Medical Care and Your 1- to 2-Year-Old

The toddler months continue to bring the medical challenges of colds, scrapes and bruises, and other minor emergencies. You'll also find yourself dealing with an emerging personality and increasing conflicts.

Your doctor will see your child four times for routine well visits during this period, at 12, 15, 18, and 24 months. If your toddler has missed any immunizations, or if a problem has been detected that needs special attention, additional visits may be scheduled.

What to Expect During the Office Visit

The well-child checkups during your child's second year are similar to those before, but discussions with your doctor about behavior and habits may become more detailed as your toddler gets older.

Your toddler's checkup will include:

• Measurement of your child's length, weight, and head circumference. Growth will be plotted on the growth chart, and you'll be advised of your toddler's progress.
• A physical exam.
• A review of your toddler's development through both observation and your progress report. Is your tot starting to walk? Scribbling? Following simple instructions? Saying a few words? Combining two words by age 2? The doctor may ask you these questions and others like them.
• The doctor may go over safety questions such as: Have you childproofed your home? (You'll need to review your babyproofing efforts now that your toddler can stand and reach.) Is your tot in an appropriate safety seat while riding in the car?
• A discussion of your child's eating habits. Is he or she eating a variety of foods? Finger feeding or using a spoon? Using a cup? Being weaned from the breast or bottle? Most doctors advise a switch from bottle to cup between 12 and 18 months.
• Advice on what to expect in the coming months.
• Some immunizations.

If they haven't already, kids this age might undergo a tuberculin skin test, especially those at risk for tuberculosis. You'll be given instructions on how to monitor the test and report results to the doctor's office. Your doctor may recommend a blood test to check for anemia and lead poisoning.

Address any questions or concerns you have, and write down any specific instructions the doctor gives you regarding special care. Keep updating your child's permanent medical record, listing information on growth and any problems or illnesses.

Immunizations Your Child Will Receive

A child who did not have them at the 12-month visit will get these vaccines at 15 months:

• the third or fourth Hib vaccine, depending on the manufacturer
• measles, mumps, and rubella (MMR) vaccine
• chickenpox (varicella) vaccine
• the fourth pneumococcal conjugate vaccines (PCV, PPSV)
• fourth diphtheria, tetanus, and pertussis (DTaP) vaccine

At the 18-month visit, if not already been given, children should get:

• fourth DTaP vaccine
• third hepatitis B vaccine (HBV), which can be given starting at 6 months
• third inactivated poliovirus vaccine (IPV), which can be given starting at 6 months

Your child may also get a flu shot, which is recommended every year before flu season for children older than 6 months. If your child is at high risk for developing meningococcal disease, a serious infection that can lead to bacterial meningitis, your doctor may offer the meningococcal vaccine as well.

Discuss possible vaccine reactions with your doctor and get advice on when to call with problems.

Developmental Progress

At the 18-month visit, toddlers undergo a screening test to help identify developmental delays and autism.

There is a wide range of normal when it comes to reaching developmental milestones. But by 18 months, most toddlers:

• walk on their own
• speak at least 15 words

By age 2, toddlers should be able to:

• put two words together to form a sentence
• follow simple directions
• imitate actions
• push and pull a toy

Talk to your doctor if you have concerns about your child's development.

When Should I Call the Doctor?

By now you have probably called your doctor's office many times with questions and concerns about your child's health. Don't hesitate to notify the doctor if you think that something is wrong — you know your child best.

And always call the doctor if your child has a fever, is acting sick, has serious problems sleeping, is refusing all food or drink, is vomiting, or has diarrhea.