Celia DiMarco MD Kathy McNeely MD 727-461-3163
NINE MONTH VISIT
Height _________Weight ________ Head Circ ________
1) Breast or Bottle feeding: Continue Breast feeding as long as you are able. Formula is recommended until 1 year of age and then switch to whole milk until 2 years of age. At 2 years most toddlers do well with out the added calories of whole milk and become accustomed to the lighter flavor of 2% milk.
2) Baby Food and beyond. Your baby is probably enjoying many different baby foods and be sitting up in his high chair excitedly watching you eat. You can easily feed your baby the same foods that you are eating. Finger foods are usually introduced around 9 months of age as your baby loves to work with his pincer grasp and start to feed himself. Foods should be soft and easily mashed by the baby’s gums. Be careful of foods that break off into chunks and can be choked on. Examples are: hot dogs, carrots, nuts, popcorn.
3) Wait until 12 months to switch to whole milk. As your baby takes in more table food, the amount of formula he needs will be 16 to 24 oz in a day. Introduce a sippy cup with formula which will make it much easier to come off the bottle. Encourage drinking water in between meals. Juice doesn’t have much nutritional value and is really a form of sweetened, flavored water. Sipping juice can cause cavities and empty calorie weight gain. It would be much better to teach your baby to drink water and enjoy eating fruits.
Eating stimulates the colon to empty so you may expect a bowel movement during or after eating. If your baby’s stools are hard, increase the fruits you give her. Peaches, pears, and prunes usually will soften up stools. Some babies need ½ jar of prunes 1 -2 times a day. Increase the amount of fruits that you give until your baby has 1 to 2 soft stools a day. If her stools are too soft then decrease the fruits.
SLEEPING AND PREVENTION OF SLEEP PROBLEMS
Separation anxiety can lead to night wakening. Your baby may wake up and realize she is alone and start to cry. Try to not go in to interact with your baby. Babies at this age do not need to feed in the night and if you comfort her by feeding or cuddling, she will probably get into the habit of crying for you in the night. Get her used to falling asleep at nap and bedtime on her own with a safe snuggly such as a blanket or stuffed animal. Tell her to hug her “teddy” and that she can fall asleep. She may need to cry for a few minutes as she falls asleep. Soon she will learn to settle herself into sleep on her own, so when she wakes at night, she may cry for a few minutes but then will be able to settle herself back to sleep.
Choking: As soon as your baby develops control of his hands, you can expect him to put anything he happens to be holding right into his mouth. Make sure everything he holds is clean, doesn’t have sharp edges or anything that can break off, and that it is too big to fit entirely in his mouth.
You can use the “toilet paper roll” rule…if it can fit through the toilet paper roll, then it is too small.
Car Seats: Motor vehicle crashes are the number one cause of death for children and adolescents ages 1 to 21. The new recommendation from the Academy of Pediatrics is to have infants face the back of the car until 2 years of age. Knowledge of common errors that are made in the installation of car seats may help to prevent injury in a crash: 1. Car seat not secured to vehicle seat 2. Harness and crotch straps too loose 3. Car seat is not appropriate for child’s age and size 4. Car seat facing in the wrong direction 5. Car seat placed in front seat especially with an active front passenger seat air bag 5. Improper fit of vehicle safety belt across child in belt-positioned seat.
Falls: can happen in a second with you being just a step away. Please be sure to never leave your infant on a changing table, sofa, or your bed. Place him on a blanket on the floor or in his crib. Check around him for things he can pick up and put in his mouth or reach up and pull down on his head.
Communication: Babies this age are big communicators. They babble, gesture and give funny facial expressions. Their actions are their communication.
- Talk a lot with your baby. For example talk about what you are doing while he is doing it. “You are eating a big banana.” “Putting on your socks.”
- Respond to her communications. She should say at least 3 words, such as “ba-ba”,”da-da” and “ma-ma”
- Soon he should follow simple commands such as “come here” and “Put it back”
- As her brain grows, your baby will start to imitate others, especially you. Play nursery games like: “Peek-a-boo” and “So Big”
- Provide a variety of safe toys. This will encourage your baby to explore and experiment with different ways to use objects.
Many babies by 9 month can pull to stand and some are walking. Most babies this age are fast crawlers. Encourage your baby to play with toys and play interactive games with you..
Vaccines given: Hepatitis B and catch up on vaccines if needed such as: DTaP = Diphtheria, Tetanus, Pertussis (Whooping Cough), Hib = Hemophilus Influenza B, IPV = Injectible Polio, Prevnar = Pneumococcal
Our pediatric journals have had recent articles showing that inflammatory response to a vaccine (or even a viral illness) is very important. A recent study reported that babies given acetaminophen after their vaccines had a slightly lower blood level of protective immunoglobulins. The Academy of Pediatrics is recommending further study. Fever and mild discomfort is common after vaccine. Try to hold off on giving medication. If you feel that your child needs acetaminophen:
Acetaminophen (Tylenol) Dose: 12-17 lbs=0.8 cc (1 dropper) 18-23 lbs=1.2 cc (1 ½ dropper)