HomeHealth Topics A to ZYour Baby at Six Months
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Your Baby at Six Months

By Dr. Michael Boettcher

Has it been six months?  Your baby has changed so much and so quickly.  You may have noticed that she has almost doubled her birthweight.  Your family has been busy caring for her and loving her.  You have done a wonderful job providing for her, and the rewards will continue to come as she grows. 

DEVELOPMENT:

Many times, just before a baby achieves a new developmental milestone (such as sitting, crawling, or walking), he becomes irritable and restless.  This may represent frustration at not being able to do what he wants.  Frequently, changes of position from playpen to seat, to swing will help keep him contented. Although he may be wobbly, he may be starting to sit already.  Most babies can now roll from belly to back and from back to belly. 

Encourage the use of all of her senses.  Find creative ways for her to use her eyes, ears, and her sense of touch and motion.  She will enjoy learning to clap her hands, "catch" running water, manipulate sticky tape, and tear or crumple paper.  Brightly colored toys, noisemakers, rattles, blocks, spoons, and soft-textured toys are all great toys for development.  Peek-a-boo is a favorite and will help her learn that you can disappear and reappear - a concept that becomes important at this age.  If she resists lying still for diaper changes, keep a music box or favorite toy (do not use a powder container) to occupy her and create less struggle for you.  Motor development will continue over the next six months so that by one year most babies are standing. 

Your baby is becoming more social.  Talk, sing, and make nonsense sounds to him while changing, feeding, and playing with him.  Use every opportunity to speak clearly to him.  When you pick him up, say "up," and when you put him down, say “down."  He will continue to babble, and by 1 year of age should be calling you Mama and Dada.

By 6 months of age, babies recognize their parents, and begin to fear strangers.  Your baby may start crying when you leave her, even if only for a moment.  This can make it difficult when you leave her at the baby-sitter or day care.  Separation games like peek-a-boo and hide-and-seek help her develop you as a permanent object that will always return to her.  During the day, respond to fears with lots of hugs and comforting.  It is important for parents working outside of the home to create individual time in the evenings for playing and cuddling with their babies.  If you have any concerns regarding your child’s development, do not hesitate to discuss this with your primary care provider, and if we are unable to address your concerns, do not hesitate to contact the Early Intervention Program at 1-800-323-GROW for a free in-home evaluation.

FEEDING:

If you haven’t started solid foods yet, now is the time.  Solid foods are started initially to give your baby practice with new tastes, new textures, and a new way of eating.  Your baby will continue to get nearly all her nutritional needs from breast or formula feedings but will be transitioning to food-based nutrition over the next three months.  Her first food should be iron fortified rice cereal.  Start with a tablespoonful and mix it with formula or breastmilk.  Do not expect your baby to swallow much cereal at first.  She will take bites, but her tongue movements may push the food out of her mouth.  This is normal and it will take a while for her to learn to keep the food in her mouth.

After he has gotten used to taking the cereal and demonstrated the ability to swallow the new texture, you can expand your baby’s menu. There are many different approaches to starting solids.  Ask your provider to recommend how to start new foods.  One method is the old-fashioned approach of slowly adding a food:  After he has gotten used to taking the cereal and demonstrated the ability to swallow the new texture, introduce a new food, one at a time.  Feed each new food a few times over three or four days before starting another new food.  Another philosophy is to ensure that the baby can take from the spoon and then just provide any combination of pureed baby foods.  Continuing to provide new experiences at meals. 

Meats can usually be started around 6-7 months of age. You can prepare baby foods at home if you puree or finely grind them and avoid excessive spices or salt.  Do not give honey before 1 year of age due to the risk of infantile botulism.

At 8 – 9 months, you may start soft unsalted table foods, such as mashed potatoes, or squash.  Rice puff cereal or the Gerber finger puffs are nice finger foods.  Do not leave her alone while she eats these new foods.  She might gag, sputter, and frighten both herself and you!  If she gags, take the item from her hands and remove only pieces you can see from her mouth.  If you think that she is choking, call 911.  You might want to introduce the cup at this age.  A small plastic cup with formula, breastmilk, or water is a good start.  DO NOT GIVE JUICES.

Over the next three months, your baby should start getting more and more nutrition from his foods and less and less from breast milk or formula.  To help him accomplish this, offer the foods before offering the cup or bottle.  By the time he reaches 1 year, he should be down to about 16-24 ounces of formula a day.  Remember to keep meal times fun.   Your baby will tell you when he has had enough.  Please contact our nurses  for more helpful hints to assist you in keeping your baby’s meals nutritious.

SLEEPING:   

You may find that your baby, who used to sleep through the night, is now awakening at night.  This is not out of hunger, but usually due to separation anxiety or may be due to some bad bedtime routine habits.  Do not get in the habit of feeding him when he awakens at night, or you will compound the problem.  Use a night-light to help offset fear of the dark, and leave the bedroom door open to offset fear of the parents being gone.  If you must respond to your child at night, do so for short periods, never more than one minute.  Gently pat and talk to him, but do not pick him up.  He may just be looking for reassurance that you will come if needed.  If you start feeding him at these times, he will become a trained night feeder and will continue to get up at night.  During the day, respond to the child's fears with lots of hugs and comforting.  Some babies get more upset if you present yourself but do not pick them up.  If your child becomes worse with each short visit, he will probably benefit from crying it out.  No parent wants to leave their child crying for an unlimited period of time, but a few nights of prolonged crying may be the one answer to getting your child to sleep through the night.  If you are having difficulty correcting his sleep problems, please call upon our nurses  for more helpful hints.

SAFETY:

Auto Safety

  • Until 24 months it is recommended that the baby ride in a carseat facing backwards every time the car is moving.
  • The center of the back seat is the safest location of the infant seat.
  • Use an infant seat appropriate of his weight and height.  It is probably time to look to get out of the infant carrier and to a convertible car seat.
  • Never leave the baby in a parked car. 
  • Always check the carseat’s temperature before using it.
  • Always put medicines away in a childproof place after use.
  • Post the phone number to the Poison Control Center next to the phone (1-800-222-1222).

Poisoning

  • Always put medicines away in a childproof place after use.
  • Post the phone number to the Poison Control Center next to the phone (1-800-222-1222).

Aspiration/ Suffocation

  • Be sure the baby's toys are too big to swallow.  If it fits in a toilet paper roll, it is too small.
  • Keep small objects (pins, buttons, coins, etc.) out of the reach of infants and toddlers.
  • Keep crib sides up and place crib away from cords to blinds and drapes.  Remove mobiles from crib now.
  • Never leave pre-school children unattended in a bathtub or wading pool.
  • Never tie toys to crib or playpen - baby may get entangled and strangle.
  • Plug all empty electrical outlets with plastic plugs designed for this purpose.
  • Place the high chair and playpen well away from stove and kitchen counters.
  • Turn pot and pan handles toward the back of the stove.  Cook on back burners.
  • Have smoke alarms installed in your home.  Fire extinguishers are also recommended.
  • Teach the word "hot" and keep children away from hot oven, iron, vent, fireplace, wood stove, etc.
  • Place gates at stairways to keep babies or toddlers from playing on stairs.  Place screens on high windows.
  • Never leave the baby unattended on any raised surface (changing table, on couch, on a bed, high chair, etc.)
  • Use safety restraints when baby is in infant seat, high chair, stroller, car seat, etc.
  • Keep crib sides in “up" position when baby is in crib.
  • Place cleaning ingredients, matches, medicines, firearms, knives, scissors, etc. in a locked cabinet.
  • Crawl through the house on hands and knees to spot enticing hazards that must be remedied.
  • Remove small tables or other furnishings that are not sturdy or that have sharp corners.

Bums

  • Plug all empty electrical outlets with plastic plugs designed for this purpose.
  • Place the high chair and playpen well away from stove and kitchen counters.
  • Turn pot and pan handles toward the back of the stove.  Cook on back burners.
  • Have smoke alarms installed in your home.  Fire extinguishers are also recommended.
  • Teach the word "hot" and keep children away from hot oven, iron, vent, fireplace, wood stove, etc.

Injury Prevention

  • Place gates at stairways to keep babies or toddlers from playing on stairs.  Place screens on high windows.
  • Never leave the baby unattended on any raised surface (changing table, on couch, on a bed, high chair, etc.)
  • Use safety restraints when baby is in infant seat, high chair, stroller, car seat, etc.
  • Keep crib sides in “up" position when baby is in crib.
  • Place cleaning ingredients, matches, medicines, firearms, knives, scissors, etc. in a locked cabinet.
  • Crawl through the house on hands and knees to spot enticing hazards that must be remedied.
  • Remove small tables or other furnishings that are not sturdy or that have sharp corners.

Smoking:

  • Do not smoke.  While in the process of quitting, go outdoors and never smoke in the car.  Smoking is associated with increased ear infections, pneumonia, colds, and increased risk of crib death.  For assistance contact the Smoking Cessation Hotline at 1-866-QUIT-YES.

Shaking Prevention:

  • Never shake or hit your baby.  If you are angry or feel out of control, place your baby down safely and take the time to regain control.  Contact the FUSSY BABY NETWORK at 1-888-431-BABY if you feel your baby’s crying or needs are overwhelming you.  This is a free service.

VITAMINS:   

If you are still breast-feeding, continue to give your baby the multivitamin drops and remember to take your prenatal vitamins and iron.

ILLNESS:  

Many common childhood illnesses can be effectively managed at home.  Please use the provided booklet:  The Baby Book:  Infant and Pediatric Care  for information on most common pediatric problems and illnesses.  For illnesses or concerns that are not responding to your care, please call your provider’s office to talk to the nurses  for advice on managing these situations.  Our nurses  have an abundant amount of information regarding common childhood illnesses, diseases, behaviors, and home management tips for these.  If your child needs to be seen, they  will make the appropriate appointment.  We are available 24 hours a day, including weekends and holidays.  If you have an urgent need after hours, please feel free to contact us, and the physician on-call will gladly assist you.

 DuPage Medical Group Pediatrics has many office hours available after work and school.  We have our Immediate Care Center, which is available seven days a week.  On the weekend afternoons and holidays, when most pediatric offices have closed, we have the Pediatric After Hours Care Clinic.  If your provider’s office is closed or does not have  availability for you, please contact  1-888-MY-DMG-DR (693-6437).  As there are many available options to be seen conveniently at times outside of normal business hours, we hope to be able to decrease your use of the emergency rooms for non-emergent illnesses. This will provide a huge savings for your family, and help with the continuity of care as the visit is within DuPage Medical Group.   Please use the emergency room for truly urgent or emergent illnesses.  Some insurance companies require physician approval prior to going to the emergency room, so if it is not a life-threatening problem, but you think your child  needs to be seen urgently, please contact your provider who can assist you in that decision and provide the proper referral if needed.  For life threatening problems, please call 911 for immediate assistance.

IMMUNIZATIONS:

At the sixth-month visit, your baby should get her Prevnar #3, DTaP #3, IPV #3, Hib #3, and Rotateq #3.   Many of these vaccines are in combination, therefore decreasing the number of actual shots.  If your child has missed any vaccinations in the past, we will give those vaccines as well.  The expected side effects are listed in the vaccine information sheets provided.  If you elect not to follow our recommendations of immunizations, we need to counsel you regarding the possible deleterious effect this may have on her and the community.  We will then request that you sign a Vaccine Refusal form indicating that we counseled you about these dangers.  If your child has had a severe or unusual reaction to shots in the past, please let us know.

Notify us if any problems occur, such as:

  • An unusual, high-pitched cry or crying without stopping for 3 hours or more.
  • Very high fever (over 105°F) or convulsions.
  • Other symptoms you think are serious.

From September to June, we recommend flu shots for infants 6 months and older, along with all family contacts.  Children less than 9 years old will need two shots separated by at least one month the first time they receive the flu shot.  In most cases, your provider is able to offer the entire family (parents, grandparents, and nannies too) the flu vaccine.  This program has made it more convenient for families and has really helped us see less influenza the last couple of years.

If mom, dad, or grandparents have not gotten the whooping cough vaccine (TdaP), which is recommended for all adult caregivers of infants, please let us know,  as in most cases we are able to provide this service for them.

MYCHART

DuPage Medical Group has become a leader in the area regarding electronic medical records.  With the expansion of the electronic medical record, we can now provide our families with access to much of the same medical information that we have through MyChart.  Immunization records, medication lists, allergies, lab and X-ray results, growth charts, and appointment reminders are all available through this wonderful program.  Also, the ability to communicate with your provider for non-urgent medical questions can be done via email with MyChart.  We encourage all our families to sign up for this secure and useful online medical record portal.  The opportunity to sign up will be given to you at check in.  If you have any questions regarding this program, please call or discuss with your provider.

NEXT APPOINTMENT:

Please schedule your baby's next appointment for 9 months of age at checkout.   Please try to arrive 5 -10 minutes before your appointment so the necessary paperwork can be done.  Unfortunately, sometimes unexpected or complicated problems will cause us to be slightly delayed and you may need to wait awhile.  Bring toys and be prepared to feed your infant if necessary.  We would appreciate your understanding. 


Topics and Subtopics: Children's Health & Infant Care

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