18 MONTH OLD: NORMAL EXAM
Behavior/Mental Status - Wants
At this age, the child indicates his wants by pointing, gesturing and using vocalizations other than crying. At 18 months, he should have a vocabulary of 10 or more words and will use single words to indicate wants. Social interaction at this age is rich and increasing in complexity as seen in this child.
Behavior/Mental Status - Understanding
The toddler understands the use of objects and knows how things work. He’s trying to get the pen to work. He will follow simple commands, but still needs reinforcement and at times demonstration.
Behavior/Mental Status - Points to Pictures
The toddler is asked to point to pictures of a cat, horse, bird and dog. These pictures are part of the Denver II assessment tool. An 18 month old should be able to point to at least 2 of the pictures. This toddler identifies 4 pictures and repeats the name of 3.
Behavior/Mental Status - Points to Body Parts
When asked to point to body parts on the finger puppet, the toddler identifies eyes and mouth correctly. The naming of 2 body parts is normal for an 18 month old. Between 18 and 30 months the toddler should learn to identify 6 out of 8 body parts.
Conjugate eye movements and the near reflex can be tested with an interesting object like a finger puppet. Facial movement is noted as the toddler smiles.
Fine Motor/Coordination - Blocks in Cup
The toddler shows good coordination as he takes blocks and puts them in the cup. He is able to control the cup as well as reaching for the blocks.
Fine Motor/Coordination - Beads in Cup
He is able to pick up small beads and place them in a small container with good fine motor control. By using both blocks and beads, one is testing increasing levels of difficulty of fine motor control and coordination.
Fine Motor/Coordination - Stacking Blocks
Even more demanding than placing blocks or beads in a container is the task of stacking blocks. The number of blocks that a child can stack is correlated with their level of motor development. A 15 month old can stack 2 blocks while an 18 month old should be able to stack at least 4 blocks. This toddler is able to stack 5 blocks.
Fine Motor/Coordination - Pincer Grasp and Handedness
The toddler has a good pincer grasp as he grasps the end of a tape measure and pulls on it. He uses both hands well, but now the parents identify that he is starting to use the right hand more than the left hand. Handedness develops in the 2nd year of life.
Fine Motor/Coordination - Drawing/Scribbling
An 18 month old child can hold a pen and imitates scribbling or can scribble spontaneously. At this age he is holding the pen between the thumb and first 3 fingers and is developing a tripod position of the hand for drawing.
Motor - Tone
Passive range of motion is tested for both the upper and lower extremities. Toddlers can be apprehensive about having the examiner move his arms and legs, but reassurance and distraction usually work to get an adequate exam.
Motor/Reflexes - Deep Tendon Reflexes/ Plantar Reflex
By making the reflex hammer into a play object and adding sound effects, the child usually cooperates enough to adequately obtain deep tendon reflexes. Testing for the plantar reflex shows that the toes are definitely down going.
Motor - Throwing Ball
The toddler is able to throw the ball overhand and shows pleasure in playing the game of throwing and chasing after the ball.
Motor/Gait - Walking
The 18 month old has a much more steady and secure gait than the infant that is just learning to walk. He still has a wide-based gait but no wobbling. His arms are held in a low guard position- at the level of his waist. He squats without falling and is able to get up in the middle of the floor without pulling himself up. Notice how he gets up from the supine position. He first rolls to his stomach, then steadies himself with his hands on the floor to get up. As he gets older he'll do a sit up rather than rolling over and he will be able to get up without using his hands. Importantly, there is no evidence for proximal pelvic girdle weakness as he gets up from the ground or walks.