9 MONTH CHECK UP

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DIET

At 6 months we started just about all foods except eggs, milk and other foods that could cause allergies. Most children will take about 24 to 28 ounces of formula per day. Egg yolks may be started at 9 months of age, while egg whites and whole milk must wait until 12 months. Formula or breast milk (and the vitamin you may be giving) has all of the vitamins your child needs until 12 months of age. There is good evidence that feeding oranges, peanuts, oatmeal and shellfish may cause allergies in a child who has a strong family history of allergies Avoid them until 1 to 2 years in that case. Continue to give your child foods that are thicker so that he or she may be on table foods at 12 to 15 months. Continue to offer the sippy cup more than the bottle so that you may wean your child off of the bottle by 12 months of age. Most dentists agree that the bottle should be removed by 12 to 15 months, but so long as your child is not sleeping with the bottle in the mouth, then a little extra time can be taken to remove the bottle. Pacifiers should be taken away by 2 to 3 years or sooner if the front teeth appear to be molding to the shape of the pacifier.

COMMON ILLNESSES & PROBLEMS

                If your child is not already walking, then he or she soon will be. Your child will be able to reach over 2 feet tall and may soon be climbing. Thousands of children each year are injured or die from electrical outlets, choking on small objects, falling down stairs, pulling things like cords and table cloths and pot handles onto themselves, etc. Accidents will soon become the most common potential cause of death for your child, therefore, go over every inch of your house and always watch your child closely.

                Approximately 25 to 30% of children will walk well by 12 months, while almost all children walk by 15 months. Remember that shoes are not necessary for walking. Shoes should fit properly and should not be tight in any way. Some children who wear their shoes too much may have sweaty feet. The sweaty feet will appear to have dry or peeling skin (a form of eczema). These children should either not wear shoes as much, should wear shoes that breathe (like canvas) or should change their socks often. Remember that shoes only protect the feet, keep the feet warm, look good and cost you money.   No child should ever limp when they walk even when they are just starting. A limping child may not show pain but rather will just favor that leg. About one third of children with a hip dislocation will not be detectable until they start walking and develop a limp or have one leg longer than the other.

Upper respiratory infections (colds) cause some release of histamine and this is why antihistamines have some minor effect on cold symptoms in adults, but not children. This is why cold medicines generally donít help cold symptoms. The current cold medicine doses are not well understood in young children and they also cause considerable side effects (100,000 children go to the emergency room each year for cold medicine side effects). This is why cold medicines are not generally recommended below certain ages.

                Most children will not get an ear infection before 6 months of age and most have at least one in the first year or so of life. Therefore, your child is at the prime age to have his or her first ear infection.

 

Teething

Ear Infection

Fever

<102

>102

Fussy

Comes and goes

Continuous and worsens

Stools

Sometimes mild loose stools

No change

Runny nose

Yes

Yes

Cough

Rare

Often

Pulling on ears

Comes and goes

Frequent

Weather change

No effect

Ear pain worse with rapid barometric pressure changes

Hearing

No effect

Frequently reduced

Drooling

Frequent

None

Teething gels help

Yes

No

SAFETY

        Infants must face backwards in the car seat until 1 year of age AND 20 pounds in weight and should never ride in the front seat of a car, especially one with an air bag.

NEXT VISIT

The next check up will be at 12 months of age.  If you get your vaccines here at the office, then you child will receive:

Two of the above vaccines will most likely be combined if you have private insurance. I will give you the choice of getting all of the vaccines at 12 months (and no more until 4 years of age) or split them up between the 12 and 15 month check ups.

We will also change from formula to cows milk (not before 12 months). When you do start milk, please use whole milk (3%), because your child needs a high fat diet for brain growth until 24 months of age. If your child does not like the taste of milk at first, then taper the taste. Do this by mixing 1/4 milk and 3/4 formula for the first few days, then 1/2 milk and 1/2 formula for a few days, then 3/4 milk and 1/4 formula, and so on, until your get your child all the way on whole milk. If your child just won't take whole milk, then use 2% or skim, but add a lot of extra fat in the diet by giving a lot of cheese, peanut butter, butter on all foods, etc. Your child needs a high fat diet (50% of calories from fat compared to 30% for an adult) until 2 years of age.

 2005 Joe Matusic, MD