6 months
The golden age of infancy. Usually not yet crawling, generally happy, love to interact, attached to parents. He can recognize his own name.
Milestones
Vision: Vision Development. Following you around the room with his eyes. Put baby in a high chair or upright seat during awake time (as opposed to crib). 3-5 mos: distinguish mother vs stranger face. 3-5 mos: can now for a 3D view of the world
Language/Communication: babbles, bababa (consonant sounds), imitates sounds. Beginning to recognize own name.
Fine Motor: reaches for toys, radial raking grasp, holds rattle, palmar grasp, transfers objects, plays with hands. Hand dominance prior to 18 mo may indicate weakness in contralateral hand.
Gross Motor: Rolls back to front; When prone, holds head high or may move into crawling position; sits with or without support, stands with hands held. Standing and bouncing. Red flag: poor head control at age 5 mos. Red flag: at 7 mos, W-sitting and bunny hopping, may indicate adductor spasticity or hypotonia.
Social: Object permanence 6-8 months (play peeka boo). Initiates social contact by smiling, laughing, squealing. Hugging (5 mos). Displeasure when parent moves away. recongnizes strangers. Stranger anxiety 6-9 months.
Red flags: Developmental problems or lack of attention may cause an infant who lies on his back, avoids eye contact, and smiles and vocalizes infrequently.
Physical Exam
- Stills murmur 3-6 y/o, but occasionally in infancy. Pulmonary flow murmur of newborn (Peripheral pulmonary stenosis), usually disappears by 6 mos.
- Eye alignment, hip dysplasia
- Reflexes: Reflexes diappearing at this age (Newborn reflexes):
- Moro 4-6 mos: sudden movement of head, causes symmetric abduction and extension of the arms, followed by gradual adduction and flexion of the arms over the body)
- Assymetric tonic neck reflex: 4-6 mos (turning head to one side causes extension of extremities on that side, and flexion on the contralateral side, putting infant in 'fencing position; must extinguish in order to roll over)
- Tear formation begins 2-3 mos of age. Nasolacrimal duct not fully patent until 5-7 months. Purulent of mucoid eye drainage is common. Treat with lacrimal massage and gentle cleansing w water and cotton ball. Beware of redness or swelling.
- We are obligate nose-breathers until about 6 m/o
- First tooth at 7 months. Soft toothbrush or cloth to clean baby’s teeth with water only.
Nutrition:
- Introducing foods into an infant's diet. Start solid foods, 2-3 meals daily, new food every 3-4 days. It may take up to 10-15 experiences before a new food is accepted.
- At 6 mos: 7-8 oz 3-6 times per day. Older infants consume 24-32 oz/day formula + complementary food, but larger male infants (90%ile weight) may take 42 oz formula daily. Offer sips from a cup. Only 2-4 oz of juice per day (it is not considered a snack or a food); offer in a cup during snack time when beginning to take solids more than 3x/day). Try to continue breastfeeding through the first year of life. No bottle propping.
- No honey or corn syrup. AVOID hot dogs, nuts, raw carrots, grapes, raisins, popcorn until age 4 (choking hazard).
- Limit finger foods to soft bits not much larger than a Cheerio.
- No cow’s milk during first year of life. Poor source of iron. Can cause intestinal blood loss and exacerbate iron deficiency. Protein and sodium levels are too high. Low in vitamin C, E, and copper. Contains butterfat, difficult for babies to digest.
- Supplement with Vit D if <1000 cc/day of formula or strictly breast fed. Vitamin D Supplementation, start between 2 weeks and 2 months of age.
- Iron supplementation, usually in the form of iron fortified cereals, should be started between 4-6 months.
- Consider delaying peanuts, tree nuts, fish and shellfish until after 1 year of life (these foods are associated with lifelong sensitization).
- Avoid sharing spoons and cleaning a dropped pacifier with your mouth, to prevent transfer of dental caries-causing bacteria. Otherwise the risk of dental decay increases when his teeth come in.
- Clean teeth with a soft toothbrush or a cloth with water only. If seems fussy and drooling, try a cold teething ring.
- Growth: Head circumference 4-6 mos: 1 cm/month. Anterior fontanelle closes 13 mos (7-19 mos). Teeth: First teeth coming in (7 mos bottom central incisors)
Anticipatory Guidance
- Sleep: nap 2x/day. Many babies will seep 6-8 hours at night. Separation anxiety (resist sleeping), try special stuffed animal orl blanket. Put baby to bed while still awake. Back to sleep, through first year of life, especially in first 6 mos. If wakes at night, comfort baby, but do not feed or play. May have been sleeping fine for weeks or months, then return abruptly to a late night wakeup schedule, usually related to growth spurts increasing the need for food (Feeding spurts), or teething or developmental changes. Regular daily naps and giving him a variety of short play activities are 2 good strategies for dealing with overtiredness and boredom.
- To prevent a flat spot on the head, alternate which end of the crib you place your infants feet, limit time in swings, bouncy chairs and car seats that put pressure on the back of the head, when feeding switch the side that baby feeds on
- Crib slats should be less than 2-3/8 inches apart. A mesh playpen or portable crib should have weave openings less than ¼ inch (6 mm)
Safety:
- Car seats. Rear facing in back seat until age 1 and 20 lbs, sometimes longer.
- Sunscreen. At least SPF 15.
- Smoke detectors.
- Childproof the home: remove small objects from floor. Electrical cords. Outlet plugs. Plastic bags, balloons.
- Never use baby walkers at any age. Your baby may tip the walker over, fall out of it, or fall down the stairs. Baby walkers let children get to places where they can pull heavy objects or hot food on themselves.
- Medications.
- Poison control center number 1-800-222-1212.
Screening and Immunizations
Screening Labs: Vision-Screening (abnormal eye alignment? Refer optho)
Immunizations: Rota3, Prevnar3, Hib3, Pediarix3 (HepB3, DTaP3, IPV3)
Next visit in 3 months at age 9 months
Advice:
- Will crawl and maybe pull to stand by next visit. Fine pincer grasp by nine mos of age.
- Never use baby walkers at any age.
- Read aloud to child. Play music and sing. Play games like “pat-a-cake”, “peek-a-boo” and “so big.”
- Advise decreasing or eliminating pacifier use to reduce incidence of otitis.