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Eighteen Month Well Visit

 The child should be walking now and saying 5-10 words or more. Girls talk more and sooner and may say 50+ words.  Boys talk less and that is true of adults. Notice at adult parties that the women are talking and the men just hanging out! Keep working on the language. Say a lot of words to them and large adult words. They are learning a vocabulary and can learn adult sophisticated words. They also can pick up the cuss words so watch your language. One slip in the car you say @%#*%#, and they repeat it in church. (you heard about the Texas Aggie [I’m one] couple who had a child this age learning to talk. He started picking up the cuss words. So the Aggie tells his wife "Honey. We need to S - T - O - P saying Dam!") Our kids clean up our language. Also correct any mispronunciations. Do not talk baby talk to them. Also it is OK to talk a second language and does not confuse or slow down their language development. They will speak only one language but learn both. Have them speak the language of the country that they will go to school in. If they speak a different language than English until 5 years old, they will do poorly in school and you will cause them to have learning difficulties.

        Their diet should not be different than discussed at 1 year old.  Milk (Whole till 2 yr.) intake should be 12-24 oz. and a balanced diet. If they don’t like white milk, flavor it up with chocolate or strawberry flavor. If they are allergic to milk, give them 2-3 chewable antacids (250-300mg cal. each) and there is a Soft Chewable 500 mg calcium tablet in the health food stores that is delicious. They need 700 mg of calcium each day. The calcium in orange juice or vitamins may not be enough. Calculate how much they get from those and supplement if needed.  Give them of a chewable vitamin with zinc (Flintstone Complete best flavor). The volume of food is up to them. Their appetite should be slowing down. They gain 14 lb. the first year, 7 lb. this year and 4 lb. next year. I can gain that in 1 week!!! So do not fight the dinner table over the next 20 years. Your job as a parent is to put a balanced diet in front of the child, it is the job of the child to eat enough, and we have never seen a child starve who’s food was not in front of them, and it is the doctor’s job to test and see what is wrong with them if they don’t eat enough to grow. It is NOT the parent’s job to make them eat. Make the meal time a pleasant time. Keep the desert in proportion to the volume of proper food eaten. Don’t make them eat all their food to get the cookie. That is like when you and I were made to sit there till midnight to finish our plate. This amount of food eaten entitles you to this many cookies. If an adult in the family has that hang-up about finishing your plate, pile on too much food on that adult’s plate and when they complain that that is too much food and can’t eat that much, you say: "Right! One person cannot tell another human being how much food they should eat!" Duh.

        Your child is now potty trained!!! Wow you did not know that! They are not going on the toilet but all kids are now potty trained in that they know how to go, where to go, the name for it, and they even will occasionally sit on it and grunt. Nothing happens because their brains cannot control the muscles. CANNOT control the sphincters. The child will go on the toilet when they are able to: 1. Recognize the full bladder or rectum (you do not teach that, they figure it out on their own) 2. Communicate it to you by patting the dry diaper and saying pee pee or poo poo. 3. Hold it back and keep it from coming out until they get to a toilet. And 4. Let it go when they get on the toilet, which is backwards from everything else they have done. They contracted muscles to walk, and crawl. To go on the potty, they have to sit and relax the muscles and let it happen. Until the child develops all 4 steps, then the child is not ready to go on the potty. Many people say their child was potty trained at 9 months, but either they do not remember when it was (you can’t remember when they first rolled over 1 year ago. Believe me the older people can’t remember and make up some young age. …… like it means they are a better parent?) Or the parent sits the child on the pot every 10 minutes all  day and catches the accidents on the toilet. Then runs to the baby book  and says potty trained. The parent is trained to catch the accidents.  And besides that: when was I trained or Bill Gates trained? And will the age one is potty  trained affect the quality of person they will be later?  We all get there some day. You only affect your child in 5 ways: Teach them a language. Work with their education. Discipline them to be a polite civilized human beings and not a wild animal in the streets. Get them a set of morals, don’t lie, cheat, steel, etc. And get them a Religion. But when you are potty trained is not going to change the person you will be later.  The age that the child develops control over the muscles and he can go on the potty is a development like sitting and walking, and you will find a bell curve for all development stages. Potty training is from 18 months to 4 years  old!!!!! Many 3 year olds walking down the mall with diapers on below their pants and you don’t know it.  Girls train earlier. Girls (as a group) talk, read, and even go through puberty earlier. Girls go through puberty at 9 and boys at 14, a 5 year difference. And even the adult male is more immature, right ladies? So girls train around 2 yr. and boys around 3 years as a group. There are differences with some males earlier and some girls not till 4, but as a group males are latter. I’ve had a few patients going on the potty before 18 months and a few over 4 years old. Also males can be urinating on the toilet at 2 and not poop on there till over 3.  Males as a group have a harder time pooping. That is why men go in there with the newspaper forever! Do not force the child to go or it becomes a game of  “lets see you make me!”   In fact you may want to use reverse psychology between 18 and 24 months by telling them no you can’t sit on the toilet.  If you tell them not to touch the TV they want to touch it all day! Let the urge to go on the toilet come from the child. When they have developed control, they will come to you saying pee pee with a dry diaper, and you put them on the toilet and they go, then you pull out the cloth pants and put them on there frequently all day. Until they can:  1. consistently tell you they need to go, 2. hold it back until they get to the potty, and 3. let it go when they get up on  there, and do this every day for a week, then they are ready to start going on the potty and wearing cloth pants.   So the best advice here is wait. They have total control.  You can make them take a bath and go to bed but you can not make them poop on the potty. This is a battle they win.  Wait until it comes from them.  If they do not want to poop on the potty, they gotcha! Don’t enter a battle you can’t win. Plus it really doesn’t matter when you are potty trained. It won’t change who you become. Grandma should be more worried about if the child is developing their language rather than pressuring you and the child to potty train.  Amazing the social  pressure put on toilet training. So you can’t train them because the weather is warm, before the next baby, or because they are a certain age. Plus they are now potty trained but do not have the control to go on the potty. So just wait. The normal range is 2-3 years old. 

They are bowed legged now, but will be knocked kneed by 6 yr. old, and straight by teens. This is a normal transition. See the doctor if bowed at 3 years old. They also may be toeing in but this is usually a muscle  coordination at the hip and works itself out without special shoes. See your doctor if there is a question but it hardly ever needs treatment.  The treated group and the barefoot group looked the same 10 years down the road. A lot of money spent needlessly. A lot of people willing to take your money and tell you your child need those special $150 shoes.  Careful. Get a second opinion.  Also one foot may turn out or in more than the other.  This is common and also straightens out latter without therapy.

Keep ignoring the temper tantrums. Get some parents’ books and read. Great advice in those $10 books. I can’t say one is better than another, read 2 or 3 of them because they say different things in each of them. You may use time out now. Warn them with a snap of your finger and a choice: Ah! Get away from the electric outlet or I’ll put you in the room! One…. Two….Three. Then if they do not get away by three, put them in their room. Once you say three it’s too late. Put them in time out even though they get away after you say three.  After they start doing better, they will still try and test this, and you will have to put them in time out every now and then.   Put  them in their room (It will not make them hate their room.  I haven’t seen too many 2 year olds that like to go to bed.) for 1 minutes. Use 1 minute for each year of age. It is a little punishment that reminds them they did wrong. Putting them in there longer will not teach it quicker.  Let them out even if still crying. They spent their time in "jail".  Let them out, kiss them and tell them not to touch it again. (They will.)  If you punish them 10 times a day for touching it, next year they will touch it less. They learn slow. Don’t get impatient. Don’t be ugly and talk hateful. AND BE CONSISTENT!  Do not get angry that your child tries to push the limits.  You can be upset only after you are willing to never drive one mile per hour over the speed limit.  We all try to push the limits.  Correct your child like the policeman who pulls you over for speeding.  He does not come to the window yelling and talking derogatorily to you.  You are the cop in the house.  You find infractions of the rules and deliver the punishment in a cold business like manner.

So most important now is to work on their language and discipline. Read to them. Start naming the letters of the alphabet, as well as learning the names of animals, etc. And don’t sweat the small stuff.

  Dr. Knapp.

        p.s. Go call your Mom or Dad, and tell them thanks. You now realize how  hard it is to raise a child and now appreciate all the effort and self sacrifice they put into raising you. That you appreciate them and love them. Because this is hard to do!  Better yet is to write a letter.  They can keep it and re-read it.  Not email but a real letter.  It would be greatly appreciated and better now while they are in decent health.