In this second episode of Season 2, Dr. Carole Keim discusses what to expect at the 18 month stage. Your baby is a toddler now, and showing ever more personality, and Dr. Keim has advice on everything from tantrums to sleep.

Dr. Keim addresses what social and motor development looks like at this age. Your baby will want to play with you and they understand a lot more language than their few words would have you believe. She talks about the “terrible twos” and shares ways to avoid tantrums. She addresses sleep and what bed your baby should sleep in at 18 months. How should teeth brushing go? How do you navigate potty training? What are major safety concerns to address? Dr. Keim has insight on all these questions and more in this episode.

In this episode….

• Social development and language
• Motor development
• Behavior
• Digital media
• Sleep
• Nutrition
• Teeth
• Elimination
• Safety
• Skin care, bathing, sun protection
• 18mo Checkup

Social development: 00:40

• Engaging with others for play
• Help with dressing and undressing
• Points at pictures in books
• Shows things to parents by pointing or bringing objects
• Looks at parent if something new happens
• Can scoop with spoon
• Starts using words to ask for help
• Can identify 2 body parts
• Can name 5 objects 
• Stranger anxiety starts getting better, but separation anxiety starts getting worse
• Follow simple instructions and love to help out
• Parents: encourage use of language by naming what you see, talk and sing to child, use words to describe feelings and emotions

Motor development: 04:30

• Can run, kick a ball
• Walks up stairs by doing step-together and while holding a hand
• Can sit in a small chair
• Walks around with toys
• Scribble
• Throw a ball 

Behavior: 06:10

• Terrible two’s start now - they know how to use “no”
• Offer 2 suitable choices as often as possible throughout the day.  Let them choose how things get done.
• They have a hard time expressing preferences; pretty good with needs 
• Modify their environment to avoid conflict; plan ahead for new and difficult situations
• Hitting and biting are attempts to communicate - teach them how to communicate effectively 
• Anticipate anxiety/clinging in new situations
• Spend at least 10-15 minutes in child-led play
• Prepare child for new sibling by reading books, getting them a doll

Digital media: 14:14

• Promote reading, physical activity, and play with non-electronic toys
• Make time for play every day
• No screens for at least 2 hours before bedtime; instead plan on tech-free play, bath, reading
• Use methods other than screens to calm them down: distraction, removing trigger, going outside, addressing needs like hunger/sleep
• If you do use digital media, choose high quality programs/apps and use them together: PBS kids, Daniel Tiger
• Limit viewing to less than 1 hour per day
• Be mindful of your own screen use; make a plan for family media use
• Avoid having TV on in the background, especially during meals 

Sleep: 17:55

• 10-14h at night, 0-1 nap per day.  
• In crib in their own room; consider moving to toddler bed when it’s ok for them to get out of bed (walking independently, able to safely get to your room and wake you up)
• Night waking is normal; reassure briefly, offer stuffed animal or blanket so they can self-console
• Lifehack while potty training: layer sheets and chucks 
• Blankets ok; no pillows til age 2
• No food or drinks in bed
• No electronic devices in the bedroom (TV, tablet)

Nutrition: 20:57

• 3 meals and 2-3 snacks per day at the same time as the family
• Offer a variety of foods and textures 
• Encourage self feeding and use of utensils 
• Use a cup for water; offer water with all meals and snacks
• Should be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per week
• You determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze).  They are typically not picky and want to try new foods at this age.
• Less than 24oz of milk per day, less than 4oz juice (ideally NO juice)

Teeth: 25:10

• Brush teeth BID with small smear of fluoride toothpaste
• They should see a dentist 1-2x per year

Elimination: 26:09

• Typical age to start potty training - start noticing them hiding to poop or anticipate when they will go, they know and tell you when they’ve peed/pooped, they can pull pants up/down
• Typically voiding at least 6x per day, stooling 1-2x per day
• If baby is constipated: first increase water intake, increase fiber (fruit and veggies), then consider prune juice or pear juice 2oz 1-2x per day.  If not enough, talk to your doctor about miralax.
• Can start potty training by putting toddler on potty after eating and upon waking
• If toddler is resistant to potty training, can start with sitting while clothed and entertain them with a book or toy, then sitting with pants and diaper off
• Read books about using the potty
• Can keep the potty in your bathroom and try going at the same time - they love to mimic adults at this age
• Start boys sitting on the toilet; they can stand later.  Standing too early can lead to constipation.  
• Potty signal: songs

Safety: 33:13

• Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools, small and sharp objects out of reach
• Don’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of them
• Set water temp to 120’F 
• Avoid secondhand smoke
• Rear facing car seat until age 2, make sure everyone in the car is using a seat belt
• Don’t leave heavy objects or hot liquids on tablecloths or coffee table 
• Save poison control number in your phone 
• Remove guns from the home or keep them locked and unloaded in a safe
• Make a fire escape plan with the family, check smoke detectors often 

Skin care: 37:38

• Bathe as often as they get dirty (daily)
• Can use lotion; many have started outgrowing eczema by now
• Use sunblock if spending more than 30 mins outside, apply 30 mins before you go outside, and use SPF 30 or higher.  Also use a hat, sun protection clothing (long sleeve swim shirts)
• Insect repellant that is safe for babies 

18mo Checkup: 39:05

• Expect them to be clingy and sad if you leave them on the table
• Full head-to-toe exam
• Routine vaccines at this visit; should be all caught up now until age 4!
• Next checkups at age 2, 2.5, and 3 years

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

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Dr. Carole Keim MD: linktree | tiktok | instagram

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