9 Month Visit

9 Month Well Child Visit

At 9 months we generally:

Check Hemoglobin or give you a requisition to go have it checked along with a lead level. This tells us if your child is making enough red blood cells. You need iron to make red blood cells. So if your child has normal hemoglobin we know that your child’s iron level is good.

Vaccines:

___ Hep B (if not given at 6 months)

____ Influenza Vaccine in season

Next Visit:

__ at 12 months of age

NUTRITION

¨ Breast feeding or formula should be continued until one year, at which time you may switch to 2% milk. At this stage, children need extra fat to ensure healthy nerve and brain development.

¨ Provide regular meals and snack times; toddlers do well with three meals and 2-3 healthy snacks daily.

¨ Respect your child’s ability to know when he or she is hungry.

¨ Expect a drop in appetite as your child enters the toddler years. This is normal because rate of growth slows.

¨ Encourage use of a cup.

¨ Children should be moving from baby foods toward all table foods by one year. Avoid nuts, hard candies, popcorn, hard raw fruits and vegetables, which can cause choking.

¨ Encourage healthy eating habits and remember that our children learn by watching us.

¨ Juice is okay in moderation. Realize that although juice contains vitamins, too much (more than 4-8 ounces per day) may cause loose stools and poor growth since the sugar (sorbitol) is hard to absorb.

BEHAVIOR/DEVELOPMENT

¨ Over the next few months you will witness your infant becoming more mobile and independent. Encourage this by providing a safe environment in which to explore and by introducing your child to new textures, scents, and sounds.

¨ Encourage children to use their emerging language. Narrate your life, point out objects, talk and sing together.

¨ Read to your child daily!

¨ This is a good time to begin establishing consistent rules and limits. Infants should be noticed more for their appropriate behavior than for their undesirable behavior. Praise your child when he or she does something well. If your child’s behavior is inappropriate, try redirecting his or her attention. Other effective disciplinary actions, when necessary, include a stern restatement of the forbidden act (“biting is not allowed”), or a brief period of non-interaction (“time-out”). It is more realistic to structure the home environment than to expect a toddler not to injure himself or break things.

¨ Cuddle! Let your child know that he or she is special.

¨ Try to wean from the bottle between 12 and 14 months. Babies at that age are so involved in learning to walk, talk and explore that they won’t miss it. Weaning is important to prevent excessive milk intake (more than 24 oz).

SLEEP

¨ Establish a regular bedtime routine. By this age a child should be able to put self to sleep.

¨ Most infants sleep through the night by this stage and are taking at least 1-2 naps during the day.

¨ Recognize that each child has different sleep requirements.

SHOES

¨ Shoes are needed only to protect the feet from sharp objects and the cold.

¨ Shoes should be flexible, with non-skid soles, inexpensive, and fit well in both length and width.

¨ Most infants have feet that turn in or out when they begin to walk and they may be bowlegged.

HEALTHY HABITS

¨ Your child’s car seat should remain rear facing until he or she has reached both 20 pounds and a year of age. At that time it may be turned to face forward. The safest place is the center of the rear seat.

¨ Make sure that the poison control number 275-3232 or 1-800-222-1222 is clearly posted in your home and in any location where your child spends much time.

Infant CPR courses are offered through The American Red Cross. Call Bill Peck at 241-4434 to schedule an appointment if you haven’t already.

¨ Make sure that your child’s environment is baby/toddler friendly:

Electrical outlets; appliance cords and window-covering cords

Poisonous plants, household cleaners, medications and other potential poisons

Stairs and open windows should be guarded against falls

Hot water temperature should be below 120-130°

Sharp objects should be out of reach

Swimming pools/hot tubs, bathtubs, and open containers with water should be off limits

Garage door openers should have safety devices

Smoke detectors and fire extinguishers

¨ Avoid small, round or hard foods that your child could choke on. Be familiar with first-aid steps for choking. Consider taking a pediatric CPR course.

¨ Avoid exposure to environmental tobacco smoke, which can increase the incidence of lung infections, ear infections and asthma.

¨ Keep children out of the sun at peak times (10:00 – 3:00) and always protect with a PABA-free sunscreen. (SPF of 15 or above). Insect repellents should contain less than 10% DEET.