Well Child Visit 2 Handout - 6 Months

6 MONTH        

Date of Visit:  ___________
Weight:           ___________
Height:            ___________
HC:                 ___________
 
NORMAL DEVELOPMENT: Your baby may . . .  
 
•  Sit with support.  This is a good time to use a high chair for meals.
•  Know the difference between strangers and family or caretakers.  Your baby may cry or get upset around strangers—this is normal.
•  May begin to creep and crawl.
•  Continue teething—which may make your baby fussy, and cause him/her to have a change in bowel movements.
•  Try to imitate sounds.
•  Show a greater interest in the detail on objects.
•  Wriggle in anticipation of play.
•  Smiles easily and spontaneously.
•  Resist pressure to do something he/she does not want to do.
•  Grasp, manipulate, mouth, and bang objects.
 
DIET:
•  Your baby should continue breast milk or formula feedings until 1 year of age.
•  Do not use a microwave oven to heat the formula.
•  If your baby has not started solid foods, now is the time to begin.  Rice cereal is preferable as it is the least allergenic.  One tablespoon mixed with breast milk or formula 1-2 times per day is enough to get started.  Continue feeding your baby rice cereal at least 5 days before trying a different type of cereal.  As long as no signs of intolerance or allergy are present, baby cream of wheat, barley, and oatmeal cereals may be introduced.  Fruit juices, baby pureed vegetables and fruits followed by pureed meats may then be introduced.  Always wait 5 days between starting new foods so any intolerance or allergic reaction can be
pinpointed to a particular food.  Avoid egg whites, honey, and fresh citrus juices until your baby is 12- months-old.  Pureed commercial or homemade baby foods may be used.  Do not add salt or sugar to your baby’s food—he/she does not need either.  There will be a gradual increase in solid foods from 6 months until one year of age.  AVOID foods that are easily choked on:  popcorn, peanuts, hot dog rounds, raw carrots, and whole grapes.   
•  IRON RECOMMENDATION:  Usually no iron drops are necessary.  Your child gets iron in his/her iron-fortified formula or in breast milk.  Breastfeeding moms should continue to take their multivitamins with iron.  Baby food, started at 4-6 months, is also a source of iron.  Exception: Supplemental iron is necessary if breast milk is the only source of nourishment for the first nine months of life.  In this case, iron supplement should be started at 6 months in the form of polyvisol with iron,  1 cc or 1 ml by mouth once a day (available at your pharmacy).
 
HYGIENE:
•  Use a mild soap for your infant’s body (i.e. Dove, Neutrogena, or Baby Magic Formula).
•  Use only water on your baby’s face.
•  Clean only the outer ear with a cotton swab; never put a swab in the ear canal.
•  Do not use baby powder—it can be inhaled and cause breathing problems.
 
SAFETY:  See Childproofing Handout
•  Always restrain your baby in an appropriate infant car safety seat in the backseat.
•  Ensure that the baby’s crib is safe.  The slats should be no more than 2 3/8” apart, and the mattress should be firm and fit snugly into the crib.  Keep the sides of the crib raised.  Do not put the baby to sleep on soft surfaces such as a waterbed, couch, or pillow.
•  Continue to put the baby to sleep on his/her back or side.
•  Never leave your baby on a surface from which he/she can roll off.  Even at this young age, he/she is active and may begin to roll over or scoot along the crib or floor.
•  Never prop a bottle—your baby may choke.
•  To avoid burns, do not hold your infant while you are cooking, smoking, or drinking hot beverages.
•  Stay with your baby every minute he/she is in the bathtub.  If interrupted during bath time (or changing diapers on the changing table) put your baby in the crib, on the floor, or in your arms.
•  Install smoke alarms on every floor and change batteries twice a year.
•  Never leave the baby alone or with a young sibling.
 
STIMULATION:
•  When your baby is awake, position him/her so that he can watch what you are doing.  You can prop your baby up in his/her car seat.  This will take pressure off the back of the head and prevent too much flattening of the back of the head.
•  Babies love to be snuggled and talked to, especially while being cuddled.  
•  Infants enjoy looking at mirrors, pictures of faces, and bright colors.
•  Babies love to suck their thumbs and/or pacifiers.
 •  Ring rattles or rattles with handles are good choices—esp. those with faces with moving eyes.
•  Squeeze toys that are soft and easy to squeak will help your baby practice the grasping motion and improve his/her idea of cause and effect connections.
 
HEALTH MAINTENANCE:
•  IMMUNIZATIONS:  DTaP, Hib, Hepatitis B (see vaccine information sheets).
•  ACETAMINOPHEN DOSAGE:  Acetaminophen (i.e., Tylenol, Tempra) can be given for fever every 4 hours (See Tylenol Dosing Handout).  Tylenol is dosed according to your baby’s weight.  
 
ANTICIPATORY GUIDANCE:  (Information credited to Brazelton’s Touchpoints)
•  Safety:  As the baby begins to move around, issues of physical safety arise.   Baby proofing the house will become important very soon.
•  Limit-setting:  The baby’s curiosity and mobility raise concerns about limit setting.
•  Sleeping and feeding:  Changes in sleeping and feeding patterns may occur if they haven’t already.  Limit-setting around going down to sleep should begin.  You can let your baby begin to feed  him-/herself soft finger foods and experiment with a cup and/or spoon in the next couple of months.
•  Stranger awareness:  The baby will begin to become wary of anyone new.