Child Health Care

Diet

Babies are getting all of their nutrients at this point from breast milk or formula. Usually infants are taking 4-5 oz at a time and feeding every 3-4 hours. If nursing, infants are feeding every 3-4 hours.

We start baby foods off of a spoon at 4-6 months depending on the baby and if food allergies are present in the family.

Elimination

Infants are usually having less bowel movements than they were. Stools should still be soft and loose.

Environment

You should dress your child with one more layer than you are wearing. In the summer, it is fine to use sunscreen on infants less than 6 months old. You always want to avoid direct sunlight with infants.

Sleep

Most children are sleeping a 5-6 hour stretch at this point. Sometimes they sleep longer or shorter. Overall infants need 16-19 hours of sleep a day.

Development

Infants are usually smiling now. They are much more interactive and awake. They are learning to roll over, so be careful where you leave an infant.

Health Tips

Immunizations may be given today. Your baby may have a fever and be fussy for 24 hours after the vaccines. You may give Tylenol every four hours to help with the discomfort. The injection site may get red or swollen. Ice can help.

Next appointment is at 4 months.

Diet

Babies are usually eating 24-32 oz a day of formula. If nursing, they are usually doing 4-6 sessions a day.

We start baby foods off of a spoon at 4-6 months depending on the baby and if food allergies are present in the family. If significant food allergies, asthma or eczema in the family, it may be wise to wait till 6 months to try food.

Otherwise we start with rice cereal. Take 2-3 tablespoons of the dry cereal and mix in 1-2 oz of water, breast milk or formula. Initially make it thin, then thicken it up as the child tolerates it. You can start stage 1 baby foods. These are single items pureed with water. Offer solid foods twice a day. It is important to start with one new item at a time. Start with fruits and vegs then go on to meats.

Elimination

Infants are usually having less bowel movements than they were. Stools should still be soft. If having hard stools, add some prunes into their diet.

Environment

You should dress your child with one more layer than you are wearing. In the summer, it is fine to use sunscreen on infants less than 6 months old. You always want to avoid direct sunlight with infants.

Sleep

Most children are sleeping a 6-7 hour stretch at this point. Sometimes they sleep longer or shorter. Overall infants need 18 hours of sleep a day. This is the time to start putting your child down to sleep, awake but drowsy. You want the child to self soothe to get to sleep, not use feeding or rocking to get to sleep.

Development

Infants are usually laughing now. They are much more interactive and awake. They are learning to roll over, so be careful where you leave an infant. They should be able to hold their head and chest up. Tools like the exersaucer are helpful.

Safety

Infant car seats usually go up to 20 lbs. Child should be rear facing in the back seat until 1 years old and 20 lbs. Consult the guidelines on the car seat label.

Please use smoke detectors in your house. Check the batteries monthly.

Health Tips

Immunizations may be given today. The vaccines are the same ones given at 2 months. Your baby may have a fever and be fussy for 24 hours after the vaccines. You may give Tylenol every four hours to help with the discomfort. The injection site may get red or swollen. Ice can help.

Next appointment is at 6 months.

Diet

Babies are usually eating 24-32 oz a day of formula. If nursing, they are usually doing 4-6 sessions a day . Most children are eating solids foods three times a day. You can advance to stage 2 foods or start table foods that are soft, cooked and are able to swallow whole.

You can try whole milk yogurt. You can try a sippy cup with water or ½ juice ½ water.  Limit juice intake to 4 oz a day.

Elimination

Infants are usually having less bowel movements than they were. Stools should still be soft. If having hard stools, add some prunes into their diet.

Environment

You should dress your child with one more layer than you are wearing. In the summer, it is fine to use sunscreen on infants less than 6 months old. You always want to avoid direct sunlight with infants.

Sleep

Most children are sleeping a through the night at this point. Sometimes they sleep longer or shorter.  Overall infants need 14 hours of sleep a day. This is the time to start putting your child down to sleep, awake but drowsy. You want the child to self soothe to get to sleep, not use feeding or rocking to get to sleep.

Development

Infants are usually babbling now.  They are much more interactive and awake.  They are learning sit with their hands stretched out.  They are working on their pincer grasp and transferring objects from one hand to the next.

Child often will start to experience stranger anxiety at this age.

Safety

Infant car seats usually go up to 20 lbs. Child should be rear facing in the back seat until 1 years old and 20 lbs. Consult the guidelines on the car seat label.

Please use smoke detectors in your house. Check the batteries monthly.

Health Tips

Immunizations may be given today. The vaccines are the same ones given at 2 and 4 months. Your baby may have a fever and be fussy for 24 hours after the vaccines.  You may give Tylenol every four hours to help with the discomfort. The injection site may get red or swollen. Ice can help.

Next appointment is at 9 months.

Diet

Over the next three months infants generally develop the ability to feed themselves. You can start to incorporate more solid foods into your child’s diet as he/she seems ready. Ensure that solid foods are cut into small enough pieces so that if the child had to, he or she could swallow it whole. Meals suggestions include cooked vegetables, fruits and meats cut into small pieces. Nine-month-old children may begin having eggs at this point. You should wait until fifteen months to incorporate fresh strawberries and nuts into your child’s diet as these foods more commonly result in allergic reactions and prolonging the exposure may make it easier to detect an allergy. Prolonged exposure to theses foods will not make your child more or less allergic. Infants are typically doing three meals a day and two snacks at nine months old. Children receiving formula generally consume between 16-24 ounces daily. Breastfed children will normally have 4-5 sessions daily. Juice should be limited to no more than 4 ounces daily mixed with water. Encourage your child to use a cup at nine months. Children should be weaned from the bottle by 12 months.

Elimination

Infants are generally having less bowel movements than they previously did. Stools should continue to be soft. If your child is having hard stools, increasing water and fruits and vegetables in the diet may be helpful.

Sleep

It is very important for nine-month-olds to have regular bedtime routines to promote healthy sleep cycles. Your routine may include a bath and a bedtime story. Children at this age should be sleeping through the night. Generally they still require about fourteen hours of sleep daily, so they will likely nap one to two times during the day. Children should not be receiving any bottles or feedings overnight at this point. If you child continues to wake in the night, try to just settle him or her back to sleep.

Development

Children often start to crawl between nine and twelve months. Your child will also become more eager to interact with other people at this point. He or she may exhibit separation anxiety as nine months can be the height of stranger awareness. Nine-month -old children begin to use gestures such as pointing as well as vocalizations to let you know what they want. They may also start to show their preferences more clearly such as refusing to eat certain foods.

Safety

Nine month old children must continue to remain in rear-facing car seats until they are at least twelve months AND twenty pounds. The newest recommendations encourage that keep you child rear-facing for as long as possible as this remains the safest position for young children. Make sure to check the specifications of you child seat as the various height and weight limits vary from model to model.

As you child become more mobile, ensure that you home is a safe environment for an infant. Outlets should have safety covers on them and cabinet doors should have safety locks. It is also important to have smoke alarms and carbon monoxide detectors in you home to protect your infant as well as the rest of your family.

Health Tips

Generally immunizations are not given at the nine month visit. You will be given a prescription today to have your child’s blood drawn to test his or her lead level and complete blood count. These are standard tests we do at one and two years. You can take this prescription to any lab to have the blood drawn.

Next appointment is at 12 months.

Diet

Twelve month-old children are rapidly gaining fine motor skills. They should be encouraged to use a cup and spoon and to eat finger foods. Children should be weaned from the bottle by twelve months as prolonged bottle use can result in dental caries. Children can switch to whole milk at 12 months old. They will generally consume between twelve and sixteen ounces daily. Avoid small, hard food on which your child may choke. Cut rounds foods (eg, hot dogs, raw carrots or grapes) into thin slices. Include your toddler in family meals by having them in a high chair or booster seat. Toddlers should be receiving three meals a day and two to three nutritious snacks. Children can often consume the same meals the rest of your family is having ensuring that the food is prepared properly and cut into small pieces. Most children at this age are no longer doing jarred foods.

Elimination

Toddler’s bowel movements may vary from multiple times a day to once every couple of days. Children can go for a couple of days without a bowel movement as long as they are having soft stools. If your child is having hard stools, increasing water and fruits and vegetables in the diet may be helpful.

Sleep

Routine continues to be essential for healthy sleep habits at 12 months. Children at this age require a period to relax prior to going to sleep. This should include some type of routine (bedtime story, bath, teeth brushing) which ends with your child soothing him/herself to sleep in their crib. Make sure the space nap times so that your child is tired at bedtime. Often children sleep for 12 hours overnight and take one to two naps daily. Some children are able to climb out of their cribs at this age. Be sure that the crib mattress is at the lowest rung.

Development

Children often start to walk at twelve months. You will notice that your child may become increasingly independent at this age and will prefer to do things for him/herself. Often children are playing interactive games (“peek-a-boo,” “pat-a-cake”). They will imitate activities, wave “good-bye” and be noted to have a strong attachment with a parent or particular caregiver. Children at twelve months should also be able to point to a desired object, imitate sounds, speak one to two words, follow simple directions, identify persons on request, and bang two blocks together. They can generally pull themselves to stand and stand alone momentarily if they are not yet walking. Temper-tantrums may start at this age. When unwanted behavior occurs, “time-outs” may be used. These can take place in a playpen, crib or designated area to protect child from injury and should be brief (one to two minutes).

Safety

Twelve month old children may switch to a forward facing car seat IF they are at least twenty pounds. The newest recommendations, however, encourage that you keep your child rear-facing for as long as possible as this remains the safest position for young children. Make sure to check the specifications of you child seat as the various height and weight limits vary from model to model.

As you child become more mobile, ensure that you home is a safe environment for an infant. Outlets should have safety covers on them and cabinet doors should have safety locks. It is also important to have smoke alarms and carbon monoxide detectors in you home to protect your infant as well as the rest of your family. You should use safety gates at the top and bottom of stairs. To prevent children from falling out of windows, keep furniture away from windows and install window guards on higher-story windows.

Health Tips

Immunizations may be given today. Your child may have a fever and be fussy for twenty-four hours after the vaccines. You may give Tylenol or Motrin as needed according to the dosing chart to help with any discomfort. They injection site may get red or swollen. Ice can help. You should have received a prescription at your last visit to have your child’s blood drawn to test his or her lead level and complete blood count. These are standard tests we do at one and two years. If you have not already gone, you can take this prescription to any lab to have the blood drawn.

Next appointment is at 15 months.