include living in an older house and having a sibling (brother or sister) who has had lead poisoning. Risks for anemia are drinking milk instead of formula (both mother's milk and cow's milk are low in iron), or the infant developing a distaste for iron rich foods. Iron supplements, if anemia is developing, are an easy treatment for this problem.
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Lead screen if child is at risk. Blood count if at risk for iron deficiency
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Possible immunizations include: DTaP booster, HIB booster, VAR, MMR, PCV booster, IPV booster, Hepatitis A (second dose) if 1st dose given at 12 or 15 months)
(DTaP=Diphtheria/Tetanus/Pertussis, HIB=Hemophila Influenza B; Varicella (chicken pox), MMR=Measles/Mumps/Rubella, PVC=Pneumoccal pneumonia, IPV=Inactivated Polio, Hepatitis A)
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Excellent
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DTaP (diptheria/tetanus/pertussis) booster is only given if it has been at least 6 months since the third dose in the series.
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Possible immunizations include: DTaP booster, HIB booster, VAR, MMR, PCV booster, IPV booster, Hepatitis A (second dose) if 1st dose given at 12 or 15 months)
The recommended age ranges for administering these vaccines are: - VAR (Varicella-Chicken Pox) 12-18 months,
- MMR (Measles/Mumps/Rubella) 12-15 months,
- HIB (Hemophilus Influenza Type B) 12-15 months,
- PCV (Pneumococcal Pneumonia) 12-15 months,
- DTaP (Diphtheria/Tetanus/Pertussis) 15-18 months.
Hepatitis A vaccination #1 (of a two part series) is now recommended for all children, with the first vaccination between 12 and 18 months.
The decision about when to give these vaccines depends on several factors including whether previous doses have been given on schedule, whether the particular vaccine is available at the time of the visit, cost, and preference of the parents. The most common side effects from these vaccines are pain at the area of the injection and fever. MMR causes fever in about 5% of children. The fever can be very high, and can trigger seizures in children who tend to seize with high fevers. The fever starts 7-12 days after the vaccine and can last 1-2 days. Sometimes children can also get a rash from MMR. Severe reactions are rare and most of these are due to allergic reactions. DTaP can rarely cause a nerve problem called brachial neuritis. MMR can rarely cause a problem with low blood counts and a serious brain problem called encephalopathy. These rare reactions occur once in every 2 million vaccinations. Physicians must give parents vaccine information statements to inform them of the risks of any vaccine. These statements are available at: http://www.immunize.org/vis/). The only babies who should not get one of these vaccines are those who have had a severe reaction or who are allergic to an ingredient in the vaccine. (See vaccine information statement at http://www.immunize.org/vis/).
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Influenza Vaccine
(flu shot)
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Good
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Children over 6 months of age should get the flu shot every year. The best time to get the shot is from October to mid-November.
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Influenza Vaccine
If a child has never had a flu shot he/she will need two doses (about a month apart) the first year the vaccine is given. After the first year only one dose is needed per year.
The major side effects are local pain and fever. There have been rare severe side effects reported involving the nervous system.
The only children who should not get a flu shot are those with a severe allergic reaction to eggs.
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Discuss nutrition, health and sleep habits, behavior, and safety issues.
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Not available
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The toddler's milk intake should be limited to 24 ounces per day. Teeth should be cleaned daily (still no toothpaste). Physicians should discuss toddler discipline (time-outs). Discuss window safety (falling out of upper story windows).
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Discuss nutrition, health and sleep habits, behavior, and safety issues.
Children who drink too much milk may not take in enough food for adequate nutrition.
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Back
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Poor 
Not available 
