The toddler months continue to bring the medical challenges of colds, cuts, bruises, and other minor emergencies.

But you'll also find yourself dealing with an emerging personality and increasing conflicts. The new ability to walk means your child can now become more independent — and might like to flaunt it!

Some doctors have their own schedule for well-child visits, but most see kids four times, at 12, 15, 18, and 24 months. If your toddler has missed any immunizations, or if a problem has been detected that needs special attention, additional visits may be scheduled.

What to Expect During the Office Visit

The well-child visits during your child's second year are similar to those before, although discussions with your doctor about behavior and habits may become more detailed as your toddler grows.

Expect these common procedures and questions:

• Measurement of your child's length, weight, and head circumference. Growth will be plotted on the growth chart, and you'll be advised of your toddler's progress. A physical examination checking for normal function of the eyes, ears, heart, lungs, abdomen, heart, hands and feet, etc. The doctor may look in your child's mouth for new teeth and signs for the appearance of others.
• A review of your toddler's physical and emotional development through both observation and your progress report. Is your tot trying or starting to walk? Recognizing his or her own name? By age 2, following simple instructions? Saying a few words? Combining two words by age 2? The doctor may ask you these questions and others like them.
• The doctor may go over safety questions such as: Have you childproofed your home? (You'll need to review your babyproofing efforts now that your toddler can stand and reach.) Is your tot in an appropriate safety seat while riding in the car?
• A discussion of your child's eating habits. Is he or she eating more and more table foods? Interested in finger foods on the high-chair tray? Using a cup? Being weaned from the breast or bottle? Most doctors advise a switch from bottle to cup by the first birthday to be sure the bottle doesn't interfere with normal tooth development, and to avoid a struggle with a determined toddler later on. Sleeping with a bottle of juice or milk will only lead to cavities now.
  
  Also, after their first birthday most kids can have foods that were off-limits before, such as cow's milk, citrus fruits, and eggs. Your doctor will discuss these additions with you.
• Advice on what to expect in the coming months.
• Your child will receive immunizations during some visits.

If they haven't already, kids this age might undergo a tuberculin skin test, especially those at risk for tuberculosis. You'll be given instructions on how to monitor the test and report results to the doctor's office. Your child may also have a hemoglobin screen to check for anemia, and if you are in a high-risk area, a screen to check for lead poisoning.

Address any questions or concerns you have, and write down any specific instructions the doctor gives you regarding special care. Keep updating your child's permanent medical record, listing information on growth and any problems or illnesses.

Immunizations Your Child Will Receive

Kids who have missed immunizations at previous visits because of illness or scheduling problems will be brought up to date by 18 months of age.

Because your child is coming in contact with other kids more often, you'll want to make sure all immunizations are given close to the recommended times. This is especially true if your child attends childcare.

Because more immunizations than ever are being given to children before the age of 2 years, doctors are spacing immunizations so kids won't need more than 3-4 shots per well-child visit.

From the Recommended Immunization Schedule of the American Academy of Pediatrics (AAP):

A child who did not have them at the 12-month visit will receive these vaccines at 15 months:

• fourth Haemophilus influenzae type b (Hib) vaccine
• measles, mumps, rubella (MMR) vaccine
• varicella (chickenpox) vaccine
• fourth pneumococcal conjugate (PCV) vaccine

At the 18-month visit, if not already been given, children should receive:

• fourth diphtheria, tetanus, pertussis (DTaP) vaccine
• third hepatitis B vaccine (Hep B)
• third polio vaccine (IPV)

Your child may also receive a flu shot, which is recommended every year before flu season for children older than 6 months, and a first and/or second dose of the hepatitis A (Hep A) vaccine (the first and second doses must be at least 6 months apart). If your child is at high risk for developing meningococcal disease, a serious bacterial infection, your doctor may offer that vaccine as well.

Discuss possible vaccine reactions with your doctor and get advice on when to call with unusual problems.

When to Call the Doctor

By now you have probably called your doctor's office many times with questions and concerns about your child's health. Don't hesitate to notify the doctor if you suspect something is wrong — you know your child best.

Be sure to call if your child is especially sluggish or irritable, has serious problems sleeping, is refusing all food or drink, is suffering from vomiting or diarrhea, or has a temperature over 102.2° F (39° C).

Some developmental delays should be reported to your doctor, although these may or may not signal a problem. By 18 months your child will probably be able to:

• walk on his or her own, with a regular heel-toe walking pattern
• speak about 15 words

By age 2 your toddler should be able to:

• put two words together to form a sentence
• follow simple directions
• imitate actions
• push and pull a toy

Again, signs of developmental delay should be brought to the doctor's attention, but they do not necessarily mean there is something wrong.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2011