Six Month Visit
DEVELOPMENT
By now some babies are sitting but are pretty wobbly. Frequently, just before a baby achieves a new developmental step (such as sitting, crawling, and walking) they become irritable and restless. This may represent frustration at not being able to do what they want and frequent changes in position from play mat to jump seat to swing will help keep them content. They are now much more active and may hitch along on his tummy and resist lying still for diaper changes. A music box, book, or favorite toy may occupy them and create less of a struggle for diaper changes.
Your baby will vocalize more. It is important while changing, feeding, and playing to talk, sing, read and make nonsense sounds to them, you will be rewarded with a marvelous string of sounds in response.
Hands are now being used to try all sorts of new things and your baby will delight in toys they can transfer, feel, and mouth. Rattles, blocks, spoons, and soft-textured toys are all good choices.
FEEDING
Your baby is now 6 months old and is ready to start solids. Cereal is usually the ideal first food to start when introducing solids. Mostly because it is fortified with iron which babies need more of at this stage. Rice, barley or oatmeal cereals are good starters. Begin with small amounts, such as a few teaspoons mixed with breast milk or formula to a soft consistency. Once this is accomplished, fruit or vegetables are a logical addition. Yellow vegetables, applesauce, bananas or pears are ideal. Just adding one new food at a time with several days between allows you to know if a food is not tolerated. Starting foods later allows mothers to use foods with more texture (table applesauce or mashed, fresh bananas for example). Once your baby is taking cereal, fruit, and vegetables, you can add meat and combination foods which have been offered singly and soft table foods. This is a good time to try a cup. A small, plastic cup with just a few drops of formula, breast milk or juice is a good way to begin.
Between now and the nine month visit is a good time to start soft table foods such as mashed potatoes, squash, cottage cheese, and yogurt. With a blender or careful chopping you can get along without buying “junior foods”. They can have small pieces of soft food. They should not be given carrot sticks, bacon, hot dogs, nuts, grapes, apples or foods which might break off into chunks that they could choke on. Wait until one year before introducing eggs or peanut butter. As a baby’s motor skills improve you may want to let them finger feed soft foods. They do not need extra sweets. Remember; do not put your child to bed with a bottle. It may result in tooth decay and make it impossible for them to sleep without.
The AAP recommends vitamin D supplementation for all infants, children, and adolescents. After reviewing the literature, it certainly looks like many children may benefit from vitamin D, although not everyone necessarily needs it. Some children are more at risk for vitamin D deficiency than others. Risk factors for vitamin D deficiency include dark skin (African-americans, Indians, Hispanics), time spent indoors and not out in the sunlight (particularly in the winter months), low amount of milk consumption (less than 16 oz a day), and exclusively breastfed infants. The recommended dose is 400 IU (international units) once daily. This can be bought over the counter in either a single drop form, or with a larger dropper. Read the label carefully when dosing this to your child. Too much vitamin D can be harmful.
TEETHING
Some babies will begin to erupt teeth by six months, others not until nine or twelve months. Once teeth have appeared, clean the mouth and teeth at bath time with a washcloth prior to washing the rest of the body. Begin tooth brushing when your child seems ready to tolerate it. If teething seems to bother them ice rubbed on the gums or teething rings that are refrigerated will make them more comfortable. A commercial preparation called “Oragel” can also be used if they awaken during the night, a teething ring and some quick reassurance should be enough to calm them.
High fevers are never caused by teething, so another reason should be sought. If they seem very uncomfortable with teething pain you can give an appropriate dose of acetaminophen. If they have a fever call us for advice.
IMMUNIZATIONS
Your baby will receive the third dose of pentacel, prevnar, rotateq, and Hep B. You may give the appropriate dose of acetaminophen if needed. Repeat every four hours if the child is uncomfortable.