Your Twelve Month Old

Developmental Milestones*

• Your baby now drinks from a cup without assistance.
• She can stand alone for several minutes or may even walk.
• She helps with dressing (puts her arm through a sleeve or gives you her foot for a shoe, etc.)
• She imitates you.
• She understands simple things, like “no”, “all gone”, “hooray”, “uhoh” etc.
• Baby says "mama" and "dada" and maybe a few other one-syllable words (like "hi").
• Baby expresses her wants with gestures and words instead of cries.  She has learned to point with her finger.

*All babies develop differently.  If your 12-month-old hasn't yet reached these milestones, rest assured that she will soon. If you have concerns about your baby's development, please schedule an appointment.

Feeding

By 12 months, your baby is ready to be weaned from breast milk or formula.  Most babies can transition directly to whole cow’s milk.  If your baby is currently on a specialty formula or has a milk protein allergy, please discuss this transition with us before proceeding.  Some babies can transition to whole milk all at once.  Others will dislike the taste at first.  In this case, a slow wean will ease this transition.  The slower the wean, the less likely they are to realize the flavor difference.  At this time, the emphasis is now placed on solid food.  No more than 24 ounces of whole milk per day is necessary.  In fact, 16-18 ounces per day is preferable. 

As long as there is no family history of any food allergies, you may now introduce chocolate, honey, orange juice, peanuts, and seafood.   Remember to wait at least 3-4 days in between introducing new foods.  If your baby has a reaction, please call our office immediately.

Pay close attention to foods that may be choking hazards.  Pea-size pieces of food are the safest. Vegetables like carrots, celery, and green beans should be diced, or cooked and cut up. Cut fruits like grapes and cherry tomatoes into quarters before serving and shred or cut meats and cheeses into very small pieces.  Nuts, popcorn, cough drops, hard candies, and raisins are potential choking hazards and should be avoided.  Peanut butter is dry and hard to swallow.  It is safer if spread thinly on bread or crackers or combined with applesauce or jelly.   

Toddlers may show a decreased appetite around this time.  At this age, many would rather explore than eat.  Teething also can make your baby lose interest in food. Try to find a balance between letting her eat when she's hungry and letting her pick at her food when she's not.  Don't force food on her, but try to pay attention to what actually is eaten.  Sometimes it is more than you think and sometimes it is less.  Please inform us if you believe your child is not gaining weight or eating enough. 

Babies can now drink water.  We still only recommend pear or prune juice for the treatment of constipation.  No other juices are necessary and can lead to tooth decay.
Calcium fortified orange juice can be beneficial if your baby does not like milk. 

Please continue to administer a multi-vitamin with fluoride daily. 

Sleep

Most babies require around 10-12 hours of sleep per night.  Naps are variable. 

At this time, babies should be sleeping through the night.  There is no need for anything to eat or drink overnight.  

Bowel Movements/ Urine

• By now you are probably pretty comfortable with your baby’s pooping schedule. You are familiar with the wide variation in frequency and consistency. Your baby’s stools will continue to vary especially as he or she is transitioned from breast milk or formula to whole milk and more and more table foods. Please inform us if the stools are watery, mucousy, hard as pebbles, red, or tarry black.
• Babies will continue to have on average 6-8 wet diapers per day.

Activity

• Don’t forget to brush your baby’s teeth and/or gums. You may use a baby toothbrush, finger mitt, or even just a wet washcloth. Still, no toothpaste. Twice a day preferably but at least once a night before bedtime. If you notice any stains or discolorations on your baby’s teeth, please let us know. By now, no baby should be waking at night to feed.
• A car seat is very important, even for short trips.  Most one-year-olds have outgrown their infant car seat.  If your baby is less than 20 lbs, they still must remain rear facing.  Convertible seats are available and most accommodate children rear facing until 35 lbs.  Please note: Babies must be at least 20 pounds and 12 months old before they can be forward facing.  The car seat must be in the back of the car.
• Have working smoke and carbon monoxide alarms and an escape plan.
• Avoid sun exposure since your baby’s skin is delicate and more likely to burn. Sunscreen can safely be used.  Try to use a sunscreen made for babies and be careful around their eyes.  Take advantage of SPF clothing and wide brimmed hats.  
• Monitor your child at the pool or beach at all times.  Educate your children never to swim unsupervised.  It is never too early to start teaching them this.  Strongly consider purchasing a pool safety fence or cover for your home pool.  Lock all hot tub covers. 
• Deet-free insect repellent may be used.  To be safe, only apply insect repellents to exposed skin. Do not apply it under clothing, on a child's hands, near the mouth or eyes, or over cuts and irritated skin.  Wash off insect repellents once your child comes inside and will no longer be exposed to mosquitoes. Combination sunscreen/insect repellent products should be avoided because sunscreen needs to be reapplied every two hours, but the insect repellent should not be reapplied. 

Baby-proofing 101

Once a baby is mobile, it can seem impossible to keep him or her out of harm’s way.  Toddlers have an uncanny ability of finding danger within 20 seconds of entering a room.  Here are some pointers:

• Keep coins, small toys, nail clippers, and balloons out of reach.
• Shorten drapery and blind cords.
• Remove the plastic end caps on doorstops, or replace the stops with a one-piece design.
• Install safety hinges on trunks/ toy boxes to prevent pinched fingers.
• Lock any potentially dangerous substance in an upper-level cabinet. This includes alcoholic beverages, household cleaning formulas, laundry supplies, medications/ vitamins, paint, kerosene, gasoline, charcoal, lighter fluid, bug spray, pesticides, and fertilizers.
• Place houseplants out of children's reach; know the names of all plants in case a child eats one of them.
• Keep a bottle of Ipecac and activated charcoal in your home, but use only when instructed by a medical professional.  Place the number for Poison Control near every phone in your home (1-800-222-1222).
• Cover every electrical outlet in your home with a child-resistant outlet cover (the plastic plugs are easy to pry out).
• Place screened barriers around fireplaces, radiators, and portable space heaters.
• Install hardware-mounted safety gates at the top and bottom of stairways with two or more steps. Pressure-mounted models may not be strong enough; use only at the bottom.
• Pad the edges of coffee tables and brick or tile fireplaces.
• Remove mobiles and other hanging toys from the crib as soon as your child can reach up and touch them.
• Remove the crib bumper pad as baby may use it as a step to climb out.
• Position audio/video equipment so children cannot pull televisions or stereos off furniture.
• Keep appliance cords wrapped short so children cannot pull coffee makers, toasters, and other appliances.
• Secure bookshelves, entertainment centers, and bureaus to walls since they can topple onto children who use furniture to pull up and stand.
• Watch with seasonal decorations as they often contain small pieces and many were bought before children were around.  Secure Christmas trees to prevent from falling.

Vaccines

Your baby will receive immunizations during his/her 12-month visit.  Please visit the vaccine section of this website for more information on specific vaccines and their administration schedule.  Your child will also be tested for tuberculosis exposure.  This test requires a small amount of liquid, which is injected just under the skin on one of his or her arms.   The result is checked 48-72 hours later.

Please note that we will not administer vaccines to any child whose parent or guardian is not present for the visit.  This is our office policy.  We understand that parents have busy schedules but no exceptions to this rule will be made.

Complete Blood Counts and Lead Testing

We routinely send all one and two year olds for blood testing.  You will receive a prescription at your child’s physical to take with you to a lab.  We report all normal and abnormal results.  If you have not received a phone call regarding your results within 5 days of going, please notify our office.  When you call, please let the receptionist know where and when you took your child so that we may track down their results. 

Why lead?  Abnormally high exposure to lead can harm a child’s growth, behavior, and ability to learn.  For years, lead was used in paint, gasoline, plumbing, and many other items.  Lead is still in some kinds of pottery.  As things are used or get worn out, the lead they contain can spread. Lead paint was banned from home use in 1978. If you live in a home built before 1978, or near a busy road, there could be lead in your house dust and soil.  A child can get lead poisoning by swallowing or breathing in lead. Young children spend a lot of time on the floor. They like to put hands, toys, and other things in their mouths. This raises their chances of swallowing lead dust and paint chips. Only a tiny amount of lead is needed to harm a young, growing child.

What is a complete blood count (CBC)?  A complete blood count is a measure of the different kinds of cells in the blood.  It is used to determine general health status and to screen for and monitor a variety of disorders.  It can detect many issues-- from anemia to leukemia.   

Medicines

Tylenol and Motrin can be safely given to your child for teething or fever.  You can safely use both medicines together as long as you adhere to their separate dosing schedules.  For most babies, however, one or the other will be just fine.  Please ask for our dosing chart or follow the instructions on the bottle.  Let us know if you have any questions.  If you are using either medication regularly, please notify our office.  We do not recommend the use of Baby Orajel or other teething/gum numbing agents.  Please ask us before using administering any other medication to your child.