9 months

Finally... mobile! And developing a mind of their own. Efficiently picking up objects and putting in mouth. Separation anxiety, height of stranger awareness and anxiety.

Milestones

Language/Communication: responds to name, mama/dada nonspecific, understands 'no', will respond to certain requests (wave bye-bye, where is mama?), babbling using several syllables. Claps. Narrate your life, imitate infant's own sounds, play social/interactive games. A good age to begin daily regular reading.
Fine Motor: radial pincer grasp, bangs objects together, hands to mouth, feeds self. Hand dominance prior to 18 mo may indicate weakness in contralateral hand.
Gross Motor: creeps on hands, pulls stand, may begin to cruise, waves bye bye
Cognitive: interested in the trajectory of falling objects, searches for hidden objects
Social: enjoys peek-a-boo, patty-cake, stranger anxiety.

PE:
Strabismus, Can now do cover/uncover test, red reflex, tooth eruption, downward parachute reaction, pincer grasp, muscle tone, Stills murmur 3-6 y/o, but occasionally in infancy. Pulmonary flow murmur of newborn (Peripheral pulmonary stenosis), usually disappears by 6 mos.
Reflexes: Plantar grasp extinguishes 9-12 mos, Parachute reflex should be present. Red flag: persistence of primitive reflexes may indicate neuromotor disorder.

Nutrition: at 9 mos: 7-8 oz 3 times per day. Drinking 7-8 oz 3 times per day. Eat solid meals with the family 3x/day + 2-3 snacks. It may take 10-15 tries before a new food is accepted. Offer table foods, like potatoes, soft carrots and peas, noodles, and fruits, and pureed foods. Can usually feed self toast, bread, teething biscuits and encourage to drink from a cup.  Avoid peanuts, hot dogs, popcorn, frozen peas, candy corn, raw celery, raw carrot sticks (aspiration). No honey or corn syrup. Limit finger foods to soft bits not much larger than a Cheerio. No cow’s milk during the first year of life. Supplement with Vit D if <1000 cc/day of formula or strictly breast fed. Vitamin D Supplementation. Plan to wean infant from bottle by 12-15 months.

Growth: Head circumference 7-12 mos: 0.5 cm/month. In first year, should grow 25 cm/year (10 inches). Anterior fontanelle closes 13 mos (7-19 mos). Teeth: by 9 mos, has all incisors.

Sleep: Sleeps through night + 2 daytime naps. Do not feed or play with if pt wakes up at night. Back to sleep, through first year of life, especially in first 6 mos. 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.

• Discipline: distraction/diversion. Easier to change the environment vs behavior. Yelling, spanking and hitting are ineffective punishment in changing behaviors. At this age, an infant is not capable of learning or remembering “rules”. Using descriptions of the desired behavior e.g. saying, “time to sit” rather than, “don’t stand” provides better direction. Limit ‘NO’ to the most important issues.

Immunizations: none due
Health:
Safety:

• gates blocking off staircases
• smoke alarms working?
• infant car seat upgraded to a toddler car restraint when weighs 20 pounds. Use your car seat, rear facing in back seat until age 1 and 20 lbs. Infants who reach 20 lbs or 26-29 inches before age 1should switchto a rear-facing convertible seat or infant only seat approved for weights greater than 22 lbs.
• strongly advise against infant walkers.
• UV protection. SPF 15.
• Lock up meds, sharp objects.
• The American Academy of Pediatrics (AAP) recommends no television viewing for children under age 2, and no more than two hours of daily media exposure for ages 2 and older.

Screening Labs: Vision-Screening. If at risk for lLead Toxicity, get lead level.
Formal developmental screening at 9 mos, 18 mos, 30 mos.
Next visit in 3 mos
Expect: wean from the bottle at 12-15 mos.