Neonatal neurodevelopmental follow-up recommendations: 18 month visit

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Recommendations to encourage neurodevelopment in babies at 18 months old who have spent time in the neonatal neurodevelopment follow-up clinic.

Key points

  • Babies who have been in the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth.
  • Recommendations at 18 months focus on walking, structural and functional play, and encouraging speech development.
  • Parents and caregivers should follow these recommendations to encourage neurodevelopment.

Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.

  • Gross motor skills include big movements such as rolling, crawling, standing or walking.
  • Fine motor skills include hand movements such as reach and grasp.
  • Early language development includes cooing, babbling, and a baby’s first words.

What is the Neonatal Neurodevelopmental Follow-Up Clinic?

The Neonatal Neurodevelopmental Follow-Up Clinic is a specialized clinic for children who had medical complications related to, or immediately after, their birth. This clinic assesses gross-motor skills, fine-motor skills, social development, language and learning ability at specific ages to determine if the child is developing normally.

The majority of patients seen in the Neonatal Neurodevelopmental Follow-Up Clinic are referred from a Neonatal Intensive Care Unit (NICU) or a Cardiac Critical Care Unit (CCCU). Babies who have been admitted to the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth. These recommendations may be used to encourage development in babies who have not spent time in the NICU or CCCU, but still require care in the Neonatal Neurodevelopmental Follow-Up Clinic. Talk to your child’s doctor to see if you should be following these guidelines with your baby.

Babies and toddlers are assessed at specific ages in the clinic and given recommendations that parents and caregivers can refer to at home to help their baby achieve their maximum potential. These recommendations are for 18 months corrected age, as most of the babies followed in the clinic were premature at birth.

If you are concerned about your baby’s development, speak with your primary healthcare provider.

Neonatal neurodevelopmental recommendations at 18 months

Gross motor

  • Practice gross motor development as a whole, including coordination, on riding toys. In playgrounds practice climbing on the small climbers and slides and walking on different terrain.
  • Practice ball games such as kicking and throwing. Do not expect catching yet.
  • Play a simplified version of “Simon Says”, encouraging your child to copy some of your body movements, such as raising your arms.

Fine motor

  • The high chair is an excellent place for structured play and ongoing development of attention skills.
  • As you play, verbally label the toys your child is playing with. This encourages both fine motor practice and language skills development.
  • Provide opportunities for container play and introduce shape sorters and simple puzzles for play.
  • Practice stacking for refinement of release skills (e.g., nesting cups, rings on pole, small blocks).
  • Continue with cause and effect toys that have to be pushed, pulled or turned (e.g., pop-up toy).
  • Introduce thick crayons and encourage scribbling. Encourage these early drawing skills in a variety of ways including painting with water on a chalkboard or sidewalk chalk outdoors. Introduce connecting toys, blocks (e.g., “Duplo”) and a variety of objects with different textures, shapes, and sizes for exploration with hands.
  • Encourage your child to use a spoon or fork during mealtimes.


  • Be face to face with your child. Use single words or short phrases to label, comment or ask questions.
  • Watch what your child is doing, wait, listen and respond. Imitate actions or sounds and keep the interaction going.
  • Make sure there are reasons to communicate; avoid anticipating all of your child’s needs.
  • Use simple picture books, with real life photos and board books when reading together.
  • Use simple language- always stay one step above your child’s level of communication.
  • Praise your child for behavior you would like to promote, such as sharing or waiting for their turn with a toy.
  • If there are any concerns about your child’s speech, contact your region’s Preschool Speech and Language Services.


  • Functional play — continue playing with toys/objects as they were intended to be used.
  • Encourage pretend play (e.g., feeding a doll or farm animals) and taking turns.
  • Attendance at structured play groups, activities, and daycare will provide opportunities for interaction with peers and assist with development of routines, socialization, self-help skills, and ongoing language development.
  • Sing rhymes with gestures or play games to label body parts, such as “Head, shoulders, knees & toes” or “If you’re happy and you know it, clap your hands”.
  • Electronic media use by children younger than two years is not recommended. This includes phones, television, computers, and tablet devices.
  • Encourage daily, unstructured playtime, and read to your child daily to promote the developing brain.


  • Continue regular visits to your family doctor/paediatrician to monitor growth.
  • Gradually stop giving your child a bottle and transition to using an open cup.
  • Limit homogenized milk intake to 500 ml per day (16 ounces) to promote a balanced diet. Juice intake is discouraged. Water is best.
  • Have your child see a dentist as part of routine oral health care. Healthy Smiles Ontario is a government-funded program that provides free dental care for children and youth under the age of 17 years. For eligibility requirements and enrollment details visit:​.


  • Maintain a regular bedtime routine.
  • Develop a regular sleep schedule and let your child fall asleep independently.

For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:

Parental mental health and well-being

All caregivers are encouraged to have ongoing discussions about their mental health and well-being with their family doctor. There are free community services available to promote coping and resilience for caregivers. Consider learning more about the following supports and interventions.

Last updated: March 30th 2021