Maternal & Child Health Nurse (MCHN) visit - eighteen months

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Article Summary

Growth should be evaluated, and sleep and discipline issues are usually on parents' minds.

This is a big and important visit. Your child is due for a lot of immunisations, his growth should be evaluated, and sleep and discipline issues are usually on parents' minds. You don't want to miss this one or settle for an "injections only" visit. From the doctor's perspective, this visit is expected to be the most challenging. Don't be surprised if your toddler isn't the least bit cooperative. Wriggles and cries are expected.

 Your baby may need booster shots for vaccines he's already had, in addition to some new vaccines. Check your immunisation schedule and double-check with your GP to make sure your baby's injections are up to date.
 Dress your toddler in a two-piece outfit that comes off easily. Plan to keep him on your lap for most of the examination. Take one or two familiar toys. Snacks will also help you get through this visit.

At this visit, your GP will probably:

 Weigh and measure your child. Click here to see our growth chart.

 Give you insights into your toddler's development and emotional growth.

 Go over his development to make sure he's on track.

 Talk about discipline issues.

Your GP will want to know:

 Has your baby seen another general practitioner since the last visit? If so, why? What was the outcome of that visit, and was any medication or treatment prescribed?
 How are your baby's walking, running and climbing skills? Can he walk backwards?
 How are his language abilities? What's he saying? Is he putting words together yet? How many words does he have?
 Does he understand one-step commands such as "Get your shoes" or "Bring me a nappy"? Can he listen to and follow a simple story? Does he look at the pictures in a book?
 Does he respond to simple requests or simple games like peekaboo?
 How does he play? The type of play a child engages in tells us about cognitive abilities. Does he imitate you at household tasks? Can he stack blocks?
 Can he use tools such as a spoon or a fork or use one toy to get another?
 Is he starting to say "no" and have temper tantrums? These are good signs of emotional and cognitive growth.
 Can he pull a toy along the ground?
 Can he use a spoon and drink from a cup?
 Can he point to any body part when asked?

Talk It Over

Most parents are concerned about three things at this age: diet, discipline and getting their child to bed. These confusing and troublesome issues are all related to your baby's growing sense of independence. Other concerns may include how to manage "noes" and temper tantrums, and how to get your child to eat.

 Diet. Let your GP know what your child is eating these days. If your baby is still having a bottle, talk about weaning him off it. If you think your baby is such a fussy eater that he isn't getting proper nutrition, talk it over with your doctor. If you're giving your baby good food, his diet is probably fine. His weight gain will tell your GP if he's eating enough. Appetite and rate of growth fall off in the toddler years. He should use a spoon, and at least drink from a training cup. Ask about vitamins and fluoride.

 Discipline. Let your doctor know if your toddler seems hard to control. Discuss the steps you take when you discipline your child - what works and what doesn't.

 Sleep. Sleep issues are common at this age. Try keeping a diary of your child's sleeping patterns for at least three days and take it to the visit. Your GP will be able to suggest solutions for you. Helping children settle down means developing good patterns. Don't allow bottles in bed.

Speak Up!

Let your doctor know:

 If your baby has a wandering eye that still wanders, even once in a while.
 If your baby gets very close to things to see them better, especially if poor vision at early ages runs in the family.
 If your baby seems especially sensitive to light or sound.
 If your baby isn't walking yet, is walking on his toes, or limps or tilts to one side when he walks.
 If your baby seems to be using only one hand when he plays, handles things or reaches for objects. If your baby is already very right- or left-handed, he will use one hand more often when he eats and points. But he should use both hands equally when he plays.
 If he can't put two objects together in play - is still playing with one object at a time.
 If he doesn't take a spoon when you offer it to him.
 If he doesn't feed himself.
 If he's lost skills he had before.
 If he has no real words.
 If he shows no affection.

Bringing up children can bring great joy, but it's also very challenging, as every parent knows. If you're feeling stressed out, talk it over with your child's GP. This is extremely important if you:

 Feel out of control.
 Hit your baby when you feel out of control.
 Leave a mark or bruise on your baby from smacking.
 Are experiencing a lot of changes in your family or childcare situation. These can really affect young children.

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Category Tags:

Health

,

Development

Article Tags:

immunisations

,

checkup

,

milestones

,

paediatrician

,

weight