The Twelve Month Visit

dearborn-peds-annual-checkups

Robert Levy, MD    Joel Moses, MD

Houda Dagher-Rodger, MD       Melissa Hoisington, MD

Tiffany A. Harris, CPNP   Kerri Bernard, CPNP

2845 Monroe    Dearborn MI  48124    Telephone:  313-730-0070

Twelve Month Visit

Today’s Measurements:  Height: _________ Weight: _________    Head:  _________

 

Feeding:

There is a wide range of normal eating habits at this age.  Some children are working on stage three foods and others are eating all table foods.  Most have mastered finger foods and enjoy them.  Encourage your child to drink from a cup, rather than a bottle.  If your child has been taking cow’s milk formula well, you may now switch to whole milk.  Those families with a history of cow’s milk allergy should proceed slowly in introducing whole milk.  Gradually increase the volume of milk while decreasing the volume of formula.  Observe for reaction such as rashes, vomiting or diarrhea.  If baby is unable to tolerate whole milk it may be necessary to wait several months before trying again.  Your child should not take more than twenty four ounces per day of whole milk since it is not iron fortified.  Encourage a balanced diet.

It is important to maintain a schedule for meals and snack times.  This will cause fewer battles and give your child an understanding of expectations for meal time.  You may notice that your child has become pickier about food choices.  This is normal.  Continue to offer healthy choices and promote a relaxed eating environment.  It is normal for children to eat less on some days and make up for it on another day.

If you have not yet offered peanut products, fish and/or eggs, you may do so now unless your child is following a separate feeding schedule as indicated by your provider.

Your child should never be put to bed with a bottle in his/her mouth.  This promotes tooth decay and increases the risk of ear infections.  Always wipe down or brush baby’s teeth gently at least twice a day.   Offer water prior to brushing teeth to wash away sugars.

Elimination:

  •     Stool frequency and consistency continues to vary with diet.  Let us know if your child has hard stools on a regular basis.
  •     If child has hard stools try increasing water intake, give diluted pasteurized apple juice mixed with water, prune juice, plums and apricots.
  •     Rice, applesauce and bananas tend to constipate.
  •     Make diaper changes fun and create a positive environment around bowel/bladder function.  This will make toilet training easier later.
  •     You may want to introduce your child to a potty chair in order to make it a familiar object for him/her to sit on for fun.  This will also make potty training easier.
  •     Do not refer to diapers as stinky as this creates a sense of shame about bowel habits and can impede your child from coming to you to use the potty later.

Sleep:

  •     Continue to follow a structured bed time regimen.  Your child is likely sleeping through the night.  You should be able to lay him/her down drowsy or nearly fully awake at the same time each night.
  •     Read to your child prior to sleep and encourage quiet time together.
  •     Never give a bottle to bed or prop a bottle as described above.
  •     Your child is likely still taking one to two naps per day.  Sleep times and duration vary from child to child.  The average is two hours a day spent in naps.

Development:  Your child is becoming more independent and curious.  The following are milestones for this age:

  • Ø Motor:  Sits without support, crawls, pulls self up and walks with support, feeds self using spoon or fingers, neat pincer grasp (uses thumb and index finger together).
  • Ø Cognitive Skills:  Plays with adult-like objects such as pretending to sweep, comb hair, talk on the phone.
  • Ø Communication Skills:  Plays peek-a-boo, pat-a-cake, waves “bye-bye”, likes to look at pictures in books and magazines, points to animals or named body parts, imitates words, follows simple commands such as “wave bye-bye” or “where is Mommy?”.  Many children use the words “mama” and “dada” correctly.  They may have three to five additional recognizable words, as well as babbling that is structured like speech.

Discipline:

Your child is becoming a great fearless explorer. He/she is learning to be self assertive and this may result in undesirable behavior.  Effective disciplinary actions at this age include distraction or using a stern voice to make a point such as “hitting is not allowed” and restating this point to the child.  Spanking has not been shown to be an effective discipline tool. Children learn faster and better when rewarded for good behavior than by being punished for bad behavior.  Praise for good behavior, even if it is a small act, should outweigh commentary on unwanted behavior.  Nonverbal messages are powerful as well, such as a hug, a smile or a pat on the back.

Safety:  Accidents are the leading cause of death in children.

Your child should continue to face the rear in either an infant or convertible car seat until two years of age.  It is OK if knees are bent while rear facing.  Home should be essentially child proofed by now.

Pay close attention to:

  •     Risk of scalding from irons, hot liquids or other items within a child’s reach.
  •     Make sure the hot water heater is set no higher than 120 degrees Fahrenheit.
  •     All medications are locked up and out of reach including vitamins.
  •     All household cleaners and toxic substances should be locked up.
  •     Windows and stairs should be guarded against falls.
  •     Do not use walkers as they cause frequent injuries.
  •     Keep your child out of the sun during peak hours (10 am to 3 pm) and use a 30 SPF sunscreen.
  •     A locked fence around a pool is the best safeguard against accidental drowning.
  •     Never leave a child unattended in water.  They can drown in an inch of water.
  •     All guns in a home should be locked up and the ammunition kept in a separate place.
  •     Check smoke detectors once a month and change batteries once a year.
  •     Syrup of ipecac is no longer recommended for any use unless instructed by Poison Control at 1-800-POISON  1-800-764-7661.