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Author: Dr. Monica Wonnacott

Age: Newborn

Posted on
Posted by Dr. Monica Wonnacott | August 15, 2020

Congratulations, your beautiful baby has finally arrived.  It’s exciting, wonderful, overwhelming, and exhausting all at the same time.  Soon you’ll find your rhythm.  You’ll get to know your baby’s cues for feeding and sleeping, what each different cry means, and which sounds are worrisome and which sounds aren’t.  Until then, here are a few pointers.

Safety

  1. Car: Use an infant seat, in the back seat of the vehicle, rear facing (I like the 5 point harness style that allows you to pull the straps tight against the infant’s chest)
  2. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/)
  • Sleep:
  • The crib or bassinet is the safest place.
  • On your baby’s back (this is to reduce the risk of SIDS).
  • No extra soft bedding (quilts, comforters), pillows, toys, positioners (these are also suffocation hazards).
  • Water: Water heater less than 120 degree F (to prevent scalding) and sponge baths only until the cord falls off.
  • Smoke: Keep home and car smoke free.
  • Sun: Limit sun exposure.

Nutrition

  1. Breast feeding. When breastfeeding it is hard to tell how much your infant is getting (unless you have a good pump and you pump occasionally before feeding).  Consequently, we indirectly measure input, by measuring output.  Your baby should be having 6-8 wet diapers a day.  Less than that can be a sign of a problem. Most babies this age feed about 8-10 times a day (roughly every 2-3 hours) and take 20-45 mins to feed. The feeding pattern has a lot of pauses at this early stage.
  2. Formula feeding.  If you choose to feed your baby with a formula, you need to use an iron fortified formula.  Nearly all infants (on formula) should use a cow’s milk-based formula.  There are very few medical indications requiring hydrolysed or hypoallergenic formulas (plus, they are expensive).  If you’re looking for cost savings, generic formula is the cheapest. Make sure you always mix formula according to the can directions.
  3. Supplements: Only needed if breastfeeding, give your baby Vit D 400 IU (international units) per day (to prevent Ricketts or soft bones).
  4. Water: Do NOT give your baby any straight water prior to 6 months.

Sleep

  1. Most newborns sleep a total of 16-17 hours in a 24 hour period.
  2. They often have their days and nights mixed up. To help:
    1. Try to keep room dark at night (use a nightlight if needed).
    2. Keep your baby calm and quiet when changing and feeding at night (limit talking and stimulation).
    3. Make daytime playtime (lights on, talk with your baby).
  3. Note: most newborns sleep best when swaddled (imitating the womb environment).

Milestones

  1. Will visually fixate.
  2. Has a startle reflex.
  3. Moves all extremities.
  4. Responds to sound by crying or blinking.

ILLNESSES AND WORRY SIGNS

Limit exposure to public/sicknesses. The first 2 months of life are the most critical in terms of staying well. If your baby gets a fever, there is good chance he/she will be admitted to the hospital. So, better to keep your infant at home, away from potentially sick people. Make sure everyone who comes to visit is healthy and washes hands before touching your baby. Bring your baby to our office (if during the day) or to the Emergency room (if at night) if your infant has any of the following in the next 2 months:

  1. Fever >100.4 (measured rectally).
  2. Poor feeding.
  3. Vomiting (not just spit up).
  4. Extreme or unusual irritability (don’t underestimate your parent instinct, if you think something is wrong, there probably is).

IS THIS NORMAL?

All of the following behaviors are normal in infants this age, so don’t worry.

  1. Hiccups.
  2. Eye rolling (esp. right before falling asleep or during feeding).
  3. Frequent startling .
  4. Whimpering noises.
  5. Sounding congested (small noses make for tight nasal passages) .
  6. Vaginal discharge/spot bleeding (this is hormonal response post pregnancy).
  7. Breast buds (this is also due to a hormonal response post pregnancy).
  8. Insatiable desire to suck.

HOME ACTIVITIES

Between now and the next visit these are things you can work on with your infant to help your infant’s development.

  1. Tummy time (while awake, a few minutes each day, arms in front of the chest, work on upper body and neck strength).
  2. Provide pictures, toys, and mobiles for your infant to look at.
  3. Talk to your infant.
  4. Play soft music.
  5. Hold/cuddle your infant (you cannot “spoil” your infant by holding him too much).
  6. Respond to your infant’s cries immediately; it develops trust and is his way of telling you something is wrong.

YOUR NEXT VISIT

Your baby’s next well child check is at 2 months of age. The vaccines at that visit are: DtaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), Hib (Haemophilus influenza type b), Hepatitis B, PCV-13 (covers 13 types pneumococcal disease), and Rotavirus (oral vaccine for viral diarrhea). Note: There are combination vaccines available to reduce the number in injections.

VACCINES FOR PARENTS/CAREGIVERS

If you (or immediate caregivers and/or siblings) haven’t had the TdaP (Tetanus, diphtheria, and acellular Pertussis) shot, get it now to protect your infant. Also get a flu shot if seasonally appropriate.

To Helmet Or Not To Helmet? That Is The Question.

Posted on
Posted by Dr. Monica Wonnacott | August 6, 2020

When the American Academy of Pediatrics recommended that babies sleep on their back to prevent SIDS (Sudden Infant Death Syndrome), there was a sharp rise in the problem of flat heads in babies. More babies were sleeping on their backs and their heads were getting flat as a result. Since sleeping babies on their backs dramatically decreased the number of cases of SIDS, having babies just sleep on their bellies again was not a viable option. So what came of all those flat heads? The baby helmet industry was born.

Everybody has seen a baby wearing one of those baby helmets or DocuBands (a type of partial helmet). The idea is to put pressure on the parts of the head that are sticking out and leave room for the flat parts to fill in a more rounded shape. The goal is that you gradually reshape the head over time. So why not just use a helmet?

Problems with helmets:

  1. The helmet interferes with natural cuddling and interactions with your baby.
  2. The baby has to wear the helmet 23 hours a day, 7 days a week, for multiple months.
  3. The helmet is heavy and uncomfortable.
  4. The helmet (by nature of applying pressure to the parts of the head that stick out) can rub or irritate the skin and/or leave sores.
  5. The helmet causes the infant’s head to be hot and sweaty.
  6. The helmet starts to have a bad odor.
  7. The helmet attracts unwanted attention (it simply feels bad having people stare or make ignorant comments about your baby’s appearance).
  8. The helmet is time consuming, requiring multiple appointments for frequent adjustments.
  9. The helmet is expensive, averaging $2300.00 and is often not covered by insurance.

How likely is an adverse effect from a helmet?

Your infant is essentially guaranteed to experience at least one adverse effect from using a helmet. A 2015 study published in the NIH, confirms this. It showed that ALL parents reported at least one adverse effect (not including lost time or economics in that list) from the children that received the helmet intervention group (compared to no a no helmet group).

Should my baby use a helmet?

Whether or not you should invest the time, money, and effort to pursue a helmet can be tricky. Pediatricians seem to have different thresholds for when they refer patients for helmets. Most agree that very severe cases should be referred for a helmet.

How do I know If my baby’s flat head is severe?

Baby’s with severe cases have very misshaped heads. The average person doesn’t have to look from any certain angle to determine that the baby’s head is flat. It is particularly concerning when the opposing forces from the flat spot cause the face to become uneven (e.g., the eyes or ears are uneven, the forehead sticks out on one side). When a child’s face is markedly uneven, it becomes visually distracting and is generally a good indicator that it may be time for a helmet or band.

Do I have to use a helmet if my baby’s head is just mild or moderately flat?

No. While you may still choose to use a helmet/band, the scientific evidence on it’s effectiveness for mild to moderate cases is mixed. According to the AAP,

“There is currently no evidence that molding helmets work any better than positioning for infants with mild or moderate skull deformity.”

What can I do instead of a helmet?

The most important thing to do is to relieve the pressure on the flat spot of the head. This is done primarily by repositioning the head during sleep (turn the head away from the flat spot). The hard part is getting the baby to keep the head in the new position; many babies will automatically reposition the head to the flat side as it is the comfortable position. The AAP discourages the use of sleep positioners and pillows as they are a suffocation risk. So what is a parent to do? The MoWo solves this dilemma. Since the positioner is attached to the infant’s back, it is impossible to suffocate on it. It keeps the infant positioned to allow the head to naturally and comfortably rotate to the correct side.

Additional measures beyond repositioning include: neck stretches (the muscles of the neck can get tight causing the head to stay positioned to the flat side), encouraging lots of tummy time and sitting up, and avoiding excess time in car seats (or other items that cause the head to rest against something hard).

Age: 2 Months

Posted on
Posted by Dr. Monica Wonnacott | July 19, 2020

Two months is a fun age; your baby is finally smiling at you interactively. It isn’t that your baby couldn’t smile before, it’s just that your baby’s vision has improved so dramatically in the past few weeks that he or she can see you well enough to consistently smile back at your funny faces. Your baby is cooing and responding to you and together, you’re finding your rhythm.

SAFETY

  1. Car: Use an infant seat, in the back seat of the vehicle, rear facing (I like the 5-point harness style that allows you to pull the straps tight against the infant’s chest)
    1. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/)
  2. Sleep:
    1. The crib is the safest place, slats less than 2 3/8 inches apart
    2. On your baby’s back (this is to reduce the risk of SIDS)
    3. No extra soft bedding (quilts, comforters), pillows, toys, positioners (these are also suffocation hazards)
  3. Water: heater less than 120 degrees F (to prevent scalding)
  4. Smoke: Keep home and car smoke free
  5. Sun: Limit sun exposure, wear sun protective clothing, too young for sunscreen

NUTRITION

  1. Milk. Your baby’s nutritional needs are met at this age by milk, either breast milk or iron-fortified infant formula. Do not introduce cow’s milk until 12 months.
  2. If breastfeeding, your baby should be feeding approximately 6-10 feedings in a 24-hour period. Most babies will decrease to 5 or 6 feeds by the end of the third month (as they spread out the feedings and increase the volume). Continue to watch output and take your child in for regular weight checks/check-ups as these are the most reliable methods of ensuring your breastfed baby is getting enough to eat.
  3. If formula feeding, your baby should be taking about 24 ounces in a 24 hour period (typically 3-4 oz a feed, 6-8 times a day). Make sure the formula is iron fortified. As for which formula, nearly all infants can tolerate a regular formula without problem. Few medical indications call for hydrolyzed formulas. The latest and greatest in formulas is trying to imitate breast milk and this contains the ingredient DHA (claiming it is better for your baby’s brain).
  4. Supplements: Only needed if breastfeeding, give your baby Vit D 400 IU (international units) per day (to prevent Ricketts or soft bones).
  5. No straight water until 6 months of age.

SLEEP

  1. Most infants sleep a total of 14-17 hours in a 24 hour period
  2. Just starting to get a bit of a routine. To help:
    1. Try to keep room dark at night (use a nightlight if needed)
    2. Keep your baby calm and quiet when changing and feeding at night (limit talking and stimulation)
    3. Make daytime- playtime (lights on, talk with your baby)
  3. Most babies still swaddle to sleep at this age (imitating the womb environment)
  4. Typically going a 3-4 hour stretch at night before waking to feed

MILESTONES

  1. Coos and makes sounds in response to parent
  2. Attentive to voices, sounds, visual stimuli
  3. Smiles
  4. Lifts head 45 degrees
  5. Can support chest on forearms

ORAL HEALTH

Do not put your baby to bed with a bottle. It establishes bad habits, causes “bottle rot” (have you seen the children with rotten teeth or capped teeth?), and is a choking hazard.

ILLNESS

At this age you may treat fever and minor illnesses at home as long as your baby looks and acts ok. Bring your baby to the doctor if: symptoms are severe or prolonged, your infant isn’t eating well, your infant is particularly fussy, or you are concerned.

YOUR NEXT VISIT

Your baby’s next well child check is at 4 months of age. The vaccines at that visit are the same as today: DtaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), Hib (Haemophilus influenza type b), Hepatitis B, PCV-13 (covers 13 types pneumococcal disease), and Rotavirus (oral vaccine for viral diarrhea).

Age: 4 Months

Posted on
Posted by Dr. Monica Wonnacott | July 18, 2020

Four months is a fun age. Your baby is becoming more and more interactive. He or she may make squealing noises and even laugh at you. If you’re lucky, your baby may even start sleeping through the night by 4 months of age. Most babies do that blessed maneuver somewhere between 4 and 6 months of age.

SAFETY

  1. Car: Continue to use an infant seat, in the back seat of the vehicle, rear facing (I like the 5 point harness style that allows you to pull the straps tight against the infant’s chest)
    1. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/)
  2. Sleep: A baby’s risk of SIDS peaks at around 4 months of age, (it is hypothesized that this increase corresponds to when a baby is just learning to roll, but is not yet good at moving his/her head to clear his/her airway). This makes the parent’s roll of providing a safe sleeping environment more important.
    1. The crib is the safest place, slats <2 3/8 in. apart
    2. On your baby’s back
    3. No extra soft bedding (quilts, comforters), pillows, toys, positioners, or bumpers (these are also suffocation hazards)
  4. Water: heater less than 120 degree F (prevent scalding)
  5. Smoke: Keep home and car smoke free
  6. Falling: Do not leave the baby on a high surface where he or she could roll off (e.g., changing table, couch, or bed).
  7. Sun: Limit sun exposure, wear sun protective clothing, no sunscreen until 6 months Childproof: A child who can roll, can also move across a room and reach a surprising number of things Safety gates over stairs Locks on cabinets Outlet plug covers Hooks for blind cords Consider what a child could pull down on him/herself (anything with a dangling cord)

NUTRITION

  1. Milk. Your baby’s nutritional needs are met at this age by milk, either breast milk or iron-fortified infant formula. Do not introduce cow’s milk until 12 months.
  2. If breastfeeding, your baby should be feeding approximately 5-6 feedings in a 24 hour period. However, some babies may feed more frequently during the day if they are sleeping through the night.
  3. If formula feeding, your baby should be taking 28-34 ounces in a 24 hour period (typically 5-6 oz bottles every 3-4 hours). Make sure the formula is iron fortified. As for which formula, nearly all infants can tolerate a cow’s milk based formula without problem. There are very few medical indications for hydrolyzed formulas. Feel free to use a generic formula if cost is a factor.
  4. Supplements: If breastfeeding (exclusively), Start Poly-vi-sol with iron—1 ml once a day (this is in place of the Vit D). If formula feeding, there are no need for supplements.
  5. Introducing solids. While many parents are very eager to try feeding their baby solid foods, their baby is often not quite developmentally ready yet. By about 5-6 months your baby should be able to hold his/her neck steady, sit with support, and draw in his/her lower lip as a spoon is removed from her mouth. This will help indicate he/she is ready. If tried too early, the tongue thrust reflex will cause him/her spit out the food and not be able to handle the spoon appropriately. Cereal is the first semi-solid food I usually recommend (for ease, not due to some official recommendation). It is easily digested, not likely to cause allergies, and a good source of iron. Try a rice, barley, or oat cereal and mix it with formula or breast milk. Start with a tablespoon and gradually increase to 3-4 tablespoons per day. Stick with the same kind of cereal for a number of days before changing to check for allergic symptoms (e.g., rash, diarrhea). FYI: Some of the latest scientific literature is suggesting that waiting until a child is older (i.e., 6 mo.) decreases the child’s risk of allergies–more food for thought.

SLEEP

  1. Should be giving you a 5-6 hour stretch of sleep at night before waking to feed
  2. Starting to fall into a more predictable schedule: typically taking 3 naps a day (a shorter morning, longer afternoon nap, and a third evening cat nap).
  3. If your baby has been in a bassinet, this is a good age to consider transitioning to the crib (more space, decrease risk of SIDS)
  4. If you have been swaddling your baby, this is a good age to start gradually transitioning out of the swaddle
  5. Total sleep is 12-16 hours (including naps) in a 24 hour period

MILESTONES

  1. Babbles, coos
  2. Is starting to roll (may only do it one direction–front to back most common)
  3. Grasps a rattle
  4. Recognizes parents voice/touch
  5. Controls head well
  6. Laughs/squeals
  7. Opens hands
  8. Puts everything in mouth (drooling is common and not necessarily a sign of teething)
  9. Coos and makes sounds in response to parent

ORAL HEALTH

    1. Do not put your baby to bed with a bottle. It establishes bad habits, causes bottle rot (have you seen the children with rotten teeth or capped teeth?), and is a choking hazard.
    2. Discuss with your pediatrician whether your infant needs supplemental fluoride (this depends on your city’s water supply).

ILLNESS

At this age you may treat fever and minor illnesses at home as long as your baby looks and acts ok. Bring your baby to the doctor if: symptoms are severe or prolonged (>5 days), your infant isn’t eating well, your infant is particularly fussy, or you are concerned.

YOUR NEXT VISIT

Your baby’s next well child check is at 6 months of age. The vaccines at that visit are: DtaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), Hib (Haemophilus influenza type b), PCV-13 (prevnar-for pneumococcal disease), Hepatits B, and Rotavirus. Depending on the time of year, your infant may qualify for a flu shot. Remember, the first time your infant gets a flu shot, he or she will require a booster dose 30+ days later.

Help! My Kid Doesn’t Sleep

Posted on
Posted by Dr. Monica Wonnacott | July 17, 2020

There are few things more frustrating for a parent than a kid who can’t sleep. Exasperated parents come into my office everyday stating that they’ve tried everything and STILL they can’t get their child to sleep. The child is exhausted and ornery. The parent is exhausted and short-tempered. Everyone is in desperate need of a good night sleep.

While it’s true that some kids are naturally “better sleepers” than others (they seem to be able to fall asleep on command and sleep through anything), few people recognize sleep as a learned behavior. Just as with anything we do, we can learn good sleep habits or bad sleep habits.

If you’re really struggling with a “bad sleeper,” I’m going to give you a crash course in sleep training. It’s ALL about strict adherence to a sleep routine. You probably remember learning about the classical training experiment of “Pavlov’s dogs” in your high school science class. In essence, the scientist, Pavlov, trained dogs to salivate at the sound of bell instead of food, by associating the bell with the food. In sleep training, we’re using the same scientific principle of training the brain to sleep with a certain routine. Here are the quick steps with the details to implementing listed afterwards.

Steps to training:

  1. Make a detailed list of the things to do before going to bed, make the list 8-15 steps long (lasting anywhere from 15-30 mins).
  2. Write the list on a paper labeled “Bedtime Routine.” (Tip: If your child is too young to read, use small pictures for each step instead of writing).
  3. Post the list in the bedroom, near the bed.
  4. Look at and read the list after every step.
  5. Be rigid in following the list (in order and don’t get distracted).
  6. After completing the list, get into bed.
  7. If not asleep after 20 mins, get out of the bed and read in a chair until sleepy or 20 mins (whichever is sooner).
  8. Go back to bed and try to sleep again (repeat steps 7 and 8 as much as needed until sleep occurs).

What time should I put my child to sleep?

The time for bed will change as the sleep training progresses. The first night, you should aim to put your child to bed at the time that they typically fall asleep. So if you’ve been starting the bedtime circus at 9, but the child doesn’t fall asleep until midnight, then the first night, put your child to bed at midnight. This means the bedtime routine would start at 11:30-11:45 (depending on the length of the routine). Each subsequent night, put your child to bed 30 mins earlier until the desired bedtime is achieved. Depending on your child’s age, typical bedtimes are 7:30 pm (infants) to 10:00 pm (teens). Most school-aged kids should be in bed between 8-9 pm.

The scientific studies show that the body can only adjust the circadian rhythm by 30 mins every 24 hours (this is why it can take so long to fully recover from jet lag). If your child is accustom to falling asleep very late, it will take time to adjust that natural sleep time.

What is a typical bedtime routine?

When you create the bedtime routine for your child, be very detailed. My kindergartner’s bedtime routine list (as an example) is:

  1. Get undressed (clothes in hamper)
  2. Go to the bathroom
  3. Take a tub
  4. Hang up towel
  5. Lotion body
  6. Put on pajamas
  7. Brush teeth
  8. Aquaphor lips
  9. Brush out hair
  10. Family prayers
  11. Set out clothes to wear the next day
  12. Child reads to mom
  13.  Mom reads a chapter from the book we’re reading together
  14. Kiss goodnight
  15. Lights out

If done correctly, the brain starts to release sleep hormones that signal a child to feel sleepy as the child progresses through the list. While my child may be a monkey during the first 3 steps, by the end, she’s super tired and ready to sleep. Keep in mind that kids need a bedtime. Try to put kids the same time every night (regardless of it being a school night or weekend).

How to create the perfect sleep environment:

  1. Make the room dark (use a small nightlight if needed). My kids all have blackout drapes in their rooms. It solves the problem of it being too light outside in the middle of the summer at 8 pm. Dark also helps the body secrete the right amount of natural melatonin (which helps with sleep)
  2. Keep the temperature just right—slightly cool. Science shows that sleep quality is slightly better when the room is cool (68-70 degrees) vs warm (74-76 degrees).
  3. Quiet. Try to make the room quiet. Kids who have trouble sleeping don’t need more distractions. Also, try to avoid “white noise.” If there is a background music or white noise, the child will get conditioned to requiring that to sleep. As soon as the noise stops, the child wakes up. Don’t create unnecessary future problems for yourself.
  4. Loose, comfortable clothes to sleep in. You want the pajamas to be a non-issue rather than a distraction.

Absolute No-No’s for bad sleepers:

If your child is struggling with sleep issues, here are a few tips:

  1. No media for 1 hour prior to bed
  2. Don’t eat meals too late (it can be hard to digest a big meal right before bed, a small snack is ok).
  3. Don’t do vigorous exercise within an hour of bedtime. You should however exercise during the day.
  4. Don’t do anything on the bed, but sleep (no playing with toys, doing homework, etc.). The bed needs to be a conditioned sleep location only.
  5. No media in the bedroom, period.
  6. Avoid scary TV, movies, news, video games. Media with conflict, drama, anxiety, and violence can all carry over into creating sleep issues for kids.
  7. No naps (unless the child is 3 years-old or younger).

It can take weeks to properly sleep train a child, but the results are well worth it. Good luck, may we all get a good night’s rest.

Age: 6 Months

Posted on
Posted by Dr. Monica Wonnacott | July 8, 2020

Six months is the golden age of infancy (in my humble opinion). Your baby is old enough to sit on his/her own, is content if you set him/her on the ground with some toys for a few minutes, won’t crawl away (yet), sleeps through the night, and is smiley and responsive; it’s all around—golden.

Safety

  1. Car: Use an infant seat, in the back seat of the vehicle, rear-facing (I like the five-point harness style that allows you to pull the straps tight against the infant’s chest). Keep in mind that if you have a big baby, you may have to buy a convertible car seat at this stage. You will know your child is too big for the infant seat if his/her head comes within two inches of the top of the car seat (or exceeds the weight limit of the seat)
    1. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/).
  2. Sleep:
  3. The crib is the safest place; slats less than 2 3/8 inches apart; lower the crib mattress
  4. On your baby’s back (to reduce the risk of SIDS); however, if your baby is a good roller, you do not need to flip him/her back over if your baby prefers belly sleeping
  5. No extra-soft bedding (quilts, comforters), pillows, toys, positioners; these are all suffocation hazards.
  • Childproofing: Get down on floor level and look for hazards
    1. Outlet covers.
    2. Safety gates in front of stairs.
    3. Consider what a rolling child can pull down on him/herself (anything with a dangling cord).
    4. Chemicals/medications/cleaners out of reach or locked.
    5. Toys with small parts and sharp objects out of reach.
  • Water: Do not leave babies unattended in the bathtub. Keep water heater less than 120 degree F (to prevent scalding).
  • Smoking: Do not smoke in the home or in your car.
  • Sun: Limit sun exposure, use sun protective clothing. Your baby is old enough to use sunscreen if needed.

NUTRITION

  1. Continue to breastfeed or use formula. The milk constitutes the major source of nutrition for your infant.
  2. Start introduction of solids. The “how to” is less science and more art. Culturally, most people start with iron-fortified cereal (rice, barley, oats because they are easy and generally well tolerated) and then move to pureed vegetables, fruits, and meats. Some people skip “baby foods” and go straight to table foods. Take your cue from your child and progress foods as he or she tolerates. Most take solids twice a day at this age (increasing to 3 times/day by 9 months).
  3. If allergies are a concern, you may want to wait a couple of days between introduction of new foods in the beginning to watch for any adverse reactions (e.g., rash or diarrhea). Usually, once you’ve given a handful of foods and done well, you can be a little quicker about introducing new foods.
  4. Table foods. Most kids are developmentally ready for table foods (think little tiny bites of whatever you are eating) by about 7 months. Just make sure it is cooked enough to make soft when possible (e.g., carrots and broccoli) or cut into small enough bites to simply “gum and swallow” whole without risk of choking.
  5. Do not give your child honey (because of botulism risks) until 1 year of age.
  6. Nuts. The newest recommendations (as of 3/2019) say you can also introduce nuts/nut products (like peanut butter). You only need to be cautious if there is an immediate family member with a nut allergy (in that case, let me know due to the increased risk of allergies). If giving peanut butter makes you nervous, consider giving it for the first time in the waiting room of your child’s next well visit (that way you are already at the doctor if there is a problem).
  7. Start to introduce sips of water with meals, typically given in a sippy cup (may need help initially).

Sleep

  1. Should be starting to sleep through the night (8+ hours).
  2. Total sleep is 12-16 hours per 24 hours (including naps).
  3. Sleeping in a crib.
  4. Typically taking 2 naps a day (a shorter morning and a longer afternoon nap), sometimes taking a third short evening cat nap.
  5. No more swaddling at this age.

Milestones

  1. Sits unsupported.
  2. Uses a raking grasp.
  3. Transfers objects from one hand to another.
  4. Babbles.
  5. Complete head control .
  6. Good at rolling both directions.

ORAL HEALTH

  1. Do not put your baby to bed with a bottle. It establishes bad habits, causes bottle rot (have you seen the children with rotten teeth or capped teeth?), and is a choking hazard.
  2. Discuss with your pediatrician whether your infant needs supplemental fluoride (this depends on your city’s water supply).
  3. Teething typically happens between 6-9 months. Start brushing teeth (with a non-fluoridated toothpaste) when teeth erupt.

Illness

At this age you may treat fever and minor illnesses at home as long as your baby looks and acts ok. Bring your baby to the doctor if: symptoms are severe or prolonged, your infant isn’t eating well, your infant is particularly fussy, or you are concerned.

YOUR NEXT VISIT

Your baby’s next well child check is at 9 months of age. If your infant’s vaccines are up to date, then your infant may not need any vaccines at that visit (except potentially a flu shot depending on the time of year). If your baby got a flu shot at this visit, remember that he or she will need a booster in 30+ days.

Age: 9 Months

Posted on
Posted by Dr. Monica Wonnacott | July 7, 2020

Nine months is the age of exploration. Your infant is, for good or bad, mobile. Your baby is discovering that he or she can finally get to things of interest and is trying to reach everything. Your baby is learning to communicate and interact with the environment.

Safety

  1. Car: The car seat should be in the back of the vehicle and rear-facing (I like the five-point harness style that allows you to pull the straps tight against the baby’s chest). Most babies transition out of the infant to the bigger convertible car seat at this age. The convertible car seat stays in the car (you don’t lift it out like an infant seat) and can convert to forward facing when your child is old enough/big enough (2+ years old). You will know your child is too big for the infant seat if his or her head comes within an inch or two of the top of the car seat (or surpasses the weight recommendation of the seat).
    1. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/)
  2. Sleep:
    1. The crib is the safest place; slats less than 2 3/8 inches apart; place the mattress at the lowest setting of the crib.
    2. Your baby can sleep in whatever position he or she finds most comfortable (the risk of SIDS has dropped significantly).
    3. You may put mesh/breathable bumpers back into the crib if your baby is a wild sleeper and arms and legs are getting stuck outside of the slats.
  3. Childproofing: Get down on floor level and look for hazards.
    1. Outlet covers
    2. Safety gates in front of stairs (starting to crawl up the stairs but are high risk for falling down).
    3. Consider what a mobile child can pull down on him/herself (anything with a dangling cord).
    4. Chemicals/medications/cleaners out of reach or locked.
    5. Toys with small parts and sharp objects out of reach (high choking risk at this age).
    6. Keep guns with ammunition separate and in a gun safe.
    7. Do NOT use walkers (they delay walking skills and are high risk for falling down the stairs).
  4. Water: Don’t leave unattended in bathtub and keep water heater less than 120 degree F (to prevent scalding).
  5. Smoking: Do not smoke in the home or in your car.
  6. Sun: Limit sun exposure, use sunscreen when outside.
  7. Choking: Risk of choking is highest at this age (foods, toys, essentially anything that goes in that mouth). Make sure you know how to do “back blows” should that happen.

Nutrition

  1. Continue to breastfeed or use formula. You will not transition to whole milk until 12 months. (total volume is 24-36 oz/day).
  2. Continue offering solid foods. Your infant should be eating 3 “meals” (sitting in the high chair) and 3 snacks a day. Most of the foods will be table style (bites of whatever you are eating), but may also include stage 2 and stage 3 baby foods, depending on your preference.
  3. Offer a cup (typically a sippy style) with eat meal.
  4. Give water throughout the day.
  5. Do not give your child honey (because of botulism risks), there are no other food limitations. You can do milk products (like yogurt or cheese), but not straight milk as your infant needs the extra nutrients found in breast milk or formula.
  6. Nuts. The newest recommendations (as of 3/2019) say you can also introduce nuts/nut products (like peanut butter). You only need to be cautious if there is an immediate family member with a nut allergy (in that case, let me know due to the increased risk of allergies). If giving peanut butter makes you nervous, consider giving it for the first time in the waiting room of your child’s next well visit (that way you are already at the doctor if there is a problem).

Sleep

  1. Should be sleeping through the night and in a crib still.
  2. Typically taking 2 naps a day (a shorter morning and a longer afternoon nap).
  3. Total sleep should be 12-16 hours per 24 hours (including naps).

Milestones

  1. Crawling
  2. Has a pincer grasp
  3. Making consonant sounds (lots of babbling)
  4. Steady sitting and maneuvering without falling over
  5. Waving
  6. Stranger danger is common at this age
  7. Pulling to a standing position

ORAL HEALTH

  1. Do not put your baby to bed with a bottle. It establishes bad habits, causes bottle rot (have you seen the children with rotten teeth or capped teeth?), and is a choking hazard.
  2. Discuss with your pediatrician whether your infant needs supplemental fluoride (this depends on your city’s water supply).
  3. Teething typically happens between 6-9 months. Start brushing teeth (with a non-fluoridated toothpaste) when teeth erupt.

Illness

At this age you may treat fever and minor illnesses at home as long as your baby looks and acts ok swiss replica rolex watches. Bring your baby to the doctor if: symptoms are severe or prolonged (e.g., fever beyond 5 days, bad cough, etc.), your infant isn’t eating well, your infant is particularly fussy, or you are concerned.

YOUR NEXT VISIT

Your baby’s next well child check is at 12 months of age. Vaccines at that visit can be split and given half at 12 months, half at 15 months, or given all at once. They include: DtaP (diphtheria, tetanus, pertussis), Hib (Haemophilus influenza type b), PCV-13 (pneumococcal disease), MMR (measles, mumps, and rubella), Varicella (chickenpox), and Hepatitis A. Depending on the time of year, your infant may qualify for a flu shot (remember, the first time your infant gets a flu shot, he or she will need a booster/2nd dose in 30+ days). Your baby will also get his/her hemoglobin checked at 12 months (typically done with a finger poke) to ensure he or she is not anemic.

Age: 12 Months

Posted on
Posted by Dr. Monica Wonnacott |

One year is huge milestone. There’s usually a big party, a face full of cake, lots of pictures, and it’s well deserved. You’ve all come a long way. As you look back at the first year and all of your baby’s “firsts,” it seems like it’s all gone by in a blink. You can hardly remember a time when your baby wasn’t in your life. Life is complete.

SAFETY

  1. Car: Use a Convertible Car Seat (rather than an infant car seat) in the back seat of the vehicle, rear-facing.
    1. Important Note: As of 11/2018, the American Academy of Pediatrics (AAP) recommends car seats remain rear facing as long as possible, until the child reaches the highest weight or height allowed by the seat. This replaces the previous age specific milestone of 2 years and 30 lbs. The recommendations are based on scientific studies showing that rear facing is safest in a crash
    2. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/)
  2. Sleep:
    1. The crib is the safest place; slats less than 2 3/8 inches apart; place the mattress at the lowest setting of the crib
    2. You may put mesh/breathable bumpers back into the crib if your baby is a wild sleeper and arms and legs are getting stuck outside of the slats
  3. Childproofing: Get down on toddler level and see what he or she can reach
    1. Use outlet covers
    2. Place safety gates in front of stairs (they can go up the stairs but are high risk for falling down)
    3. Consider what your baby can pull down on him/herself (anything with a dangling cord)
    4. Store chemicals/medications/cleaners out of reach or locked
    5. Keep toys with small parts and sharp objects out of reach
    6. Lock guns with ammunition separate and in a gun safe
    7. Do NOT use walkers (they delay walking skills and are high risk for falling down the stairs)
  4. Water: Do not leave unattended in the bathtub and keep water heater at less than 120 degree F (to prevent scalding)
  5. Smoking: Do not smoke in the home or in your car
  6. Sun: Limit sun exposure, use sunscreen when outside
  7. Choking: Risk of choking is high at this age (foods, toys, essentially anything that goes in that mouth). Make sure you know how to do “back blows” should that happen.

NUTRITION

  1. Transition to whole milk. Continue whole milk from 1-2 years of age. If your child doesn’t tolerate/care for whole milk just ensure your child is getting enough calcium and vitamin D from other sources (e.g., almond milk, milk products, dark leafy greens, supplements, etc.).
  2. Transition off of baby foods and just feed table foods. Any and all foods are acceptable. Only limit foods that seem to cause your child grief/allergies.
  3. Make sure diet has a good variety, rich in fruits, vegetables, whole grains, and proteins.
  4. Wean off of the bottle. Use a cup (can be sippy style) only for fluids.
  5. Ensure your child is getting plenty of water.
  6. Limit juice to no more than 4 oz. a day (no juice is the best).
  7. May need supplementation of a multivitamin (with or without iron depending on how good your child is about eating a balanced diet).

SLEEP

  1. Should be sleeping through the night and in a crib still
  2. Typically taking 2 naps a day (a shorter morning and a longer afternoon nap)
  3. Total sleep should be 11-15 hours in a 24 hour period (including naps)

MILESTONES

  1. Walking (may only be cruising along furniture)
  2. One to two words
  3. Playing social games (like peek-a-boo and so-big)
  4. Points with index finger
  5. Feeding self (although messy)
  6. Can look for a hidden object

ORAL HEALTH

  1. Brush teeth twice daily with a non-fluoridated toothpaste
  2. May need fluoride supplementation (depending on the content of your local water source)

ILLNESS

At this age you may treat fever and minor illnesses at home as long as your baby looks and acts ok. Bring your baby to the doctor if: symptoms are severe or prolonged (e.g., fever beyond 5 days, bad cough, etc.), your baby isn’t eating well, your baby is particularly fussy, or you are concerned.

YOUR NEXT VISIT

Your baby’s next well child check is at 15 months of age. If your baby’s vaccines are up to date, then your infant may not need any vaccines at that visit. If you chose to split the 12 month shots, then the remaining shots will be at the 15 month visit. Also, depending on the time of year, your baby may qualify for a flu shot (remember, the first time your infant gets a flu shot, he or she will need a booster/2nd dose 30+ days later).

Age: 15 Months

Posted on
Posted by Dr. Monica Wonnacott | July 6, 2020

Fifteen months is age of exploration, activity, and curiosity. Your baby is walking now, starting to talk, and developing a mind of his or her own. With these newfound skills, there often comes resistance to being fed, dressed, diapered, and going to bed. Setting safe limits becomes key.

Safety

  1. Car: Use a Convertible Car Seat in the back seat of the vehicle, rear-facing.
    1. Important Note: As of 11/2018, the American Academy of Pediatrics (AAP) recommends car seats remain rear facing as long as possible, until the child reaches the highest weight or height allowed by the seat. This replaces the previous age specific milestone of 2 years and 30 lbs. The recommendations are based on scientific studies showing that rear facing is safest in a crash
    2. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/).
  2. Sleep:
    1. The crib is the safest place; slats less than 2 3/8 inches apart; place the mattress at the lowest setting of the crib.
    2. You may put mesh/breathable bumpers back into the crib if your baby is a wild sleeper and arms and legs are getting stuck outside of the slats.
  3. Childproofing: Injuries are a big concern at this age. Toddlers this age will manage to get into everything and usually don’t have innate fear of getting hurt to stop them. Toddlers can climb onto and fall off of anything.
    1. Use outlet covers.
    2. Be very cautious about stairs. Toddlers are high risk for falling down them.
    3. Store chemicals/medications/cleaners out of reach or locked.
    4. Burns are common at this age, both by pulling hot things down onto themselves (e.g., cords from curling irons, handles from pots) and touching hot surfaces (e.g., fireplaces, grills, stovetops, etc.).
    5. Lock guns with ammunition separate and in a gun safe.
  4. Water: Don’t leave unattended in the bathtub and keep water heater at less than 120 degree F (to prevent scalding).
  5. Smoking: Do not smoke in the home or in your car.
  6. Sun: Limit sun exposure, use sunscreen when outside.
  7. Choking: Risk of choking is high at this age (foods, toys, essentially anything that goes in that mouth). Make sure you know how to do “back blows” should that happen.

Nutrition

  1. Continue whole milk from 1-2 years of age. If your child doesn’t tolerate/care for whole milk just ensure your child is getting enough calcium and vitamin D from other sources (e.g., almond milk, dark leafy greens, milk products, supplements, etc.).
  2. Should be eating all table foods (no baby style foods). The only diet limitations are foods that seem to cause your child grief/allergies.
  3. Offer a wide variety of healthy foods, rich in fruits, vegetables, whole grains, and proteins.
  4. No bottles at this age. Use a cup (can by sippy style) for fluids.
  5. Ensure your child is getting plenty of water.
  6. Limit juice to no more than 4 oz. a day (no juice is the best).
  7. May need supplementation of a multivitamin (with or without iron depending on how good your child is about eating a balanced diet).

Sleep

  1. Should be sleeping through the night and in a crib still.
  2. May be starting to transition down to one nap daily instead of two.
  3. Total sleep should be 11–14 hours in a 24-hour time period (including naps).

Milestones

  1. Walking well and starting to run.
  2. Four to six words with lots of babbling that imitates speech (e.g., voice inflection).
  3. Follows commands without a gesture (e.g., go get the ball).
  4. May be independent one minute and clingy the next.
  5. Points with index finger to ask for something or get help.
  6. Feeding self, starting to use a fork and spoon.

ORAL HEALTH

  1. Brush teeth twice daily with a non-fluoridated toothpaste.
  2. May need fluoride supplementation (depending on the content of your local water source).

Illness

At this age you may treat fever and minor illnesses at home as long as your child looks and acts ok. Bring your child to the doctor if: symptoms are severe or prolonged (e.g., fever beyond 5 days, bad cough, etc.) or you are concerned.

YOUR NEXT VISIT

Your child’s next well child check is at 18 months of age. Anticipate a second Hepatitis A shot at that visit. Keep in mind that there must be 6 months between the first and second dose of Hepatitis A. The first one is typically given at 12 months. Also, depending on the time of year, your child may need a flu shot (remember, the first time your child gets a flu shot, he or she will need a booster/2nd dose 30+ days later).

Age: 18 Months

Posted on
Posted by Dr. Monica Wonnacott |

Eighteen months can be a challenging age of balancing a child’s growing independence and confidence with his or her limited ability to communicate. This leads to frustration and temper tantrums that are typical for this age. Patience, consistent boundaries, gentle transitions, and improving verbal abilities will help significantly during this time.

Safety

  1. Car: Use a Convertible Car Seat in the back seat of the vehicle, rear-facing.
    1. Important Note: As of 11/2018, the American Academy of Pediatrics (AAP) recommends car seats remain rear facing as long as possible, until the child reaches the highest weight or height allowed by the seat. This replaces the previous age specific milestone of 2 years and 30 lbs. The recommendations are based on scientific studies showing that rear facing is safest in a crash.
    2. For help securing the seat make an appointment with a Nationally Certified Child Passenger Safety Technician (to find a location nearest you visit https://highwaysafety.utah.gov/seat-belts-and-car-seats/car-seat-safety/).
  2. Sleep:
    1. The crib is the safest place; slats less than 2 3/8 inches apart; place the mattress at the lowest setting of the crib.
    2. You may put mesh/breathable bumpers back into the crib if your baby is a wild sleeper and arms and legs are getting stuck outside of the slats.
  3. Childproofing: Injuries are a big concern at this age. Toddlers this age will manage to get into everything and usually don’t have innate fear of getting hurt to stop them. Toddlers can climb onto and fall off of anything.
    1. Use outlet covers.
    2. Be very cautious about stairs. While they are getting more adept and going up and down at this age, we still see many injuries from falling down the stairs.
    3. Store matches/chemicals/medications/cleaners/toxic household products out of reach or locked.
    4. Burns are common at this age, both by pulling hot things down onto themselves (e.g., cords from curling irons, handles from pots) and touching hot surfaces (e.g., fireplaces, grills, stovetops, etc.)
    5. Lock guns with ammunition separate and in a gun safe
  4. Water: Don’t leave unattended in the bath tub and keep water heater at less than 120 degree F (to prevent scalding).
  5. Smoking: Do not smoke in the home or in your car.
  6. Sun: Limit sun exposure, use sunscreen when outside.
  7. Helmet: Wear a helmet on all things a kid can ride (e.g., bicycles, tricycles, scooters, ATVs, as passengers on adult bicycles, etc.).

Nutrition

  1. Continue whole milk from 1-2 years of age. If your child doesn’t tolerate/care for whole milk just ensure your child is getting enough calcium and vitamin D from other sources (e.g., almond milk, milk products, supplements, etc.).
  2. Should be eating all table foods (no baby style foods). The only diet limitations are foods that seem to cause your child grief/allergies.
  3. No bottles at this age. Use a cup (can by sippy style) for fluids.
  4. Ensure your child is getting plenty of water.
  5. Limit juice to no more than 4 oz. a day (no juice is the best).
  6. May need supplementation of a multivitamin (with or without iron depending on how good your child is about eating a balanced diet).

Sleep

  1. Should be sleeping through the night and in a crib still.
  2. Usually transitioned to one nap a daily instead of two.
  3. Total sleep should be 11–14 hours in a 24 hour time period (including naps).

MILESTONES

  1. Running everywhere.
  2. Climbing on everything (can navigate pushing a chair up to a counter/table to climb on top).
  3. Twenty words with lots of babbling that imitates speech (e.g., voice inflection).
  4. Understands and follows commands (e.g., go get the ball).
  5. May be independent one minute and clingy the next.
  6. Points with index finger.
  7. Feeding self, good at using a fork and spoon.

ORAL HEALTH

  1. Brush teeth twice daily with a non-fluoridated toothpaste.
  2. May need fluoride supplementation (depending on the content of your local water source).

Illness

At this age you may treat fever and minor illnesses at home as long as your child looks and acts ok. Bring your child to the doctor if: symptoms are severe or prolonged (e.g., fever beyond 5 days, bad cough, etc.) or you are concerned.

YOUR NEXT VISIT

Your child’s next well child check is at 2 years of age. If all shots are caught up, there shouldn’t be any routine vaccines. Depending on the time of year, your child may need a flu shot (remember, the first time your child gets a flu shot, he/she will need a booster/2nd dose 30 days later).