12 to 18 months
t Recognizes familiar objects and
2 pictures in books and may point to
these and name them
Handling middle t “No”
ear infections t Knows a few words before pro-
12 – 18 month gressing to using words meaningfully.
Next, names pictures and some colors.
Milestones Eventually uses two- and three-word
t Experiments with pitch, tone, and
Suggestions What can my baby… sound of his own voice
Separation Anxiety Do Hear and Understand
While children develop at different rates, the t Understands almost everything
following activities may be among some that you say
4 your toddler is beginning to engage in during t Follows a simple command by
the next six months: 18 months is able to follow a few simple
Building t Stands alone, initiate steps, walks well, stoops and rules
Your Child’s picks something up, walks backward and forward, t Knows at least 20 words
t Uses two- to three-word sentences to
runs and then climbs
t Turns pages in a book
talk about and ask for things
t Sits down on small stool or chair
t Points or looks at familiar objects or
t Climbs stairs while holding on people when asked to
t Dances with music t Understands that waving “bye-bye”
t Pushes and pulls toys means “goodbye”
5 t Builds towers of blocks, eventually going from two t Understands object permanence; can
An Unruffled to six cubes high find a hidden object
t Washes and dries hands; brushes teeth with help t Understands cause and effect and can
t Kicks a ball solve problems
t Knows that interesting things may be
t Navigates two-to-three-piece puzzles
t Scribbles with crayons or pencils; draws lines or circles
inside drawers and boxes
t Understands pretend play, such as
t Picks up small items like Cheerios with thumb and
feeding a doll
6 index finger
t Feeds self with fingers
t Knows body parts and can point to
t Drinks from cup, uses a spoon and fork
them when asked
t Enjoys imitating what you do around
and Your Toddler t Takes one afternoon nap the house. Knows appropriate use for
t May sleep 10-12 hours at night familiar objects, such as sweeping with
t First molar may appear a broom or dusting with a rag.
t Begins to play make believe t Understands how to ask for help by
t Begins to sort by shapes and colors pointing
Ask Baby Did you
Advocate Advocate Lutheran General Children’s
Q. “My daughter already has had Hospital in Park Ridge is the premier
children's hospital serving the north
several middle ear infections. and northwest metropolitan area. The
medical staff features over 175 pedi-
What causes them and how atric and family practice physicians, as
well as physician specialists and servic-
can they be treated?” es in the following areas:
t Advanced Level III Perinatal Center
A. “Next to the common cold, t The Center for Pediatric Therapies
middle ear infections are one and Audiology
David Walner, M.D. t Developmental Pediatric Clinics:
of the most regularly experienced Attention Deficit Disorder Plus
of childhood illnesses.” Cleft Palate
Education Consulting and Evaluation
Also known as otitis media, middle ear amoxicillin. Even if your daughter’s con- Martha Washington Special Needs
infections are most often seen in children dition seems to improve, she should use Neonatal Follow-up
between the ages of three months and all of her medication. If you stop using School Age Program
three years old. Ear infections are fre- an antibiotic too soon, bacteria still pres- Bronchopulmonary Dysplagia
quently preceded by colds, the flu, sea- ent in the ear could cause the infection Williams Syndrome
t Heart Institute for Children
sonal allergies or an upper respiratory to recur. A stronger antibiotic often takes
infection. Most children will have had at care of repeat infections.
least one ear infection by the time they t Level III Neonatal Intensive
If your daughter has had three or more Care Unit
are three years old.
t Midwest Children's Brain
ear infections in six months or six or more
Often infections occur when bacteria or ear infections in a year, more aggressive Tumor Center
t Newly Renovated Adolescent Unit
viruses travel along the Eustachian tube treatment will likely be needed.
— the channel between the ear and the
throat — to fluid in the middle ear, cre-
The next step may be a myringotomy t Pediatric Emergency and
and tube placement, an outpatient surgi- Trauma Services
ating a prime environment for bacteria
t Pediatric Intensive Care Services
cal procedure in which small tubes are
t Pediatric Subspecialty Clinics:
inserted in your child’s eardrum. The
Unlike the common cold, however, tubes allow fluid to drain from the ear,
where you will notice a runny nose or minimizing the chances of further infec- Cystic Fibrosis
sneezing, ear infections may be more tion, fluid build-up or hearing loss. Dermatology
difficult to for you to identify, especially Endocrinology
The procedure is not complicated and
before your child can tell you exactly Gastroenterology and Nutrition
your child can go home the same day.
what she is experiencing. Be on the Hematology and Oncology
If your child has recurrent ear infections,
lookout for these symptoms: Infectious Diseases
talk with your pediatrician, seek special-
t Pulling or batting at the ear
Feeding and Motility Clinic
ized care and put an end to his or her pain. Nephrology and Hypertension
t More noticeably cranky, especially Neurology
when you go to lay her down Surgical Services
t Trouble sleeping and feeding
David Walner, M.D. Pulmonology
Advocate Lutheran General Children’s Hospital t State-of-the-Art Pediatric Inpatient
Until you can see a doctor, give your Services
child an age- and weight-appropriate
dose of acetaminophen or ibuprofen to
For information about For more…
dull the pain. You can soothe her ear(s)
Advocate pediatricians, call For more information about
with warm compresses.
1-800-3-ADVOCATE Advocate’s children’s hospitals,
If your child’s ear infection appears mild, (1-800-323-8622). call 1-800-3-ADVOCATE
it may be viral and is likely to clear up on Or visit
its own without medication. For a more (1-800-323-8622). Or visit
severe bacterial ear infection, your doc- and click on “Doctors Directory.” www.advocatehealth.com/kids.
tor may prescribe antibiotics, such as
8 Suggestions For Avoiding
Have you noticed
lately that your
child clings more
tightly to you in
new situations or
when he is around
strangers? This is a
sign of separation
How a parent can help a child who has separa-
1. Comfort and reassure your child when he is
2. Allow your baby to crawl around your home in
safe areas for short periods to experience
the beginnings of independence.
3. If you need to leave the room for a few
Martin Adeoye, M.D. Part of a baby’s
moments, and your baby can not see you, tell
your baby that you will be right back – and
ment is learning that separation
then be sure to do so. Keep talking to him
from parents is not permanent.
from the other room so he knows you are
Young babies do not understand
time, so they think a parent
who walks out of the room is 4. Plan your separations when your baby is rest-
gone forever. They may have not yet developed the concept of object perma- ed and fed, rather than before a nap or meal.
nence — that a hidden object (or person) is still there, though it cannot be 5. Introduce new people and places gradually so
seen. Without these concepts, babies become anxious and fearful when a par- that he will have time to get to know a new
ent leaves their sight. However, once your baby understands that although caregiver or friend.
you cannot be seen, he or she can still picture you in his or her mind. That 6. Avoid prolonging goodbyes and have the sit-
way he or she knows you are still there if you are needed. ter distract your child with a toy as you
While separation anxiety usually begins around the age of six months, the leave.
anxiety over being separated from a trusted person usually reaches its peak 7. Introduce a transitional object such as a
between 10 and 18 months. Babies may suddenly be afraid of familiar people blanket or soft toy to help ease separations.
like a babysitter or grandparent. Stranger anxiety is also common at this age. 8. During night wakings, pat or soothe your
Children have different temperaments. Some children are more secure and child to reassure him, but avoid letting your
do well when other people are around, while other children are more anx- child get out of bed. You can reassure from
ious. If your child has an anxious temperament, you can help ease his anxiety your room first and go to him if necessary.
by being calm and in control.
Separation anxiety typically ends by the time a child is three years old. If it Martin Adeoye, M.D.
doesn’t, you need to seek help from your pediatrician, a child psychiatrist or Child Psychiatrist
Advocate’s Hope Children’s Hospital
The “ NO”word
Your probably will hear your toddler
say “NO” quite often during this peri-
od to everything you ask, even if you
A bit about biting
It is very NORMAL for toddlers to bite and also very NORMAL for parents to be
ask if he wants his favorite treat. It is upset about it. Toddlers go through a period of grabbing and biting because they
his way of becoming independent and don’t always have the language to express themselves. Therefore, they sometimes
feeling like he is in control, two very try to communicate their frustration physically by hitting, biting, or grabbing.
important developmental tasks at this
time. Choose your battles but remain How to handle biting:
in charge because your toddler needs 1. Try to figure out what is going on. Is he angry? Is he kissing too hard?
you to be in charge. He also needs to Does he need something to chew on? Is he imitating another child?
feel he is able to be independent and 2. Let him know that biting is not O.K. by saying, “no biting!”
make choices. Give him choices of 3. Pay attention to the person who has been bitten, making a much bigger
two things that are O.K. with you. For fuss over them. Your toddler is beginning to see that others have feelings
example, ask him if he would like to and may try to comfort them by the time he is 18 months old.
eat peaches or a banana. Routines for
mealtime, bathtime and bedtime will 4. Move your child away from the situation.
help, as toddlers love things to be pre- 5. Don’t bite your child back. This encourages biting and is not recommended.
dictable. 6. Be ready to praise and hug even when you have had to set a limit.
Healthy Ideas At this age, find toys and playthings that:
t Can be filled up or emptied t Played with in water, like a
for Building Your Child’s t Require problem solving skills, funnel and cups or sponges
like shape sorters and puzzles t Sweep or vacuum
Independence and Socialization with six or fewer pieces t Withstand rough play, like
t Roll, like balls of all sizes and plastic dishes, bowls and
As your child begins to take her first steps, unbreakable toys with wheels unbreakable mirrors
she may begin to show signs of independ- t Can be stacked, such as t Allow pretend play, like dolls,
ence and signs of a “social life.” She may blocks doll bottles and toy phones
walk further away from you but return to
t Push and pull t Can be read, like sturdy, color-
look at the expression on your face. She
may be thinking, “What does mommy do t Rock, like a rocking horse ful board books
when I go away? Does she get mad? Is it t Dig and collect like a shovel
okay?” This use of “social referencing” and bucket Melissa Cavanaugh, C.C.L.S.
t Play music
Child Life Specialist
allows her to explore and then look back to Advocate Hope Children’s Hospital
use you to interpret a situation. If you are
smiling, to her it means “go ahead.” If you
are frowning, to her it is a signal to stop. Soon she learns — (clip and save)
with your support — that it is okay to explore a little, with
mommy or daddy in close range. Your Next Doctor Visit
While every child is unique, at around 18 months, separation What to expect at the 18 month well child visit.
anxiety and fear of strangers may decrease. You may notice other
signs of social consciousness, such as: Your child’s 18 month well child visit is scheduled for:
t Your child may begin to play alongside of others, which is
called parallel play Date ________________________ Time _________________
t She may say “no” more frequently to commands
with Dr. ____________________________________________
t Temper tantrums may crop up
t She may use a blanket or stuffed animal as a security object Telephone __________________________________________
How can a parent support a child’s growing independence and If you have any questions or need to reschedule, call your
socialization? Through lots of love and attention, and also, of doctor’s office.
course, through opportunities to play.
What to bring:
Here are some ideas and playful activities for encouraging t Your child’s vaccination record
your child’s emotional growth: t A list of the questions you have about your child’s
t Allow your young child to help
health and development
with simple chores around the
house. At this visit, your baby’s physician may:
t Consider providing safe house- t Measure your baby’s length, weight and head
hold items as playthings, such t Listen to your baby’s heart
t Look at your baby’s eyes, ears and mouth
as pots and pans or a broom.
t Give her large crayons and
t Talk to you about injury prevention
t Check your child’s development
paper for scribbling and
t Read to her and talk to her t Test him for lead poisoning or tuberculosis
— using the correct words for t Ask about his sleeping patterns and feeding habits
objects. t Give recommended immunizations
t Limit or omit television watch- t Talk with you about any stress or concerns you have
ing in favor of active playtime.
t Provide her with space to play
and explore. Baby’s height________ Baby’s weight________
t Visit playgrounds and swings.
t Expose her to others for the Don’t forget to talk to the doctor about:
chance to imitate and pretend. ______________________________________________________
t Play with her in the bathtub and ______________________________________________________
visit infant and toddler pools, ______________________________________________________
remembering never to leave her ______________________________________________________
alone near even shallow water.
t Help her to practice language
with finger play and simple
An Unruffled Approach
Temper tantrums are a way for a young
t Knowing your child and thinking ahead t are severe;
child to let out strong emotions before she can help. t last a long time;
is able to express herself in a socially accept- t Keep your child from becoming overtired t happen very often;
able way. It may feel to you like your child
t disable your child from speaking;
t Stick to routines for meals and sleep
has completely lost control, but these fits of
rage — which may t get worse after three to four years of age;
t are accompanied by signs of illness or
times. Avoid long outings and delayed
include foot stomping,
screaming, and collaps-
t Distract your child with a favorite toy.
if the child is holding her breath to cause
ing to the floor — are a
t Be reasonable about what to expect
t include your child harming herself or others.
normal part of child-
hood development. from your child — remember not to
expect perfection. Tantrums are emotionally draining, so do
tantrums often occur t Help your child avoid being frustrated — something nice for yourself and your child
only when a toddler is prepare her for changes or events by afterward. Be ready to reassure with a hug
Anita Berry, with a parent. They are talking about them before they happen. and relax take a bath or a walk.
t Let your child know your rules and stick
a way a child communi-
cates feelings that may be held in while she is to them. Anita Berry, M.S.N., C.N.P.
t To ease communication frustrations, try
away from mom or dad. You can learn a great Pediatric Nurse Practitioner, Infant Mental Health
Specialist; Director, Advocate’s Healthy Steps for
deal about your child by paying attention to teaching your child some simple baby Young Children Program
what prompted the tantrum. Does it happen signs (sign language) for words like “hot,”
at certain times of the day? In special places? “cold,” “hungry,” “bottle,” “hurt”, etc.
Temper flare-ups often begin around one
year and continue until about age three.
Responding to a Tantrum Attend a Free Class
1. Stay calm.
Nearly all children have them and, by age Positive Discipline
four, most children develop the necessary 2. Ignore the tantrum until your child is
communication skills to express their feelings calmer. Keep doing what you were doing
with words. Some tantrums occur out of prior to it occurring. Where do you draw the line? Learn
frustration when children try to let adults 3. Do not hit or spank your child. basic goals for discipline and tips on
know their wants and needs but do not have limit-setting and discipline strategies.
the language skills to communicate them. 4. Do not give in to the tantrum. When par-
Parents will also learn the develop-
ents give in, children learn inappropriate
mental, emotional and behavioral
Be Aware of Prompts behavior to get their way.
issues associated with toddlers and
As your toddler learns more and becomes 5. Do not bribe your child to stop the discipline. Taught by a child
more independent, she wants to do more tantrum — this will teach your child to development specialist, this free
than she may physically or emotionally be act inappropriately to get a reward. workshop helps parents learn:
t Whether and when using a
able to manage. This can be frustrating to 6. Remove any potentially dangerous
the child and can be expressed in a variety objects from your child — or her path
of ways. Tantrums tend to occur more “time-out” technique might
7. Resist the temptation to stop the be appropriate
often when a child is hungry or tired or
not feeling well. Sometimes there are other tantrum. Your child will work through t Alternatives to spanking
t How to handle temper tantrums,
prompts. Your child might want to “do it her inner turmoil.
herself.” She may want to get attention; 8. Give yourself and your child a few min- biting and sibling rivalry
test the rules; be upset that you took some- utes to take a deep breath and regain
thing away from her; not know how to say control. This class is offered at various
what she wants to; not understand what 9. Ask for help when you need it. Advocate locations throughout
you want her to do; feel worried or upset the Chicago area. To find a class near
or stressed in the home. Temper tantrums are NORMAL and you or to register, call
happen less often as children get older. 1-800-3-ADVOCATE (1-800-323-8622)
Preventing or Minimizing Tantrums Children should play and act normally or visit our website,
Although tantrums sometimes happen between tantrums. But consult your www.advocateheallth.com and click
without warning, parents can often tell physician if you notice if tantrums on “Classes and Screenings.”
when a child is becoming upset.
Food, Mood and
This is a trying age for
parents who want to
get nutritious food into
their child. This is
because several devel-
opmental changes are
occurring in your tod-
dler. He is striving for
William Wittert, independence and con-
Toddlerhood is a great time for M.D. trol. Simultaneously,
families to come together and his growth rate is slowing, causing a
play and to be a little silly. decrease in his appetite. These changes
Toddlers enjoy pretending to do can get in the way of your child sitting
everyday tasks as well as unusual down for a good meal, often when parents
things. Develop routines and are ready to sit down and enjoy family Make food easy to eat
traditions; toddlers love struc- time together! t Cut food into small, safe, bite-sized pieces.
ture and routine. t Offer foods that are soft and moist.
To soften or skip battles over
The simple things often are the food and mealtime, consider the t Serve foods near room temperature.
most fun. Talk with your child’s following tactics: t Use ground meat instead of steak or chops.
grandparents about traditions
t Offer regular meals and nutritious t Use child-sized silverware, including
they had as children. Think a fork with dull prongs.
snacks, even if your child doesn’t accept
t Seat your child at a comfortable
about what you and your part-
ner liked as a child. Or make up them.
some new traditions unique to t Keep in mind that toddlers are often height in a secure chair.
your family. afraid of new things, so be flexible with t Make meals a social time where all
their food acceptances and rejections. family members are present enjoying
Start a book or a photo album
about your child. Take pictures t Be realistic about food amounts – each others company and catching up
portions should be one-fourth the size on what’s new, and turn the TV off.
of him and put them into plastic
sandwich bags, stapling the bags of an adults’. Their tummy is about the
together to create a book. Your size of their fist.
t Try not to give juice or liquids containing
t Slowly add more difficult-to-chew foods
child will enjoy hearing stories
about himself and the people he sugar. If juice is given, try to limit juice
to your child’s menu.
loves while looking at the pic-
t Until your child is four years old, avoid
intake to four to six ounces a day.
tures with you. t Dessert should not be used as a reward
foods that are choking hazards or that
Most of all, have fun with each — try serving it with the rest of the
are hard to chew and swallow. These
other. By this age, siblings really meal. Just tell your child that we eat
include nuts, raw carrots, gum drops,
need some special time alone this first, that next and dessert third,
jelly beans and peanut butter (by itself).
t Supervise your child when he is eating.
with their parents. If you have as opposed to promising that when
more than one child, consider you finish your dinner you can have a
letting the older sibling stay up cookie. t Keep your child seated while he eats.
later to play a game, or plan a t Your job is to offer nutritious meals;
special outing with him. Mom your child will decide how much to eat. William Wittert, M.D.
and Dad will need to get away Pediatrician,
together alone, too. The best Advocate Lutheran General Children’s Hospital
thing you can do for your child
is stay together, so work on your
relationship. It’s a good time to
ask Grandma and Grandpa to
come spend the night! Is It Time for Toilet Training?
A child younger than 12 months has no control over his bladder or bowel
movements. He still he has very little control between 12 and 18 months.
Most children are unable to obtain bowel and bladder control until 24 to 30
months. The average age that these developments occur is around 27 months.