Educational Materials for 6 Month Well-Visit

The topics listed below are based on American Academy of Pediatrics national recommendations about the kinds of things that are important to discuss or get more information about for children your child's age.

Click on the info to get education and tips from pediatric health care experts about each topic.

How you and your family are doing:

How you balance taking care of yourself while being a parent More Info
How you balance taking care of yourself while being a parent
What is this and why is it important?

Parenting is a 24/7 job—even when you aren’t actually with your child, you are still responsible for his well-being. A key part to a child being happy and healthy is having a parent whose own needs are met.  Where do you and YOUR interests and other responsibilities fit in?

Now that your baby is awake more and perhaps more demanding of your attention, it’s natural for you to need help sometimes. Striking a balance between finding a way to meet the needs of your child without ignoring your own needs is important and is often a challenge.

It is important to find a balance that ensures that the child’s needs are met, and the parent still feels like they has a life as well. Remind yourself of all the interests and things you did before this child was born! Schedule some time for yourself – whether to take a walk, attend a class, get together with friends – and take it seriously.  Maybe you’d like to develop some new interests and skills? Learn what’s available in your community – check at the library or in the newspaper or through adult education sources.  Also, don’t forget your own health appointments.

You can talk to your child’s health care provider about how to balance taking care of yourself while being a parent if you have any concerns about this. Your child’s health care provider sees many parents and may know about different strategies that other parents use to balance meeting their child’s needs while meeting their own.

What are common questions I can ask my health care provider?
  • Is it ok to let my child play by himself when I have other things to do – how much time does he need me?
  • My partner has been leaving more of the care giving to me now that my child is getting older. What should I say so he/she continues to spend quality time with my child?
  • How do I know when I need to contact the doctor or ER for a sick child?
Where can I find more information about this topic?

Family Functioning and the 6 Month Visit: Help Wanted (AAP)

Parenting: Being supermom stressing you out? (APA)

Parenting: High expectations, dads and stress (APA)

How Becoming Parents Can Affect Your Relationship (KidsHealth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Making sure you have somewhere or someone to turn to for emotional support More Info
Making sure you have somewhere or someone to turn to for emotional support
What is this and why is it important?

At 6 months, your child is still very dependent on you. It can be a challenge to meet the needs of your child and still have time for yourself, your partner and other family members.  Even though infants usually are lovable, most parents have moments of frustration, and even anger, with their baby. Feeling this way is common and normal. Support from family, friends and your health care provider can help you through rough times. It’s important to have someone – friend or professional – who can really listen to you. It’s also important to make time to get out, to resume friendships and the activities you were interested in before the birth of your child.
 
Your child’s health care provider can talk with you about how you are handling the role of being a parent and ways to balance that role, while also making sure that your own needs are met.

What are common questions I can ask my health care provider?
  • It’s amazing how much time babies take! How can I make more time for myself?
  • I still feel tired so much of the time. Is this normal and how can I get more rest?
  • What are some tips for balancing work and being a parent?
  • I am with the baby most of the time and feel very isolated. Is this normal?
Where can I find more information about this topic?

Family Functioning and the 6 Month Visit: Help Wanted (AAP)

How Becoming Parents Can Affect Your Relationship (KidsHealth)

Replenish thyself: Steering clear of parent burnout (KidsGrowth)

How To Avoid the Hyper-Parenting Trap (KidsGrowth)

A "Perfect" Parent (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Issues related to childcare, such as a nanny, daycare or babysitters More Info
Issues related to childcare, such as a nanny, daycare or babysitters
What is this and why is it important?

Childcare can mean a loving grandparent who cares for your child, a teenager who babysits for you from time to time or a childcare center or fulltime nanny. It’s likely that you use a combination of the above.  Finding childcare that is best for your child and your family’s needs can be a challenge.

At this age lots of parents are back at work. No one else will provide care exactly the way you do – and that’s okay. When considering different childcare options, think about what is important to you and what your child’s needs are.  Make sure these priorities are met and that the care your child receives is loving, caring and safe.

In child care, the ratio of babies to adults is absolutely critical – it should not be more than three babies to one adult. Equally important is the caregiver’s ability to understand and respond to each baby as an individual. Be sure to check references and spend some time watching caregivers with your child to be sure their styles match what you want for your child before choosing one.  It’s a good idea to have backup plans as well—consider who you can call on if your regular caregiver is unavailable.  There are many resources for finding, screening and choosing high quality childcare for your child.  ChildCareAware has many resources for finding, screening and choosing high quality childcare for your child, learn more at their website.

You can talk to your child’s health care provider about issues related to childcare.

What are common questions I can ask my health care provider?
  • I don’t want to upset our childcare provider by asking too much. What are reasonable duties for a childcare worker?
  • Where can I go to find out how to choose a good sitter or childcare center?
  • My mother has some old-fashioned ideas about child care. How do I ask my mother to respect my childcare wishes?
  • What would happen if my child gets sick while in someone else’s care? How can I make sure my child gets medical care if I’m not there?
Where can I find more information about this topic?

Checklist: Is This the Right Place for My Child? (NACCRRA)

Child Care Aware: Parent Publications (CCA)

A Guide for Families (NAEYC)

National Association for the Education of Young Children

Child Care and Early Childhood Programs (MCH Library)

Choosing and Instructing a Babysitter (KidsHealth)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

National Association of Child Care Resource & Referral Agencies (NACCRRA). Child Care Aware. http://www.childcareaware.org/. Accessed 4/1/2010.

How your child is developing:

Behaviors to expect in the next few months More Info
Behaviors to expect in the next few months
What is this and why is it important?

You’re probably seeing lots of changes in what your child can do now and also what he is getting ready to do. Every day brings a new talent—and often a new challenge!  Especially in terms of keeping your child safe.  By this age, a baby’s personality seems to be clearer and more predictable. Your child’s tendencies and signs of temperament- a child’s style of dealing with his world – are now full expressed.

From age four to seven months, the most important changes take place within your child. This is the period when he will learn to coordinate his emerging perceptive abilities (the use of senses like vision, touch, and hearing) and his increasing motor abilities to develop skills like grasping, rolling over, sitting up, and possibly even crawling.  He will be developing his “pincer” grasp – using his index finger and thumb to pick things up. Your child will increasingly enjoy social play and will respond to other people’s expressions of emotions and he appears joyful often.

“Tummy time” is still important for this age. And if you put your child in a highchair or upright seat some of the time, this will give him a chance to look around and interact with others. You can also play games – pat-a-cake, peek-a-boo, so-big and reading and singing. These kinds of activities are not only fun for you and your child – they’re the beginning steps in learning to communicate. If you have questions or concerns about your child’s development, this visit is a good time to ask about them. Children’s development varies so much, but on the other hand, you may be noting a concern that could be addressed early.   Your baby will also be “talking” more every day. At least he’s making more and more sounds. And he’s learning that there are other ways to communicate - like pointing.

Beyond 7 months, you will see your child’s behavior change around new people. At around 8 or 9 months, your child might sometimes seem like two separate babies. First there’s the one who’s open, affectionate, and outgoing with you. But then there’s another who’s anxious, clinging, and easily frightened around unfamiliar people or objects. Some people may tell you that your child is fearful or shy because you’re “spoiling” him , but don’t believe it. His widely diverse behavior patterns aren’t caused by you or your parenting style; they occur because he’s now, for the first time, able to tell the difference between familiar and unfamiliar situations. If anything, the predictable anxieties of this period are evidence of his healthy relationship with you.

Anxiety around strangers is usually one of the first emotional milestones your baby will reach. When your child was three months old, he might have interacted calmly  with people he didn't know so it can be surprising when you see him start to tense up when strangers come too close. This is normal for this age, and you need not worry. Even relatives and frequent babysitters with whom your baby was once comfortable may prompt him to hide or cry now, especially if they approach him hastily.  How long should you expect this anxiety to last? It usually peaks between ten and eighteen months and then fades during the last half of the second year.

You can talk to your child’s health care provider about behaviors to expect in the next few months.

What are common questions I can ask my health care provider?
  • Should I play with my child with his toys or just leave it to him to decide what to do with them?
  • What are some top ways that I can promote my child’s development?
  • My best friend’s child is the same age as mine, but my friend's child can do lots more - should I worry?
Where can I find more information about this topic?

Infant Development: Some Highlights of the 6 Month Health Visit (AAP)

The Magic of Everyday Moments: 4 to 6 Months (Zero to Three)

From Baby to Big Kid: Month 6 (Zero to Three)

Your Baby's Development: 6 to 9 Months (Zero to Three)

Growth Milestones: 6 Months (KidsGrowth)

References

American Academy of Pediatrics (AAP). Developmental Milestones: 7 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/pages/Developmental-Milestones-7-Months.aspx

AAP. Emotional and Social Development: 8 to 12 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/pages/Emotional-and-Social-Development-8-12-Months.aspx

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

What your child is able to understand More Info
What your child is able to understand
What is this and why is it important?

Your 6-month-old knows his name now and understands that you're speaking to him when you say it. He'll even respond by turning toward you. He's becoming more familiar with changes in your tone of voice, too. Talk to your baby, and he will talk to you. When you sound happy, he'll react joyfully, and if you speak to him sharply he'll become distressed and may cry.

Babies learn in many ways – watching and imitating you or older siblings, paying close attention to your conversations and games, mouthing anything they can grab.  When he bangs certain things on the table or drops them on the floor, he’ll start a chain of responses from his audience, including funny faces, groans, and other reactions that may lead to the reappearance—or disappearance—of the object. Before long, he’ll begin dropping things intentionally to see you pick them up. As annoying as this may be at times, it’s one important way for him to learn about cause and effect and his personal ability to influence his environment.

It’s important that you give your child the objects he needs for these experiments and encourage him to test his “theories.” But make sure that everything you give him to play with is unbreakable, lightweight, and large enough that he can’t possibly swallow it. If you run out of the usual toys or he loses interest in them, plastic or wooden spoons, unbreakable cups, and jar or bowl lids and boxes are endlessly entertaining and inexpensive.

Another major discovery that your baby will make toward the end of this period is that objects continue to exist when they’re out of his sight—a principle called object permanence. During his first few months, he assumed that the world consisted only of things that he could see. When you left his room, he assumed you vanished; when you returned, you were a whole new person to him . In much the same way, when you hide a toy under a cloth or a box, he thought it was gone for good and wouldn’t bother looking for it. But sometime after four months, he’ll begin to realize that the world is more permanent than he thought. You’re the same person who greets him every morning. His teddy bear on the floor is the same one that was in bed with him the night before. The block that you hid under the can did not actually vanish after all. By playing hiding games like peekaboo and observing the comings and goings of people and things around him , your baby will continue to learn about object permanence for many months to come.

You can talk to your child’s health care provider about what he is able to understand.

What are common questions I can ask my health care provider?
  • What are the best toys to give my child?
  • How much should I talk and explain things to my child – I feel like he can’t really understand anything that I am saying?
  • What can I do to encourage my child’s development and skills?
Where can I find more information about this topic?

Cognitive Development: 4 to 7 Months (AAP)

Infant Development: Some Highlights of the 6 Month Health Visit (AAP)

The Magic of Everyday Moments: 4 to 6 Months (Zero to Three)

Your Baby's Development: 6 to 9 Months

References

American Academy of Pediatrics (AAP). Cognitive Development: 4 to 7 Month. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/pages/Cognitive-Development-4-to-7-Months.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How your child communicates his needs More Info
How your child communicates his needs
What is this and why is it important?

Your 6-month-old has a definite personality! Figuring out his moods, what makes him happy, what makes him mad and the best ways to soothe him when he’s crying are very important.  Respecting your child’s likes and dislikes help him learn that he is important as an individual.

Your participation in your child’s language development will become even more important after six or seven months, when he begins actively imitating the sounds of speech. Up to this point, he might repeat one sound for a whole day or even several days at a stretch before trying another. But now he’ll become much more responsive to the sounds he hears you make, and he’ll try to follow your lead. So introduce him to simple syllables and words such as “baby,” “cat,” “dog,” “go,” “hot,” “cold,” and “walk,” as well as “Mama” and “Dada.” Although it may be as much as a year or more before you can interpret any of his babbling, your baby can understand many of your words well before his first birthday.

If he doesn’t babble or imitate any sounds by his seventh month, it could mean a problem with his hearing or speech development. A baby with a partial hearing loss still can be startled by loud noises or will turn his head in their direction, and he may even respond to your voice. But he will have difficulty imitating speech. If your child does not babble or produce a variety of sounds, alert your pediatrician. If he has had frequent ear infections, he might have some fluid remaining in his inner ear, and this could interfere with his hearing.

Special equipment is used to check a very young baby’s hearing. All newborns should be tested for hearing loss. Your observations are the early warning system that tells whether further testing is needed. If you suspect a problem, you might ask your pediatrician for a referral to a children’s hearing specialist.

You can talk with child’s health care provider about tips for understanding your child’s behavior and temperament and ways to read your child’s verbal and non-verbal cues. Your health care provider can also share ideas about how to help your child relax and to soothe or console him .

What are common questions I can ask my health care provider?
  • My child likes us to sing songs to her, is that a good sign for learning to talk?
  • How soon will my child start to say words?
  • When should my child be imitating sounds he hears?
Where can I find more information about this topic?

Healthy start, grow smart (AAP)

Healthy Minds: Nurturing Your Child’s Development from 2 to 6 Months (Zero to Three)

The Magic of Everyday Moments: 4 to 6 Months (Zero to Three)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Kids Health. Communication and Your 4- to 7-Month-Old. Retrieved 4/1/2010 from http://kidshealth.org/parent/growth/communication/c47m.html#

How your child responds to new people or caregivers More Info
How your child responds to new people or caregivers
What is this and why is it important?

During these months, your child sometimes may seem like two separate babies. First there’s the one who’s open, affectionate, and outgoing with you. But then there’s another who’s anxious, clinging, and easily frightened around unfamiliar people or objects. Some people may tell you that your child is fearful or shy because you’re “spoiling” him , but don’t believe it. His widely diverse behavior patterns aren’t caused by you or your parenting style; they occur because he’s now, for the first time, able to tell the difference between familiar and unfamiliar situations. If anything, the predictable anxieties of this period are evidence of his healthy relationship with you.

Anxiety around strangers is usually one of the first emotional milestones your baby will reach. You may think something is wrong when your child who, at the age of three months, interacted calmly with people he didn’t know is now beginning to tense up when strangers come too close. This is normal for this age, and you need not worry. Even relatives and frequent babysitters with whom your baby was once comfortable may prompt him to hide or cry now, especially if they approach him hastily.

As the months pass and your child’s self-concept becomes more secure, he’ll have less trouble meeting strangers and separating from you. He’ll also become more assertive. If your child is experiencing separation anxiety (which we know can be just as hard on you as a parent) here are some tips:

  1. Give baby time. Let your baby warm up to someone new, even someone familiar like a grandparent.
  2. Don’t leave home without blankie. Find an object that comforts your child and make sure he has it when you have to be away.
  3. Don’t feel guilty. Those parting cries can be heart wrenching. But if baby is with a trusted caregiver, go to work or school or out with your spouse and leave the guilt behind.
  4. You’re still number one. Some parents worry that their baby will start to care more about his caregiver than his mommy and daddy. But no one can take your place. In fact, when he cries most loudly for you, it means he trusts you most with his real feelings.

You can talk to your child’s health care provider about how he responds to new people and caregivers.

What are common questions I can ask my health care provider?
  • My child is becoming more apprehensive with even family members – is this normal?
  • I’m returning to work – how will my child handle all the new people who’ll soon be in his life?
Where can I find more information about this topic?

Social and Emotional Skills: Your Infant and Others (AAP)

Separation Anxiety (AAP)

From Baby to Big Kid: Month 6 (Zero to Three)

Preventing Separation Anxiety (KidsGrowth)

How I Grow in your Care: Birth to Eight Months (KidsGrowth)

References

American Academy of Pediatrics (AAP). Emotional and Social Development: 8 to 12 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/pages/Emotional-and-Social-Development-8-12-Months.aspx

AAP Bright Futures. Separation Anxiety. Retrieved 4/1/2010 from http://www.healthyfuturesva.com/detail.aspx?id=150

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Why showing a picture book to or reading with your child is important More Info
Why showing a picture book to or reading with your child is important
What is this and why is it important?

Your child is communicating and learning about the world in many ways – looking at pictures in books and reading to your child promotes closeness as well as language. And it offers you a chance enjoy your child’s interests and emerging skills. 
 
Reading helps with language and speech development – even this early!  At this age babies can see well and enjoy simple picture books, even if they don’t understand the words. Looking, touching, and putting things in mouths are all ways that babies learn, so books that are forgiving and sturdy enough to withstand their interests are good choices.  And because reading involves physical closeness, as you hold your child in your arms, it strengthens the bond you have with her. Interesting things to look at, love and individual attention – what could be better?!  Reading to your child has so many benefits – try to do it every day.

You can talk to your child’s health care provider about the importance of showing a picture book to and reading with your child.

What are common questions I can ask my health care provider?
  • Should I bother to read the words in a book or just name the pictures?
  • My child likes to slap and eat the books – he’s not really following along. Is reading to him beneficial at this point?
Where can I find more information about this topic?

Tips for Parents of Babies (Reading Rockets)

Importance of Reading Aloud (Reach Out and Read)

Reading Tips for Parents and Educators (Reach Out and Read)

Developmental Milestones of Early Literacy (Reach Out and Read)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Establishing consistent daily routines and their impact on behavior More Info
Establishing consistent daily routines and their impact on behavior
What is this and why is it important?

By now, your child (and your family) has probably settled into predictable daily routines for eating, sleeping, napping and play time. If not, now is a great time to start! Consistent daily routines have been shown to have a positive impact on a child’s sleep and overall behavior. Continuing to provide regular structure and routines for your child will increase his sense of security.

Even 6-month-olds may have periods of fussiness and irritability.  Infants who have consistent and predictable daily routines are able to develop their own self-regulation in the first year of life, which leads to better self-regulation later.  While it can be tricky sometimes, strive to have a regular daily schedule for your child – eat around the same times, nap at the same times, allow for regular playtime and a bedtime routine.

Watch for signs of hunger or tiredness, even the signs come at different times each day. Becoming overtired or too hungry leaves babies unable to cope well. Babies let us know what they like and don’t like and you are likely beginning to learn your child’s moods and emotions. Fears may begin to show up - to new people, loud noises, or even to some toys adults think are fun. Whenever possible child preferences should be respected - it’s their way of letting you know what they can like and what they can tolerate. Introduce new people or pets slowly—let your child tell you what’s okay.

If you’re not sure about your child’s routines or how to establish them, your child’s health care provider can help you learn your child’s cues and can suggest ways you can help your child settle into routines.  You can talk to your child’s health care provider about strategies for establishing and keeping a consistent daily routine and its impact on behavior.

What are common questions I can ask my health care provider?
  • How can I predict when my child needs one nap or two a day?
  • Do babies need regular playtimes with me?
  • Our schedule can be pretty unpredictable – what’s most important?
Where can I find more information about this topic?

Infant Development: Some Highlights of the 6 Month Health Visit (AAP)

Make the Most of Playtime (Zero to Three)

References

American Academy of Pediatrics (AAP) Bright Futures. 6 Month Visit - Infant Development. Retrieved 4/1/2010 from http://www.healthyfuturesva.com/Text.aspx?html=v07_development&type=snapshot

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Sleep patterns and sleep routines More Info
Sleep patterns and sleep routines
What is this and why is it important?

By 6 months, some, but not all, babies are sleeping for longer stretches at night (6-8 hours).  Babies this age have usually established regular sleep cycles but you might see that change in the coming weeks (if you haven't already!). However, different infants have different sleep needs.

Prior to this state your child may have been sleeping through the night, but now with the excitement and frustration of learning new skills such as sitting, crawling, and new fine motor tasks, his sleep may be disrupted. One way to get through this is make sure that the naptime and bedtime routines are consistent. Your child still needs two naps or two quiet breaks in the day – mid-morning and mid-afternoon. So, whether he sleeps or not, he should be put into his crib in his room at these times.

Here are some suggestions that may help your baby (and you) sleep better at night.

  • Keep your baby calm and quiet when you feed or change him during the night. Try not to stimulate or wake him too much.
  • Make daytime playtime. Talking and playing with your baby during the day will help lengthen his awake times. This will help him sleep for longer periods during the night.
  • Put your baby to bed when drowsy but still awake. This will help your baby learn to fall asleep on his own in his own bed. Holding or rocking him until he is completely asleep may make it hard for him to go back to sleep if he wakes up during the night. Any soothing activities, performed consistently and in the same order each night, can make up the routine. Your child will associate these with sleeping, and they'll help him wind down. You want your child to fall asleep independently, and a routine encourages babies to go back to sleep if they should wake up in the middle of the night.
  • Wait a few minutes before responding to your child's fussing. See if he can fall back to sleep on his own. If he continues to cry, check on him , but don't turn on the light, play with him , or pick him up. If he gets frantic or is unable to settle himself , consider what else might be bothering him . He may be hungry, wet or soiled, feverish, or otherwise not feeling well.

Experts say that at this age babies should sleep in their own cribs, not in your bed but some cultures view this differently – feel encouraged to discuss this at your visit if you have different ideas. Remember to always put your baby down to sleep on his back, not his tummy or side, even though he may now roll over on his own during sleep.   Be sure your baby’s crib is safe.  The slats should be no more than 2 3/8 inches (60 mm) apart.  The mattress should be firm and fit snugly into the crib.  Keep the sides of the crib up when your child is sleeping in it.  You should not put your baby to bed with a bottle, but if you must, only put water in the bottle, not juice or milk.

Families all need a good night’s sleep and babies are part of the picture. Helping your child settle into good naptime and bedtime patterns benefits everyone.

You can talk to your child’s health care provider about sleep patterns and routines.

What are common questions I can ask my health care provider?
  • We put our child to sleep on his back – but now he rolls over! What should I do?
  • My child wakes up at night and I am sure he is hungry still at night. Is it all right to feed him ?
  • How do I get my child to take longer naps?
  • My mother says I should just let my child cry himself to sleep, but I’m not comfortable doing that. Should I be letting him ?
Where can I find more information about this topic?

Infant Sleep Patterns and Locations (AAP)

Infant Development: Some Highlights of the 6 Month Health Visit (AAP)

US Consumer Products Safety Commission (CPSC)

From Baby to Big Kid: Month 6 (Zero to Three)

References

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Fussiness, irritability and night waking More Info
Fussiness, irritability and night waking
What is this and why is it important?

With the excitement and frustration of learning new skills such as sitting, crawling and new fine motor tasks, is not uncommon for a 6 month old to begin night waking.

One way to get through this is make sure that the naptime and bedtime routines are consistent. Your child still needs two naps or two quiet breaks in the day – mid-morning and mid-afternon. So, whether he sleeps or not, he should be put into his crib in his room at these times.

At bedtime, place your child on his back in the crib when he’s drowsy and massage can help your child go to sleep or return to sleep if he wakes up.

If your child wakes in the night and cries for you, wait for about five minutes.  He may be able to fall back to sleep by himself .   If his crying continues, here are some tips:

  • Check on him , but don't turn on the light, play quietly with him , or pick him up. If he gets frantic or is unable to settle himself , consider what else might be bothering him . He may be hungry, wet or soiled, feverish, or otherwise not feeling well. As tempting as it may be to calm him down with food or cuddling, he’ll learn and come to expect these responses when he wakes up and night and he won’t go back to sleep without them.
  • Also, don’t feed your child unless you have a reason to believe he’s really hungry (e.g,. if he fell asleep earlier than usual and missed a feeding). If your baby is already feeding at night, gradually decrease the amount (or time at breast) until the feeding can be discontinued.
  • Limit each daytime nap to no longer than 3 hours a day.

You can talk to your child’s health care provider about night waking and fussing. 

What are common questions I can ask my health care provider?
  • We’re so tired - how do other parents handle night waking?
  • He’s so adorable that even when he wakes at night we can’t resist picking him up and playing with him . Is this advisable?
Where can I find more information about this topic?

Good Night, Sleep Tight (AAP)

Sleep and Your 4 to 7-Month-Old

Baby sleep basics: 3 to 6 months (BabyCenter)

Calming A Fussy Baby (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Your child’s moods and emotions More Info
Your child’s moods and emotions
What is this and why is it important?

Between four and seven months, your baby may undergo a dramatic change in personality. At the beginning of this period, he may seem relatively passive and preoccupied with getting enough food, sleep, and affection. But as he learns to sit up, use his hands, and move about, he’s likely to become increasingly assertive and more attentive to the world outside. He’ll be eager to reach out and touch everything he sees, and if he can’t manage on his own, he’ll demand your help by yelling, banging, or dropping the nearest object at hand. Once you’ve come to his rescue, he’ll probably forget what he was doing and concentrate on you—smiling, laughing, babbling, and imitating you for many minutes at a stretch. While he’ll quickly get bored with even the most engaging toy, he’ll never tire of your attention.

Key emotional milestones for this age are that he enjoys social play, responds to expressions of emotions, and often appears joyful. The more subtle aspects of your baby’s personality are determined largely by his constitutional makeup or temperament. Is he rambunctious or gentle? Easygoing or easily upset? Headstrong or compliant? To a large extent, these are inborn character traits. Just as infants come in different sizes and shapes, their temperaments differ as well. Their unique character traits include their activity levels, their persistence, and their adaptability to the world around them—and these traits will become increasingly apparent during these months. You won’t necessarily find all of their personal characteristics enjoyable all the time—especially not when your determined six-month-old is screaming in frustration as he lunges for the family cat. But in the long run, adapting to his natural personality is best for both of you. And because your baby’s temperament is real and directly affects you and the rest of the family, it’s important to understand him as completely as possible.

As you’ve probably discovered already, some infants of this age are “easy,” calm and predictable, while others are much more difficult. Strong-willed and high-strung babies require an extra dose of patience and gentle guidance. They often don’t adapt to changing surroundings as easily as calmer babies, and will become increasingly upset if pushed to move or perform before they’re ready. To a large degree, you’ll fare better not by trying to change your child’s temperament, but by accommodating it. You can reduce the stresses of rearing an infant by recognizing and acknowledging his temperament rather than resisting or working against it.

Language and cuddling sometimes will do wonders to calm the nerves of an irritable child. Distracting him can help refocus his energy. For instance, if he screams because you won’t go get the toy he dropped for the tenth time, move him to the floor so he can reach the toy himself .

The shy or “sensitive” child also requires special attention, particularly if you have more boisterous children in the household who overshadow him . When a baby is quiet and undemanding, it’s easy to assume he’s content, or if he doesn’t laugh or smile a lot, you may lose interest in playing with him . But a baby like this often needs personal contact even more than other children. He may be overwhelmed easily and needs you to show him how to be assertive and become involved in the activities around him . How should you do this? Give him plenty of time to warm up to any situation, and make sure that other people approach him slowly. Once he feels secure, gradually he’ll become more responsive to the people around him .

You can talk to your child’s health care provider about his moods and emotions.

What are common questions I can ask my health care provider?
  • My child is so irritable and fussy most of the time, am I doing something wrong?
  • My child is so quiet and always seems content, it’s easy to overlook him with my rambunctious 3-year-old, does he notice?
  • My child doesn’t seem to adapt to changes in routine or settings well, how can I help him develop this skill?
Where can I find more information about this topic?

Emotional and Social Development: 4 to 7 Months (AAP)

Social-Emotional Development: Birth to 12 Months (Zero to Three)

How I Grow in your Care: Birth to Eight Months (KidsGrowth)

References

American Academy of Pediatrics (AAP). Emotional and Social Development: 4 to 7 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/pages/Emotional-and-Social-Development-4-7-Months.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

“Back-to-sleep” and crib safety - avoiding soft toys and bedding More Info
“Back-to-sleep” and crib safety - avoiding soft toys and bedding
What is this and why is it important?

Your child’s sleep environment needs to be safe to prevent suffocation. Research studies show that the safest sleep position for infants is on their backs. The “back to sleep” campaign has been linked to fewer infant deaths from Sudden Infant Death Syndrome (SIDS) – overall SIDS rates have declined by 50% since this campaign started. Even though he may roll over now on his own during sleep, you should still put him down on his back.

Cribs and playpens should meet current safety standards.  The slats should be no more than 2 and 3/8 inches (60 mm) apart.  The matress should be firma nd fit snugly into the crib.  Keep the sides f the crib raised when your baby is sleeping in it.  Be sure that it is certified by the Juvenile Products Manufacturers Association (JPMA).  Be especially sure to check if you’re using older equipment – standards have changed.  While soft toys and bedding, including bumpers, seem cozy, they increase the risk for suffocation for babies and are not recommended by experts. Bumper pads can also be used as steps as your child begins to stand, which is dangerous.

Parents and caregivers often worry about their baby developing a flat spot on the back of the head because of sleeping on the back. Though it is possible for a baby to develop a flat spot, it usually rounds out as they grow older and sit up. There are ways to reduce the risk of the baby developing a flat spot:

  1. Alternate which end of the crib you place your child’s feet. This will cause him to naturally turn toward light or objects in different positions, which will lessen the pressure on one particular spot on his head.
  2. When your child is awake, vary his position. Limit time spent in freestanding swings, bouncy chairs, and car seats. These items all put added pressure on the back of your baby’s head.
  3. Spend time holding your baby in your arms as well as watching him play on the floor, both on his tummy and on his back.
  4. A breastfed child would normally change breasts during feeding; if the baby is bottle fed, switch the side that he feeds on during feeding.

You can talk to your child’s health care provider about sleep and crib safety.

 

What are common questions I can ask my health care provider?
  • Grandma isn’t sure “back to sleep” is necessary at this age – should I try to convince her?
  • At what age can I safely let him sleep on histummy?
  • My child’s head looks flat on the back – what can be done about that?
  • What do I do if my child rolls over onto his tummy while he’s sleeping?
  • Are bumpers ok to have in the crib? If not, why do most children’s stores sell them?
Where can I find more information about this topic?

Choosing a Crib (AAP)

Reducing the risk of SIDS (BabyCenter)

Safe Sleep for Your Baby: Reduce the Risk of Sudden Infant Death Syndrome (SIDS) (NICHD)

Preventing injuries: at home, at play, and on the way (SafeKidsUSA)

Baby Safety Basics (SafeKidsUSA)

References

American Academy of Pediatrics (AAP). Back to Sleep, Tummy to Play. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

National Institute of Child Health and Human Development (NICHD). Back to Sleep Public Education Campaign. Retrieved 4/1/2010 fromhttp://www.nichd.nih.gov/sids/

Tips for calming and relaxing your child More Info
Tips for calming and relaxing your child
What is this and why is it important?

All babies have fussy times. That’s a given!  As you’ve probably discovered already, some infants at this age are “easy,” calm and predictable, while others are much more difficult. Strong-willed and easily-excitable babies require an extra dose of patience and gentle guidance. They often don’t adapt to changing surroundings as easily as calmer babies, and will become increasingly upset if pushed to move or perform before they are ready. To a large degree, you’ll fare better by accommodating your child’s temperament, not by trying to change it.  You can reduce the stresses of parenting an infant by recognizing and acknowledging his temperament rather than resisting or working against it.

Talking and cuddling can do wonders to calm the nerves of an irritable child. Distracting him or changing his surroundings can also help refocus him energy. For instance, if he screams because you won’t retrieve the toy he dropped for the tenth time, move him to the floor so he can reach the toy himself .

Here are some basic tips for calming and relaxing your child:

  • Hold him!
  • Turn on a calming sound (such as a white noise device, the humming sound of a fan or the recording of a heartbeat)
  • Walk around with your child in a carrier or holding him
  • Avoid overfeeding
  • If it is not yet time to feed your child, offer the pacifier
  • If food sensitivity is the cause of discomfort, a change in diet may help.
  • Keep a diary of when your baby is awake, asleep, eating and crying so you can identify patterns and red flags.
  • Limit each daytime nap to no longer than 3 hours a day

And remember, if you ever think you might do something in frustration that would hurt the child, try to discuss this ahead of time with your health care provider. And have numbers nearby to call for help.

You can talk to your child’s health care provider about tips for calming and relaxing your child.

What are common questions I can ask my health care provider?
  • How much fussiness is too much – when should I think there is really something wrong?
  • What number(s) could I call for help if I’m really frustrated?
Where can I find more information about this topic?

Crying & Colic: Parent Resources (AAP)

Self Regulation: A Matter of Time (AAP)

Soothing the Stress (PBS)

Fussy baby Index (DrSears)

References

American Academy of Pediatrics (AAP). Healthy Children. http://www.healthychildren.org/English/Pages/default.aspx. Accessed 4/1/2010.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How your child is eating and growing:

Understanding feeding time behaviors More Info
Understanding feeding time behaviors
What is this and why is it important?

Your 6-month-old is maturing rapidly and acquiring a whole new set of skills by eating solid foods – this transition can be a tricky period to understand his feeding time behaviors! 

As you begin solids, it is important to feed your child in a bouncy seat or high chair that is adjusted to make sure his head, trunk and feet are supported and so that you can look at each other.  Your child’s arms also should be free, as this is his way of communicating with you.  Your child will want to hold one spoon while you feed him from another. And you can expect him to drop the spoon, look down for it and then look up at you to pick it up – yes, he is learning about object permanence and this fun game begins.

You can begin offering sips of breast milk, formula or water from a small sippy cup held by you, but an infant this age is unlikely or unable to take adequate amounts of fluids and energy needs in a cup.  When you are drinking from a cup, let him hold the glass for you and then offer him a sip.  This kind of play and experimentation that accompany feeding are to be enjoyed and encouraged.  His “pincer” grip will also be developing – where he can pick something up with his index finger and thumb.  Letting him explore these skills will enhance your child’s own sense of his independence in the feeding area and will ward off many problems.

Your child may tell you when he’s full or doesn’t want food by leaning back and turning away.  As with all feeding interactions, watch your child’s verbal and nonverbal cues and use that determine whether your child has had enough. Responding appropriately to your child’s behaviors during feedings lets him know that you understand his needs so you can provide the appropriate amount of food at a feeding.  Remember, you are responsible for providing a variety of nutritious foods, but he is responsible for deciding how much to eat. If a food is rejected, move on and try it again later.  Don’t force him to eat or finish foods.  Feeding time is a social event.  Include your child at family meals, and develop the habit of eating as a family at the table. 

Of course, when offering a bottle, it is still very important to continue to hold your child so that you can see each other and communicate with each other.  Your child then will be able to let you know when he is still hungry and when he is full.

You can talk to your child’s health care provider about feeding time strategies.

What are common questions I can ask my health care provider?
  • How will I know when my child is full?
  • When can I teach my child to drink from a cup and how do I start?
  • Should my 6-month-old eat separately from family mealtimes or together?
Where can I find more information about this topic?

Feeding Solid Foods (The Children's Clinic)

Nutrition News at the 6 Month Health Visit (AAP)

Healthy Nutrition: Introducing Solid Foods (AAP)

Help Me Be Healthy: 6 to 12 Months (AAP)

References

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

What to feed your child, what to avoid More Info
What to feed your child, what to avoid
What is this and why is it important?

Breast milk or iron-fortified formula should be given for the first 12 months of life. These will continue to be the primary source of nutrition for the next several months. Most babies are ready to eat solid foods at 6 months of age. Before this age instead of swallowing the food, they push their tongues against the spoon or the food because this tongue-pushing reflex is necessary when they are breastfeeding or drinking from a bottle. Most babies stop doing this at about 4 months. Energy needs of babies begin to increase around this age as well, making this a good time to introduce solids.

You may start solid foods with any meal of the day – breakfast, lunch, dinner or snack time. You can try to schedule feedings during meals that your family eats together but if your baby is easily distracted, you may want to pick a quiet time when you can focus on feeding him . However, keep in mind that as your child gets older, he will want to eat with the rest of the family.

For most babies it does not matter what the first solid foods are. By tradition, single-grain cereals are usually introduced first. However, there is no medical evidence that introducing solid foods in any particular order has an advantage for your baby. Though many pediatricians will recommend starting vegetables before fruits, there is no evidence that your baby will develop a dislike for vegetables if fruit is given first. Babies are born with a preference for sweets, and the order of introducing foods does not change this. If your baby has been mostly breastfeeding, he may benefit from baby food containing meat, which has more easily absorbed sources of iron and zinc that are needed by 4 to 6 months of age. Be sure to discuss this with your child's doctor.

Baby cereals are available premixed in individual containers or dry, to which you can add breast milk, formula or water. Premixed baby cereals are convenient, while dry cereals are richer in iron and allow you to control the thickness of the cereal. Whichever type of cereal you use, make sure that it is made for babies because these cereals contain extra nutrients your baby needs at this age.

Avoid honey, cow’s milk, egg whites, chocolate, nuts, peanut butter, and shellfish until at least one year old. Acidic foods like strawberries,
raspberries, oranges and tomatoes may cause a rash in the first year of life and should also be postponed. Many pediatricians recommend against giving eggs and fish in the first year of life because of allergic reactions, but there is no evidence that introducing these nutrient-dense foods after 4 to 6 months of age determines whether your baby will be allergic to them. 

Give your baby one new food at a time, and wait at least 2 to 3 days before starting another. After each new food, watch for any allergic reactions such as diarrhea, rash or vomiting. If any of these occur, stop using the new food and consult with your child’s doctor.

Once your baby learns to eat one food, gradually give him other foods. Generally, meats and vegetables contain more nutrients per serving than fruits or cereals. When your child begins to pick things up with his pointer finger and thumb, he is ready to try finger foods like cheerios, pasta, cooked peas, small pieces of fruit, and cheese. If gagging occurs, wait several weeks, and try again.

Within a few months of starting solid foods, your baby’s daily diet should include a variety of foods each day that may include the following:

  • Breast milk and/or formula
  • Meats
  • Cereal
  • Vegetables
  • Fruits

Discuss any supplements, vitamins or herbs you’re using or considering with your child’s health care provider.

In the resources you will find a list of tips to consider when your child is starting solids.  You can also talk to your child’s health care provider about what to feed your child and what to avoid if you have questions or concerns.

What are common questions I can ask my health care provider?
  • Will my child now get most of his nutrition from food or it still from formula or breast milk?
  • What foods should I begin to offer?
  • Should I mash up food we eat or buy child food?
Where can I find more information about this topic?

Switching To Solid Foods (AAP)

Nutrition News at the 6 Month Health Visit (AAP)

Healthy Nutrition: Introducing Solid Foods (AAP)

Feeding Solid Foods (The Children's Clinic)

Help Me Be Healthy: 6 to 12 Months (AAP)

References

American Academy of Pediatrics (AAP). Switching to Solid Foods. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

How much food your child needs, weight gain More Info
How much food your child needs, weight gain
What is this and why is it important?

How much food your child needs
Breast milk or iron-fortified formula continues to be the primary source of nutrition for the next several months.  At this age you most likely have started or will start the introduction of solid foods.   With complementary solids, breastfed babies usually breastfeed 4-6 times a day and formula fed babies usually consume from 24-32 ounces per day or up to 42 oz for larger infants. Gradually introduce solid foods by offering them 2-3 times per day and let him decide how much to eat.  At each of the meals, your child should eat about 4 ounces (120ml) of strained baby food.

As with all feeding interactions, watch your child’s verbal and nonverbal cues for when he is full and use that determine whether your child has had enough.  Responding appropriately to your child’s behaviors during feedings lets him know that you understand his needs so you can provide the appropriate amount of food at a feeding.  Remember, you are responsible for providing a variety of nutritious foods, but he is responsible for deciding how much to eat. If a food is rejected, move on and try it again later.  Don’t force him to eat or finish foods. 

AT 6 months, a typical feeding schedule might be as follows:

  • 7:00 A.M. Breast milk or formula feeding
  • 8:30 A.M. Fruit, cooked and strained
  • 12:00 P.M. Meat, vegetables, and breast milk or formula
  • 3:00 P.M.  Water
  • 5:00 P.M.  Cereal and cooked and strained fruit
  • 6:30 P.M.  Breast milk or formula feeding
  • 10:30 P.M. Fourth breast milk or formula feeding

By separating out solid food meals at first for the morning and afternoons, your child can get accustomed to four breast milk/formula feedings.  When he is used to them, the solid and breast milk/formula feedings can be combined. 

Weight gain
Between four and seven months, your baby continues to gain approximately 1 to 1-1/4 pounds (0.45 to 0.56 kg) a month. By the time he reaches his eight month birthday, he probably will weigh about two and a half times what he did at birth. His bones also will continue to grow at a rapid rate. As a result, during these months his length will increase by about 2 inches (5 cm) and his head circumference by about 1 inch (2.5 cm).  It is typical for his growth to slow down a little after 6 months compared to the rapid growth that occurs during the first several months.

Your child’s specific weight and height are not as important as his rate of growth. Your health care provider will continue to plot his measurements at regular intervals to make sure he keeps growing at the same rate. If you find that he’s beginning to follow a different curve or gaining weight or height unusually slowly, you and your pediatrician will discuss this.

You can talk to your child’s health care provider about how much food your child needs and his weight gain.

What are common questions I can ask my health care provider?
  • People say my child is big/small for his age. What is the ideal size for my 6-month-old?
  • How many feedings should my child have at this age?
  • Is it all right to still have feedings during the night?
Where can I find more information about this topic?

How Often and How Much Should Your Baby Eat? (AAP)

Healthy Nutrition: Infant Growth (AAP)

Help Me Be Healthy: 6 to 12 Months (AAP)

Growth Charts (KidsHealth)

Growth and Your 4 to 7-Month-Old (KidsHealth)

References

American Academy of Pediatrics (AAP). Physical Appearance and Growth: 4 to 7 Months. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

Brazelton, Terry and Sparrow, Joshua. Touchpoints: Birth to Three, 2nd Edition. Massachusetts: Da Capo Press, 2006.

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Vitamins your child may or should take More Info
Vitamins your child may or should take
What is this and why is it important?

Not getting needed vitamins can negatively affect a child’s growth and development.  Supplementing your child’s diet depends on whether your child is breastfed or formula fed, whether he's full-term and healthy and if he gets any sunshine. If your child was born prematurely or has any health problems, consult his health care provider about the need for special vitamin supplementation. As your child gets older, his intake of solid foods will help determine his need for a multivitamin-mineral supplement.

Vitamin D
Breastfed infants need supplemental vitamin D. Vitamin D is important in preventing rickets which leads to softening and weakening of the bones. This vitamin is naturally manufactured by the skin when it is exposed to sunlight. However, the American Academy of Pediatrics feels strongly that all children should be kept out of the direct sun as much as possible and wear sunscreen while in the sun to avoid long-term risk of sun exposure, which may contribute to skin cancer. Sunscreen keeps the skin from manufacturing vitamin D. For that reason, talk to your pediatrician about the need for supplemental vitamin D drops. The current Academy recommendation is that all infants and children should have a minimum intake of 400 IU (International Units) of vitamin D per day beginning soon after birth. Be sure to talk to your child’s health care provider before starting these.
 
While formula-fed infants receive Vitamin D supplementation from the formula, research has shown that the amount consumed may not be adequate to meet the 2008 AAP recommendation of 400 IU per day.  Check the label of your formula to see if you need to give a Vitamin D supplement to your 6-month-old. 

Once your baby is one-year-old and if he is drinking whole cow’s milk, it is vitamin D fortified and a vitamin D supplement is no longer needed. Your baby also may need vitamin supplements if he was born prematurely or has certain other medical problems. Discuss the need for supplements of vitamins or minerals with your doctor.  Be sure to talk to your child’s health care provider before starting these.

Iron
Most babies are born with sufficient reserves of iron that will protect them from anemia. If your baby is breastfed, there is sufficient, well-absorbed iron to give him an adequate supply so that no additional supplement is necessary. When he is between four and six-months-old, you should be starting your breastfed infant on baby foods that contain supplemental iron (cereals, meats, green vegetables), which should further guarantee sufficient iron for proper growth.

If you are bottle-feeding your baby, it is now recommended that you use iron-fortified formula (containing from 4 to 12 mg of iron) from birth through the entire first year of life. Premature babies have fewer iron stores, so they often need additional iron beyond what they receive from breast milk or formula. 

Mothers Who Are Breastfeeding
If you breastfeed, don't forget that your diet affects the quality of your breast milk. So make sure you are eating a balanced diet and getting adequate nutrition. Be sure to take a multivitamin-mineral supplement while you're breastfeeding. And if you're vegan and breastfeeding, it's important to have a reliable source of vitamin B12 — preferably from a supplement — so that your child's diet will also contain adequate amounts of the vitamin which is critical for development of your baby’s  nervous system and  for prevention of anemia.  

You can talk to your child’s health care provider about vitamins you and your child may or should take.

What are common questions I can ask my health care provider?
  • Isn’t my child getting everything needed from breast milk or formula?
  • If I take vitamins won’t that be enough while I am breastfeeding?
  • Should my child be out in the sun more to get Vitamin D?
  • My child has started solid foods, will that give my child all the vitamins needed?
Where can I find more information about this topic?

Vitamin & Iron Supplements (AAP)

Vitamin D and Your Baby (AAP)

Healthy Nutrition: Infant Growth (AAP)

Vitamin D Deficiency Clinical Report (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Swinney, B. Should I give my baby vitamin supplements? Retrieved 4/1/2010 from http://www.babycenter.com/404_should-i-give-my-baby-vitamin-supplements_9154.bc

Guidance on breast feeding More Info
Guidance on breast feeding
What is this and why is it important?

Breastfeeding still provides the most important nutrition for your child. You probably know that breastfeeding is recommended for at least the first year of life and beyond for as long as mutually desired by mother and child. There is no upper limit to the duration of breast-feeding and breastfeeding continues to offer benefits to mother and child. 

Since your 6-month-old is beginning solid foods, you will be breastfeeding approximately 4-6 times per day. From ages 6 to 12 months, breast milk and solid foods provide the best nutrition for your child.  Your child’s health care provider can talk with you about any issues you are having with breastfeeding and any supplements, vitamins or herbs you may consider.

Weaning ages vary considerably from child to child.  Although breastfeeding is recommended for at least 12 months, some infants are ready to wean earlier than that.  If you suspect that your child is ready to wean but you are willing to continue breastfeeding for as long as you can, meet with a lactation specialist first to determine if there are some strategies you can try.

Some women think that when they are sick, they should not breastfeed. But, most common illnesses, such as colds, flu, or diarrhea, can't be passed through breast milk. In fact, if you are sick, your breast milk will have antibodies in it. These antibodies will help protect your child from getting the same sickness.

If you’re returning to work (or already have) you may find that you need to make adjustments that meet your child’s needs and your schedule.   You can combine breastfeeding and the use of bottles with breast milk or formula to help you meet your needs if you’re back at school or work.
Be sure to store breast milk in clean containers. Try to use screw-cap bottles, hard plastic cups with tight caps or special heavy nursing bags that can be used to feed your child. Make sure to keep it stored in a refrigerator. Freeze the breast milk if you do not plan to use it within 24 hours.  Frozen breast milk is good for at least one month.  You can learn more at the links below as well as by asking your child’s health care provider for written guidelines. 

You can talk to your child’s health care provider about guidance on breastfeeding.

What are common questions I can ask my health care provider?
  • What should I know about pumping and storing milk at work?
  • Can I put breast milk or formula in a cup for my child now?
  • Should I give my child juice in a cup or bottle?
  • Is it ok to breastfeed when I’m sick?
Where can I find more information about this topic?

Breastfeeding Resources for Parents (AAP)

Family Resource Guide (AAP)

An Easy Guide to Breast Feeding (DHHS)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Guidance on formula feeding More Info
Guidance on formula feeding
What is this and why is it important?

Iron-fortified formula (and/or breast milk) still provides the most important nutrition for your child.  Continue to feed your child when he shows hunger cues, usually 5 to 6 times in 24 hours.  This is about 24 to 32 oz per day with complementary solid food but larger infants may take as much as 42 oz of formula per day.  Supplements are not needed if the formula is iron-fortified and your child is consuming an adequate volume of formula for appropriate growth. 

It is important to hold your baby for all bottle-feedings to reduce the risks of choking and to ensure that your baby gets enough of the formula.  To reduce the risk of developing cavities, do not prop the bottle in his mouth.  It also deprives you of the closeness and interaction you get with your child when you hold him to feed him – feeding your child builds and strengthens the emotional bonds you have and is “quality time” for the two of you.

You should not give your child cow’s milk until after one year of age. Young infants cannot digest cow’s milk as completely or easily as they digest formula. Also, cow’s milk contains high concentrations of protein and minerals, which can stress a newborn’s immature kidneys and cause severe illness at times of heat stress, fever or diarrhea. In addition, cow’s milk lacks the proper amounts of iron, vitamin C, and other nutrients that infants need. It may even cause iron-deficiency anemia in some babies, since cow’s milk protein can irritate the lining of the stomach and intestine, leading to loss of blood into the stools. Cow’s milk also does not contain the healthiest types of fat for growing babies. For these reasons, your baby should not receive any regular cow’s milk for the first twelve months of life.  If the cost of formula is a concern for you, programs such as WIC or other community services may be able to help you.

You can talk to your child’s health care provider about guidance on formula feeding.

What are common questions I can ask my health care provider?
  • Can my child switch soon to cow’s milk? Formula is so expensive!
  • How much formula should my child be drinking now that he is eating solid foods as well?
  • My child can hold his bottle now, can I leave him with it in his crib?
Where can I find more information about this topic?

Choosing a Formula (AAP)

Amount and Schedule of Formula Feedings (AAP)

Healthy Nutrition: Formula Feeding (AAP)

Feeding your Infant: Frequency and Amount (AAP)

References

American Academy of Pediatrics (AAP). Why Formula Instead of Cow's Milk? Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Your child’s dental health – before teeth:

Fluoride for your child’s teeth More Info
Fluoride for your child’s teeth
What is this and why is it important?

Fluoride exists naturally in water sources and is derived from fluorine, the thirteenth most common element in the Earth's crust. It is well known that fluoride helps prevent and even reverse the early stages of tooth decay. Your child's 6-month checkup offers a great chance to discuss fluoride supplementation with a health professional. If you live in a nonfluoridated area, your doctor or dentist may prescribe fluoride drops, tablets, or vitamins after your baby is 6 months old.   To see if your water source is fluoridated in the county you live in, visit the CDC's website.

The AAP recommends that fluoride drop supplements be given daily to kids between the ages of 6 months and 16 years. The dosage depends on how much fluoride naturally occurs in the water and the child's age. Only kids living in nonfluoridated areas or those who drink only nonfluoridated bottled water should receive supplements. It is important that you talk to your child’s health care provider about this before beginning.
 
If you live in a nonfluoridated area or have questions about fluoride talk to your child’s health care provider or dentist about fluoride supplements.

What are common questions I can ask my health care provider?
  • I give my child water that has fluoride, is that good enough?
  • When should I schedule my child’s first trip to the dentist?
Where can I find more information about this topic?

Oral Health Resources (AAP)

Fluoride and Water (KidsHealth)

A Healthy Smile for Your Baby (MCH Oral Health)

Fluoride Facts (AAPD)

Fluoride and Water: What Parents Should Know (SD Dept. of Health)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Kids Health. Fluoride and Water. Retrieved 4/1/2010 from http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=191&article_set=27801

Tips for brushing teeth or gums More Info
Tips for brushing teeth or gums
What is this and why is it important?

Tooth decay develops when a child's teeth and gums are exposed to any liquids or foods other than water for long periods. The most common way this happens is when parents put their children to bed with a bottle of formula, milk, juice, soft drinks, sugar water, or sugared drinks. It can also occur when children are allowed to drink from a sippy cup, suck on a bottle, or breastfeed for long periods during the day or night.

Keep your baby's mouth clean by gently brushing the gums and teeth with water and a soft infant toothbrush or gauze. Once your baby has 8 teeth, you can start using a child-sized toothbrush for daily cleanings.
Brush your child's teeth 2 times a day. Start by using fluoride-free toothpaste. When your child is able to spit and not swallow the toothpaste (usually around 2 to 3 years old), you should continue brushing his teeth using a pea-sized amount of fluoride toothpaste.

You can talk to your child’s health care provider about brushing your child’s teeth or gums and its importance.

What are common questions I can ask my health care provider?
  • My child still has no teeth, is that a problem?
  • Isn’t too early to worry about cavities?
Where can I find more information about this topic?

Teething & Tooth Care (AAP)

A Healthy Smile for Your Baby (MCH Oral Health)

Taking Care of Your Child's Teeth (AAFP)

References

American Academy of Pediatrics (AAP). Preventing Tooth Decay. Retrieved 4/1/2010 fromhttp://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/pages/Preventing-Tooth-Decay.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Why to avoid bottles in bed More Info
Why to avoid bottles in bed
What is this and why is it important?

Decay in baby teeth is on the rise among 2 to 5-year-olds, according to the Centers for Disease Control. Tooth decay develops when a child's teeth and gums are exposed to any liquids or foods other than water for long periods. The most common way this happens is when parents put their children to bed with a bottle of formula, milk, juice, sugar water or other sugared drinks. In addition to being at risk for cavities, babies who develop the habit of going to bed with a bottle may harm their teeth when they do come in.  It can also put your child at risk for ear infections and choking.

Habits begun early can be hard to change later – try to avoid the bottle in bed issue by not even starting it.  Always hold your child for bottle feeding and use a pacifier at sleep time.

You can talk to your child’s health care provider about the importance of not putting your child to bed with the bottle and tips for weaning your child from this habit.

What are common questions I can ask my health care provider?
  • A bottle in bed really helps him go to sleep – what would be a good substitute?
  • Is just the milk/juice in the bottle that’s harmful or is it okay to give him a bottle in bed that has water in it?
Where can I find more information about this topic?

A Healthy Smile for Your Baby (MCH Oral Health)

Dental Care for Your Baby (AAPD)

References

American Academy of Pediatrics (AAP). Preventing Tooth Decay. Retrieved 4/1/2010 from http://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/pages/Preventing-Tooth-Decay.aspx

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Your child’s safety:

Childproofing for a crawling baby More Info
Childproofing for a crawling baby
What is this and why is it important?

Your 6-month-old is now or will soon be rolling over and crawling.  New muscle strength and coordination now means he can explore more freely on his own and is getting ready to walk.  He’ll need sturdy and securely attached furniture with no sharp edges.  Stairs will tempt him , but he should not be allowed to play on them alone.  Your child also wants to taste everything he touches, so keep choking hazards such as small toys and latex balloons out of his reach.

Keep a close eye on your child, and plan ahead to minimize potential dangers.  A 6-month-old who is able to move around under his own power can get into, onto, and around things that might not be safe.  Parents and caregivers have to keep an eye on these infants, but also can try to make the home and other play areas, inside and outside, as safe as possible.  This also includes grandparents’ homes or anywhere your child visits. Try getting down on your child’s level to see if there are dangers you may have missed.

There are great tips and checklists for childproofing in the resources below.  That being said, no matter how safe your home is of what child-proofing you do, children this age need constant watching, unless they are in a playpen or crib.

You can talk to your child’s health care provider about childproofing for a baby on the move.

What are common questions I can ask my health care provider?
  • What changes should I make – my child isn’t crawling yet?
  • Do you have any safety or childproofing tip sheets to share with me?
Where can I find more information about this topic?

Safety and the 6 Month Visit: Home Safe Home (AAP)

Baby Safety (Home Safety Council)

Preventing injuries: at home, at play, and on the way (Safe Kids USA)

Home Safety: Here's How (AAP)

Baby Safety Basics (Safe Kids USA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Installing and using the car-seat correctly More Info
Installing and using the car-seat correctly
What is this and why is it important?

Car seats, when correctly installed and used, are extremely effective in saving children’s lives, reducing the risk of death by as much as 71 % for infants. However, they can be complicated to install and use and making mistakes is extremely common. In fact, studies have found that as many as 4 out of 5 car seats are installed or used incorrectly.

A correctly installed, rear-facing safety seat in the backseat of the car is the safest place for your child. It’s best to keep the car seat rear-facing until your child reaches the highest weight and height specified by the manufacturer. At the earliest, do not switch your child to a forward-facing safety seat before he is at least one year and weighs at least 20 pounds.  New recommendations are emerging, however, and some experts are saying that children should not face forward until 2 years old.  This is an important topic to discuss with your child’s health care provider.

This is also a good time to double check the manufacturer’s instructions. Or perhaps even better, contact the Child Safety Seat Inspection Station locator to find the nearest certified inspector who can check the installation and make any corrections needed.   You can find this information at www.seatcheck.org or by calling 1-866-SEAT-CHECK.

You can talk to your child’s health care provider about how to install your car seat correctly, in what position the car seat should face, and where you can go to have someone check the installation of your car seat.

What are common questions I can ask my health care provider?
  • Can I use a car seat from a neighbor’s yard sale?
  • My child is too big for the infant seat, but not yet 20 pounds, what do I do?
  • My child cries if I put him in the car seat. How can I keep him happy?
Where can I find more information about this topic?

Car Seats for Your Infant (Children's Hospital of Philadelphia)

Child Safety Seat Inspection Station Locator

Car Safety Seats: Information for Families for 2012 (AAP)

Car seat safety: The biggest mistakes parents make, and how to avoid them (BabyCenter)

1 Minute Car Safety Seat Check-Up (AAP)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Preventing burns and how to change hot water heater temperature More Info
Preventing burns and how to change hot water heater temperature
What is this and why is it important?

Burns are one of the leading causes of death among children, with most of these fatalities occurring in home fires. Even more often, fire-related deaths are caused by smoke inhalation. Your family's best protection against fire-related injuries is to equip your home with smoke detectors and to have an emergency escape route. To protect your child from house fires, be sure you have a working smoke alarm on every level of your home, especially in furnace and sleeping areas. Test the alarms every month. It is best to use smoke alarms that use long-life batteries, but if you do not, change the batteries at least once a year.

Most non-fatal burns are caused by scalds from hot liquids—for example, when a child turns over a cooking pot upon himself , or turns the knobs on a bathtub faucet so that hot water flows on him . Children also sometimes suffer burns by touching a hot iron, a coil on an electric stove, a curling iron, hot barbecue charcoal, or fireworks.

To avoid scalding burns, reduce the temperature of your water heater so the water is never hotter than 120 degrees Fahrenheit. Keep hot irons out of chil¬dren's reach and keep children away from the stove when food is cooking. Also, keep hot-steam vaporizers away from a child's reach, and keep portable heaters away from children and from flammable materials, such as curtains, as well. Teach your child not to play with matches.

You can talk to your child’s health care provider about preventing burns.

What are common questions I can ask my health care provider?
  • Where is the hot water temperature controlled in an apartment building?
  • Can I adjust the temperature myself or do I need a plumber?
  • Do I need sunscreen on cloudy days?
Where can I find more information about this topic?

Fire Prevention Tips (Home Safety Council)

Scald Prevention (Home Safety Council)

Baby Safety Basics (Safe Kids USA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Preventing falls, safety issues with wheeled baby walkers More Info
Preventing falls, safety issues with wheeled baby walkers
What is this and why is it important?

Your baby may be able to crawl as early as 6 months.  Use gates on stairways to prevent falls and close doors to keep him out of rooms where he might get hurt.  Always keep a hand on him when he is on a changing table or high surface, such as a bed or sofa.

Although many of us used baby walkers and many parents think walkers will help their children learn to walk, research has shown that they are not safe and that walkers can actually delay when a child starts to walk.  They are no longer recommended for young children. In fact, the American Academy of Pediatrics has called for a ban on the manufacture and sale of baby walkers with wheels.

Children are not recommended to be in wheeled baby walkers because they can:

  • Roll down the stairs — which often causes broken bones and severe head injuries. This is how most children get hurt in baby walkers.
  • Get burned — a child can reach higher in a walker. It is now easier for a child to pull a tablecloth off a table and spill hot coffee, grab pot handles off the stove, and reach radiators, fireplaces, or space heaters.
  • Drown — a child can fall into a pool or bathtub while in a walker.
  • Be poisoned — reaching high objects is easier in a walker.

Most walker injuries happen while adults are watching. Parents or caregivers simply cannot respond quickly enough. A child in a walker can move more than 3 feet in 1 second! That is why walkers are never safe to use, even with an adult close by.

What you can do

  • Throw out your baby walkers! Also, be sure that there are no walkers wherever your child is being cared for, such as child care centers or in someone else's home.
  • Try something just as enjoyable but safer, such as:
    • Stationary activity centers—they look like walkers but have no wheels. They usually have seats that rotate, tip, and bounce.
    • Play yards or playpens—these are great safety zones for children as they learn to sit, crawl, or walk.
    • High chairs—older children often enjoy sitting up in a high chair and playing with toys on the tray.

You can talk to your child’s health care provider about safety issues with using wheeled baby walkers and alternatives for your child.

What are common questions I can ask my health care provider?
  • If baby walkers are unsafe for babies why do you see them advertised so much?
  • My sisters used a child walker with their kids and nothing happened – aren’t they ok to use?
  • What are safe alternatives to baby walkers?
  • Why don’t child walkers help my child learn to walk?
Where can I find more information about this topic?

Consumer Product Safety Commission Gets New, Safer Baby Walkers on the Market

Baby Walkers: A Dangerous Choice (AAP)

Baby Safety Basics (Safe Kids USA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Preventing choking, common hazards More Info
Preventing choking, common hazards
What is this and why is it important?

Choking is a very common cause of unintentional injury or death in children under age one, and the danger remains significant until the age of five. Food is responsible for most choking incidents. Never feed your baby hard pieces of food such as chunks of raw carrots, apples, hot dogs, grapes, peanuts, and popcorn.

Because young children put everything into their mouths, small non-food objects are also responsible for many choking incidents. Look for age guidelines in selecting toys, but use your own judgment concerning your child. Also be aware that certain objects have been associated with choking, including uninflated or broken balloons, baby powder, items from the trash (e.g., eggshells, pop-tops from beverage cans), safety pins, coins, marbles, small balls, pen or marker caps, small and button- type batteries. If older siblings are playing with toys with small parts, make sure they are pick up after playing and put in a safe place, out of your baby’s reach. 

If you are unsure whether an object or food item could be harmful, you can purchase a standard small-parts cylinder at juvenile products stores or test toys using a toilet paper roll, which has a diameter of approximately 1¾ inches.

You can talk to your child’s health care provider about how to prevent choking and minimize choking hazards.

What are common questions I can ask my health care provider?
  • What are the most common things babies choke on?
  • What types of foods are choking hazards?
  • Is there a list of safety concerns we should be thinking about, for home and childcare?
  • If we’re watching closely is it ok for my child to play with toys with small pieces?
Where can I find more information about this topic?

Prevent Airway Obstruction (Home Safety Council)

Choking Prevention (AAP)

Baby Safety Basics (Safe Kids USA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

What to do if your child swallows poison and when to call the poison control center More Info
What to do if your child swallows poison and when to call the poison control center
What is this and why is it important?

At this age babies put so much in their mouths.  Many substances that seem safe can be dangerous for children, including soaps, shampoos, pet products and medicines. A safe home means one where your child can’t reach foods or cleaning agents that could be dangerous for him . You can lock or block cabinets where you keep unsafe products or move them to high cabinets instead of keeping them under the counters. Be aware that many of these items come in colorful containers that may attract your child.

If you suspect that your child has swallowed something poisonous, FIRST call the National Poison Control Center at 1-800-222-1222 and follow their instructions.  (The Poison Control Center should be called before your child’s doctor’s office when you are concerned about what poisoning). Syrup of Ipecac is no longer recommended nor is anything else to induce vomiting.

Some plants are poisonous, so avoid them or make sure they’re out of reach.  If you are unsure about any of the plants in your house or yard, call your local Poison Help Line (1–800–222–1222) and request a list of poisonous plants common to your area. If you have any poisonous plants, either replace them or securely fence and lock that area of the yard away from your child.

You can talk to your child’s health care provider about what you should do if your child swallows poison.

What are common questions I can ask my health care provider?
  • If I think my child has eaten or drunk something I am not sure is safe should I call you or the poison control center?
  • Should I make my child vomit if he drinks something dangerous?
Where can I find more information about this topic?

The National Poison Control Hotline and How to Use It (Home Safety Council)

Poison Prevention Tips (Home Safety Council)

Tips for Poison Prevention and Treatment (AAP)

Keep Your Home Safe From Poisons (AAP)

Tips to Prevent Poisonings (CDC)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.

Bathtub, water and pool safety More Info
Bathtub, water and pool safety
What is this and why is it important?

Drowning is a leading cause of injury-related death in children and is a risk even for your 6-month-old.  Keeping your child safe in the bath and around water takes extra attention. Always have at least one hand on your child and try to keep two hands at this age when they are getting more wriggly.

Children love water whether it is in toilets, pails or in the tub. But they can drown in only an inch or two of water.  Because you will have a crawling child in the next couple of months, it is important to take precautions to reduce drowning risks: put safety locks on toilets, bathroom doors and hot tubs. Never be more than a few inches from your child in the tub, ready and able to grab him .

Think ahead. Learn infant CPR and know how to get emergency help.  Remember that even though your child may not be able to reach the toilet or tub now, crawling and climbing to stand are just around the corner. Taking these actions can prevent a tragedy.

You can talk to your child’s health care provider about keeping your child safe around water.

What are common questions I can ask my health care provider?
  • Are baths necessary every day?
  • Can I just take my child into the shower with me?
  • What about infant swimming classes? Are these a good idea?
Where can I find more information about this topic?

Safety Guide (Home Safety Council)

Pool Safety (Home Safety Council)

Making Your Home Safe for Your Child

Baby Safety Basics (Safe Kids USA)

References

Hagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.