Free None - Wisconsin

DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-1068H (07/08)

STATE OF WISCONSIN Reprinted and adapted with permission from Memee K. Chun, M.D.

GENERAL PEDIATRIC CLINIC / 18 MONTH VISIT
(See 2nd page for 18-Month Anticipatory Guidance) Date of Birth Completion of this form is voluntary. Patient Name Accompanied by Age Height Weight Today's Date

Head Circumference Adaptability to exam Activity Distractibility

Parental Concerns

General Health

Words Spoken (Cross off parts not examined or not applicable) Part N Skin: Color, texture, hair, scalp Head & Face: Symmetry, AF size _____ cms _____ Eyes: Pupils, conjunctivae, EOM, red reflex Ears & Nose: Canals, tympanic membranes, turbinates Nose: Discharge Mouth: Gums, tongue, number of teeth ( ) Nodes: Cervical, inguinal Lungs Heart: Rhythm, S1, S2, murmur Abdomen: Contour, masses, hernia Genitalia: Vaginal opening, testes ( ) ( ) Extremities: Range of motion, stance Neuromuscular: Tone, strength, equilibrium coordination, gait, DTRs Describe abnormal findings.

Abn

General Behavior

Peer Interactions

Eating Habits: Diet, behavior at meals

Parents' Description of Child's Temperament

Problems Identified and Reviewed

Physical and Emotional Status

Diet: Snacks, pickiness, independent feeding

Anticipatory Guidance: Discipline, limit setting, obedience, temper tantrums, toilet training, peer activities. Safety: Climbing, stove, water, poisons, plants, street, need for supervision, car seats, lead exposure.

Immunization DTaP IPV Varicella

Drug Co. & Lot. No.

Expiration Date

_____________________________ ______________
SIGNATURE ­ Provider
Return to clinic in _____ months.

Developmental Observations NO*.=Not Observed by parents or R. O. NO* examiners R. = Reported, O.= Observed G.M. Walks backwards Walks up steps without holding Walks up steps with help Kicks a ball forward Throws a ball overhead P.M. Scribbles with a pencil Makes a tower of two cubes Makes a tower of four cubes Lang. Says ten single words, besides Mama & Dada Combines two different words together Names one picture Puts a toy under the table Puts a toy on the floor Gives a toy to the mother P.S. Removes own clothing Imitates simple housework Uses spoon with spilling Comforted by touching parents Comforted by parent's voice Will not go to strangers Parents' Interactions with child NO* = Not Observed Here O. NO* O. = Observed M = Mother F = Father Gives simple, short directions / explanations Voice calm when talking to child Reinforces behavior through approval & attention Terminates activity with some forwarding Ignores temper tantrum Interrupts temper tantrum physically Interrupts temper tantrum vocally Calmly holds to quiet Other Observations Development and Parent-Child Interactions

Date Signed

General Pediatric Clinic / 18 Month Visit F-1068H (07/08)

Anticipatory Guidance for 18 Month Visit Page 2

Diet Since most toddlers eat small meals, nutritious snacks such as cheese cubes, fruits, graham crackers, juices or milk can be given with the child seated. Pickiness ­ see "15 Month" health supervision.

Peer Activities See "15 Month" health supervision. Safety

Independent Feeding Most 18 month olds object to being fed unless there is much attention related to the process. Self-feeding can be accomplished, albeit with some mess. The child will usually eat enough for growth and not get fat. Anticipatory Guidance Discipline, limit setting and obedience are gone over as in previous visits. Reinforce the parent's efforts to do these. Toilet Training Many girls have been or will soon be trained. Warn parents not to remove the night diaper too soon. Although the child may have been dry for many nights, illnesses, minor upsets, changes in environment and weather can cause temporary setbacks. Wet beds cause child/parent annoyance and/or anger, which can lead to a major behavioral problem. Boys can be evaluated for readiness. Regularity of bowel movements helps in knowing when to put the child on the toilet. It is important to stress that a child who is not showing any interest or balking at attempts to train, should not be forced to conform. The average age for boys to be trained during the day in the United States is 2 ½ years.

The hazards of the street should be reviewed, see "15 Month" health supervision. Continue to use car seats every time the child is in the car. The child should never be left alone in the car as they can probably get out of the seat and play with the driving equipment. It may also help to raise the child's car seat so that they can look out of the window, being sure that adequate neck support is provided. The child is not safe in the bathtub alone for more than a few seconds and certainly not safe near any open water area even if they do know how to swim. The child's motor coordination is adept enough to turn on the hot water and the parents should check the water temperature again. It should be below 120° F. Climbing is an activity many children enjoy. Encourage and teach the child to climb safely, using jungle gyms but discourage from climbing on to chairs, tables, bookshelves, stoves, etc. Plants and poisons, see "15 Month" health supervision. Need for Supervision An 18-month-old cannot be left alone to play in a yard with access to the street, where potentially poisonous plants grow, or where there are filled pools. They may be able to play alone in their room or family room which has been set up as "child proofed" or outside where there is a fence and no dangerous plants. Parents should be within hearing distance of any child left alone.