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.

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.

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.

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.

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.

·         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).

·         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).

·         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.

·         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.

·         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.

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.

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).

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 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.

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.

·     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.

·         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.

·         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).

·     Make sure windows are closed or have screens that cannot be pushed out. Don’t underestimate your child’s ability to climb.

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.

·     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.

·     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

·     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.

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.

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.

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.

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.

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.

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.

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.

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.

·         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.

·         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).

·         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.

·         Never leave your child alone in the car

·         Children must ride in the back seat of the car.

·         Hold onto your child when you are near traffic.

·         Provide a play area where balls and riding toys cannot roll into the street.

·         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.

·         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.

·         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.

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.

·         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.

Family meals are important for your child. Letting your child eat with you makes her feel like part of the family. Let your child feed herself. It is good to let your child help choose what foods to eat. Be sure to give her only nutritious foods to choose from. 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. Your doctor will advise you if you should be using milk with a higher fat content.

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 a bottle.

Development

Two-and-a-half year olds often have lots of energy and curiosity; yet they often lack social and language skills to know the limits of appropriate behavior. As such, this is a time when parents and child alike need lots of support. A parent needs lots of energy, patience and interest in teaching her child. Preschoolers require 11-13 hours of sleep per night.

Toilet Training

Some children show 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.

Testing the rules and limits is common. Parents need to be consistent in following through with reasonable rules. 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. Here are some good methods to help children learn rules and keep them safe:

1.  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.”

2.  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. It is very important that a “time-out” comes immediately after a rule is broken.

3.  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.

4.  Be consistent with discipline. Don’t make threats that you cannot carry out. If you say you’re going to do it, do it.  Children do best with a single set of rules that mom and dad enforce equally.

Spend time teaching your child how to play. Encourage imaginative play and sharing of toys, but don’t be surprised that 2-and-one-half 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. Ask your healthcare provider about your child’s speech if you are worried.

It is important to set rules about television watching. Limit total TV time to 1-2 hours per day. Watch television shows with your child. Ask your child questions about what the characters were doing and how they were feeling. Children should not be allowed to watch shows with violence or sexual behaviors. Find other activities you can do with your child. Reading, hobbies, and physical activities are good alternatives to TV.  Children should never have televisions in their rooms.

Safety Tips

·         Practice your fire escape plan. Children under the age of 5 should be led from the house in a calm, efficient way.  Check smoke 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).

·         Teach your child not to climb on furniture or cabinets. Do not place furniture (on which children may climb) near windows or on balconies.

·         Lock doors to dangerous areas like the basement.

·         Your child should use a forward facing car seat as long as possible, up to the highest weight and height allowed by the manufacturer.   Your child must ride in the back seat. 

·         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.

·         Hold onto your child when you are near traffic.

·         Provide a play area where balls and riding toys cannot roll into the street.

·         Continuously watch your child around any water.

·         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.

·         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.

·         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).