12 Months

Welcome to the one-year milestone in your journey of parenthood! As your little one celebrates their first birthday, there are exciting developments and challenges - prepare yourself with the tips below.

Hot topic: Feeding 

1. Encourage Self-Feeding: Allow your little one to practice self-feeding with their fingers. Forks and spoons are not usually mastered for quite a while, and generally are not used until 15-18 months. Finger feeding fosters independence and helps develop their fine motor skills and hand-eye coordination. Expect a mess as they learn. 
2. Offer Variety: At every meal and snack offer a protein (meat, nuts, egg, dairy, legumes), a fruit or vegetable, and a whole grain. Since kids don't eat much at any given time, they tend to eat small amounts every few hours during the day. Use every meal and snack as an opportunity to give nutritious foods.
3. Transitioning Breastmilk or Formula: Breastfeeding can continue as long as mutually desired with the child and parent. Bottles should stop at 1 year of age. Cups can be used for breast milk, cow's milk, pea milk or water. Toddler formulas are not recommended - they tend to be less nutritious than infant formula or whole milk. Juice is not recommended at this age. Whole milk is great for protein, calcium, and vitamin D, but it is not a meal substitute, so should be limited to 24 ounces per 24 hour period. Too much milk leads to nutritional deficiencies because kids fill up with milk and don't eat a variety of foods. Offer it in a cup with meals to help decrease the amount they would take from a bottle.
   
   If your child doesn't like milk they can get nutrition from foods and hydration from water. Some kids never drink cow's milk and that is okay as long as they get nutrition elsewhere.
   
   If your child is allergic to cow's milk or your family doesn't eat animal products, you can use pea milk as a substitute. It provides the best protein and nutrient balance of all the plant-based milks.
   
   If you're worried about milk intake, talk to us!
4. Limit Sugary and Processed Foods: The picture above with a one year old eating her birthday cake exemplifies that special occasions can be special times that general rules are broken, but most days it's important to minimize the intake of sugary snacks, sweets, and processed foods. Focus on offering whole, nutrient-dense foods to support overall health and well-being. Watch labels for added sugar in foods - it's often found in yogurt, ketchup, pouches, and other popular foods. The American Academy of Pediatrics recommends that children under 2 years of age don’t consume any added sugar at all. Kids 2 and older should have no more than 25 grams (or 6 teaspoons) of added sugar daily. 
5. Establish Regular Meal and Snack Times: Aim for three meals and two to three snacks per day to provide your baby with consistent nourishment throughout the day. Establishing a routine can help regulate your baby's appetite and energy levels. Each snack should be considered a mini-meal with a plant (fruit or vegetable), protein, and whole grain.
6. Stay Hydrated: Offer water in a sippy cup with meals and throughout the day to keep your baby hydrated. Avoid fruit juices and sugary beverages, as they can contribute to tooth decay and provide empty calories.
7. Be Patient with Picky Eating: It's common for toddlers to be picky eaters as they assert their independence and explore their preferences. Offer a variety of foods, and don't be discouraged if your toddler starts to refuse foods. Keep offering them in different ways and be patient. If your child is restricted in types of foods they will eat, talk to us! Picky eating is common, but sometimes it indicates a more serious concern. 
8. Lead by Example: Be a positive role model by enjoying a variety of nutritious foods yourself. Eating together as a family can make mealtimes more enjoyable and encourage your baby to try new foods. Avoid talking about the food - that increases anxiety around eating. Talk about your day and keep the conversation light and fun.
9. Ask about concerns: If you have concerns about your baby's weight gain, nutrition, or feeding habits, don't hesitate to talk with us. Sometimes we'll recommend an occupational therapist or registered dietitian to help too.

Keep reading for more tips for parenting your 12-month-old as they continue to grow and thrive.

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.
• Anemia - we will do a fingerstick for hemoglobin at the 1 year visit. If it is low, the anemia page will help you understand what this means and what we do about it.
• Lead - we also check for lead at this age. If the level is high, this page has important things you need to know.
• Thumb sucking and pacifier use 
• Immunizations This page has answers to all your questions about the vaccines we give and what to expect after vaccinations. There are no standard vaccines at the 9 month visit, but seasonal vaccines and any catch up vaccines will be offered if they apply.
• Safety This page has a large number of subtopics to learn all about safety and prevention topics for your family. There is also a specific page for this age: Safety for 1-2 year olds
• 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
• Vitamin D
• Special Needs for those of you with children who have special needs.
  

Help your child optimize development

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

MILESTONE TRACKING AND DEVELOPMENTAL TOOLS 

• 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 generally are not too picky at this age, but establishing healthy eating habits are very important.

• Offer small servings of each food. Children often become overwhelmed by large portions of food.
• Solid Starts is a fabulous resource for feeding your young child.
• Your child may decide they don't like certain foods at any given time. Never force them to eat. Keep offering those foods every once in a while. As children get older, their tastes change. The less pressure your child feels with meals, the better they will eat. Model healthy eating.
• Parents choose what types of foods are offered, children will decide how much they eat. If they don't eat much, that can be very normal. Let them follow their hunger cues, but remember to not allow them to fill up on only one food group. Offer variety throughout the week.
• Children need to eat small, frequent meals. Think of snacks as mini meals and offer foods at the same time each day. If they aren't hungry, they won't eat, but if they're offered healthy choices for each meal and snack, they will get the nutrition they need most of the time. If your child is restricted to only a few food types, talk to us about the details.
• Let your child self feed with fingers. Toddlers typically start to use a fork and spoon between 15 and 18 months but finger feeding is an important skill to learn now.
• We recommend getting rid of bottles at this age and use cups for milk and water. 
• Milk and milk alternatives:
• Never allow more than 24 ounces of milk (or milk alternative) per day. Kids will fill up on it and miss out on the variety of nutrients in foods. 
• Milk is not a required food group. If your child does not drink it, offer water and foods with protein and calcium. 
• If cow's milk is not appropriate for any reason, either staying on breast milk or infant formula may be appropriate. Talk to your pediatrician if you want to use a milk alternative.
• Continue to give Vitamin D, even if your toddler is taking Vitamin D milk. They need too much milk to be able to get all vitamin D through milk. 
• Meal times will be messy. Have fun! Be patient. Kids will eat with their fingers at this age. They won't use utensils until 15-18 months of age.
• Family meals are one of the best ways to build family bonds. Sit at the table as a family to eat together as often as possible. Toddlers will learn about eating by watching you. Keep conversations about your day, not about the food. 
• Keep the tv and other screens off while eating. Distracted eating contributes to many long term poor eating habits, even if it seems like they eat better in the short term.
• Honey is now allowed but we still recommend limiting juice.
• Avoid round and chewy foods due to choking risk. Cut grapes and similar round foods.
  

Safety for baby & 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 your child in thick clothing under a car seat belt. Remove coats and put blankets on top of the seatbelt.
• Make sure your child 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.
• Toddlers climb! Make sure furniture is secure and won't tip. 
• Never use a walker with wheels. Exersaucers are acceptable.
• 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

• At 1 year we give vaccines to protect against measles, mumps, rubella, chicken pox, and hepatitis A. Babies need to be at least 12 months of age for these to "count" so be sure your visit is scheduled after the birthday.
• ASK (Autoimmunity Screening for Kids) is a free, research-based program that screens for T1D and celiac disease.
• For people 1 to 99 years old
• No family history of T1D required
• No current or past diagnosis of diabetes
• Visit AskHealth.org to learn more.
• Seasonal vaccines and catch-up vaccines may also be offered at this visit when available. 
• 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. Ibuprofen can be given once babies are 6 months of age.
• 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:
• ​Babies can get their first tooth anywhere between 4 and 12 months.
• 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:
• Start even before the first tooth erupts by using a washcloth on the gums.
• Once your baby has teeth, use a soft toothbrush twice a day with a grain of rice amount of children's toothpaste with fluoride. 
• We offer fluoride varnish once babies have enough teeth - ask about it at your check up if you have questions!
  

Looking ahead to the 15 month visit:

• We'll talk about
• Taking care of your baby, your family, and yourself.
• Your baby's developmental milestones - use the tools at the top of this page to prepare! There will not be an ASQ survey for 15 months, but we will ask questions about development.
• At 15 months of age we give boosters of vaccines previously given. We also may offer seasonal vaccines. Review the vaccines we'll give before your visit.