4171 Westport Rd-Louisville, KY Crestwood Stn-Crestwood, KY (502)

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1 4-6 months Babies are getting better control of their neck and head muscles. Babies enjoy being held to sit or stand, and they enjoy sitting in seats or in your lap. Babies like to coo, chuckle, squeal, and follow you around the room with his/her eyes. Babies are learning that they have hands. They look their hands, reach their hands towards mobiles or rattles, and love to bring their hands to their mouths. They recognize familiar people, especially parents; and they recognize familiar object, like their bottles. At this age, babies are very personable and happy much of the time; however, crying can come quickly if a favorite face disappears, if they tire of a certain activity, position, and, of course, if they are hungry or tired. Just remember this behavior is the beginning of normal likes and dislikes. Babies now have more abilities to show you their preferences by cries, smiles, and body movement. As your baby responds, even a little more strongly and happily at times, you will continue to learn the special qualities of your baby s unique personality. Feeding Babies are taking breast milk or formula steadily. The total amount of milk per day does not usually increase beyond this age. Babies are more capable of swallowing solid foods, and we may suggest starting with cereal and vegetables (See Infant Nutrition). Many babies will be eating 1-2 (sometimes 3) meals of solid food per day by age 6 months. You may gradually increase the food used while continuing the formula intake at about 24 to 36 ounces. When your child shows interest in the cup, we encourage starting out with water, formula, or breast milk in it. Safety Falls Rolling over comes during this period. NEVER leave your baby unattended on any high surfaces couch, bed, changing table, dining table or kitchen cabinet. Always keep one hand on your baby at changing times and on our office tables during checkups. Playpens, the floor (away from stairs), or cribs are SAFE places for play and changing diapers. NEVER turn your back or trust infant seats to hold your baby at this stage. Heating Bottles Microwave ovens are NOT recommended. Bottle warmers or a container of warm water is best. (This also applies to baby food when your child is older, too.) Equipment Many types of baby equipment may be useful (bounce seats, high chairs, walkers) but all must be used safely. We ll be glad to discuss the pro and cons of each. 1

2 Activity Begin to watch stairs and small objects as your baby rolls and reaches. It s not too early to latch cabinet doors, block plugs, and gate stairs. A NOTE OF EXTREME CAUTION ABOUT MOVABLE BABY WALKERS Baby walkers that children can move across the floor have been responsible for many injuries. Stationary baby exer-saucers are much safer. While the walkers are convenient, they provide no assistance or enhancement to your child s development or walking. If you use one, do so in moderation. Never leave your child unattended and never use a baby walker near dangers like stairs, edges of decks, cook tops, ovens or ranges, space heaters, radiators, or fire places. A Few Words About Being a Parent This is a cute social age. Smiles, coos, and vocalizations come regularly. Babies can entertain themselves and you with their voices. Nighttime sleep is usually improved from early months. Enjoy this time and let your baby s patterns help you work into more regular routines. With your help, your baby will continue to make new discoveries about the strength of his/her body, the use of his/her voice, and will also become more and more responsive. Encourage these things by: Using different positions to see the world play time on the back, some on the tummy, is safe seats, and of course, mom and dad s arms. Tummy play is especially important for encouraging future sitting balance. As babies adjust their head position while on their tummy, they practice the type of balance so important to future sitting and upper body strength. Textured quilts and bright noisy or musical toys are helpful to keep baby s interest in this position. Use mobiles and toys hung or placed within easy reach. Toys that suction to a tray or toys that sit themselves up after being reached or hit are especially useful at this age. (Be sure to watch carefully to prevent any entanglement in any strings or cords.) Talk, smile, sing, and respond to your baby s vocalizations, and imitate those sounds you hear! Mirrors are still great fun. Let your baby see himself/herself often. When crying comes, as in inevitably does, give steady reassurance and distract with a variety of activities, a new position, or a little extra comfort in your arms. Next check-up is 6 months of age. 2

3 CONSTIPATION in the infant during the first year of life Before we talk about constipation, we should decide what it is and when and whether it is abnormal. Some babies normally have three of four bowel movements a day, others will have only two or three a week. Some breast babies can go as long as a week between BM s. All young infants during the early weeks of life will stain and get red in the face when they try to have a bowel movement. This doesn t mean anything is wrong. If your baby s stools are soft, you can usually forget about it, although occasionally we may have you use a suppository to help him get started. If the stools are hard and infrequent and the baby has pain, difficulty or bleeding from the rectum when his bowels move, he is constipated. At this point, the baby should be checked in our office. Outlined below are some of the things I suggest for constipated babies. The things that I would like you to do are indicated by a check mark; Give your baby prune juice. Begin with one or two teaspoons and increase by one teaspoon daily until you get up to two ounces or unless stools become softer. Offer strained prunes. Begin with one teaspoon, increase up to one-half jar daily. If you are using while Karo in the formula, change it to brown Karo in equal amounts. Substitute 1-1/2 teaspoons Malt Suprex instead of Karo in the formula 1-2 times daily Use the stool softener in the formula as prescribed. This acts somewhat like a detergent and keeps the stool from becoming so tightly packed. It usually takes several days for it to help. Occasionally, a mild stimulant laxative will be advised a temporary measure. Cut down on the amount of formula that you are giving and increase the intake of fruits and vegetables. In the child the second year of life Constipation in this age group is more often troublesome and can cause hard packed and painful stools. Especially in the child around two, it may make him afraid to sit on his potty and so may slow down toilet training. The treatment measures as checked below should be instituted. Wean your baby. By reducing his milk intake, his constipation problem may be rapidly eliminated. Encourage more fruits, vegetables, and bran cereals. Use the stool softener as prescribed. 3

4 Use the mineral oil laxative by mouth as prescribed. (Caution: Never force any medicine containing mineral oil down a child. He/She might choke and have serious lung effects) Use Kondremul as directed. This is a mile laxative. If stools are very hard, painful and impacted, make an appointment for your child to be checked. INFANT NUTRITION As you may already know, theories on infant nutrition have changed rather drastically over the last few years and for many scientifically proven reasons. We, as your baby s health care providers, have chosen to follow the guidelines set forth by the Committee on Infant Nutrition of the American Academy of Pediatrics. Essentially, the recommendations are total formula or breast feeding for a period of at least 12 months with the institution of solids at weeks of age or later. The need for vitamin supplementation will be determined by whether your baby is breast fed or bottle fed. If you are nursing, your baby will be places on vitamins to supplement Vitamin D. If you are formula feeding, the vitamins and Iron will be in the formula. Iron supplementation is suggested from birth and should be continued as a daily maintenance supplement until at least 18 months of age. We understand that as new parents you ll be given all kinds of well-meaning advice with regard to your baby s diet. Remember that total infant nutrition with just formula or breast milk for the beginning months of life until 3 or 4 months of age is thought to be best. Please remember to be flexible. Most babies take a period of getting-used-to solids, so don t be discouraged if your baby s appetite varies. By 4 months of age, babies can turn their head to signal they are full, so use your judgment and follow your baby s signals as to amount. In short, be patient when introducing solids into your baby s diet. 4

5 FROM BOTTLE (OR BREAST) TO CUP Learning about the cup can be a natural progression for you and your baby. There is no one magic time, but some of the developmental changes that babies go through around 4-8 months signal that they are ready to begin to learn gradually about the cup. Your goal is to have your baby off the bottle by approximately age one. Why is it a good idea for babies to be drinking from the cup by this age? Babies have developed a memory (object permanence). If the bottle is part of their routine after this age, they do not easily forget it. Out of sight out of mind It is normal for older babies and toddlers to have security objects-- toys, blankets, etc. If a child is still on the bottle age 12 months, the bottle can become the security object and it is much harder to give up. Most important, it is the normal age for babies to switch from formula to milk. A baby tends to drink more from a bottle that from a cup. If baby is still taking a bottle when he/she starts milk, there is a tendency to fill up on milk and not be interested enough in eating to have a good balanced diet. Helpful Hints By age 4-6 months, begin use of a cup (any kind) to bring your baby s lips to allow sips of formula, breast milk, or water. By age 6-8 months, begin to use the cup at meals. Offer at least one ounce. Continue to support the cup with your hand as your baby begins his/her own attempts to bring the cup to their mouth. After the drink, put the cup out of baby s reach to prevent spills. When practicing with the cup, have bottles out your baby s sight. Don t give bottles in bed because they can cause cavities in baby s front teeth. Taking bottles in bed can also increase the likelihood of ear infections. After age 4-6 months, try to get your baby back to sleep at night without a bottle. Babies are able to last the night without feeding by this age, and feeding will continue a habit of night hunger. Most babies are down to 4 bottles a day by age 6 months and 3 bottles a day by age 9 months. After age 6-8 months, try not to allow yourself or your baby to become more dependent on the bottle. You will notice a normal decreased interest in bottles by age 8-10 months and the amount of formula taken usually decreases at this age. Try other methods of soothing your baby instead of a bottle. Try humming, talking slowly and quietly, playing games with rhymes, or reading stories from hardback or cloth books. 5

6 With older babies, leave bottles at home-- instead take containers of Cheerios or Rice Krispies for a snack. Non-spill cups with straws and lids are excellent for drinking on the go. 6