History

The 12-month well child visit marks an important milestone for families—the transition from infancy to toddlerhood. Most 12-month-olds will be cruising (walking while holding onto objects such as a couch) or walking independently—this is an exciting benchmark for parents and the child alike.¹ The child starts to exert his/her independence; exploration of the environment becomes the child’s main goal. Pediatric residents should become familiar with the physical, cognitive/verbal, social-emotional, and behavioral development occurring during this time. Knowledge about normal development will help with addressing parent concerns and conveying age-appropriate anticipatory guidance. For example, temper tantrums and discipline are important topics to discuss with parents at the 12-month visit. Independent toddlers are trying to exert their wishes and wants on the world. Yet this world quickly becomes full of “No’s.” It is no wonder that children want to exert their will with their own “No,” and lack of being able to communicate their own wants leads to frustration and the well-known temper tantrum, or as some parents say, “fallout.” Dr. Lieberman² describes the temper tantrum as “a wonderfully eloquent if seldom appreciated expression of the toddler’s inner experience,” that is, “throwing oneself on the floor with a mixture of heart-rending crying and angry screaming.” Helping parents understand temper tantrums as a normal part of development and giving them advice on handling them will help the parents handle unavoidable parent–child conflicts as they arise.³ In addition, learning to support parents in their role as the child’s first teacher is essential.¹ Discipline means to teach⁴ and is essentially behavior management, that is, teaching the child how to behave. Knowledge about appropriate discipline techniques such as limit setting and positive reinforcement is important.⁴ In addition, the parent should be the toddler’s secure base; therefore parents need to be consistent and firm yet loving and encouraging.² Toddlers thrive in a safe, secure environment with clear limits and predictable routines.