First pillar
Medical prevention
At the visit: follow growth, complete an examination, screen general development and autism, review earlier tests, protect teeth, and give vaccines that are due.
Academy · Prevention · Pediatrics
18months
Preventive visit
At eighteen months, development becomes a central part of the visit—and daily life is changing just as quickly.
Use this guide to understand the developmental screens, tests and vaccines that may be due, and how food, sleep, play, relationships, and safety support your toddler at home.
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Start here · Five useful questions
Eighteen months brings two formal screens—and a wider look at the whole toddler.
Second pillar
Lifestyle prevention
Every day: offer varied family foods, active play, language and connection, steady sleep and behavior routines, and a safer space for growing independence.
What the doctor does
The visit follows one simple arc: listen, check, screen, plan.
The exact order may change. These are the main parts most families can expect.
01
Listen
Your concerns, recent health, words and gestures, play, walking, eating, sleep, behavior, childcare, family wellbeing, exposures, and safety.
02
Check
Weight, length, head size, growth over time, eyes, hearing responses, mouth and teeth, heart, movement, gait, and a complete examination.
03
Screen
A parent questionnaire looks broadly at development. A second questionnaire looks for early signs associated with autism.
04
Plan
Results and follow-up, vaccines and tests when needed, family foods, teeth, play, sleep, tantrums, childproofing, and the 24-month visit.
The defining part of this visit
Screening adds structure to the conversation about development.
The questionnaires do not replace what you have noticed or what the doctor observes. They help gather those pieces consistently—and they do not diagnose a condition by themselves.
Prepare for the visit
A small list you can actually use.
0 of 5 ready
Development and autism screening
Two screens. One goal: notice when a child may need more support.
The visit combines your observations, the doctor's observations, and two short standardized questionnaires.
Routine at 18 months
General developmental screen
This parent questionnaire looks across communication, movement, problem-solving, and social development. It is one of the scheduled general developmental screens in early childhood.
Routine at 18 and 24 months
Autism-specific screen
This separate parent questionnaire looks for patterns that may be associated with autism. A positive result means more evaluation is needed; it is not a diagnosis.
Why you may hear different recommendations
Routine pediatric guidance schedules this screen at 18 and 24 months. A separate national evidence review found there was not enough evidence to determine the benefit of screening every child when no concern had been raised. Any concern or loss of a skill still deserves evaluation, whatever the questionnaire result.
What the visit may explore
Communication
Uses words and communication attempts, follows a simple direction with a gesture, and responds to familiar words, names, or sounds.
What the visit may explore
Connection and play
Points to share interest, looks to a caregiver in a new situation, imitates, and uses familiar objects in simple play.
What the visit may explore
Movement and hands
Walks independently, climbs on and off furniture, scribbles, and feeds themself with fingers.
Do not wait
Bring up a concern even if a screen looks reassuring.
Any loss of a word, social, play, or movement skill
No words or meaningful attempts to communicate
No pointing or other gestures
No response to name or sound
Very limited eye contact, imitation, or shared interest
Not walking independently, or very stiff, floppy, uneven movement
Tests and vaccines
Some care is routine. Some depends on what happened earlier.
Bring the complete record. Feeding history, earlier results, exposure risk, season, and local requirements can all change what is needed.
Routine at this visit
Development, autism, eyes, hearing, mouth, and teeth
The two developmental screens are central to the visit. The doctor also watches vision and response to sound and checks the mouth, teeth, brushing, fluoride, and dental care.
Depends on history or risk
Iron, lead, blood pressure, and formal testing
Testing depends on earlier results, first-year feeding, current milk and food intake, exposure, symptoms, medical risk, and program or local requirements.
Earlier testing and feeding matter
Iron and anemia
If screening was not completed earlier, it may be due within the 9–18-month window. Too much milk, too few iron-rich foods, prematurity, an earlier abnormal result, or another risk may change the plan.
Why recommendations may sound different
Pediatric guidance recommends screening once within this age window, with timing influenced by the child's first-year nutrition. A separate evidence review found there was not enough evidence to recommend for or against routine screening in children without symptoms.
Risk, missed testing, and local rules
Lead
At 18 months, testing may be needed if an earlier required test was missed, a new exposure is possible, an earlier level was high, or an insurance program or local rule requires it. Older or renovated housing and certain imported or workplace-carried products can increase concern.
Vaccines
The full record decides what is due.
The doctor will use the current schedule, prior products and doses, season, health history, and travel to make the plan.
DTaP
The fourth dose may be due within the 15–18-month window.
Hepatitis A
The second dose may be due if at least six months have passed since the first.
Earlier series
Hib, pneumococcal, MMR, chickenpox, hepatitis B, or polio doses depend on the complete record.
Seasonal protection
Influenza is reviewed each season. Some higher-risk children may qualify for RSV protection during a second season.
Vaccine recommendations change over time. This guide does not replace the live schedule or your child's individualized vaccine review.
Food, milk, and teeth
Build the pattern: shared food, steady structure, no pressure.
Appetite can vary widely in toddlerhood. Adults choose what and when to offer; the child decides whether and how much to eat.
Eating and drinking
Let family meals do the teaching.
- Offer varied family foods and textures, including iron-rich foods, without pressure to finish.
- Whole milk is the usual default after age 1. About 16–24 ounces a day is the range used in this guide.
- Use a cup, keep moving away from bottles, serve water regularly, and keep juice to no more than 4 ounces a day.
- Children ages 12–24 months need 600 IU of vitamin D each day from food, fortified drinks, or a supplement when intake is not enough.
When the plan changes
More than 24 ounces of milk can crowd out iron-rich foods. Lower-fat milk before age 2 is an individualized choice based on growth, weight, and family risk—not the routine plan for every toddler.
Teeth and oral prevention
Brush twice a day. The adult still leads.
- Use a smear—about a grain of rice—of fluoride toothpaste.
- Maintain a dental home and avoid a bottle in bed.
- Fluoride varnish may be applied after teeth erupt. Supplements depend on the fluoride level in the main drinking water.
Keep the child seated and supervised while eating. Cut food into safe shapes and avoid hard, round, or large choking hazards.
Life at home · Contrada second pillar
A toddler learns health through ordinary days.
Play, language, sleep, relationships, boundaries, and the environment all shape development between visits.
Daily practice 01
Make movement part of the day
Offer safe floor and outdoor play. Let your toddler walk, climb, push, carry, scribble, and explore with close supervision.
Daily practice 02
Build language through connection
Talk, read, sing, name objects and feelings, imitate sounds, and respond to words, gestures, and pointing.
Daily practice 03
Expect big feelings
Tantrums and growing independence can be normal. Use predictable routines, calm limits, redirection, and a few simple choices.
Daily practice 04
Protect sleep
Aim for 11–14 total hours in 24 hours, including naps, with a consistent routine and the child falling asleep in their own sleep space.
Daily practice 05
Childproof for climbing and curiosity
Secure stairs, windows, furniture, medicines, cleaners, hot liquids, water, button batteries, magnets, and firearms. Keep the car seat rear-facing to its stated limits.
Daily practice 06
Reduce harmful exposure
Keep the home and car free of tobacco smoke, nicotine, vaping aerosol, and cannabis exposure. Avoid screen media other than live video chatting at this age.
Around water: stay within reach. Bathtubs, pools, buckets, and other water can become dangerous quickly.
Poisoning: lock medicines and chemicals away and keep the U.S. Poison Control number available: 1-800-222-1222.
When to get help
Know what can wait—and what should not.
This is a focused guide, not a complete emergency manual. Contact your child's clinician whenever something feels seriously wrong.
Discuss with the clinician
Concerns about words, gestures, interaction, walking, hearing, vision, sleep, tantrums, feeding, growth, too much milk, tooth care, or caregiver stress.
Seek same-day assessment
A lost skill, unusual sleepiness or reduced activity, poor feeding, repeated vomiting, dehydration, fast breathing, or a fever with a child who looks unwell.
Emergency care
Serious breathing difficulty, blue lips or face, a seizure, no response or great difficulty waking, signs of shock, a severe injury, drowning event, or suspected poisoning.
Looking ahead
Next routine visit: 24 months.
The next visit continues growth, development, food, teeth, behavior, safety, lifestyle, and vaccine review—and repeats the autism-specific screen.
The immediate next step
The 24-month visit
The second routine autism-specific screen is scheduled, alongside the usual review of growth, development, oral health, family life, safety, exposures, screening history, and immunizations.
Until then
Keep watching, talking, playing, and making room for independence.
Continue family foods, cup use, brushing, movement, language-rich play, calm boundaries, close connection, steady sleep, and careful supervision. Do not wait for the next visit if a skill is lost or something concerns you.
References & review
This family guide was last reviewed October 9, 2026. It is educational and does not replace individualized clinical care.
Evidence reviewed includes guidance from national pediatric preventive-care recommendations and evidence reviews. Where recommendations differ, those differences are identified explicitly.