The first priority is to listen to the concerns of the parents. Always observe the parent-child interaction during the entire visit. Reinforce positive interactions and discuss any concerns. If there are siblings in the room, how do they interact with the child? Is the parent positive about the child?

The 18-month-old child is both independent and dependent with an emerging sense of his own identity. He is very resistant to a physical examination. Often it helps to examine a doll or stuffed animal first. Let him hold your tools (stethoscope, otoscope, etc.). Give him choices, such as sitting on his parents’ lap for an exam or sitting up on the exam table; or which eye/ear to examine first).

Bright Futures gives priority to these topics during the 18-month visit [PDF]: