18 Months

Five people stand in a line posing for a photo in front of a modern, multi-colored glass building facade.

Some babies are born with a short frenulum under the tongue. This inhibits the baby from extending the tongue past the lips.


Many people refer to this condition as "tongue-tied" (medically called ankyloglossia).


The tongue’s frenulum attaches the tongue to the floor of the mouth. It should allow the tongue to extend past the lower gums and lip, elevate to the roof of the mouth, and move from side to side. If it is too thick, too short, or too far toward the tip of the tongue it can affect feeding, speech, tooth placement, and growth of the mouth. 


Not all frenulums that appear thick need to be treated. If the tongue functions well and the baby is feeding successfully, we do not need to do any procedures. Dr. Stuppy has written a summary of the guidelines recommended by otolaryngolosts (ear, nose, and throat specialists) on management of tongue, lip, and cheek ties that you can read here. 


Tongue tie affects about 4 in 100 people. It is more common in boys and there often is a family history of tongue tie.

  • Check your baby’s weight (we check length and head circumference too at standard well visits)
  • Ask about your baby’s feeding, bowel, and sleeping habits
  • Do a physical examination
  • Ask questions about development (in a pre-visit survey- watch for these texts before visits
  • Ask if you have questions or concerns about your baby
  • Update immunizations as recommended per our office schedule and standard guidelines

HOW IS IT TREATED?

We usually schedule the first visit 1-2 days after discharge. You will need to call to schedule this visit. Due to the nature of our scheduling availability, you may be asked to schedule with a member of our team that you have not yet met, but we think you'll like every one of our physicians and nurse practitioners. All have extensive training and experience and work well together to care for our patient families. 


After the first visit newborns usually have several weight checks to be sure they are feeding well and establishing good weight gain. After that, they follow the typical well visit schedule.

PHOTOS FROM STANFORD.EDU

Our physicians take turns seeing newborns in the hospital. You may get to see a face you already know or meet someone new, but we all trust our work teammates to take great care of our patients.

There are times that newborns require evaluation and care from a neonatologist (specialist in newborn care), such as if your baby is premature, has breathing difficulties, is suspected of an infection, or has need of intensive care. The local neonatologists will update us on how your baby is doing before they go home.

In the office

We see newborns at the following hospitals each morning:

WHEN THE TONGUE'S MOVEMENT AFFECTS FEEDING, A FRENOTOMY MAY BE RECOMMENDED

  • Infection
  • Bleeding (usually minor)
  • Swallowed blood can lead to spitting up
  • Damage to salivary glands (rare)
  • Need for more surgery
  • Feeding aversion

After the clipping the underside of the tongue will get a yellowed area (called "granulation tissue"). This is the normal healing tissue and will resolve within a few days.

What if your baby needs special care?

If you will be delivering at another hospital, just give us a call after you deliver to schedule your first visit. Please bring any paperwork given on discharge to your first visit. This may include your baby's birth weight, discharge weight, any lab values - such as bilirubin, screening results (such as hearing and cardiac screens) and any other information provided. This can help us learn about the hospital stay and continue care most effectively.

Newborns are scheduled to see one of our nurse practitioners or pediatricians for each visit. While we know that you will eventually see one of our staff primarily, initially it may be necessary to schedule with another person.

We all trust each other to work within our team, and newborns present the unique circumstance of needing a visit without much notice. Most of our routine well visits are scheduled 2-3 months in advance, so we hold spots for newborns, but it may not be with the person you will choose to see long term. We know this is not ideal because you want to introduce your baby to your chosen practitioner, but we cannot all have newborn spots open or it would cause scheduling issues for all the other patients - including your family long term. While we each have our unique personalities and bedside manners, we all follow standard care guidelines and will take great care of your little one!

If you want to learn more about us, check out the videos we have from each of our pediatricians, about our office locations, general medical advice we give and more.

Learn about each of the physicians and nurse practitioners on our individual pages.

  • Work with lactation to improve latch
  • Work with a speech pathologist or occupational therapist for feeding therapy

Kansas and Missouri each have routine newborn screens that are done in the hospital or birthing center to identify conditions that can be dangerous when not treated but not easily identified on a physical exam alone. The goal is to identify and treat diseases early enough to prevent serious complications such as growth problems, developmental delays, intellectual disabilities, blindness, deafness, and seizures.

You can learn more about the screenings from:

Risks of clipping:

Treatment of tongue tie involves lifting the tongue and clipping the frenulum (frenotomy).

A frenotomy can be done by trained pediatricians, ENTs, or dentists. Some of our pediatricians have this training, so if you're concerned we can make sure you get scheduled with one of them for an evaluation. ​There are local dentists who do a laser procedure, but this is more expensive and has not been shown to offer any benefit. (See Dr. Stuppy's review of guidelines for more details.)

​The frenulum does not have nerves for pain, and most newborns tolerate the procedure well without any anesthetic. We usually ask that they feed immediately after the procedure to assess their feeding. 

It is recommended if the frenulum is very thick, posterior, very vascular or if there is a family history of bleeding disorders that an ENT specialist does the procedure.

We work as a team at Pediatric Partners - from the front desk receptionists, to our nursing staff, to our nurse practitioners and pediatricians, we're all here to take the best care of your family!

  • Advent Health -Shawnee Mission
  • Overland Park Regional Medical Center

In the hospital

Most of the time we can start our relationship at the hospital when we see your baby soon after birth, but sometimes we begin care after they are discharged from the hospital. We generally see babies in our office 1-2 days after they are discharged from the newborn nursery or NICU.


If you choose our office, be sure to let the hospital know who your pediatrician will be. The hospitals call us after the baby is delivered and we will see you each morning.


One of our physicians will round each morning in the hospital to check on your baby, see how feeding is going, and treat most problems that arise. Most babies are in the hospital 2-3 days and we see them on daily rounds to evaluate how they are feeding, how much weight loss they have, perform a physical exam, and discuss parental concerns.


As mentioned above, we work as a team. Our pediatricians take turns rounding each day, so you may meet several of us during your stay at one of the above hospitals and it may not be the pediatrician you plan to see long term in our office, but we will be sure that person hears all about your baby. 

What if you're delivering somewhere else?

We occasionally care for babies in the Newborn Intensive Care Nursery (NICU) if they are there for a short time and for minor issues.

We have a relationship with the Neonatologists (specialists in sick and premature newborn care) at each of the hospitals. They help care for the infants who are requiring more specialized care and let us know when they're ready to see us.

Alternates to frenotomy:

During the visit we will :

A newborn with a noticeable tongue-tie, characterized by a short, tight lingual frenulum restricting tongue movement.
Close-up of a newborn with an open mouth, showing the tongue and gums.

The pictures are the same baby before and after the frenulum was clipped.

Three panels showing an uncircumcised penis, a healing circumcised penis with granulation tissue, and a healed penis.

PROCEDURE DESCRIPTIONS

MOGEN CLAMP:

The type of procedure done is dependent on the training and experience of the person performing the procedure. Risks and benefits overall are similar. The final "look" of the penis will be the same after the first week.

Both types use a local anesthetic called lidocaine to numb the area. This injection may sting initially (sugar and a pacifier are used to help pain control for the sting) and the injection may leave a bruise at the base of the penis. Babies can still feel the cold of the cleaning product we use to decrease risk of infection and they can still feel tugging, but the sharp pains of the procedure are lessened with the lidocaine. The foreskin is pulled away from the head of the penis (aka glans). 

The remainder of the procedure done and aftercare depends on the type of circumcision.

There are two main types of circumcision, one that leaves a plastic ring (Plastibell) on the head of the penis, and another that removes the foreskin and is left open with petrolatum jelly on gauze.

Care depends on the procedure done. After a baby's circumcision, it takes about a week to heal regardless of the method used. 

After the healing has taken place, no special care is needed other than routine cleaning.

We recommend putting petroleum jelly on the head of the penis during the healing process to keep it from sticking to the diaper. If stool gets to the area, simply rinse with water without rubbing the area much. Reapply petroleum jelly each diaper change. We suggest you do not use any creamy products or lotions on the healing penis, as they cause irritation. 



  • The foreskin is pulled up and the clamp is placed over the glans, to protect it from being cut.
  • The clamp puts pressure on the tissues to prevent bleeding.
  • The foreskin above the clamp is removed.
  • No stitches are needed unless there is excessive bleeding, which is a rare complication.
  • The head of the penis will look open and raw during the healing process. This is normal!
  • Change the gauze pad with petrolatum jelly (Vaseline) with diaper changes since it will be soiled. 
  • Rinse the head of the penis with water if stool (poop, bowel movement, meconium) gets on it, but usually simply changing the gauze is sufficient.
  • Continue to place Vaseline gauze on the head of the penis until it is healed. You will know when it is healed when there are no more red or yellow areas.
  • If there are signs of infection, such as redness of the penis shaft, temperature over 100.4F, poor feeding or fussiness, your baby should be evaluated.

Sometimes the penis will sink into the fat pad surrounding it, allowing the skin to reattach over time.



If your child's foreskin comes back over the head of the penis, push back on the fat pad to pull the skin off the head of the penis with diaper changes. Apply petrolatum jelly (Vaseline) to the area to prevent sticking.

If it does stick, it is called an adhesion. This usually doesn't cause any problems - remember that uncircumcised penises generally pull away from the foreskin over the pre-pubertal years. The adhesions of a circumcised penis will also naturally pull away over time. If they cause pain, they should be addressed. 

A white substance called smegma sometimes is seen around the edges of the head of the penis. This looks like cottage cheese and is sometimes mistaken for pus. It is not pus and is a normal substance made by the penis. Gentle removal with a moist cloth is all that's needed if it's bothersome.

Circumcision types and care

The foreskin is attached to the head of the penis at birth and will usually naturally pull away over the first few years of life. A white substance may be seen as the foreskin pulls back. This is smegma and normal, not a sign of infection.

As long as the foreskin doesn’t easily retract, only the outside skin needs to be cleaned.


If the foreskin retracts a little, clean only the exposed area with water. Don’t use soap on this area - this can irritate the skin. After cleaning always replace the foreskin back over the head of the penis. 


As your child gets older and the foreskin has completely separated and retracts easily, begin to teach him to clean underneath it as he bathes. 


If the foreskin does not naturally pull away from the head of the penis an this causes painful erections, bring your child in for an evaluation of the situation.

Uncircumcised penis

A WORD ABOUT ADHESIONS...

After the Mogen Clamp it will look bright red and swollen initially, then less swollen. As it heals, yellow granulation tissue appears on the head of the penis. This is normal and NOT an infection. 

PLASTIBELL

  • A plastic ring (Plastibell) is inserted between the head of the penis and the foreskin and tied off.
  • The ring is left in place until it falls off naturally, generally 3-7 days later. 
  • Routine cleaning with diaper changes is done.
  • If the ring does not fall off within 14 days or if it slips down the shaft of the penis, bring your baby in to be evaluated. This is an emergency if it seems red, tender, or your baby has a temperature over 100.5F, is fussy or not feeding well.
  • Track your child's development with FREE online tools. 
  • Find developmental milestone information so you can keep track at home.
  • Pathways offers resources for infant and child development.
  • Zero to Three offers resources for infant and child development and parenting.
  • Did you know you can sign up for free weekly texts coinciding with your due date to help with every stage of pregnancy and the baby's first year? Visit text4baby for more details. 

Milestone Tracking and Tools to Maximize Your Child's Development

Childcare can be done in a person's home or in an established child care center. There are pros and cons to each, so consider your family's needs to start your search. 

ChildCare Aware has a searchable database to help locate childcare providers, check licensing of childcare providers and see inspection reports. Click on the state to find providers in Kansas and Missouri.

To help locate a childcare provider, learn how to find the best childcare, and more use this searchable database: Childcare.gov. Use their Tip Sheets to help find the best care for your child(ren).

Local Resources to Optimize Development

  • Parents As Teachers works with parents to teach them how to teach their infants through 3 year olds. 
  • Infant and Toddler Services provides therapies for Kansas infants and toddlers through 3 years of age with delays in developmental skills, such as speech and language or gross motor skills. 
  • First Steps provides therapies for Missouri infants and toddlers through 3 years of age with developmental delays.

Daycare:

Colic (Fussy baby) Resources:

Welcome to the 18-month milestone in your journey of parenthood! As your little one continues to grow and thrive, it's essential to focus on their development and provide opportunities for meaningful play and exploration

Hot Topic: Development and Importance of Play


At 18 months old, your toddler is undergoing significant developmental changes and milestones. You have probably realized that kids of all ages are drawn to screens (tvs, tablets, computers). Consider how screen time will affect your toddler's development by asking the 5C's - with age-specific advice: healthychildren.org/English/family-life/Media/Pages/kids-and-screen-time-how-to-use-the-5-cs-of-media-guidance.aspx

Read daily with your child to help increase vocabulary, bond, and calm. If you haven't signed up for the Imagination Library, be sure to do so - your child will get a free book every month until their 5th birthday! 

Communication is important - even before your child speaks many words!

  • Gestures and Body Language: Encourage your toddler to use gestures such as pointing, waving, nodding, and shaking their head to express their needs, preferences, or emotions.
  • Facial Expressions: Pay attention to your toddler's facial expressions, as they often convey a wealth of information about their feelings and moods. Smile, frown, or use exaggerated facial expressions to communicate with your toddler nonverbally.
  • Eye Contact: Maintain eye contact with your toddler during interactions to establish a connection and convey empathy, understanding, and attention.
  • Imitation: Model the behavior you want to see in your toddler and encourage them to imitate your actions. This can include clapping, blowing kisses, or pretending to talk on the phone.
  • Nonverbal Cues: Pay attention to your toddler's nonverbal cues, such as body movements, posture, and gestures, to gain insight into their thoughts, feelings, and needs.
  • Play and Pretend: Engage in pretend play activities with your toddler, using toys, dolls, or stuffed animals to act out scenarios and communicate without words.
  • Sign Language: Introduce basic sign language signs such as "more," "please," "thank you," and "all done" to help your toddler communicate their needs and desires before they can verbalize them. If you need to learn too, check out Miss Rachel videos.
  • Picture Cards or Symbols: Use picture cards or symbols to help your toddler communicate specific requests or choices. For example, you can create a visual schedule with pictures representing different daily activities.
  • Music and Singing: Sing songs, play music, or use nursery rhymes to engage your toddler's interest and convey emotions or instructions through melody and rhythm.
  • Physical Touch: Offer comforting hugs, gentle touches, or cuddles to communicate love, support, and reassurance to your toddler.
  • Responsive Listening: Practice active listening and respond promptly and attentively to your toddler's attempts to communicate, whether through words, gestures, or expressions.
  • Observe and Interpret: Pay close attention to your toddler's behavior and environment to understand their needs and preferences. Anticipate their needs based on their cues and respond accordingly.
  • Don't be afraid to speak multiple languages. If you can speak multiple languages, we encourage you to talk with your toddler in multiple languages. This will not delay speech and will help overall language development.

The Pathways.org app offers a wealth of fun and educational activities tailored to your child's age and developmental stage. Use it as a resource to discover new ways to engage and stimulate your toddler's curiosity.

Encourage Positive Interaction: Foster opportunities for your toddler to interact with others in a supportive and nurturing environment. Encourage simple social interactions like waving hello and goodbye, sharing toys, and taking turns.

Model Empathy and Kindness: Be a positive role model by demonstrating empathy, kindness, and patience in your interactions with others. Use gentle and respectful language when addressing your toddler and others.

Validate Feelings: Help your toddler identify and express their emotions by acknowledging and validating their feelings. Use phrases like "I see you're feeling sad" or "You look excited!" to help them understand and label their emotions.

Teach Problem-Solving Skills: Encourage your toddler to problem-solve and find solutions to minor conflicts or challenges they encounter. Offer guidance and support as they navigate social situations and learn to communicate their needs effectively.

Provide Opportunities for Play: Play is not only enjoyable for toddlers but also essential for their cognitive, social, and emotional development. Limiting screen time and prioritizing active, hands-on play can help your child learn and grow in meaningful ways. Instead of relying on educational shows, encourage your toddler to engage in imaginative play, explore their surroundings, and interact with others. Consider creating obstacle courses from household items, visiting parks, and allowing your child to engage in risky play under supervision. While it may seem daunting, risky play provides valuable opportunities for children to develop resilience, problem-solving skills, and emotional regulation. Create opportunities for your toddler to engage in imaginative play with peers or siblings. Encourage cooperative play activities like building blocks, playing with dolls, or pretending to cook in a toy kitchen.

Practice Empathy: Help your toddler understand the feelings of others by pointing out emotions in books, movies, or real-life situations. Encourage them to offer comfort or assistance to others when they are upset or in need.

Establish Routines and Consistency: Create a predictable and consistent daily routine to help your toddler feel secure and develop a sense of trust. Consistent routines provide a sense of stability and comfort, which is essential for healthy social-emotional development.

Praise Effort and Progress: Recognize and praise your toddler's efforts and achievements, no matter how small. Celebrate their successes and encourage them to persevere when faced with challenges.

Set Clear and Age-Appropriate Boundaries: Establish clear boundaries and expectations for behavior, and be consistent in enforcing them. Use gentle redirection and positive reinforcement to guide your toddler's behavior.

Provide Unconditional Love and Support: Shower your toddler with love, affection, and support. Offer hugs, cuddles, and words of encouragement to reassure them of your unwavering love and acceptance.

Watch for signs of delays: We screen with validated screening tools for general development and autism at 18 and 24 months. As you observe their growth and progress, it's important to be aware of potential signs of autism and general delays in milestones. Early intervention and support makes a huge impact to prepare kids for the future. Keep an eye out for red flags such as social difficulties, communication challenges, repetitive behaviors, and sensory sensitivities. If you have concerns about your child's development, don't hesitate to discuss them with us.

By fostering an environment that encourages exploration and play, you're laying the foundation for your child's healthy development and well-being. 



Continue reading below for more 18 month old topics and tips!

Our website has many resources.


Some pages you might find helpful at this age include:

  • Nutrition This page has several articles related to feeding your child.
  • Some of the most common questions for this age are covered on:
  • Thumb sucking and pacifier use 
  • How to Prevent Tooth Decay in Your Baby
  • Immunizations This page has answers to all your questions about the vaccines we give and what to expect after vaccinations. The LAST of the "baby" shots is at 18 months usually. It is a Hepatitis A vaccine and must be separated at least 6 months from the 1st dose around the 1st birthday. If there is not enough spacing, we will do this at a future visit. Seasonal and catch-up vaccines may be offered at this visit too. 
  • Safety This page has a large number of subtopics to learn all about safety and prevention topics for your family.
  • Parenting Tips This page has tips on sibling rivalry, tooth care, sleep and more. 
  • Is your child sick? This page has a searchable list of articles to help manage illnesses.
  • Medicine dosages Always make sure you're giving the right amount of medication to your baby. Over the counter medications won't say how much to give, so we have weight based guidance on our site. Tip: If you're buying over the counter medicines, usually the infant specific versions are more expensive than children's versions without any benefit other than a syringe. You can usually buy a syringe and children's syrup for less! Some common questions about medications are covered on:
  • Acetaminophen (Tylenol)
  • Ibuprofen
  • How to give your child medications
  • Special Needs for those of you with children who have special needs.


MILESTONE TRACKING AND TOOLS 

Many toddlers are walking by 15 months, but if yours is not, try some of these activities to help them learn. Toddlers love to play! If you're out of ideas of things to do, find ways to engage your child in active play on Pathways. 

  • Pathways provides weekly motor, communication, sensory, and feeding activities to support baby at their exact age and stage of development. They have a robust website and free app and we highly recommend using it.
  • Zero to Three offers resources for infant and child development and parenting.
  • Reading to your baby daily has been proven to boost development. The Imagination Library will ship a free book to your home monthly for your child(ren) from birth to 5 years. Sign up here! 
  • Just In Time Parenting offers many developmental tools in English and Spanish delivered to your inbox once you sign up. There are PDFs, podcasts, videos, and more!


LOCAL RESOURCES 

  • Parents As Teachers works with parents to teach them how to teach their infants through 3 year olds. This is available to everyone and especially encouraged for first time parents and families who will not use a daycare center, since daycare centers work on developmental skills much like schools do for older kids.
  • Infant and Toddler Services provides therapies for Kansas infants and toddlers through 3 years of age with delays in developmental skills, such as speech and language or gross motor skills. 
  • First Steps provides therapies for Missouri infants and toddlers through 3 years of age with developmental delays

Feeding & Nutrition


  • Toddlers should have meals and snacks offered at the same times each day. Don't let them graze on snacks all day long - think of snacks as mini meals with healthy food choices offered at a standard time.
  • Offer small servings of each food. Children become overwhelmed by large portions of food and often will eat more if offered less.
  • Your child may decide they don't like certain foods. Never force them to eat. Keep offering those foods every once in a while. As children get older their tastes change.
  • Parents choose the types of foods offered, children will decide how much they eat.
  • Let your child self feed with fingers. Toddlers typically start to use a fork and spoon between 15 and 18 months, but often prefer fingers. Expect meal times to be messy. They're learning important self regulation and fine motor skills when they do it themselves!
  • Keep the tv and other screens off while eating.
  • Vitamin D 15 mcg or 600 IU/day is recommended for everyone over 6 months. Liquid versions are best tolerated in young children.
  • Limit milk to 24 oz or LESS per day. Too much milk increases the risk of malnutrition and iron deficiency anemia. If you need a cow's milk substitute, talk to us about which is most appropriate for your toddler. Many (including almond, rice, and other milks) sound healthy, but offer little nutrition and are not appropriate for toddlers.
  • Juice and other flavored drinks should still be limited. They have too much sugar and fill toddlers without providing much nutrition (even 100% fruit juice).

Safety for your family


  • If you are worried about your living or food situation, talk with us. Community agencies and programs such as WIC and SNAP provide information and assistance. Find information about this and more on our Community Resources Page. See the "Economic and Financial Help" tab.
  • Ask us for help if you have been hurt by your partner or another important person in your life. Hotlines and community agencies can also provide confidential help.
  • A fabulous local resource to help you learn about child proofing your home is Charlie's House. Ask us for furniture latches so you can secure bookshelves, dressers, and other furniture that may tip as your baby learns to climb.
  • Tobacco-free spaces keep children healthy. Don't smoke or use e-cigarettes. Keep your home and car smoke-free. If you need help quitting, find information on our Community Resources Page.
  • Car safety:
  • Use a rear-facing car safety seat in the back seat of all vehicles.
  • If you need a car seat sticker, ask us! They can help identify who to call in case of emergencies.
  • Do not put kids in thick clothing under a car seat belt. Remove coats and put blankets on top of the seatbelt.
  • Make sure your child is always stays properly strapped in the car safety seat during travel. 
  • Always wear your lap and shoulder seat belt to better protect yourself in case of accident.
  • Never drive after drinking alcohol or using drugs.
  • Never text or use a cell phone while driving.
  • Do not smoke or vape in the car - even if children aren't in the car, it is an enclosed space and your baby will be exposed to third hand smoke or vaping chemicals.
  • Turn your hot water heater down to below 120° F to decrease the risk of burns.
  • Check your smoke and carbon monoxide detectors and replace batteries regularly.
  • All parents should learn CPR and refresh skills every 2 years. For a list of CPR classes for both non-medical and medical professionals, search for "CPR" with your zip code on a web search engine.
  • Watch for small objects a child may choke on (toy parts, buttons). Get down to their eye level to childproof. Notice door stoppers (the tip might come off!), cords that can be wrapped around a neck or cords that can pull heavy or hot objects down.
  • Never leave young children alone in a bathtub or near water. Close the bathroom door when not in use. Put toilet seats down so children don't try to climb in!
  • Always leave contact information with babysitters. For more babysitter tips, see our Babysitter page.

Health


  • Vaccines
  • At 18 months most kids get the last of the "baby shots" with a booster of the Hepatitis A vaccine.
  • The Hep A vaccine must be given a minimum of 6 months after the 1st dose.
  • If the 1 year visit was within a couple of weeks of the birthday, make sure there is a 6 month gap when scheduling the 18 month visit.
  • If there was a significant delay for the 12 month visit, we can give the Hep A vaccine at a future visit. Do not delay the 18 month visit significantly just for the vaccine - this is a very important age for developmental milestones to be checked. We can work on the vaccine catch up later!
  • We also may offer seasonal vaccines when they're available. 
  • Review the vaccines we'll give before your visit. 
  • Babies and young children often seem like they're sick all the time. They get 8-12 colds a year, and each lasts about 2 weeks (some less, some more). Treat symptoms:
  • Saline can be more helpful than many imagine. Nasal spray for infants is available at your pharmacy.
  • If there is nasal congestion or a runny nose, use a nasal aspirator to suck mucus from the nose. First use saline to loosen the mucus, then one of the aspirators that you provide the suction with your mouth or an electronic aspirator. We do not recommend bulb syringes because they are less effective and traumatize the nose more.
  • Fever is the body's immune response at work.
  • Temperatures over 100.4F are considered a fever and keep babies out of daycare, but we only use fever reducers to make kids comfortable, not to bring the temperature to normal.
  • There is no temperature we worry about more if babies are over 3 months and vaccinated. The child's symptoms are what we watch, not the thermometer.
  • Generally over 102F, the fever itself leads to discomfort enough to need a fever reducer, but they can be used for temperatures less than that if babies have fussiness, won't eat, or can't settle to sleep.
  • Acetaminophen can be given every 3-4 hours and Ibuprofen can be given every 6-8 hours, so many parents prefer ibuprofen for less frequent dosing. 
  • When to have your toddler seen:
  • If the fever lasts more than 3-5 days.
  • If there are signs of difficulty breathing (rapid breathing, sucking in ribs or at the bottom of the neck, grunting, or looking scared) seek medical attention.
  • Signs of dehydration include lethargy/very tired, no tears, dry tongue, and decreased urine output. If this occurs, your child should be seen.
  • A phone call cannot diagnose a source of fever.
  • If your child has ear pain, treat the pain. Most ear infections are due to a virus, but if your child is under 2 years, the symptoms persist more than 3-4 days, or if the symptoms are not manageable, antibiotics may be considered. Learn more about ear infections here.
  • We recommend that all caregivers stay up to date on their immunizations to help protect infants. If a caregiver is sick, they can use precautions to limit exposure to others, especially infants.
  • Tobacco-free spaces keep children healthy. Exposure increases risk of frequent ear infections and wheezing. Don't smoke or use e-cigarettes. Keep your home and car smoke-free. If you need help quitting, find information on our Community Resources Page.
  • Tooth and oral care:
  • Most experts say there are no symptoms associated with teething, but many parents report pain, fussiness, runny nose and loose stools. 
  • Teething pain should be managed with massage, cold cloths, chew toys or a pain reliever, such as acetaminophen.
  • Do not use amber necklaces or teething gel. 
  • Oral hygiene and cavity prevention:
  • Use a soft toothbrush twice a day with a grain of rice amount of children's toothpaste with fluoride. 
  • We offer fluoride varnish until kids start seeing a dentist - ask about it at your check up if you have questions!

Looking ahead to the 2 year visit:


  • We'll talk about
  • Taking care of your toddler, your family, and yourself.
  • Developmental milestones - use the tools above to prepare!
  • There are no routine vaccines at 2 years, but we may offer seasonal or catch up vaccines. If your child is not able to get the 2nd hepatitis A vaccine at the 18 month visit, we encourage you to schedule the 2 year visit just before the birthday so all vaccines are done prior to 2 years of age. Review the vaccines we'll give before your visit.