Six-Month Checkup

Date ______________________________________

A.  MEASUREMENTS                   

Length _________________ in     (         %tile) 

Weight ___________ lb ___ oz    (          %tile) 

Head Size ______________ cm    (         % tile)

B.  IMMUNIZATIONS

Your child will receive the following:                               

 Although most infants do fine with these immunizations, some may experience fever or fussiness.  This should subside within 48 hours.  You can give acetaminophen if your child develops a fever.

C.  LABORATORY STUDIES AND PROCEDURES

No routine tests are performed today.

D.  FEEDING

Your baby should continue to take breast milk or infant formula until she is one year old.  Do not let her lie down with a bottle because this can lead to tooth decay or ear infections.  Remember to check with us before switching formulas.

When giving cereal, start with one or two tablespoons of dry rice cereal and mix it with expressed breast milk or formula.  Make the mixture soupy at first, and once your baby gets down the mechanics of eating, mix the cereal to a thicker consistency.  Use a spoon to feed her the cereal, not a bottle or an infant feeder.  Often babies have a tongue thrust and push the food back out, but this does not mean they do not like the food.  Within a few weeks your baby will learn how to eat solid foods.

You may introduce apple or white grape juice.  This should initially be cut to half-strength with water, and offered once or twice a day.  Juice should not replace a regular feeding with breast milk or formula.

Once your baby is eating cereal well, you can offer other baby foods.  Many babies do better starting with vegetables rather than fruits.  Introduce only one new food every five days to make sure your baby can digest that particular food.   Do not offer eggs until 12 months.  Wait on peanut butter until at least 3 years of age.  You can make your own baby foods with well-ripened fruits or well-cooked vegetables (but not carrots or beets, since they may be high in nitrates).  Most babies eat solids twice a day at first, and then advance to three or more feedings by eight months.  As babies eat more solids, they usually decrease the amount of breast milk or formula they take.

E.  DEVELOPMENT AND BEHAVIOR

Six-month-old babies are usually able to roll over, and are beginning to sit by themselves briefly.  They typically become noisier as they squeal, babble, laugh, and cry.  Your baby will soon cry when you are out of sight (separation anxiety) or when a stranger gets too close (stranger anxiety).  These are normal stages, so be patient with your baby.  Your baby will enjoy playing with rattles and squeaky toys.  He will enjoy “talking” to you.  He will reach for objects and pass them from one hand to the other.

Visit http://www.aap.org/family/2004PAFBrochure.pdf for a downloadable developmental checklist that covers ages three through fifteen months.

F.  SLEEP 

Many six-month-olds do not want to be put in bed.  A stuffed animal or favorite blanket may make bedtime easier.  Keep a consistent bedtime and bedtime routine, such as singing a lullaby, turning out the lights, and giving a goodnight kiss.  If your baby has problems falling asleep or awakening frequently, ask us for further information about sleep problems.

G.  GENERAL INFORMATION AND SUGGESTIONS

(1)  BEDTIME BOTTLE: Do not send your baby to bed with a bottle of milk or juice.  This practice can easily lead to tooth decay on the back side of the teeth where it may not be noticed until too late.  While it is fine to give your child something to drink in either a cup or bottle prior to bedtime, you should be sure to brush or wipe off the teeth with a soft cloth before allowing your child to fall asleep.

 (2) VITAMINS, IRON, AND FLUORIDE: The formulas which we recommend contain the recommended amounts of vitamins, so additional vitamins are not necessary.  Daily use of iron-fortified infant cereal will provide your child with the proper amounts of iron. We may recommend fluoride if you have a well water supply with little or no natural fluoride.  We also strongly recommend the application of fluoride varnish on a regular basis in the first three years of life to protect against cavities.

 (3)  TEETHING: Most babies start getting teeth between 4 and 8 months of age.  Teeth erupt regularly until children have all 20 teeth, usually around two years of age.  It may take weeks or longer for teeth to erupt through the gum surface.  While babies may be fussier than usual around the time of an eruption, teething does not cause fever, vomiting, runny nose, or other symptoms of illness.

H.   SAFETY TIPS

(1)  CAR SEAT SAFETY:  Motor vehicle accidents are the leading cause of death and serious injury after the first month of life.  Infants are required by law to remain in a rear-facing car seat in the back seat of a vehicle until they are BOTH one year of age AND at least 20 pounds.  For more information, visit http://www.buckleupnc.org/.  Carefully follow the manufacturer's recommendations to be certain the seat is properly installed in your vehicle. Remember, NEVER seat children in the front seat of cars with or without a passenger-side air bag.  For more information, call the National Highway Traffic Safety Administration at 1-800-424-9393, or visit their web site at http://www.nhtsa.dot.gov/.

(2)  CHOKING:  Should your baby ever choke, first attempt to remove all visible food or objects from his mouth.  Do not sweep blindly with your fingers because this could push the object in further.  If she cannot breathe and is turning blue, attempt to dislodge the object using a series of back blows and chest thrusts, as described in detail in the AAP book, "Caring for Your Child, Birth to Five."   If these measures are unsuccessful, call 911.   Prevention is the key, so do not put necklaces or strings around your baby’s neck, and keep drapery or blind cords away from the crib.  Use only unbreakable toys without small parts or sharp edges.  Avoid foods that a child might choke on, such as candy, hot dogs, whole grapes, peanuts, and popcorn.

(3) FIRES AND BURNS:  Be sure to check smoke detectors regularly.  Develop and practice a fire escape plan.  Place safety plugs in electrical outlets.  Keep all electrical appliances out of the bathroom to avoid electrical shock.  Do not cook with your baby in your arms or at your feet.  Check food temperatures carefully, especially those foods heated in a microwave oven.  Turn your hot water heater down to 120 degrees F (50 C).

(4)  WATER SAFETY:  Never leave an infant or toddler alone in a bathtub, even for a moment.  Supervise your child continuously around any kind of water.

(5)  FALLS:  Keep crib and playpen sides up at all times.  Do not use walkers.  Install safety gates to prevent falls down stairways.  Check drawers, tall furniture, and lamps to make sure they cannot fall over easily.

(6)  POISON PREVENTION:  Keep ALL medications, vitamins, cleaning solutions, and chemicals in locked cabinets.  High shelves are not good enough.  Should your child get into something you believe is poisonous, call the Poison Control Center immediately.  The number is on the inside cover of your phone book.  We no longer recommend the use of Syrup of Ipecac.

(7)  SUN EXPOSURE:  Avoid direct sun exposure whenever possible.  If your baby will be outside in direct sunlight for more than fifteen minutes, apply a sunscreen with SPF of 30 or higher thirty minutes before going outside.   If you visit the beach, avoid sun exposure in the hottest part of the day, from 11am to 3 pm, and remember to fit your child with sunglasses that block UV rays.

(8)  INSECT REPELLANTS:  During the time of year when mosquito bites are common, the AAP recommends that you protect your child with products that have 30% DEET as the active ingredient.  Other repellants simply do not work consistently or for long.  Do not use products that contain both sunscreen and repellant.  Apply the repellant with 30% DEET to exposed areas of skin, but avoid the nose, mouth, and eyes.  Wash the repellant off when you bring your child back inside.

For additional safety tips, visit http://www.aap.org/healthtopics/safety.cfm

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The next checkup is at 9 months of age.  We will be checking your child’s vision at the next visit.

Last modified: Monday February 16, 2015