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Age: 9 Months

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.

Arsenic In Your Infant’s Rice Cereal?

I didn’t get any Facebook questions this week, so thought I would post on a topic that I have had a number of parents ask about in the last couple of months: arsenic in infant rice cereal. In April, there was a lot of press about inorganic arsenic levels found in infant rice cereal and the potential toxic effects (following a study that was published in JAMA).

Quick background

Arsenic is element in the Earth’s crust. It is found naturally in the air, water, and soil. It is also in fertilizers and pesticides. It has two forms: organic and inorganic. The inorganic form is considered the more toxic of the two forms when it’s found in food. Rice has higher levels than many other foods, because the plant and grain absorb arsenic from the environment more than other crops do.

The big deal is that infants eat lots of rice cereal, and arsenic isn’t good for you.

What is the harm?

Exposure to arsenic is associated with bad pregnancy outcomes. It is also has some bad brain effects early on in life.

What is being done about it?

In response, the FDA has proposed a limit or “action level” of 100 parts per billion (ppb) for inorganic arsenic in infant rice cereal. In April, the FDA released results of a study they conducted from 2014 that showed of 76 samples of rice cereal sampled from retail stores, 47% were at the recommended 100 ppb already (and 78% were close at 110 ppb or less). Little aside, this recommended 100 ppb is the level the European Food Safety Authority is already at.

What is a parent to do?

Don’t freak out that you’ve caused permanent brain damage to your child because you gave your little one some rice cereal (like all the rest of us did). Chances are he or she is just fine. It also doesn’t mean that you need to avoid rice cereal completely. I would, however (now this is Dr. Wonnacott’s opinion only), try and offer a good variety. Try many different grains (barley, oats, wheat, multi-grain cereals, etc.). Your baby won’t be as bored, and it’s more nutritionally sound anyhow.

Introducing Solids: The Magic, The Myth

Introducing solids to your baby is not nearly as scientific as we like to make it out to be. I trained in the era of give rice cereal first, then vegetables, then fruits, and finally meats. If you didn’t give foods in a certain way/order, you somehow would make it so your baby wouldn’t eat the other stuff. There was also some magic number of days that you had to wait between new foods. I have since learned that the science doesn’t support that how you introduce solids makes an ounce of difference. Don’t tell my husband, but I may be admitting I was wrong.

Most people still start with a cereal of some sort. However, that is a cultural thing only, not a scientific fact. Interestingly, there are some who even tout the harms of starting with cereals. My advice, do what you think is best for your child. Generally speaking, cereal (whether that be rice, barley, multigrain, etc.) is pretty well tolerated. Little tip though, mix it thicker than the box says (slightly more runny than pudding); it makes it easier to work with.

There isn’t a magic interval you need to wait between new foods either. The logic holds that if your child is going to have a reaction, you want you to be able to pinpoint the cause of it (so introducing 5 new foods at once just muddies the waters). If you have a kid that is particularly sensitive (inclined to easy face and butt rashes), you may want to wait a few days between new foods. This gives whatever you’ve given a chance to go through the kid and make sure it doesn’t cause a problem.  So for most kids, it is appropriate to introduce new foods somewhere between every meal to every 1-2 days.

Once your child shows that he can tolerate the cereal (or whatever you started with), start adding new things one at a time. You might do pureed green beans or chicken next. FYI, the only difference between stage 1 and stage 2 baby foods is size of the container. You can buy the baby food or make it yourself, whatever suits your lifestyle.

Food handling safety tip: Don’t feed your baby directly from the jar unless he is going to eat the entire container in one sitting. Otherwise, pour some of it into a baby bowl first and then feed it to him. That way, digestive enzymes and bacteria from his mouth don’t contaminate the jar that you intend to put back into the fridge.

After your child is really good at the smooth, pureed foods, feel free to start small bites off your plate. Just keep in mind that if you want your child to eat a good variety of healthy foods, you have to introduce those foods early. If you feed your child French fries, chicken nuggets, and mac n’ cheese, then that is what he is going to know and love. If you feed your child baked Salmon and Asparagus, he’ll eat it because he doesn’t know any different.

Eating healthy is expensive and time consuming. However, the investment is well worth it. Bon appetite!