Parenting Principles

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The first question to ask yourself is whether you have a positive relationship with your child. Are your interactions positive or negative. If you have overall positive interactions then focus on continuing to provide uncritical and non-judgemental support and attention while praising good behaviors. In this way you will continue to foster cooperation and respect. If your interactions are increasingly negative then you must pursue strategies to rebuild a foundation of cooperation. Negative and punitive responses will not succeed.

Cooperation is enhanced through positive interactions with your child. This may occur randomly during day to day activities and also through established routines and expectations. These can be called creative parenting and schedule or event based parenting. Both types of parenting categories require a consistent approach based on clearly identified and communicated rules and expectations. Your child must be made the focus of your attention and you must encourage  your child by promoting your expectations. At the same time you must discourage inappropriate behaviors through the imposition of consequences. Behavioral consequences are especially important when safety issues are present. Even when punishment is used positive interactions are the goal.

The guiding principle is for you as parent to have the courage to deal with conflicts between you and your child every time challenging or contrary behaviors happen. You must be ready to seek cooperation by providing the discipline that is required.This is the fundamental principal of parenting.

Emotions Are Real

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When a child becomes upset and shows it in what they say or do parents are prone to pay too little or too much attention. By over responding you are actually supporting the duration and recurrence of the negative behavior. By paying too little attention to an emotion that seems insignificant to you your child will feel you are disavowing their feelings and often become frustrated. Frustration often leads to a progression negative behaviors that are compounded by a sense of grief, anger, insecurity, worry or hopelessness over not being able to have something your child really wants. Remember, young children are not capable of separating wants from true needs. This takes time and will only occur with training and personal development. This personal development occurs in relationships based on responsive and sensitive attention and attunement. Being aware and attuned to the wants and needs of your child in various situations will allow you to understand her emotions. Your child will only learn to accept
feelings as real if you treat her feelings as real. Any other response teaches them to dismiss, disavow or simply mirror emotions without learning how to recognize, respond and grow with them.

Simple techniques can help a child calm down. these include any activity that supports relaxation. Choose what is best for your child based on her interests and her age and skill sets. Some children respond to reading or singing a song. Others respond to physical activities including dancing or going for a walk. Others require a short nap or
massage. Your response is not only for support. It tells your child you recognize they are upset and you want to help them learn to manage and respond to their emotions. Once the initial response is made you can move on to more solution-based responses based on the situation that evoked the emotion. You can always give her a list of possible responses and allow her to choose the best one for her. If she comes up with inappropriate solutions explain why a new choice will be needed. The goal is to return to an appropriate activity where the ability to handle unhappiness and dissatisfaction are recalled but remain in the background and the normal activity of life is emphasized.

By spending time with your child every day you will have the opportunity to play and laugh together. Be attentive and responsive to them. Listen to what your child says and how she says it. Is she happy or sad; mad or glad; or angered or surprised.  Look for cues in her facial expression, body gestures, tone and pace of speech or any other verbal and non verbal cues. These experiences foster the sharing of emotions and are at the center of human relationships. Bonding and attachment during these periods provide the environment for the modeling of appropriate behavioral responses and expands the meaning of discipline from obedience to the modeling of behaviors that will last a lifetime.

Well Child Care 2 Months

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Feeding
At this age, your baby needs only breast milk or infant formula to grow healthy and strong. At this age most babies take about 4 to 5 ounces of formula every 3 to 4 hours. Although not mandatory, some mothers who breast feed also give their babies pumped breast milk or commercial formula that is put in a bottle. Avoid giving a supplement if this hinders breast feeding. This can allow your baby to learn another way to drink milk and other people can enjoy feeding your baby. Always hold your baby during feeding time. Then your baby learns that you are there to meet his needs. This is an important and special time. It is not time to start cereal or baby foods yet. Cereal can be started at 4 to 6 months of age.   Don’t forget: breast fed babies need a daily Vitamin D supplement such as Tri Vi Sol drops.
Development
Babies start to lift their heads briefly. They reach for things with their hands. They enjoy smiling faces and sometimes smile in return. Cooing sounds are in response to people speaking gentle, soothing words.
Sleep
Many babies wake up every 3 to 4 hours, while others sleep for longer periods during the night. Every baby is different. Feeding your baby a lot just before bedtime doesn’t have much to do with how long your baby will sleep.  This is a good time to move your baby out of your room and put him in his own room if one is available.
When babies spend almost all of their time on their back they sometimes get flattening of one side of their head.  This happens when an infant’s head is always turned to the same direction (either the right or left).  The weight of the baby’s head will actually flatten one side of the head more than the other and the head will look lopsided.  (It is important to understand that this does not affect brain function, only the shape of the head.) To prevent this:
1.) Give your infant plenty of tummy time every day.  Remember, that in order to be on his tummy, you baby MUST be with an adult and awake.
2.) Place your child in such a way that he looks to his left some times and to the right other times.  For example, this can be accomplished by putting your baby’s head at the opposite end of the crib on alternate days.
Tips to get your baby to sleep through the night:
1.) Place your baby in the crib when he’s drowsy but still awake.  Babies who fall asleep more independently often learn to sleep through the night more quickly.
2.) Never put your baby in bed with a bottle.
Reading and Electronic Media
Your baby will enjoy just hearing your voice. You can read aloud your favorite novel while feeding or cuddling with the baby. Never prop your baby in front of a television.
Safety Tips
Never leave your child alone, except in a crib.
Choking and Suffocation
·         Use a crib with slats not more than 2 and 3/8 inches apart.
·         Place your baby in bed on his back.
·         Use a mattress that fits the crib snugly.
·         Keep plastic bags, balloons, and baby powder out of reach.
Fires and Burns
·         Never eat, drink, or carry anything hot near the baby or while you are holding the baby.
·         Turn your water heater down to 120°F (50°C).
·         Install smoke detectors and carbon monoxide detectors.
·         Keep a fire extinguisher in or near the kitchen.
Falls
·         Never step away when the baby is on a high place, such as on a changing table.
·         Keep the crib sides up.
Car Safety
·         Never leave a child alone in a car.
·         Use an approved infant car safety seat and follow the instructions for proper use. If you aren’t sure how to install the seat in your car, contact a local fire department.
·         Parents should always wear seat belts.
·         Babies must ride in the back seat of the car.
Smoking
·         Infants who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.
Immunizations
Vaccines are now combined to reduce the total number of shots for your baby.
Babies cannot receive influenza vaccinations (also called flu vaccinations) until 6 months of age.  If your baby cannot be protected against the flu, make sure all family members and close contacts get flu vaccinations.
Your baby may run a fever and be irritable for about 1 day after getting shots. Your baby may also have some soreness, redness, and swelling where the shots were given.

Well Child Care 4 Months

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Feeding
Your baby should still be taking breast milk or infant formula. Most formula-fed babies now take about 6 to 7 ounces every 4 to 5 hours. If you give your baby breast milk, you might want to feed your baby an occasional bottle with pumped milk or commercial formula. Then your baby will learn another way to drink milk and other people can enjoy feeding your baby. Some babies are now ready to start cereal. A baby is ready for cereal when he is able to hold his head up enough to eat from a spoon. Use a spoon to feed your baby cereal, not a bottle or an infant feeder. Sitting up while eating helps your baby learn good eating habits. When you start cereal, start with rice cereal mixed with breast milk or formula so that it has a pea soup consistency.
Pureed fruits and vegetables can also be started between 4 and 6 months. Start a new food no more often than every 3 days to make sure your baby is not allergic to the new food.
Babies will respond gleefully when they see a bottle, but don’t give your baby a bottle just to quiet him when he really isn’t hungry. Babies who spend too much time with a bottle in their mouth start to use the bottle as a security object, which makes weaning more difficult. They are also more likely to have ear infections and tooth decay problems. Find another security object like a stuffed animal or a blanket.
Development
Babies are starting to roll over from stomach to back. In order to encourage this your baby will need lots of tummy time (when your baby is both awake and with an adult).  Tummy time also decreases the likelihood that the back of your baby’s head will become flattened.
Your baby’s voice may become louder. He may squeal when happy or cry when he wants food or to be held. In both cases, gentle, soothing voices are the best way to calm your baby. Babies at this age enjoy toys that make noise when shaken.
It is normal for babies to cry.
Sleep
Many babies are sleeping through the night by 4 months of age and will also nap 4 to 6 hours during the daytime. If your baby’s sleeping patterns are very different than this you may want to ask your doctor for ideas about ways to keep your baby alert and awake during the day and sound asleep at night. Remember to place your baby in bed on her back, NOT the side or tummy.
Reading and Electronic Media
As the baby gets older, read to her every day. Choose books that are durable (cloth or board books). Pick books with bright colors and large simple pictures. Never prop your baby in front of a television.
Teething
Your baby may begin teething.  A teething ring may be useful if you believe your baby is in pain.
Safety Tips
All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.
Choking and Suffocation
·         Remove hanging mobiles or toys before the baby can reach them.
·         Keep cords, ropes, or strings away from your baby, especially near the crib. Ropes and strings around the baby’s neck can choke him.
·         Keep plastic bags and balloons out of reach.
·         Use only unbreakable toys without sharp edges or small parts that can come loose.
Fires and Burns
·         Never eat, drink, or carry anything hot near the baby or while you are holding the baby.
·         Turn down your water heater to 120°F (50°C).
·         Check your smoke and carbon monoxide detectors to make sure they work.
·         Check formula temperature carefully. Formula should be warm or cool to the touch.
Falls
·         Never leave the baby alone on a high place.
·         Keep crib and playpen sides up.
·         Do not put your baby in a walker.
Car Safety
·         Use an approved infant car seat correctly in the back seat.
·         Never leave your baby alone in a car.
·         Wear your safety belt.
Smoking
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.
Immunizations
Babies cannot receive flu vaccinations (also called influenza) until 6 months of age.  If your baby cannot be protected against the flu, make sure all family members and close contacts get flu vaccines.Vaccines can be combined to reduce the total number of shots for your baby.
Your baby may run a fever and be irritable for about 1 day after the shots. Your baby may also have some soreness, redness, and swelling where the shots were given.
You may give acetaminophen drops in the appropriate dose to prevent the fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed for comfort.
Call your child’s pediatrician if your child has a rash or any reaction other than fever and mild irritability or your child has a fever that lasts more than 36 hours.

Well Child Care 6 Months

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Feeding

Your baby should continue to have breast milk or infant formula until he is 1 year old.  Please continue your Vitamin D drops for those babies who are mostly breast fed.  Your baby may soon be ready for a cup although it will be messy at first. Try giving a cup sometimes to see if your baby likes it. Don’t put your baby to bed with a bottle. Your baby will see the bottle as a security object and this will make it hard to wean your child from the bottle. Leaving a bottle with your baby, especially at night, will lead to tooth decay and may cause ear infections.
Make cereal with formula or breast milk only. Use a spoon to feed your baby cereal, not a bottle or an infant feeder. Sitting up while eating helps your baby learn good eating habits.
If you haven’t started your baby on baby foods (other than cereal), you can start now. Start with pureed fruits and vegetables. Start one new food at a time for a few days to make sure your baby digests it well. If your family eats meat you may begin pureed meats at this time.  Do not give finger foods or foods that require chewing.

Development

At this age babies are usually rolling over and beginning to sit by themselves. Babies squeal, babble, laugh, and often cry very loudly. They may be afraid of people they do not know. If you feel overwhelmed, ask people you trust for help, or talk with your healthcare provider.
Sleep
6-month-olds may not want to be put in bed. A favorite blanket or stuffed animal may make bedtime easier. Do not put a bottle in the bed with your baby. Develop a bedtime routine like playing a game, singing a lullaby, turning the lights out, and giving a goodnight kiss. Make the routine the same every night. Be calm and consistent with your baby at bedtime.
When babies do not sleep through the night the problem is not typically something that occurs in the middle of the night.  The problem most often occurs when you are putting your baby to sleep.
In order for healthy babies to sleep through the night it is important for them to fall asleep in the same environment he or she will experience the rest of the night.  Sleep is divided into deeper and lighter stages.  It is normal to wake up enough to assess your surroundings.  It is not hard to imagine that a baby who wakes up in the middle of the night might become upset if he or she is no longer in mom’s arms.
So, it is important that your baby fall asleep independently.  At bed time put your child in his or her crib while awake enough to know where he is (not with eyes so heavy he or she can barely stay awake).  Dim the lights the way they will be the rest of the night.  Do not put your child to bed with a bottle, and mom and dad must not be in the room.  If your baby cries, allow it to go on for 5 – 10 minutes.  If your baby is still crying, go back into the room and calm your baby with the least amount of contact possible.  If you have to pick up your baby do not feed him back to sleep.  Once your baby stops crying put him or her back down, leave the room and allow another 5 – 10 minutes of crying before going back in.  Be prepared for quite a bit of crying the first few nights.  Most families get very good results in less than 2 weeks.  If you are not making any progress in 2 weeks please call your pediatrician. Infants require 14-15 hours per night. Never put a bottle in the bed with your baby.

Reading and Electronic Media

Books help parent and child grow closer. One way to help your child learn to love reading is to show that you enjoy reading. Pick books with bright colors and large simple pictures. Reading the same books over and over will help your baby to recognize and name familiar objects. Do not prop a baby in front of a television.

Teething

Teeth come in almost constantly from 6 months to 2 years of age.  It may help to massage your baby’s swollen gums with your finger for 2 minutes. A teething ring may be useful.
Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your baby.

Safety Tips

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Choking and Suffocation
·         Cords, ropes, or strings around the baby’s neck can choke him. Keep cords away from the crib.
·         Keep all small, hard objects out of reach.
·         Use only unbreakable toys without sharp edges or small parts that can come loose.
·         Avoid foods on which a child might choke (such as candy, hot dogs, peanuts, popcorn).
Fires and Burns
·         Check your smoke detector to make sure it is working.
·         Keep a fire extinguisher in or near the kitchen.
·         Check food temperatures carefully, especially if a microwave is used.
·         Keep hot foods and liquids out of reach.
·         Put plastic covers on unused electrical outlets.
·         Throw away cracked or frayed old electrical cords.
·         Turn the water heater down to 120°F (50°C).
Falls
·         Keep crib and playpen sides up.
·         Do not use walkers.
·         Install safety gates to guard stairways.
·         Lock doors to dangerous areas like the basement or garage.
·         Check drawers, tall furniture, and lamps to make sure they can’t fall over easily.
Poisoning
·         Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away. Dispose of them safely.
·         Put safety latches on cabinets.
·         Keep the POISON CONTROL number (1-800-222-1222) on all phones.
Smoking
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Ask your healthcare provider for help in quitting. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

Flu (also called influenza) vaccines are given every year starting in late September.  Your baby will require a flu vaccine every year because each flu season is caused by a different set of viruses.  If flu season has not started please mark your calendar and call our office in late September.
Vaccines can be combined to reduce the total number of shots for your baby.
Your baby may run a fever and be irritable for about 1 day after the shots. Your baby may also have some soreness, redness, and swelling in the area where the shots were given.
You may give acetaminophen drops in the appropriate dose to prevent fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed to provide comfort.
Call your child’s healthcare provider if:
·         Your child has a rash or any reaction to the shots other than fever and mild irritability.
·         Your child has a fever that lasts more than 36 hours.

Well Child Care 9 Months

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Feeding

Your baby should continue to have breast milk or infant formula until he is 1 year old. Babies at this age will eat 3 meals and 2 to 3 snacks each day. This is a good time to begin weaning from the bottle.  Encourage your child to drink formula, water, and juice from a cup now. Do not let your baby keep the bottle between meal times.
If your doctor recommended finger foods today, you may start with slightly overcooked vegetables cut into small pieces.  You may also begin pieces of soft, ripe fruit without the skin.  Do not offer foods your baby may choke on (nuts, seeds, raisins, whole grapes, candy, raw vegetables, hot dogs, popcorn or peanut butter).  Babies may not have honey until they are 1 year old.

Development

Babies are starting to pull themselves up to stand. They love to bang things together to make sounds. Soon, they may start to say “dada” and “mama.” At this age, babies learn what “no” means. Say “no” calmly and firmly and either take away the item that your child should not be playing with or remove him from the situation. Comfort your baby by using a soothing voice and being gentle with him.
Give your baby a choice of toys. Talk to him about the toy he chooses and what he is doing with the toy. Peek-a-boo is a favorite game.
9-month-olds have a lot of energy and it requires a lot of energy to take care of them. Make sure you get enough rest. Ask friends and family for help so you can take a break and rest. If you are rested, you will be better able to take care of your child.
Sleep
A regular bedtime hour and routine are important. Babies enjoy looking at picture books. You may want to read one regularly with your child. A favorite blanket or stuffed animal may help your baby feel secure at bedtime. Never put your baby in bed with a bottle. Put your baby to bed awake. If your baby wakes up a lot at night, ask your doctor or nurse for advice.
Shoes
Shoes protect your child’s feet, but are not necessary when your child is learning to walk inside. When your child finally needs shoes, choose a flexible sole tennis shoe.

Reading and Electronic Media

Your child will enjoy feeling the rough and smooth textures found in “touching” books and listening to the sounds of nonsense verse and nursery rhymes. You’ll be surprised at how quickly she will learn to join in the rhymes and songs. Do not prop an infant in front of a television.

Dental Care

By now, many children have 2 or more teeth. After meals and before bedtime, try to brush the teeth.  Do not use any toothpaste until after the first birthday.  Try to make this a fun time for your baby.
Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your baby.

Safety Tips

Child-proof the home. Remove or pad furniture with sharp corners. Keep sharp objects out of reach.  Babysitters and relatives who watch your child must child proof their homes as well.

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Choking and Suffocation
·         Avoid foods on which a child might choke (such as candy, hot dogs, popcorn, raw vegetables or peanuts).
·         Cut food into small pieces.
·         Store toys in a chest without a dropping lid.
Fires and Burns
·         Check your smoke detector to make sure it is working.
·         Put plastic covers in unused electrical outlets.
·         Keep hot appliances and cords out of reach.
·         Keep all electrical appliances out of the bathroom.
·         Don’t cook when your child is at your feet.
·         Use the back burners on the stove with the pan handles out of reach.
·         Turn your water heater down to 120°F (50°C).
Falls
·         Make sure windows are closed or have screens that cannot be pushed out.
·         Don’t underestimate your child’s ability to climb.
Car Safety
Children must ride facing backwards in the back seat of the car.  If your child reaches 20 pounds and is still riding in an infant seat, it is time for a new car seat. Some car seats can convert from a backward-facing infant seat to a forward-facing toddler seat. Carefully follow the manufacturer’s instructions when installing new or converting old car seats for your child.
Water Safety
·         Never leave an infant or toddler in a bathtub alone — NEVER.
·         Be within arm’s reach of your baby around any water, including toilets and buckets. Infants can drown in a bucket that has water in it. Empty all water and store buckets turned over.
Poisoning
·         Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away. Dispose of them safely.
·         Put safety latches on cabinets.
·         Keep the POISON CONTROL number (1-800-222-1222) on all phones
Smoking
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

Flu vaccines (also called influenza vaccines) are given every year starting in late September.  Your baby will require a flu vaccine every year because each flu season is caused by a different set of viruses.  If flu season has not started please mark your calendar and call our office in late September.

Well Child Care 12 Months

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Nutrition

Table foods that are cut up into very small pieces are best now. Baby food is usually not needed at this age. It is important for your toddler to eat foods from many food groups (fruits, vegetables, grains, and dairy products). If your family eats meat, please include it on a regular basis.  Most one year olds have 2-3 snacks each day. Cheese, fruit, and vegetables are all good snacks. Serve milk at all meals. Your child will not grow as fast during the second year of life. Your toddler may eat less. Trust his appetite.
Although you may not feed your child anything he or she may choke on, it is reasonable to begin peanut butter.  However, peanut butter on bread still presents a choking hazard.  Instead, put a small dab of peanut butter on cut up pieces of a soft fruit such as banana.
If you are still breastfeeding, you may choose to continue breastfeeding or may wean your child at this time. When a child is 1 year old, you can start using 2% milk. Almost all toddlers need the calories of 2% milk (not low-fat or skim) until they are 2 years old. Some children have harder bowel movements at first with whole milk. This is also the time to wean completely off the bottle and switch to an open-rimmed cup (not a Sippy cup).
Many doctors now recommend Vitamin D supplements even for healthy children who are good eaters.  Since Western Pennsylvania has many days with heavy cloud cover, long winters and we use sunscreen during the summer, many doctors feel the sun does not shine on our skin enough for our body to manufacture adequate Vitamin D for healthy bones.  Although milk is Vitamin D fortified, it does not contain enough.
If your doctor recommends Vitamin D supplementation your child should take 400 IU of Vitamin D every day.  Name-brand vitamin supplements usually contain other vitamins that your child most likely does not need, but will not hurt your child.
Here is a suggestion, but feel free to substitute and please get into the habit of reading labels: Children under the age of 2 years should take Tri Vi Sol every day.
Remember – in order to make strong bones your child needs a good source of Calcium in the diet in addition to Vitamin D.  Every day your child requires 4 servings containing Calcium (milk, cheese, yogurt, cottage cheese, Calcium fortified orange or apple juice).

Development

Every child is different. Some have learned to walk before their first birthday. Most 1-year-olds use and know the meaning of words like “mama” and “dada.” Pointing to things and saying the word helps them learn more words. Speak in a conversational voice with your child and give them lots of encouragement to use their voice. Smile and praise your child when he learns new things. Allow your child to touch things while you name them. Children enjoy knowing that you are pleased that they are learning.
As children learn to walk they will want to explore new places. Watch your child closely.
Shoes
Shoes protect your child’s feet, but are not necessary when your child is learning to walk inside. When your child finally needs shoes, choose shoes with a flexible sole.

Reading and Electronic Media

Read to your child every day. Children who have books read to them learn more quickly. Choose books with interesting pictures and colors. Choose television shows carefully. Limit their total time and watch the show with your child. More importantly, use the time to turn off the TV and interact and play with your child.

Dental Care

·     Brush your child’s teeth 2-3 times a day including before bed. If you decide to use toothpaste be very stingy with it because you child will not spit after brushing.
·     Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your child.  Since your child is receiving fluoride in either the water or by supplement please limit toothpaste that contains fluoride.

Safety Tips

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Choking and Suffocation
·         Avoid foods on which a child might choke easily (candy, hot dogs, popcorn, peanuts).
·         Cut food into small pieces, about half the width of a pencil.
·         Store toys in a chest without a dropping lid.
Fires and Burns
·         Check your smoke and carbon monoxide detectors. Replace the batteries if necessary.
·         Put plastic covers in unused electrical outlets.
·         Keep hot appliances and cords out of reach.
·         Keep all electrical appliances out of the bathroom.
·         Don’t cook with your child at your feet.
·         Use the back burners on the stove with the pan handles out of reach.
·         Turn your water heater down to 120°F (50°C).
Falls
·     Make sure windows are closed or have screens that cannot be pushed out. Don’t underestimate your child’s ability to climb.
Car Safety
All infants and toddlers should ride in a REAR-FACING car seat until they are 2 years old or until they have reached the highest weight or height allowed by the manufacturer.  (Babies typically ride in a rear-only car seat.  Once your child outgrows the rear-only car seat, he or she should be switched to a convertible seat facing the rear of the car.) Never leave your child alone in the car.
Water Safety
·     Never leave an infant or toddler in a bathtub alone — NEVER.
·     Stay within arm’s reach of your child around any water, including toilets and buckets. Keep lids to toilets down, never leave water in an unattended bucket, and store buckets upside down.
Poisoning
·     Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away. Dispose of them safely. Install safety latches on cabinets.
·     Keep the POISON CONTROL number (1-800-222-1222) on all phones
Smoking
·     Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home. If you smoke, set a quit date and stop. Ask your healthcare provider for help in quitting. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

Children over 6 months of age should receive an annual flu vaccine (also called influenza vaccine). Children during the first year of getting a flu vaccine should get a second dose of influenza vaccine one month after the first dose.   We will begin flu vaccines in late September so mark your calendar.
Your child may run a fever and be irritable for about 1 day after the vaccines and may also have soreness, redness, and swelling in the area where the shots were given.
You may give your child acetaminophen drops in the appropriate dose to help to prevent fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed for comfort.
Call your child’s healthcare provider if your child has a rash or any reaction to the shots other than fever and mild irritability or your child has a fever that lasts more than 36 hours.

Well Child Care 15 Months

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Nutrition

Toddlers should eat small portions from all food groups: meats, fruits and vegetables, dairy products, and cereals and grains. Your child should be learning to feed himself. He will use his fingers and maybe start using a spoon. This will be messy. Make sure you cut food into small pieces so that your child won’t choke. Children need healthy snacks like cheese, fruit, and vegetables. Do not use food as a reward. Your child should be served 2% milk until two years of age.
If your doctor has recommended Vitamin D supplementation continue to give your child Tri Vi Sol every day and make sure your child consumes 4 or more calcium servings per day.
By now, most toddlers should be using a cup only. If your child is still using a bottle, it will soon start to cause problems with his teeth and might cause ear infections. A child at this age will be sad to give up a bottle, so try to replace it with another treasured item – perhaps a teddy bear or blanket. Never let a child take a bottle to bed.

Development

Toddlers are very curious and want to be the boss. This is normal. If they are safe, this is a time to let your child explore new things. As long as you are there to protect your child, let him satisfy his curiosity. Stuffed animals, toys for pounding, pots, pans, measuring cups, empty boxes, and Nerf balls are some examples of toys your child may enjoy. Toddlers may want to imitate what you are doing. Sweeping, dusting, or washing play dishes can be fun for children. Toddlers require 12-14 hours of sleep per night.

Behavior Control

Toddlers start to have temper tantrums at about this age. You need patience. Trying to reason with or punish your child may actually make the tantrum last longer. It is best to make sure your toddler is in a safe place and then ignore the tantrum. You can best ignore by not looking directly at him and not speaking to him or about him to others when he can hear what you are saying. At a later time, find things that are praiseworthy about your child. Let him know that you notice good qualities and behaviors. It is not yet time to start time-outs.

Reading and Electronic Media

Reading to your child should be a part of every day. Children that have books read to them learn more quickly. Choose books with interesting pictures and colors. Children at this age may ask to read the same book over and over. This repetition is a natural part of learning.

Dental Care

After meals and before bedtime, brush your toddler’s teeth.  If you use toothpaste be very stingy with it.  Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your child.  Since your child is receiving fluoride in either the water or by supplement please do not use toothpaste that contains fluoride.
Safety Tips

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Choking and Suffocation
·         Keep plastic bags, balloons, and small hard objects out of reach.
·         Use only unbreakable toys without sharp edges or small parts that can come loose.
·         Cut foods into small pieces. Avoid foods on which a child might choke (popcorn, peanuts, hot dogs, chewing gum).
Fires and Burns
·         Keep lighters and matches out of reach.
·         Don’t let your child play near the stove.
·         Use the back burners on the stove with the pan handles out of reach.
·         Turn the water heater down to 120°F (50°C).
Car Safety
All infants and toddlers should ride in a REAR-FACING car seat until they are 2 years old or until they have reached the highest weight or height allowed by the manufacturer.  (Babies typically ride in a rear-only car seat.  Once your child outgrows the rear-only car seat, he or she should be switched to a convertible seat facing the rear of the car.)
Pedestrian Safety
·         Hold onto your child when you are around traffic.
·         Supervise outside play areas.
Water Safety
·         Never leave an infant or toddler in a bathtub alone — NEVER.
·         Continuously watch your child around any water, including toilets and buckets. Keep lids of toilets down. Never leave water in an unattended bucket. Store buckets upside down.
Poisoning
·         Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
·         Keep the POISON CONTROL number (1-800-222-1222) on all phones
·         Buy medicines in containers with safety caps.
·         Do not store poisons in drink bottles, glasses, or jars.
Smoking
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Ask your healthcare provider for help in quitting. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

The virus that cause influenza (also called the flu) changes each year.  Children over 6 months of age should receive an annual flu vaccine starting in late September.
Your child may run a fever and be irritable for about 1 day and may have soreness, redness, and swelling in the area where the shots were given. You may give acetaminophen or ibuprofen drops in the appropriate dose to prevent fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed to provide comfort.
Call your child’s healthcare provider if:
·         Your child has a rash or any reaction to the shots other than fever and mild irritability.
·         Your child has a fever that lasts more than 36 hours.

Well Child Care 18 Months

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Nutrition

Family meals are important for your child. Let him eat with you. This helps him learn that eating is a time to be together and talk with others. Don’t make mealtime a battle. Let your child feed himself. Your child should use a spoon and drink from an open-rimmed cup (not a Sippy-cup).  Do not use food as a reward. Your child should be served whole milk until two years of age.  If your doctor has recommended Vitamin D supplementation continue to give your child Tri Vi Sol every day and make sure your child consumes 4 or more calcium servings per day.

Development

Children at this age should be learning many new words. You can help your child’s vocabulary grow by showing and naming lots of things. Children at this age can engage in pretend play. They will look where you point and will try to get your attention when they want to point something out to you. Children have many different feelings and behaviors such as pleasure, anger, joy, curiosity, warmth, and assertiveness. Praise your child for doing things that you like.
Toddlers require 12-14 hours of sleep per night.
Toilet Training
At 18 months, most toddlers are not yet showing signs that they are ready for toilet training. When toddlers report to parents that they have wet or soiled their diaper, they are starting to be aware that they prefer dryness. This is a good sign and you should praise your child. Toddlers are naturally curious about the use of the bathroom by other people. Let them watch you or other family members use the toilet. It is important not to put too many demands on a child or shame the child during toilet training.

Behavior Control

Toddlers sometimes seem out of control, or too stubborn or demanding. At this age, children often say “no”. To help children learn about rules:
·         Divert and substitute. If a child is playing with something you don’t want him to have, replace it with another object or toy that he enjoys. This approach avoids a fight and does not place children in a situation where they’ll say “no.”
·         Teach and lead. Have as few rules as necessary and enforce them. Make rules for the child’s safety. If a rule is broken, after a short, clear, and gentle explanation, immediately find a place for your child to sit alone for 1 minute. It is very important that a “time-out” comes right after a rule is broken.
·         Make consequences as logical as possible. For example, if you don’t stay in your car seat, the car doesn’t go. If you throw your food, you don’t get any more and may be hungry.
·         RULE OF THUMB:  Be consistent with discipline. Don’t make threats that you cannot or will not carry out.  If you say you’re going to do it, do it.  If it is a rule for mom then it must also be a rule for dad.   Children will always follow the easiest set of rules so it is important to have ONE set of rules.  
·         Be warm and positive. Children like to please their parents. Give lots of praise and be enthusiastic. When children misbehave, stay calm and say “We can’t do that. The rule is ________.” Then repeat the rule.

Reading and Electronic Media

Toddlers have short attention spans, so stories should always be short, simple, and have lots of pictures. The best choices are large-format books that develop one main character through action and activity. Make sure the books have happy, clear-cut endings. It is important to set rules about television watching. Limit total TV time to no more than 1 hour per day. Watch TV shows with your child and discuss them with her.

Dental Care

After meals and before bedtime, brush your toddler’s teeth.  If you use toothpaste be very stingy with it because your toddler will not spit when finished brushing. Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your child.  Since your child is receiving fluoride in either the water or by supplement please limit toothpaste that contains fluoride.

Safety Tips

Child-proof your home. Go through every room in your house and remove anything that is valuable, dangerous, or messy. Preventive child-proofing will stop many possible discipline problems. Don’t expect a child not to get into things just because you say no.  If you have a gun, store it unloaded and locked. Store the ammunition in a separate place that is also locked.

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Choking and Suffocation
·         Keep plastic bags, balloons, and small hard objects out of reach.
·         Cut foods into small pieces.
·         Store toys in a chest without a dropping lid.
Fires and Burns
·         Keep hot appliances and cords out of reach.
·         Don’t cook with your child at your feet.
·         Keep hot foods and liquids out of reach.
·         Keep matches and lighters out of reach.
·         Turn your water heater down to 120°F (50°C).
Falls
·         Make sure that drawers, furniture, and lamps cannot be tipped over. Do not place furniture (on which children may climb) near windows or on balconies.
·         Use stair gates.
·         Make sure windows are closed or have screens that cannot be pushed out.
·         Don’t underestimate your child’s ability to climb.
Car Safety
All infants and toddlers should ride in a REAR-FACING car seat until they are 2 years old or until they have reached the highest weight or height allowed by the manufacturer.  (Babies typically ride in a rear-only car seat.  Once your child outgrows the rear-only car seat, he or she should be switched to a convertible seat facing the rear of the car.)
All children under 2 years who have outgrown the rear-facing weight or height limit for their car seat should use a forward facing car seat with a harness.
·         Never leave your child alone in the car
·         Children must ride in the back seat of the car.
Pedestrian Safety
·         Hold onto your child when you are near traffic.
·         Provide a play area where balls and riding toys cannot roll into the street.
Water Safety
·         Never leave an infant or toddler in a bathtub alone — NEVER.
·         Continuously watch your child around any water, including toilets and buckets. Keep the lids of toilets down. Never leave water in an unattended bucket and store buckets upside down.
Poisoning
·         Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
·         Keep the POISON CONTROL number (1-800-222-1222) on all phones
·         Buy medicines in containers with safety caps.
·         Do not store poisons in drink bottles, glasses, or jars.
Smoking
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.

Immunizations

Each year the virus that cause influenza (also called the flu) changes.  Children over 6 months of age should receive an annual flu vaccine starting in late September.
Your child may run a fever and be irritable for about 1 day after the shots. Your child may also have some soreness, redness, and swelling in the area where the shots were given.
You may give your child acetaminophen drops in the appropriate dose to prevent fever and irritability. For swelling or soreness, put a wet, warm washcloth on the area of the shots as often and as long as needed for comfort.
Call your child’s healthcare provider if:
·         Your child has a rash or any reaction to the shots other than fever and mild irritability.
·         Your child has a fever that lasts more than 36 hours.

Well Child Care 2 Years

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Nutrition
Family meals are important for your child. They teach your child that eating is a time to be together and talk with others. Letting your child eat with you makes her feel like part of the family. Let your child feed herself. Your toddler will get better at using the spoon, with fewer and fewer spills. It is good to let your child help choose what foods to eat. Be sure to give her only healthy foods to choose from. For many children, this is the time to switch from 2% milk to nonfat or 1% milk. Lower fat content in milk and other dairy products is almost always a good idea. Lowering the fat content of milk DOES NOT change any of the nutritional value of the milk.  Most families should be using nonfat or 1% milk.   Televisions should never be on during mealtime.
If your doctor recommends Vitamin D please continue it every day.  Many children will be ready for chewable vitamins that contain 400 I.U. of Vitamin D.  Make sure your child consumes 4 or more calcium servings per day (milk, cheese, yogurt, cottage cheese or calcium fortified fruit juices such as orange or apple). It is very important for your child to be completely off the bottle. Ask your doctor for help if she is still using one.
Development
Spend time teaching your child how to play. Encourage imaginative play and sharing of toys, but don’t be surprised that 2-year-olds usually do not want to share toys with anyone else. Mild stuttering is common at this age. It usually goes away on its own by the age of 4 years. Do not hurry your child’s speech. Preschoolers require 11-13 hours of sleep per night.
Toilet Training
Some children at this age are showing signs that they are ready for toilet training. When your child starts reporting wet or soiled diapers to you, this is a sign that your child prefers to be dry. Praise your child for telling you. Toddlers are naturally curious about other people using the bathroom. If your child seems curious, let him go to the bathroom with you. Buy a potty chair and leave it in a room in which your child usually plays. It is important not to put too many demands on the child or shame the child about toilet training. When your child does use the toilet, let him know how proud you are.
Behavior Control
At this age, children often say “no” or refuse to do what you want them to do. This normal phase of development involves testing the rules that parents make. Parents need to be consistent in following through with reasonable rules. Your rules should not be too strict or too lenient. Enforce the rules fairly every time. Be gentle but firm with your child even when the child wants to break a rule. Many parents find this age difficult, so ask your doctor for advice on managing behavior.
Here are some good methods for helping children learn about rules:
·         Divert and substitute. If a child is playing with something you don’t want him to have, re-place it with another object or toy that he enjoys. This approach avoids a fight and does not place children in a situation where they’ll say “no.”
·         Teach and lead. Have as few rules as necessary and enforce them. These rules should be rules important for the child’s safety. If a rule is broken, after a short, clear, and gentle explanation, immediately find a place for your child to sit alone for 2 minutes (for example in the dining room). It is very important that a “time-out” comes immediately after a rule is broken.
·         Make consequences as logical as possible. Remember that encouragement and praise are more likely to motivate a young child than threats and fear. Do not threaten a consequence that you do not carry out. If you say there is a consequence for misbehavior and the child misbehaves, carry through with the consequence.
·         RULE OF THUMB:  Be consistent with discipline. Don’t make threats that you cannot or will not carry out.  If you say you’re going to do it, do it.  If it is a rule for mom then it must also be a rule for dad.   Unfortunately, children will always follow the easiest set of rules.  Don’t confuse your kids – have ONE set of rules.
·         Be warm and positive. Children like to please their parents. Give lots of praise and be enthusiastic. When children misbehave, stay calm and say “We can’t do that. The rule is ________.” Then repeat the rule.
Reading and Electronic Media
Children learn reading skills while watching you read. They start to figure out that printed symbols have certain meanings. Young children love to participate directly with you and the book. They like to open flaps, ask questions, and make comments. It is important to set rules about television watching. Limit TV and video to no more than 1 to 2 hours of quality programming per day. If you allow TV, watch with your child and discuss. Choose other activities instead of TV, such as reading, games, singing, and physical activity.
Dental Care
·         Brushing teeth regularly after meals is important. Think up a game and make brushing fun.
·         Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your child.  Since your child is receiving fluoride in either the water or by supplement avoid toothpaste that contains fluoride.
Safety Tips
Child-proof the home. Go through every room in your house and remove anything that is either valuable, dangerous, or messy. Preventive child-proofing will stop many possible discipline problems. Don’t expect a child not to get into things just because you say no.
All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.
Fires and Burns
·         Practice a fire escape plan every 3 months.  First, set off your smoke detectors.  Everyone in the house should walk outside and go to the same meeting place every time.  Make sure the meeting place is at least 20 adult paces from your home so that your children not be standing in smoke.
·         Check smoke detectors and carbon monoxide detectors.  Replace the batteries if necessary.
·         Check food temperatures carefully. They should not be too hot.
·         Keep hot appliances and cords out of reach.
·         Keep electrical appliances out of the bathroom.
·         Keep matches and lighters out of reach.
·         Don’t allow your child to use the stove, microwave, hot curlers, or iron.
·         Turn your water heater down to 120°F (50°C).
Falls
·         Teach your child not to climb on furniture or cabinets. Do not place furniture (on which children may climb) near windows or on balconies.
·         Use stair gates or lock doors to dangerous areas like the basement.
Car Safety
All children 2 years or older should use a forward facing car seat as long as possible, up to the highest weight and height allowed by the manufacturer. 
·         Sometimes toddlers may not want to be placed in car seats. Gently but consistently put your child into the car seat every time you ride in the car.
·         Give the child a toy to play with once in the seat.
·         Parents wear seat belts.
·         Never leave your child alone in a car.
·         Children must ride in the back seat.
Pedestrian Safety
·         Hold onto your child when you are near traffic.
·         Provide a play area where balls and riding toys cannot roll into the street.
Water Safety
·         Continuously watch your child around any water.
Poisoning
·         Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
·         Keep the POISON CONTROL number (1-800-222-1222) on all phones.
·         Buy medicines in containers with safety caps.
·         Do not store poisons in drink bottles, glasses, or jars.
Smoking
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, NEVER smoke in the house or near children.
 
Immunizations
Routine infant vaccinations are usually completed before this age. However some children may need to catch up on recommended shots at this visit.
The virus that cause influenza (also called the flu) changes each year.  Children over 6 months of age should receive an annual flu vaccine starting in late September.  Many offices offer both tradition flu shots as well as Flumist (which is a painless squirt in the nose without any needles).