Well Child Information

Every step of the way...

Your child’s health is best maintained through regular check-ups when she or he is well. At these visits, we evaluate growth and development; check hearing, vision, and speech; promote good safety habits and accident prevention; discuss anticipated changes in your child’s development and behavior; evaluate school readiness; prevent illness with immunizations; and explore questions and concerns you may have about your child’s health, growth, development, and behavior.

We recommend the following routine office visits from 2 weeks to 24 month-olds, and then yearly after age 2 until college:

Doctor and child

  • 2 Week Old

    Your 2-Week-Old

    By now, you should start feeling a little more comfortable with your baby. You are starting to realize when your baby cries for hunger, cries for attention, or cries when in pain. Your baby is also becoming comfortable in his new world. He is learning patterns related to eating and sleeping. He is learning how to interact with his environment and he is gathering information which affects his emotions and actions. This, in turn, helps him to feel content, safe, and secure.

    Diet

    Breast milk or formula continues to be your child's basic source of nutrition for the first 12 months of his life. Your baby will not require any solid foods until 4-6 months of life. Babies tend to know how much they want to feed and when they want to feed. Learn your baby's feeding cues.

    Bottle Feeding - Typically, a bottle-fed baby will feed every 3 to 4 hours, taking 2 to 4 ounces each feeding (about 3 ounces per pound over 24 hours).

    Breast-Feeding - Breastfed babies will typically nurse for 5 to 20 minutes per breast, every 2 to 3 hours. Because of the nature of breast milk, breastfed babies will feed more often, have a more active digestive system, and have more frequent bowel movements than formula fed babies. Bowel movements will be looser, and in some cases, be no more than a release of gas. Moms of breastfed babies should continue to take prenatal vitamins. Breastfed babies should be given vitamin D (sold as "D-vi-sol" or "Just D") once a day until they turn 1 or are no longer fed breast milk.

    Hygiene and Safety

    Umbilical Cord - There is no need to clean the umbilical cord. The cord usually dries and falls off between 14-21 days. Sometimes there is a small amount of blood; this is normal. Give only sponge baths until the cord completely comes off.

    Bathing - Daily baths are not necessary; every 2 — 3 days is satisfactory. Use only lukewarm water on the baby's face and a mild soap without added scents or dyes) for the rest of the body. Make sure your water heater is kept to less than 120° F.

    Nails - Keep your baby's nails short. Do not use mittens because they will prevent your baby from exploring his environment with his fingers.

    Diapers - Change diapers frequently to prevent rashes. Rashes are due to prolonged exposure to urine and/or stool. The new absorbent diapers may feel a lot drier than they actually are. Try to provide a good barrier between the diaper and your baby's bottom (Vaseline, diaper creams). Avoid talc.

    Circumcision - We suggest that your baby is circumcised only if you choose. There is no increased risk of infection for those uncircumcised males who maintain good hygiene techniques. Most decisions to circumcise are made according to social and cultural factors - a family decision.

    Vaginal Discharge - Girls often have a slight clear discharge from the vagina; that is normal. Also normal is slight vaginal bleeding that starts around the seventh day and lasts 2 or 3 days.

    Dressing - Babies are usually comfortable in one more layer than what you are wearing.

    Safety

    SIDS - We recommend that babies sleep on their backs, in their own bed, in order to decrease the incidence of Sudden Infant Death Syndrome (SIDS). There is a 75% decrease in SIDS for those infants sleeping on their backs. You can further decrease the risk by breastfeeding, using a pacifier during sleep, running a fan in the baby's room, having the baby's bed in your room, and by having no smoking in the home. We recommend swaddling the baby. Sleeping on the back may cause some flattening of the back of the head. You may want to have your baby's head facing one direction for a few nights, then the other direction for a few nights. This will help keep your baby's head rounded instead of flat.

    Infection - Babies have immature immune systems. Going outside is NOT dangerous, but exposure to large numbers of people should be avoided. Other than siblings, exposure to children and ill adults should be limited. It is best to limit exposure until your baby is 2 months old. The best way to prevent illness is through thorough hand washing either with soap and water, or a hand sanitizer like Purell. Call the office immediately for temperatures greater than 100.4° rectally. Do not give any medicines without speaking with our office first.

    Smoking - Smoking around the baby, or smelling like cigarette smoke, can increase your baby's risk of asthma, sinus infections, ear infections, SIDS, and other respiratory illnesses. One of the best "gifts" you can give your baby is to stop smoking.

    Chairs/Cribs - Never leave your baby unattended on a table, couch, bed, or other elevated surfaces. Make sure that crib slats are no more than 2-3/8" apart on your crib. To decrease the risk of suffocation, do not put pillows, stuffed animals, bumper pads, or extra blankets in the crib. When traveling in a car, never have the baby in your lap. Use only an approved rear-facing infant car seat that is placed in the middle of the rear seat.

    Illness Warning Signs - You should call us if you think your baby is sick. Some warning signs in the first month are:

    1. A temperature of over 100.5° when taken rectally (THIS IS SERIOUS IN ANY BABY YOUNGER THAN 2 MONTHS, so call the office immediately)
    2. Refusal to nurse or take a bottle
    3. Repeated vomiting
    4. Not urinating at least every 8 hours
    5. Being very restless and irritable or difficult to wake up at feeding time
    6. Looking sick, or "just not right"

    Advance Preparation - You may find it convenient to purchase in advance from your drug store: a rectal thermometer, liquid acetaminophen (Tylenol), a cool mist vaporizer, an infant nasal aspirator. Check with us before administering any medication.

    Never leave your baby unattended on any elevated surfaces. Keep the crib free of loose bedding, bumpers, and/or stuffed animals. Test smoke detectors monthly. Do not attach pacifiers or any other object, to your baby. Do not place strings or necklaces around your baby's neck.

    Development and Behavior

    Motor Skills - Your baby's movements will start as quivering and jerking, but by the end of the first month, the movements will be more fluid. Your baby may start to push up on his arms when lying on his stomach. By the end of this month, your baby may bring his hands to his mouth and eyes, keep his hands in a tight fist and have an increase in neck control.

    Vision - By the end of the first month, your baby may start to focus on objects as far away as three feet. Your baby may start to track and follow objects and faces. Newborn eyes are still weak and may occasionally become cross-eyed. Eventually, this will disappear and your baby will be able to recognize more complex patterns and shapes. Babies will always prefer to look at a human face.

    Hearing - Your baby will pay close attention to the human voice. A baby will turn to the direction from which the sound is coming. An annoying and loud sound will eventually be ignored by babies. This is their way of protecting themselves. By the end of the first month, your baby's hearing will be fully mature, and he will be able to recognize sounds and voices. It is never too early to read to your baby!

    Fussiness - Many babies have a crying or fussy period lasting from 10 minutes to 4 hours each day. Occasionally, babies will have more than one fussy period a day. Most fussy periods tend to occur late in the afternoon and early evening. Crying is your baby's way of communicating. It does not always mean that your baby is hungry. Your baby will cry to be fed, to be held, to go to sleep, and to play. Babies who are responded to, tend to eventually cry for shorter periods of time. Carrying your baby helps to establish trust, prevents SIDS, and helps to prevent flat heads. The time not to respond to your baby is that time when you are feeling frustrated and angry. Let someone else take a turn at meeting your baby's needs. NEVER SHAKE YOUR BABY.

    Sucking - Some babies require more sucking in the first few months than others. Sucking does not necessarily mean that your baby is hungry. Thumb sucking and pacifiers are not harmful, but they do have their advantages and disadvantages. In general, look for a one-piece, solid pacifier with a large mouth guard. Do not tie a pacifier around your baby's neck. It is best to wait until 3 to 4 weeks of age to introduce a pacifier to a breastfed baby (to avoid nipple confusion).

    Spitting-Up - Some spitting-up is normal. It always looks worse than it actually is. Apart from being messy, there is usually no cause for concern unless your baby has poor weight gain or is overly irritable. Spitting-up does not indicate a need to change formulas. To minimize spitting-up, feed your baby in an upright position, burp your baby frequently, and try to keep your baby upright for 15 to 20 minutes after each feeding.

    Bowel Movements - Many infants appear to have difficulty passing even soft stools. Straining, turning "red in the face", and infrequent stools are all part of normal intestinal development. All babies have their own bowel patterns, ranging from one with every feeding to one every several days. By definition, constipation refers to the "hardness" of the stool, not the frequency. Straining with bowel movements does not indicate the need for a formula change.

    Sleep - The amount of sleep each infant requires varies a great deal. Typically, a newborn will sleep a total of 14-20 hours a day. This total amount of sleep may randomly be divided into anywhere from eight 2-hour periods to four 4-hour periods. You can help a baby realize that it is sleep time by keeping your baby in a quiet room with minimal activity at night, and in a more active area of the house during the day.

    Toys - During the first month, your baby will enjoy mobiles with contrasting colors and patterns, looking at mirrors securely attached to the crib, soft music, and toys with colors and patterns. But remember, babies will always prefer interacting with another human instead of a toy.

    Interaction - Try to figure out what your baby is saying to you. Respond to your baby. This will build a positive sense of self and a desire to communicate. Talk and sing to your baby. Offer your baby many lots of different objects to look at, touch, and even grip. Play "tracking" games by moving yourself and interesting objects back and forth. Babies are most stimulated by big, bold patterns; and the colors black, white, red, and yellow. Your baby will first only move his eyes, but eventually, he will move his head.

    Vaccine Information

    One of the important roles of a pediatrician is to prevent illness. This is why we like to perform well-child visits so that we have time to examine your child and observe potential problems, to provide anticipatory guidance, and to provide vaccinations to prevent devastating diseases. The vaccination is one of the most important tools to prevent illnesses and diseases.

    Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine - Whooping cough (pertussis) is a very dangerous disease, especially for infants. The risk of suffering and death caused by whooping cough is far greater than the possible side effects of the vaccine. A child who has not been immunized against pertussis has a chance of 1:3000 of getting whooping cough. In contrast, a child who got the vaccine is estimated to have a chance of 1:2,000,000 of having neurological damage with the vaccine. The risk of children getting pertussis increases if fewer children are immunized. Parents should make sure they have had their Pertussis (Tdap) booster shot.

    Haemophilus influenza type b (Hib) Vaccine - Contrary to the way the name sounds, the Hib vaccine does not protect against the flu. Haemophilus influenza is a type of bacteria that can cause several life-threatening diseases in young children such as meningitis, epiglottitis, and pneumonia. Before the vaccine was available, over 10,000 children in the U.S. developed Haemophilus meningitis each year. About 500 of them died and 3,800 became mentally retarded, blind, deaf, or got cerebral palsy as a result of the disease. Because of the vaccine, Haemophilus influenza type B is now uncommon in the U.S.

    Hepatitis B Vaccine - Vaccination against hepatitis B prevents this type of hepatitis and the severe liver damage that can occur 20 to 30 years after a person is first infected. More than 5000 adults die each year in the U.S. from hepatitis-related liver cancer or cirrhosis. The younger the age when the infection occurs, the greater the risk of serious problems. Adolescents and adults are at the greatest risk of contracting hepatitis B, but we are immunizing all children in order to have "herd" immunity. If all children in the U.S. are vaccinated, there will be no more hepatitis B when these children become adults.

    Polio Vaccine - The polio vaccine protects children from this crippling disease. The inactivated vaccine (IPV) is now recommended for all polio doses.

    Pneumococcal Vaccine - Pneumococcal infections are serious infections that may cause pneumonia, bloodstream infections, meningitis, and ear infections. There are many types of Pneumococcal bacteria, and this vaccine protects against the most common types in the U.S. Like all vaccines, the risk of suffering and potential death is far greater than any possible side effect of the vaccine.

    Rotavirus Oral Vaccine - This vaccine prevents a stomach infection called Rotavirus. Although most infants will do well when they have this infection, a few may have such severe diarrhea that they must be hospitalized due to dehydration. The intention of this vaccine is to prevent the risk of hospitalization and in some cases, death, resulting from dehydration secondarily to Rotavirus infection.

    Measles, Mumps, and Rubella Vaccine - These diseases are nearly gone from the U.S.; however, they will come back if children are not fully immunized. There have been several outbreaks of Measles in communities with under-immunized children. There has been a lot of recent controversy surrounding this combination vaccine, but all of the research has been unable to support any connection between this vaccine and developmental disorders. As with other vaccines, the risk of suffering and potential death is far greater than any possible side effect of the vaccine.

    Chickenpox (Varicella) Vaccine - The chickenpox vaccine is recommended in order to prevent the complications associated with the disease. Although many people remember "suffering" through chickenpox without any major difficulties, before the vaccine, more than 5000 children a year had been hospitalized and more than 500 children had died due to complications from chickenpox. The vaccine may not prevent chickenpox in all individuals, but it will decrease the duration of the illness and the chance of complications like pneumonia, meningitis, or lifetime balance problems.

    Influenza Vaccine - It is recommended that all children 6 months and older get the influenza vaccine yearly, in order to prevent any chance of becoming severely ill or becoming hospitalized because of the flu.

    Very small infants often accept the first injection easily, since they are not expecting it. The vaccinations become more difficult, however, with every succeeding shot. Simply providing love and warmth helps children of all ages accept immunizations. We prefer to administer as many vaccines as possible during a single visit because it is better for your child to get over the discomfort on a single day than draw out the fear of the doctor visit from month-to-month.

    No one should lie and tell a child that a shot will be painless. Some health providers suggest telling them that it "stings" a little and to count to five while it is being administered. One study reported very good results with a breathing technique - the child is told to inhale very deeply right before the shot and blow out very hard as the injection is given.

    Giving a sweet fluid before the shot and a little reward, such as nursing or feeding the baby immediately after the shot is very helpful. Sugar has actual mild pain relieving properties for infants. Likewise, you can give some Acetaminophen (Tylenol) if you think your child is in pain or has a fever due to the vaccine. It may reduce your baby's immune response to vaccines if given routinely after vaccines, so we recommend giving Acetaminophen only if the baby is uncomfortable or has a fever.

    Unwarranted Reasons Not To Vaccinate - Many children in the U.S. have not received all of the recommended immunizations. Unnecessary precautions have led parents to postpone or cancel scheduled immunizations. The following list of conditions are NOT routine reasons for postponing or canceling immunizations. That is, a child can still be immunized even if one or more of the following conditions is true:

    • Your child had soreness, redness, or swelling at the injection site after a previous vaccine injection
    • Your child had a fever of less than 105° F after a previous vaccine injection
    • Your child has either had or currently has a mild illness such as a cold, cough, or diarrhea without significant fever
    • Your child has been exposed to an infectious disease
    • Your child is taking antibiotics
    • Your child was born prematurely
    • You are pregnant or currently breastfeeding
    • Your child has an allergy (except egg allergy in some instances)
    • Your family has a history of seizures or Sudden Infant Death Syndrome (SIDS)

    Symptoms of Severe Reactions to Vaccinations - Call the office immediately if a child has any of the following symptoms:

    • Extremely high fever. A rectal temperature of 105° F or higher. (Temperatures taken under the arm, or in the mouth, may tend to be lower)
    • Inconsolable crying. Your child has been crying for over 3 hours without stopping or has a cry which does not sound normal (high-pitched), despite using a pain medication.
    • Seizures. This is usually secondary to fever. Febrile seizures are not dangerous, but you should notify our office regardless.
    • Shock. Your child collapses and turns pale or unresponsive. (call 911 first)
    • Severe Allergic Reaction. Swelling of the mouth and throat, wheezing, breathing difficulties, and dizziness. (call 911 first)

    Call the office within 24 hours if your child has any of the following symptoms:

    • Injection site is still red and swollen
    • Fever does not improve or if he is still fussy

    Your next visit is your 2 Month Checkup

    At your baby's 2 Month visit, look forward to receiving more information on Breastfeeding, Developmental Expectations, and advice on ensuring a continuing healthy baby. Contact us if you would like information sooner.

  • 2 Month Old

    Your 2-Month-Old

    By two months of age, you will notice that your baby may no longer look and act like a newborn. Her movements may be more intentional, and he may be vocalizing to get your attention. So much has changed!

    Diet

    Your baby still requires only breast milk or an iron-fortified formula. It is too early to begin cereals, juices, or other solid foods. Most babies at this age are feeding approximately 4-5 ounces every 3 to 4 hours (slightly more frequently for breastfeeding babies). Breastfed babies should remain on D-Vi-Sol vitamins, 1.0ml/day.

    Always hold your baby during feedings. Never let the baby sleep with the bottle because this can cause cavities and ear infections.

    Hygiene

    Continue with lukewarm water on your baby’s face. A hypoallergenic soap may be used for the rest of the body. Moisturizing lotions are usually not necessary, but if you choose to use them, make sure that the lotion is hypoallergenic (no added scents or dyes). You also may want to do a “test patch” (put lotion on a small area on her leg, and wait 24 hours to make sure she doesn’t react). Wash your baby’s hair/scalp with a baby shampoo 2 to 3 times per week. Give your baby a bath anywhere from once a day to 2 or 3 times per week. Wash her face once to twice per day, with lukewarm water.

    Do not use Q-Tips in your baby’s ears. Instead, wash away any wax you can see with a washcloth. Any wax that is still in the ear canal is protective. Keep finger and toenails short enough to prevent scratching. Cut the nails straight across using scissors or an emery board.

    Safety

    Continue to use an approved car seat in the back and middle seat of the car. Do not use an upright car seat until your baby has good head support, typically closer to 4 months of age.

    Infants are becoming more active and may begin to roll over in the next few months. Never leave your baby on an elevated surface unattended. To be safe, never place an infant seat on anything but the floor.

    Avoid holding your baby while cooking, smoking, or drinking hot liquids. No necklaces or pacifiers on strings.

    Behavior and Development

    Fussiness - Your baby may continue to have fussy periods and continue to spit up. This does not indicate a change in formula or that your baby is ready for food. To minimize fussiness and spitting up, keep your baby upright for 15-30 minutes after feedings and burp your baby frequently.

    Sleep - Most babies are still not sleeping through the night. Infant sleep requirements vary; some sleep best during the evening while others sleep better during the day. To avoid the development of sleep problems later in life, put your baby down in the crib while still awake, yet sleepy. She needs to learn to be a “self-soother”. There is no need for parents to be the baby’s pacifier. We do not expect babies to start sleeping through the night until they are at least 4 months old. Now is a good time to start working on a bedtime routine (the same series of events that lead up to bedtime). This helps your baby learn to fall asleep better on her own, as she will expect that ending up in bed is the final part of the routine. You may choose to start with a bath, then massage with lotion, read a book, then a quick snuggle in the rocking chair.

    Stimulation - Babies at this age enjoy stimulation. Infants enjoy looking at mirrors, pictures, and bright colors. Make sure that you vary your baby’s environment to maximize her stimulation; on her back under an activity gym, on her stomach on an activity mat, and in an infant seat to watch your activity. Talk to your baby while you cook dinner, clean up, or do other things around the house. Everything you do is an opportunity for social interaction with your baby.

    Babies enjoy hearing someone talk or sing to them. They enjoy listening to music (not watching television). They enjoy being cuddled and rocked and will respond by smiling and cooing.

    Development - You may notice that your baby has more head support. She may begin to push up and lift her head when she is on her stomach. She may lift her head off your shoulder and begin to look around. She may start to kick her legs and move her arms more purposefully. She may begin to roll over. She may hold onto rattles and bring her fingers to her mouth. She may start to coo and vocalize in response to your actions and even in order to get your attention. Cooing is a sound which consists primarily of vowel sounds like “ooh” or “aah”. She will start to smile.

    We recommend supervised “tummy time”, putting your baby on her tummy on a blanket on the floor, while you and the baby are awake. Some babies may not enjoy “tummy time”, but still attempt it for a few minutes each day. This will help your baby to practice using her neck and arm muscles.

    Illnesses

    Cold Symptoms - His chance of infection is increased when you expose him to large groups of people. Most infants, toddlers, and children get close to 8 colds a year. Most of these colds occur during the Fall and Winter. Since most colds last for two weeks, your child could conceivably have a cold every week of the Fall and Winter seasons.

    Most cold symptoms can be controlled with saline nose drops, suctioning, head elevation, and a cool mist humidifier. Cold medicines will not change the duration of illness, and at this age can be dangerous.

    Illness Warning Signs - You should call us if you think your baby is sick. Some warning signs are:

    1. A temperature of over 100.5° when taken rectally
    2. Refusal to nurse or take a bottle
    3. Repeated vomiting
    4. Not urinating at least every 8 hours
    5. Being very restless and irritable
    6. Difficult to wake up at feeding time
    7. Looking sick, or “just not right”

    Vaccination Tips

    After today’s vaccinations, you may notice that your baby is a little more cranky than usual or sleeps more than usual. In most cases, this is normal. Extra care and attention are usually all your baby will require. Occasionally, a cool compress to a sore injection site or an appropriate dose of Tylenol may alleviate some pain and discomfort.

    Call the office immediately if a child has any of the following symptoms:

    • Extremely high fever. A rectal temperature of 105° or higher. (Temperatures taken under the arm or in the mouth tend to be lower)
    • Inconsolable crying. Your child has been crying for over 3 hours without stopping or has a cry which does not sound normal (high-pitched), despite using a pain medication.
    • Seizures. This is usually secondary to fever. Febrile seizures are not dangerous, but you should notify our office regardless.
    • Shock. Your child collapses and turns pale or unresponsive.
    • Severe Allergic Reaction. Swelling of the mouth and throat, wheezing, breathing difficulties, and dizziness.

    Call the office within 24 hours if your child has any of the following symptoms:

    • Injection site is still red and swollen
    • Fever does not improve or if he is still fussy

    Your next visit is your 4 Month Checkup

    At your baby's 4 month visit, look forward to receiving additional information on: Learning how to stimulate and interact with your baby, and learn about signs that  your baby may be ready for solid foods

  • 4 Month Old

    Your 4-Month-Old

    Diet

    Breast milk and formula remain the primary nutrient source for your growing baby. At this age, feedings usually become less frequent. Most babies feed approximately 5-6 ounces every 3-4 hours. Most formula fed babies at this age take a total of 26 to 36 ounces per 24 hour period.

    Breastfed babies feed every 3 to 4 hours for 5 to 20 minutes per breast. Breastfed babies should remain on D-vi-sol.

    Typically, we do not start solid foods until 6-months of age, but at this age, some babies may require additional calories (energy) to supplement the breast milk or formula. This may depend on how often they feed throughout the day, whether they continue to feed throughout the night, and the total amount they feed in 24 hours. Babies may be ready for solid foods when they seem hungrier throughout the day. At this age, most of the baby’s calories still come from breast milk or formula.

    In 2000, parents were told to delay giving highly allergenic foods, such as eggs, peanuts, tree nuts, and fish, for months or years longer than other foods. However, this advice was changed in 2008, because studies did not show enough evidence in support of waiting to introduce these foods. Furthermore, there is now evidence that early introduction of these foods may actually decrease the risk of allergy. Experts now recommend that high-risk infants be introduced to traditional supplemental foods between four and six months of age

    If your infant has no signs of allergy (including eczema) with the initial foods, additional foods can be introduced gradually, including the highly allergenic foods (eg, cow’s milk, eggs, peanuts, tree nuts [although not whole nuts because of choking risk], soy, wheat, fish, and shellfish). Whole cow's milk should not be given to any child until after age 12 months, but yogurt and cheese can be given before 12 months.

    If solid foods are introduced, always feed with a spoon; never put the cereal in a bottle. Babies know when they are full. When they have had enough, they will stop eating.  Many infants have a normal reflex called a “tongue thrust”. Whenever something touches their tongue, they thrust the tongue out. This is commonly confused with not liking the food they are eating. Try to drip the food on the back of his tongue.

    Every 3 to 4 days, you may introduce a new food. You can try meats, vegetables, and fruits, in any order. Try one new food at a time, including combination foods. After each new food, watch your baby for allergic reactions - rashes, diarrhea, vomiting. There is no rush; remember that the solid foods are only supplemental calories.

    Always feed your baby while sitting up. Do not force food into your baby. If your baby does not easily accept solid foods, stop and try again in a few days.

    Some parents wish to make their own baby food, by pureeing cooked vegetables in a blender (with some added water to make it thin enough for baby to swallow). You can freeze the baby food in individual portions using an ice cube tray. The only baby foods that you should not make from scratch are carrots, spinach, beets, turnips, and collard greens. Some of these vegetables contain high amounts of nitrates (baby food companies screen for these).

    Babies are usually ready for regular foods when they are about 6 months old. We will discuss this more at the 6-month check-up.

    When introducing new foods, be sure to avoid all nuts, fish, and shellfish, until at least age 1 (or later depending on your family history).

    Development and Behavior

    Babies at this age may begin to laugh out loud, reach for objects, roll over, hold their head up, and transfer objects from hand to hand. They will follow objects well with their eyes. They enjoy looking at their hands and feet and may enjoy looking into a mirror.

    Babies enjoy as much sensory stimulation as possible. They may scream in joy in order to hear their own voice. They love to hear music and to be read to (board, cloth, or vinyl books). Limit the amount of time your baby spends in a playpen. Instead, allow him to explore under supervision; on his back under an activity gym, on his stomach on an activity mat, or in an infant seat so that he can watch your activity.

    He will enjoy holding and feeling different textured objects. He may place these objects in his mouth, so be careful that the object is large enough as not to risk choking.

    Read to your baby!

    Sleeping

    At this age, most babies will sleep for at least eight hours in a row at night, and two naps during the day. Make sure to stick to your bedtime routine for baby.

    Your baby may begin to roll over in his crib at night. There is not much that you can do to prevent this. We still recommend putting a baby in his crib on his back, but if he rolls over by himself in the middle of the night, that’s OK.

    The sleeping habits of your baby may now be changing. Put your baby in the crib “sleepy, but awake”. He needs to learn how to be a self-soother and put himself to sleep. He may want to use a pacifier or a toy as a comforter. Make sure that you do not become the comforter or you will be awake all night. This is a good age to start to let your baby “cry it out” in order to fall asleep. You have to be ready for it too! When you are, we can help you through this transition. “Crying it out” is NOT psychologically damaging to a baby. There are ways to do this that are less traumatic both for the parents, and the baby. We often refer parents to Richard Ferber’s book Solve Your Child’s Sleep Problems.

    Health and Safety

    Continue to use a mild moisturizing soap and baby shampoo every 2-3 days. No Q-Tips in your baby’s ears. Keep fingernails/toenails short enough to prevent scratches utilizing an emery board or baby scissors.

    Remember that your baby is beginning to roll over. Never leave your baby unattended, especially on an elevated surface. Do not use a high chair until your baby is able to sit up without support or unless the high chair angles backward.

    You may notice a change in your baby’s bowel movements after the introduction of solid foods. Remember that constipation only refers to the hardness of the stool and not the frequency. These changes in stool consistency are normal and are a part of a normal adjustment period. If the stools are as hard as “rocks”, let your doctor know.

    Never use a walker because it inhibits normal motor development and is the cause of numerous accidents. You may use stationary exersaucers, treadmills, or Jumpers.

    Since most things are going into your baby’s mouth, make sure you examine toys for sharp points and removable parts.

    Always use a rear-facing car seat in the middle of the back seat of the car.

    Teething

    Your baby may begin cutting his front teeth. Most babies will get their first tooth (or teeth) at 6 or 7 months of age. There is a wide range though (anywhere from 4 to 13 months). Usually, the lower middle two teeth are the first to come in. Teething may cause drooling, but it does not cause fevers. If your baby has a temperature above 100.4° rectally, the fever is due to an illness, not teething.

    You can start to brush your baby’s teeth daily with a soft toothbrush and water, or a washcloth. To prevent cavities, never let your baby fall asleep with a bottle.

    To help ease your baby’s pain from teething, use cold teething rings. We do not recommend using frozen objects as they may cause frostbite. As a last resort, use Tylenol.

    Your next visit is the 6-Month-Old Checkup

    At your 6 month visit, you will receive additional information on Encouraging your child's communication skills and visiting relatives.

  • 6 Month Old

    Your 6-Month-Old

    Diet

    If you haven’t already done so, introduce cereals and other solid foods one at a time. You may also introduce diluted fruit juices and pureed vegetables and fruits. For foods, it doesn’t necessarily make a difference if you start with a fruit or a vegetable. Fruits are easier to digest, but vegetables are healthier. Your child may refuse to eat vegetables once he tastes the sweetness of fruits! Remember that it is best to let your child get used to each new food for 3-4 days before adding another new food. For fruit juice, start with less acidic juices such as apple and grape juice. No more than 4 ounces of undiluted juice a day.

    In 2000, parents were told to delay giving highly allergenic foods, such as eggs, peanuts, tree nuts, and fish, for months or years longer than other foods. However, this advice was changed in 2008, because studies did not show enough evidence in support of waiting to introduce these foods. Furthermore, there is now evidence that early introduction of these foods may actually decrease the risk of allergy. Experts now recommend that high-risk infants be introduced to traditional supplemental foods between four and six months of age.

    If your infant has no signs of allergy (including eczema) with the initial foods, additional foods can be introduced gradually, including the highly allergenic foods (eg, cow’s milk, eggs, peanuts, tree nuts [although not whole nuts because of choking risk], soy, wheat, fish, and shellfish). Whole cow's milk should not be given to any child until after age 12 months, but yogurt and cheese can be given before 12 months.

    Some children may be ready for handheld foods. These include Zwieback or teething biscuits. Avoid peanuts, raisins, popcorn, raw carrots, hot dogs, grapes, and other small foods that your baby could choke on. Also stay away from eggs, fish, shellfish, and nuts until after one year of age. Babies at this age will also do well with soft table foods such as a piece of a pancake, soft pasta, avocado, banana, etc. After each new food, watch your baby for allergic reactions - rashes, diarrhea, vomiting.

    As always, continue to breastfeed or use an iron-fortified formula until 1 year of age. You may begin trying sips from a cup. Keep the amounts to approximately 24-32 ounces per day, or 4-5 breastfeedings a day. Fluoride should be added to the diet either through fluorinated tap water, fluoridated bottled water, or a fluoride supplement. Be sure to let your doctor know if you have well water. Your baby may need a fluoride supplement.

    Make mealtime a family time. It should not be a time for fighting or confrontation. This is a time your baby will start experimenting with his hands to feel textures. It is all right to make a mess.

    Development

    This is the age when babies start to develop faster than you are ready. They will roll over when you are not watching (they can fall off of the changing table), objects will magically disappear from their hands and reappear in their mouth (watch for choking), and they will begin to take pleasure in playing with you. If you haven’t done so already, start to “childproof your home”.

    Your baby may now have developed significant motor strength and dexterity to be able to roll over, sit without support for short periods of time, and transfer objects from hand to hand. It is important to play with your baby. Babies need opportunities to develop new skills through play. Place objects slightly out of your baby’s reach to encourage him to move or crawl the extra distance. Playing with a cup in the bath will help him learn how to use it at mealtime. Let him explore the textures and sensations of various objects. Let him explore how he can manipulate objects by playing with pots and pans, stacking toys, or hide-and-seek toys.

    Socially, you may notice increased interaction with you and with others. He will be babbling more frequently. He will start to imitate sounds. As opposed to cooing, babbling refers to the use of more consonants rather than just vowels, like “a-goo” or “b-b-b-b-b”. He will begin to know the difference between family and strangers which may result in getting shy or crying when left with strangers. This is a type of “object permanence” - knowing that an object or a person has significance. Another manifestation of this is looking for a toy when it is hidden or watching something fall to the ground to see where it goes.

    You play games with your baby such as “pat-a-cake” or “peek-a-boo”. Your baby may also enjoy music and singing. Don’t forget to read to your baby daily.

    Teething

    Teething-Your baby may begin cutting his front teeth. Most babies will get their first tooth (or teeth) at 6 or 7 months of age. There is a wide range though (anywhere from 4 to 13 months). Usually, the lower middle two teeth are the first to come in. Teething may cause drooling, but it does not cause fevers. If your baby has a temperature above 100.4° rectally, the fever is due to an illness, not teething.

    You can start to brush your baby’s teeth daily with a soft toothbrush and water, or a washcloth. To prevent cavities, never let your baby fall asleep with a bottle.

    To help ease your baby’s pain from teething, use cold teething rings. We do not recommend using frozen objects as they may cause frostbite. As a last resort, use Tylenol.

    Sleep

    Sleep - At this age, many babies who have been sleeping through the night may begin to wake up one or more times. This is again because of “object permanence”. Your baby now knows when you have left the room, the same way your baby looks for a ball you hid behind your back. To resolve this separation anxiety, it is important to reassure yourself that your baby is alright. Rocking or feeding him is rarely necessary and may even develop into a habit that is hard to break. Remember that consistent bedtimes and few distractions are essential to develop sleep patterns. Babies need to learn to be “self-soothers”. Make sure that you do not become your baby’s soother. Instead, a transitional object or a “lovey” may comfort him at night.

    Discipline

    Discipline your baby by rewarding desired behavior and withholding reward or praise from undesirable behavior. Focus on positive reinforcement. Time outs do not work at this age, but briefly ignoring your baby will have the same effect. Never hit your baby.

    Safety

    Since your baby is more mobile, never leave him unattended in a bath, high chair, or changing table. He may only be alone in a closed crib or a playpen. He will probably crawl sooner than you are ready, so place gates at the top and bottom of stairs and protect any overhangs. Babies will grab almost anything. Keep small choking hazards out of his reach. Keep tablecloths, dangling electrical cords, electrical outlets, and other loose objects out of his reach or covered. Have at least one room in your home that is completely “childproofed”, so that your baby can explore and play safely.

    Always use an infant car seat. Make sure your baby is in the middle of the rear seat facing toward the back. A front-facing car seat cannot be used until your baby is at least two years old.

    Keep all medicines, cleaners, detergents, and other poisons locked up and out of reach. No Q-tips for cleaning the ears - wax protects the eardrums.

    Your next visit is the 9-Month-Old Checkup

    At your baby's 9 month visit, look forward to learning more about: Stranger anxiety, limit setting.

  • 9 Month Old

    Your 9-Month-Old

    Diet

    Continue with approximately 24-28 oz/day of an iron-fortified formula, or breastfeeding 4-6 times/day until 1 year of age. If your baby is doing well with a cup, you may try to wean from the bottle. Continue to use fluoridated water or a supplement (as directed by your pediatrician).

    You may further expand your baby’s diet by introducing some textured junior foods, well-cut finger foods, and egg yolk. Avoid raisins, popcorn, peanuts, raw carrots, uncut hot dogs, and other small foods which may become a choking hazard. Avoid peanuts and shellfish, and other foods which may tend towards allergic reactions. For solid foods, your baby should be on 3 meals per day, plus a healthy snack.

    You may start to introduce milk products like cheese and yogurt, but not whole milk until 12 months of age. Allow mealtime to be messy so that your baby can experiment with his fingers and with a spoon.

    Hygiene

    As your child gets his teeth, you may use some gauze, a soft washcloth, or a soft baby toothbrush to get the sugar off of his teeth. No toothpaste is needed.

    Continue to bathe as needed. You should try to refrain from using bubble bath because it can cause irritation of the skin. Allow your child to play in the bath before you use soap and shampoo because this too can be irritating.

    Shoes are needed only to protect your child’s feet from the cold and from sharp objects. Use only well-fitting, soft-soled, and flexible shoes.

    Safety

    Do not leave your child unattended. Babies should be briefly left alone only in a crib or playpen. Walkers do not help a child learn to walk and are not recommended due to the high incidence of injury. Walkers may also delay motor development. You may use stationary treadmills or jumpers. Contrary to popular belief, a child does not become bowlegged by being on his legs.

    Continue to childproof your home. Try to be several months ahead of your child’s development. Install gates above and below stairs. Make sure you use socket covers, window guards, railing guards, edge protectors, and cabinet and drawer locks. Since your child is exploring, touching, and tasting everything, make sure you keep small objects off the floor, keep dangling tablecloths away from the floor, and hot objects out of reach.

    To avoid poisonings, keep medicines, cleaners, detergents, powders, and other toxic materials locked away and out of reach. If your child ingests something dangerous, immediately call Poison Control (1-800-222-1222). Poison control will instruct you as to whether to go to the hospital, call the physician, or whether to give an antidote. Do not do anything unless instructed by Poison Control or your doctor.

    Continue to use the appropriate car seat. Rear-facing until at least until age 2. Keep the seat in the middle of the back seat.

    Development

    Your child is becoming much more mobile. Most, but not all, will be crawling and getting into a seated position without help. Some may pull to a standing position and walk along the furniture (cruising). They will have improved finger dexterity and be able to pick up objects with a pincer grip instead of scooping with their whole hand. Your child may be able to take cheerios out of a cup or bowl.

    Your child’s speech will start to change. He will transition from cooing with vowels to non-specific babbling with consonants. Remember that it is always easier to say Da-da than Ma-ma. It is important to repeat words slowly and distinctly. Continue to read, sing, and talk often to your child.

    If your family is bilingual (speaks two languages), encourage your child to speak both languages. Babies do not become confused by hearing two different languages in their home. The younger babies are exposed to multiple languages, the easier it is for them to learn them.

    Behavior

    Your baby will explore his new environment by touching and tasting everything in sight. Playing with a spoon will help him learn to eat, even if he is not very successful getting anything into his mouth. By making and imitating noise and sounds, your child is perfecting his speech. Use toys and household utensils to give your child a variety of stimulation: blocks, pans, lids, motion toys, cloth or cardboard books, unbreakable mirrors.

    Now is the time you could start to spoil your child. He is beginning to learn how to manipulate objects, and soon he will learn how to manipulate you. He knows when you hide an object behind your back, and he knows when you are out of his sight in the other room. It is time to begin letting go and not solve all of your child’s problems.

    He is watching you in order to learn appropriate (and inappropriate) behaviors. Make sure that you are aware that he is watching your every move and that your behavior may soon become his behavior.

    Your next visit is the 12 Month Checkup

    At your 12 month checkup, look forward to receiving more information on healthy toddler eating habits, toy safety, and routines.

  • 12 Month Old

    Your 12-Month-Old

    Diet

    Your child’s appetite may seem decreased as compared to the previous months. He may be eating less food at each meal and not want to eat at every meal. This is normal at this age because your child is no longer growing as fast as he was during the first 12 months. Less growth means a lessened need for calories.

    You may now begin whole milk in your child’s diet. Many children will simply make the switch to whole milk from formula or breast milk easily. Others may need to slowly dilute the whole milk with either formula or breast milk in order to slowly adjust to the taste. We recommend putting the milk in a cup, and giving with meals. Aim to be done with the bottle by 18 months. 16-24 oz of whole milk/day should be enough. Do not use low-fat milk until after 2 years of age. They need the milk fat for brain development. You can continue to breastfeed your child. Remember that juice is not a nutritional requirement. If you do use juice, keep it to less than 4 oz per day.

    You can now try whole eggs, strawberries, citrus, and shellfish. Save peanut butter as one of the last new foods (unless your family has a history of food allergies). Watch for allergic reactions like rashes, vomiting, or diarrhea. Continue to avoid raisins, popcorn, raw carrots, uncut hot dogs, and other small foods which are choking hazards. Cut foods into small bites.

    Many children this age will be eating all finger foods for meals, while some may still prefer baby food. You may need to start to think of each meal in terms of only finger foods, as your child becomes more independent and will not want to be fed.

    Check the temperature of the food, especially micro-waved food, prior to serving.

    Development

    Your child may begin to walk at this age, although some do not walk until close to 15-months of age. You can provide an incentive to walk by allowing him to “cruise” while holding onto furniture and placing his favorite toys slightly out of his reach. Ensure that your house is well protected from your wandering child.

    Your child will become more proficient in using his hands. He may start using a spoon, although he may not be very accurate in making it to his mouth. He may start using stacking blocks and rings. Clapping games and pat-a-cake will be of interest.

    Your child’s speech is also becoming more specific. You may notice specific babbling like “Da-da” or “ma-ma”. It is important to talk to your child slowly and distinctly so that he can learn the nuances of speech. Read books, sing songs, and hold conversations with your child.

    His brain is like a sponge and will absorb as much information as you can give to him. Be your child’s learning coach. Observe him closely to see what he can do, then help him take the next step.

    Behavior

    A child’s relationship with his mother and father is usually characterized by a mixture of independence and dependence. One moment he may fight being held, and the next he may be clinging to you “for dear life”. Your child may be able to tell you and show you his wants and his displeasures. Infants at this age know that when you leave, you still exist. This is a very important skill but can lead to difficulty because he knows he can get you back into his room when he cries in the middle of the night. Be positive when you leave him and give him something as a “soother”.

    A child likes to imitate your behavior, so be a good role model. Occasional temper tantrums are best ignored. It would be better to discipline your child by rewarding desired behavior and ignoring the undesired behavior. Try not to give your child negative re-enforcement. It is best to be consistent; setting limits primarily for safety reasons through verbal “no’s” and removing him from potential danger. Prohibition should be clear and firm. It will take repeated practice before your child will learn right from wrong.

    Unfortunately, he will thrive on repetition, so you may find that you are always reading the same book, playing with the same toys, or singing the same song. This is the way that he figures out how things work, and doing things repeatedly builds self-confidence and strengthens connections in the brain.

    Continue to read to your child and keep “screen” time to a minimum. The American Academy of Pediatrics recommends no TV until age 2. Engage in conversations with your infant and keep it going as long as he is interested. These conversations help boost his overall development - social, emotional, verbal, intellectual, and even motor.

    Your next visit is the 15 Month Checkup

    Look forward to receiving additional information on Weaning from bedtime bottles and temper tantrums. Contact us if you would like information sooner.

  • 15 Month Old

    Your 15-Month-Old

    The following information is an excellent source for answers to your age-specific health and development concerns. These are available at the office, but are here for you as a convenient resource. At times, the information may be somewhat different than what we discussed at the time of your visit. If you have questions, please call us.

    Diet

    Remember that your child’s appetite may not be as consistent as it had been in the past. Their eating habits are usually not consistent from day to day. Most toddlers eat one good meal a day. It is common that toddlers may suddenly not want to eat foods that seemed to be their favorite in the past. Make sure that what you attempt to feed your toddler is a meal that is well-rounded, including foods from all of the food groups. Mealtime should be a happy time; do not force your child to eat.

    Keep on introducing new foods and watching for any allergic reactions. Continue to avoid raisins, popcorn, and other foods which may be a choking hazard. Cut up foods into cubes such as cherry tomatoes and grapes.

    Continue to give your toddler a total of 16 to 24 ounces of whole milk per day (until he is 2 years old). Give all of his milk in a cup instead of a bottle. Allow your child to use utensils with age-appropriate handles. Use non-breakable dishes, small forks, and spoons. Your child may not be very accurate with the spoon, but with time, his accuracy will improve. Hopefully, your child will be off of the bottle during the next few months.

    Development

    Children at this age can usually walk and may begin to run and climb furniture. You may notice that your child walks “pigeon-toed” or “bowlegged”. This is normal leg development which may not look normal until he is 6 years old. You do not need to do anything to help the bone development other than letting your child do what comes naturally.

    Your child’s finger dexterity will be improving and becoming more accurate. Allow him to play with a variety of toys which will allow him to turn wheels, push buttons, open doors, and slide panels. This will help in finger dexterity.

    Continue to read to your child every day.

    You will notice a lot of babbling with a combination of gibberish and identifiable words. Make sure that you encourage speech development by continuing to have “conversations” with your child. Reading the same book over-and-over will help your child learn new words and give a sense of consistency. He will most enjoy animal books and word books. Keep “screen” time to a minimum. Your child will always prefer human companionship to television companionship.

    Behavior

    It is important to expose him to other children. Your child will start to become curious about other children, but will generally prefer to play alone. This is called parallel playing. He probably won’t start to play with other children until after his second birthday.

    Your child is becoming more adept at manipulating you. He knows how to get your attention and he knows how to try to get what he wants. Temper tantrums are a part of normal development and may include screaming, biting, head banging, kicking, and breath holding. It is best to try to ignore this behavior. Refrain from physical punishment or spanking. Remember that he is observing you and that your behavior may soon become his behavior. Don’t forget to smile and praise your child when he is doing something right.

    Children at this age are becoming real explorers. They will want to look into everything, touch everything, and try everything. This curiosity even applies to exploring their own bodies and genitalia. This is all healthy and normal.

    Safety

    Your new “explorer” will tend to be where not expected. Make sure that you continue to childproof your home with gates, outlet covers, cushions, and locks. All playtime should be supervised, especially when near a street.

    If your child can climb the stairs and climb onto chairs, he most likely will be able to climb out of the crib. Make sure that the crib mattress is at the lowest level. If he can still climb out of the crib, it is time for a child bed.

    Continue to use the appropriate car seat rear-facing in the back and middle. To avoid poisonings, keep medicines, cleaners, detergents, powders, and other toxic materials locked away and out of reach. If your child ingests something dangerous, immediately call Poison Control (1-800-222-1222). Poison control will instruct you as to whether to go to the hospital, call the physician, or whether to give an antidote. Do not do anything unless instructed by Poison Control or your doctor.

    Your next visit is the 18 Month Checkup

    At your child's 18-month-old check up, look forward to receiving additional information on Temper tantrums and speech development.

  • 18 Month Old

    Your 18-Month-Old

    The following information is an excellent source for answers to your age-specific health and development concerns. These are available at the office, but are here for you as a convenient resource. At times, the information may be somewhat different than what we discussed at the time of your visit. If you have questions, please call us.

    Diet

    Your child may become a picky eater and refuse foods that use to be his favorites. He may turn his head away after only a few bites of food. He may resist coming to the table at mealtime. In spite of this, remember to offer a balanced diet. Don't compensate with sweets and crackers between meals because this will decrease his mealtime appetite and increase his chance of obesity. Continue to offer a small variety of foods, tastes, and textures at each meal. Let him choose what he wants to eat. Meal time should be fun and not an ongoing fight. Continue to use whole milk until age 2.

    Many parents worry that their child is not eating enough at this age. Most toddlers "eat to grow", meaning that they consume the right amount of calories that they need to meet their needs every day. Your child's rate of growth is less than it was when he was a baby.

    Most children should be completely off the bottle by now. Most bottle feedings are acting solely as a comfort to your child, especially those before nap time, bedtime, and in the middle of the night. Try to find other methods of comfort, like a stuffed animal, blanket, or music. If you do have trouble removing the bottle during bedtime, use water instead of milk or juice to help protect teeth.

    Most children do not need a dietary supplement if they are eating a well-rounded diet of multiple colors. Some families may be missing specific vitamins and supplements because of cultural or religious restrictions. For example, vegetarians will need a vitamin B12 supplement (along with others). Make sure to discuss this with your pediatrician.

    Development

    Your child will continue to perfect his walking. He may run awkwardly at first, but with more practice, he will start to have more balance and fall less often. He may use his hands and arms for balance instead of carrying things around the house. He may enjoy pushing carts around which will help with his balance. But remember, do not use walkers - they will only injure your child and not improve his walking.

    His finger dexterity will be more proficient. Some children may have a preference for being either left or right handed, but most will appear ambidextrous for several years. Your child will enjoy building towers and knocking them down, covering and uncovering boxes, putting pegs into holes, scribbling and painting, and folding paper. All of these activities will further develop his fine motor skills.

    His speech should continue to progress. Over the next 6 months, you should note a weekly increase in the number of spoken words to a point of 50 or more words by age 2. (Most 18-month-old children can say about 15 words.) As a parent or daily caregiver, you should begin to understand about one-half of what your child has to say. For the remainder of the conversation, "pretend" that you understand and continue the conversation with your child. Speak slowly and distinctly so that your child can learn the fine nuances of speech. Repeat words while pointing so that your child can continue to make word associations. Soon, you will not be able to stop your child from talking.

    Behavior

    Your child will begin to "pretend" play. He will start imitating your activities and others by brushing a toy's hair, reading a book to a stuffed animal, talking on a toy telephone, or having a tea party. He will start to use his imagination in new and creative ways like using a spoon as an airplane, a brush as a boat, or pillows as a fort. This is a great age for your child where he actually starts to enjoy playing with you and learning new things.

    Your child will still feel that he is at the center of the world, but he now knows that other people exist and that they could be of interest to him. He will enjoy playing alongside other friends but still have difficulty sharing. Make sure that you have plenty of toys around so that each friend has his own.

    Try to get a feeling for your type of child. Is he an aggressive child who wants to take charge and control everything? Or is he a shy child who will sit back to watch and wait before joining an activity? You will have to gear your behavior toward the behavior of your child. For the aggressive child, you should set firm limits, give him plenty of activities for his high level of energy, and supervise play dates to prevent problems before they happen. For the shy child, you should allow him to move at his own pace allowing him to adapt to situations slowly, holding his hand for reassurance, and not getting frustrated when he refuses to get involved.

    Because children at this age love imitation, you may notice that your child is beginning to have an interest in potty training. Now is a good time to start to introduce your child to the concept of potty training, by letting him observe you going to the bathroom, reading books about the potty, and talking to him about it. When you notice dry diapers for several hours, or if he wakes up dry after a nap, this is the time that his body is now ready to be potty trained. This usually happens around age two but could be much later.

    Safety

    Remember that prevention is the best action. Attention needs to be given to cigarette lighters, electrical outlets, electrical cords, curling irons, and hot beverages. Protect open windows, stairs, and balconies with barriers or guards.

    Never leave your child alone in or near any body of water (bathtub, swimming pool, hot tub, wading pool, a large bucket of water, etc.) without constant supervision. Never leave your child alone when you are both outside.

    Continue to use a car seat rear-facing in the back seat and in the middle.

    Your next visit is the 2-Year-Old Checkup

    At your child's 2-year-old check-up, look forward to receiving more information on discipline, toilet training, and sharing.

  • 2 Year Old

    Your 24-Month-Old

    The following information is an excellent source for answers to your age-specific health and development concerns. These are available at the office but are here for you as a convenient resource. At times, the information may be somewhat different than what we discussed at the time of your visit. If you have questions, please call us.

    Diet

    Your child should now feel a part of the family during meals. Most toddlers eat three meals a day with 1 or 2 healthy snacks in between. Your child will become an active participant in meals, using a spoon, fork, and cup.

    You may try any foods at this age. Keep the size of food small in order to prevent choking. The amount of milk should be 16-24 ounces of low-fat milk per day. You may also find that your child no longer eats some of the foods that he used to eat. This is a typical show of independence. Wait a few weeks and re-introduce the food.

    You may have noticed that your child no longer wants to eat as much as before, has become a picky eater, refuses food, or resists mealtime. This is normal behavior because your child is no longer growing as fast as before. Skipping several meals or eating only one healthy meal a day is not unusual. A serving size should be not much more than 2-3 tablespoons; larger portions may be overwhelming.

    Because many people do not get enough vitamin D in their diets, we recommend that all children take a children's multivitamin daily. There are many varieties available over the counter.

    Development

    Speech is now becoming an integral part of your child's development and socialization. He should now have at least 50 words in his vocabulary and be speaking two-word sentences. A stranger should understand at least half of his speech. You should try to avoid comparing your child's speech to that of others. There will be a lot of variation. Some children may be hearing several languages spoken at home which will result in normal speech delay because he is learning several languages at once.

    Since his language is now developing, he will now be able to communicate his wants and desires. There are definite advantages and disadvantages to this milestone. While it is great to finally understand what your child is asking for, it is quite another thing to hear him continually say "no" to every question and pretending that he does not understand what you are saying. This is just another example of your child exerting his independence.

    You will see more refinement in your child's gross and fine motor skills. He should now be able to jump with two feet, walk up and down stairs, and kick a ball. He will be able to color and scribble with crayons. Some toddlers can take off their clothes.

    Temperament

    Your child will try to exert his independence by having temper tantrums, throwing toys at you and at friends, and turning simple dressing and undressing into civil wars. This is normal behavior at this age. Your child views the world as his own and expects others to realize this fact. He may be so self-centered that you think he is spoiled. With time, this stage will pass and you will have to deal with new problems. For now, consistency, ignoring the unacceptable behavior, and praising acceptable behavior are usually the best responses.

    Temper Tantrums

    Your child may be starting to have "temper tantrums". Some children are able to be distracted at this age. If you cannot distract your child, it is best to ignore him. If you are in public and your child has a tantrum, leave with your child and return when he has calmed down.

    Discipline

    It is important to be consistent with your 2-year-old. Set clear limits. You can start to put your child in "time out". Your child should be in time out for the number of minutes that is equal to his age in years (For example a two-year-old will be in time out for two minutes).

    Refrain from spanking. This only teaches your child to be physical when he is upset.

    Stimulation

    Monitor the amount of screen time that your child has during the day. Screen time includes television watching, video games, and computer games. Not only is there a direct relationship between the amount of screen time and the amount of obesity in children, but too much screen time may "mis-wire" their brain and cause attentional problems in the future.

    It is more important to help your child learn how to entertain himself by looking at picture books, playing with puzzles, using clay or Play-Doh, or coloring with crayons. These skills will become more important as he gets older. Your two year old will be very curious. Talk to him about your world. Everyday events like going to the grocery store or making cookies can be very educational.

    Continue to read to your child. Remember that he will probably want to read the same book over and over. This is a great way for your child to learn both the spoken and written language. He may be able to read the book to you looking at the pictures. Repetition reinforces consistency and comfort.

    Sleep

    Your child will probably sleep between 9 and 13 hours a day. This may include one or two naps a day, which may become much shorter in duration. Do not be surprised if your child begins to eliminate naps all together.

    It would be great to have a predictable bedtime routine, but many children begin to resist. This is another way for them to exert some independence. Let them make some bedtime choices like which pajamas to wear or which bedtime story to read. Do not let them take advantage of you. They may be trying to get negative attention by climbing out of bed, crying to get you into the room, or asking for a diaper change. Remember that consistency, ignoring the unacceptable behavior, and praising acceptable behavior are usually the best responses.

    Toilet Training

    During this second year of life, most children are ready for toilet training. You may have noticed that they are more aware of "bodily functions" and are interested in doing the same things that you are doing.

    Pediatricians look for two major clues that toddlers are ready for toilet training. The first is having an interest. Your child may enjoy sitting on the potty to read a book, or may want to bring his potty seat to different rooms of the house. He may begin to tell you when he needs diaper changing. These are great clues that your toddler is psychologically ready for potty training. But, your toddler also has to be ready physiologically. This means that your toddler's body needs to be ready to hold onto his urine or his stool. Clues such as a dry diaper after a nap, or the fact that you have not changed a diaper for several hours, are good hints that he is ready for potty training.

    Have your child use the potty when his diaper has been dry for several hours. Use the potty within a half-hour after meals since this is the time most children use the bathroom. If you notice that your child urinates into the bath every time he steps into the bath water, hold the potty or a bucket out so that he urinates into the bucket instead of the bathwater; next time he may hold his urine until the bucket is ready.

    It may take several YEARS for your child to be completely potty trained. Sometimes children take a break from potty training after they are doing so well. This is normal as well and should not be discouraging. Being dry overnight even takes longer. It is not unusual to find 10% of children, even at the age of seven, still having "accidents" overnight.

    For many children, potty training is about control. Positive reinforcement (rewarding for using the potty) is a good way to motivate your two-year-old to want to use the potty. If they are not interested, wait a week or two and try again. Many children will finally use the potty when they feel that the decision is entirely up to them.

    Safety

    Keep the crib at the lowest setting and keep objects, which could be used for climbing, out of the crib. If your child can easily get out of the crib, it may be time to consider a toddler bed.

    Be careful with toys and make sure you check them out before your child does for small and pointed parts which could break off. Do not give any toys that need to be plugged into an electrical outlet. Do not give any motorized riding toys.

    Never leave your child alone near any water. Children can drown in only a small amount of water, even water left in a bucket.

    Make sure that your child is in an approved car seat which fits appropriately, regardless of his age or weight. Use a five-point car seat for as long as your child fits. Go to the various car seat check-points to make sure that your car seat is installed properly. Never leave your child alone in the car.

    Continue to protect your home from potential accidents. Hold your child's hand whenever near the street. Remember that your child will get into trouble faster than you could ever imagine.

    Survey

    The table on the next page is the result of a survey taken from mothers with 2-year-old children from the 1980's. This will give you a good idea that what was normal in the 1980's, is still normal today.

    Type of Behavior

    Eat Too Little

    Doesn't Eat the Right Foods

    Resists Going to Bed

    Awakens During the Night

    Resists Sitting on the Toilet

    Has Bowel Movements in Pants

    Wets Self During the Day

    Wets Self During the Night

    Curious About Babies and Sex Differences

    Touches and Plays With Genitals

    Fights or Quarrels With Siblings

    Jealous of Siblings

    Hurts Younger Siblings

    Is Teased or Picked-On By Siblings

    Shy and Tends to Play by Himself

    Hits Other Children or Takes Their Things

    Give's Into Others Demands

    Stubborn

    Acts Fresh to Parents and Talks Back

    Disobedient

    Constantly Seeks Attention

    Clings to Mother

    Whines and Nags

    Percentage of Parents Responding

    50

    64

    70

    52

    43

    71

    75

    82

    28

    56

    72

    54

    44

    50

    50

    68

    78

    95

    42

    82

    94

    79

    83

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