Fillable General Pediatric Clinic/12 Month Visit (Page 2 of 2) in pdf

GENERAL PEDIATRIC CLINIC / 12 MONTH VISIT

ANTICIPATORY GUIDANCE FOR 12 MONTH VISIT

F-01068F (01/11)

Page 2

Diet

Speech Stimulation

Weaning — Breast-feeding weaning actually may have started a

Around one year, children make all kinds of sounds. Speech consists

few months back as the baby may have cut back to three nursings.

of words put together with certain intonations. Language includes

The mother can gradually decrease the number of feedings, often

speech or expressive language and understanding through hearing or

leaving the night feeding to last. Some children will be so

bodily motions, which is receptive language. Receptive language has

interested in the environment that they don't nurse completely and

been developing since birth. Most parents will say "they understand

the milk will decrease so the whole process is spontaneous and

everything I say," and through body language the child is able to

painless. If the mother wants to stop all of a sudden, she will feel

express themselves so that the parents also understand. Speech has

discomfort for a few days.

to be taught. It is done by mimicking the parents. Adult speech is long

and complicated. For the child to mimic the sentence structure, it

Table foods can be encouraged totally with cup, spoon, and fingers

should be grammatically correct with the proper intonations but

used for self-feeding. The appetite may drop automatically in some

shortened and the word labeling the object being discussed,

children. If allowed to feed themselves, and offered a good

repeated. This is called labeling. For example, "Here is a glass of

balanced diet, the children will lose their baby fat and maintain a

milk" (as the parent gives the milk to the child) and then repeat "milk."

more proportional weight to the height. Parents need a lot of

reassurance at this time that the child will not starve. The poor

Safety

weight gain is normal and the new body dimensions are healthy.

Car seats need to be reinforced even though the child may raise

Many parents will feed, give frequent snacks, and use food for

objections, especially if not consistently placed in the car seat. Pot

reward or bribe for the child's other demands. This can set up an

handles should be turned in as they present temptation to reaching

eating problem such as obesity, poor diet, or control of parents with

hands. Plants must be placed out of reach. Stair gates are used

food.

until the child can be consistent at sliding down or climbing up.

Sometimes, giving the parents the permission to use one vitamin

PICA — the eating of non-edibles needs to be watched.

per day will relieve their anxiety regarding health needs and, with

Swallowed or aspirated objects can cause major medical

a lot of reinforcement, they will let the child develop good eating

problems in this second year of life.

habits. They should be told to call the vitamin a vitamin and not

candy and warned that the child can be poisoned from too many

Lead Exposure

vitamins.

Sources include: Lead-based paint, gasoline, solder. Possible

pathways include: air, drinking water, food. Lead-based paint is the

Anticipatory Guidance

most common high dose source of lead in children. About 74 percent

Manipulative behavior — a 1-year old can manipulate his or her

of privately owned, occupied housing units in the U.S. built before

parents with his or her eating or lack of it. They also can use

1980 contain lead-based paint (CDC, October 1991).

crying, smiling, or looking cute to manipulate parents. The parents

have to realize that this behavior often exists. Negativism is usually

Review fever control and care of minor illnesses, adjust antipyretic

not severe but if everything he touches is a "no-no," the child may

doses, and warn about overdoing. The child needs to be told these

mirror the behavior. Setting limits and consistency in approach is

are medicine and not candy.

extremely important and useful for the child in learning discipline.

Inconsistency confuses the child and no limits make them

insecure. A pattern can be started at this age and carried through

the toddler years so that the child can know his or her limits and be

disciplined in later years when parental influencing is in conflict

with peer pressure.

Toilet Training

Find out the degree of interest felt by the parents. Discuss the

norms in the United States and the physiologic development of the

child. If the parents are not interested, then postpone what follows

until the next visit. If they want to start toilet training, the child needs

to be able to sit and get up when they want to or stand and move

away from the toilet freely. They need to know the bladder and

bowel signals. They need to dislike the feeling of urine or stool in

the diaper and also want to please the parents in putting all these

skills together to get to the toilet in time to perform. Children vary in

development of all of these above skills. Girls seem to dislike the

soiled diapers more than the boys do. She shows this by coming to

the parent and wanting the diapers changed as soon as soiled. A

child often shows recognition of bladder and bowel control function

by stopping play or other activities for awhile.

General Pediatric Clinic/12 Month Visit Page 2

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