Nine Month Visit

DEVELOPMENT

Although your nine month old is still very dependant on you, they are less dependant than they were three months ago.  They are now beginning to move about and communicate.  They may get to a sitting position without help and hitch on their belly.  They may crawl on all fours and may pull themselves up into a standing position.  They may also be starting to climb and seems to have a strong need to explore and a tendency to put things in their mouth.  This is the beginning of a period of active exploration and a time when they are learning a lot about the world.

Communication, at this age, does not mean that they are talking, although they may say some sounds such as “dada”.  They are beginning to understand words and phrases, though, and for example, will respond to “where’s daddy or mommy”?  You can enhance language development in your nine month old by talking, singing, and reading to them as you play with them and care for them.  You will notice a large gap between her capacity to understand speech (receptive language) and her ability to talk (expressive language).  They may also develop ways of communicating with gestures, facial expressions, and tugs at your clothing are effective.

Behavior problems are not common at this age, although some babies who are, by temperament, strong willed babies may make for a rough time.  Babies at this age are frequently very shy with strangers and cling to their parents and cry if separated.  This stage will pass.  This is probably the earliest age when it can easily be shown that behavior is learned.  Your baby will repeat a performance if they laughed at.  The laughter serves to reinforce the performance, since the laughter is agreeable to them, they will repeat the act.  If, on the other hand, the performance is ignored, it will be abandoned by the baby as a non-rewarding activity.  This principle of teaching behavior by giving approval of desired behavior is even more applicable to older children (and spouses too!) and is far more productive than a negative approach utilizing criticism and punishment.

FEEDING

Your nine month old probably has a good appetite and is beginning to eat some table foods and may insist on feeding themselves with their fingers.  Most babies at this age are still nursing or taking formula from a bottle, but may have reduced their intake to one pint per day (16 OZ) which is adequate for their needs.  Snacks are commonly needed at this age, and it is a good idea to use basic foods (fruit, bread, cheese, juice) rather then establish the habit of using “junk foods” (cookies, candy etc).  Do not give nuts, raw carrots, grapes, apples, popcorn, or hotdogs because these foods may cause serious respiratory problems if a child chokes and breathes them into the lungs.

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.

SAFETY

• This is an age when accidents are a major threat.  Medicines, cleaning supplies, plastic bags, and any toxic substances should be out of reach.  This includes poisons in the garbage, insecticides, etc.  If your baby ingests anything you think could be poisonous, call poison control 1-800-222-1222 immediately.
• Make sure stairs are gated.Your hot water heater should be set for a maximum of 120 degrees fahrenheit.
• Place a lock on the cellar door to prevent your crawling baby from falling down a flight of stairs because someone left the basement door open.
• Keep your baby rear facing until their second birthday or until they reach the maximum weight allowed by your car seat manufacturer.  The longer you can keep them rear facing, the better.

IMMUNIZATIONS

No immunizations are given at this visit however a blood count for anemia and a lead level are checked at this age.

SLEEPING

Sleep patterns are variable, but most babies at nine months sleep about twelve hours at night and take at least one nap a day.  If your baby develops a pattern of waking at night, the habit is best broken by ignoring it as much as possible or using the “ten minute rule” before going in to check on them.  By going to them, and especially feeding them in the middle of the night, you reinforce the behavior and reward them for the behavior you would prefer to change.  Night waking can be part of the separation anxiety seen at this age.  Playing peek-a-boo during the day helps your baby to learn that you will come back when you have gone away.  A good resource for sleep concerns is Richard Ferber’s book “Solve Your Child’s Sleep Problems.”