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Your Baby at Two Months

By Dr. Michael Boettcher

Congratulations, you have made it through the first eight weeks!  During this time, your whole family has had to adjust to some new routines, hopefully without too much hardship.

GROWTH AND DEVELOPMENT: 

Your baby has already changed a lot since you brought him home.  He has probably gained 2 to 4 pounds and grown 2 to 2 1/2 inches.  This rapid growth rate will continue for the first six months before leveling off somewhat.  He is probably staying awake a little longer.  When he lies on his stomach, he can lift his head about 45 degrees off the table.  When pulled from his back to a sitting position, his head is not lagging as far behind.  When held in a sitting position, he holds his head up, though it bobs forward a little.

You may have also noticed that her hands are open more frequently and her grasp reflex is starting to fade.  Her wakeful periods are lasting longer, and she will follow objects from her side to beyond the midline.  She also visually searches in response to sounds and turns her head to the side when a sound is made at ear level.  Changes have even developed in her language.  Her cries have become differentiated; she coos, and makes sounds in response to a familiar voice.  In response to various types of stimulation, she produces a social smile.

Over the next few months, you will notice even more changes in your baby's development.  By 4 months, he will have almost no head lag when pulled to a sitting position and can balance his head well.  If propped, he is able to sit up and his back is less rounded in the sitting position.  When on his belly, he lifts his head and chest off the floor.  He will be trying to roll over as well.

Other changes in the next couple months to watch for include reaching for and grasping objects, which she puts in her mouth.  Although she will not be able to pick up dropped objects; she will enjoy playing with a rattle placed in her hand.  You will see more vocalizations and more awareness of her environment.

Ways to stimulate your baby at this age include providing bright objects, mobiles, and mirrors for him to look at.  When doing chores around the house, place him in an infant seat and take him with you!  Be sure to talk to him and include him in family gatherings.  He will enjoy environmental noises and views other than those of the house.  Rattles and wind chimes can also stimulate his sense of hearing.  His sense of touch can be stimulated with a soft brush to comb his hair, and caressing his skin while bathing or during diaper changes.  You can also exercise his body by moving his extremities in a swimming motion.

FEEDING:

Breast-feeding or an iron-fortified formula is all your baby requires for nutrition at this age.  If breast-feeding, we encourage you to continue throughout the first year of your baby’s life.  Also, a multivitamin (Polyvisol, Trivisol, Vid-Daylin, etc.) or over the counter vitamin D drops (D-visol) are recommended for your breast-fed infant to ensure she receives the necessary amount of Vitamin D.  At this age, there is no need for solids, such as cereal, fruits, or vegetables.  If she has been receiving two nighttime feedings, she will probably go to just one feeding over the next couple of months.  If your baby continues to demand 2 feedings during the night as she approaches 4 months, you can help by increasing daytime feeding intervals to closer to 4 hours. This can help train the stomach not to expect such frequent feedings.  During the day, her demand for unnecessary feedings can be met with extra holding, attention, or a pacifier.  Regardless of her nighttime feeding patterns, do not let the baby have the bottle in the bed.  Your provider will be able to give you more advice regarding the amount of feedings she is getting based on her growth pattern.

SLEEPING: 

Sleeping is another common area of concern for many parents.  Your baby may still be awakening during the nighttime hours at this age.  All children, especially during the first year of life, may awaken several times each night, but most can put themselves back to sleep.  If he has not learned this skill, he will cry for you. The earlier that good bedtime routine and sleep habits are developed, the better your child’s (and your) sleep will be.   If you provide too much attention, such as constant rocking or feeding to get the baby to sleep, he becomes dependent on you for returning to sleep.  In order to teach him to put himself back to sleep, put him to bed when he is awake but drowsy.  This way, his last memory is of the crib, not of you holding, rocking, or feeding him. 

If the baby is still sleeping in your room, it may be time to move her to a separate room.  This will allow you to  not be awakened by her normal tossing and turning.  If this is not possible, cover one of the side rails with a blanket so the baby cannot see you when she awakens.  If she awakens and cries, wait at least 5 minutes before going into the room.  Any intervention should be brief and boring.  Eliminating long daytime naps can also be helpful.  Waken your baby if she has napped for over 3 hours.  If she is in the habit of taking 3 naps per day, try to convert her to just 2 per day.  Skipping naps altogether will only result in an overtired baby who does not sleep - it will not improve the sleep situation.

SAFETY:

Auto safety

  • For the first 24 months, it is recommended that your baby ride in a car seat facing the back of the car every time the car is moving. 
  • The center of the back seat, if possible, is the safest location for the infant seat.  Use an infant seat appropriate for his weight.
  • Never leave the baby in a parked car and always check the car seat’s temperature before using it.
  • For information on all types of car seats, you can call the Auto Safety Hotline at 1-800-424-9393.

Crib Safety

  • Keep the crib sides up at any time the baby is unattended.
  • If your crib is not new, be sure the slats are less than 2 3/8 inches apart.  The mattress should fit snugly.
  • Place the crib in a safe area of the room - away from windows, strings, cords, blinds, hanging toys, and any other potential strangulation hazards.
  • Place the baby on his back or side to sleep.  Sleeping on the abdomen increases the risk of crib death.

Falls

  • Never leave the baby unattended on the changing table, couch, bed, or any other raised surface. When using an infant carrier, do not place it on a raised surface, such as a table or counter.  The floor is the only safe location in case the baby squirms his way out of the carrier or rocks the carrier off the table.
  • Any fall greater than 3 feet needs to be seen immediately.  Any fall associated with loss of consciousness, sleepiness, or vomiting needs to be seen as well.

Suffocation

  • Keep all plastic bags out of your baby's reach.
  • Do not use a pillow or quilt in the crib.  Do not place your infant on a waterbed.
  • Do not hang a pacifier or use any jewelry around the baby's neck, and remove bibs and necklaces at bedtime.
  • Never leave the baby's side during bath time.

Fires and burns

  • Install smoke detectors in the home and use them as recommended by the manufacturer.  Fire extinguishers are also recommended.
  • Do not warm formula in a microwave oven.
  • Turn your water heater down to 120 degrees F.  Always check water temperature before bathing.
  • Do not smoke or hold hot liquids while holding your baby.
  • Do not leave the infant in the direct sun for more than a few minutes.

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.
  • 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:

Multivitamin or over the counter vitamin D drops are recommended for breast-fed infants.  Also, if you are breast-feeding, please continue your prenatal vitamins with iron as long as you are nursing.  You may also consider the DHA supplements for nursing moms as well.

POSTPARTUM DEPRESSION:

You should have received another screening questionnaire regarding postpartum depression.  This is to help us identify moms who are having a tough time with the hormonal, psychological, and physical stresses of having a new baby.  Please fill out the forms and if at any time you are concerned about your mental well-being, please contact us or your primary care provider, in order to get assistance with this very common and potentially dangerous condition.  DMG is committed to taking care of not just your child, but your family as a whole.

 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 is it is needed.  For life threatening problems, please call 911 for immediate assistance.

IMMUNIZATIONS:

At the 2 month visit, your baby will be getting her first set of shots:  DTaP #1 for diphtheria, tetanus, and whooping cough; IPV #1 for polio, HBV#2 for Hepatitis B, Hib#1 for Hib meningitis, Prevnar #1 for pneumococcal meningitis, and oral Rotavirus #1 to prevent Rotavirus (the most common cause of the “stomach flu” in infants). Most of these vaccines are combined, which decreases  the total number of actual shots.  Following the immunizations, babies may experience minor side effects that include soreness, swelling, and redness where the shot was given; fussiness; and a mild fever for two days.  We suggest you treat this with acetaminophen (Tylenol) at the recommended dose for your baby's weight.  The dosing charts can be found in “The Baby Book:  Infant and Pediatric Care”.  Acetaminophen may be repeated every 4-6 hours as needed. A warm compress may relieve discomfort. If you elect not to follow our recommendations of immunizations, we need to counsel you regarding the possible deleterious effect this may have on him 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 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 greatly 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.

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 4 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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