Nine-Month Checkup

Date ______________________________________

A.  MEASUREMENTS                   

Length _________________ in     (         %tile) 

Weight ___________ lb ___ oz    (          %tile) 

Head Size ______________ cm    (         % tile)

B.  IMMUNIZATIONS

Unless your child is behind on an immunization, or it is time for a flu vaccine, there will be no immunizations today.

C.  LABORATORY STUDIES AND PROCEDURES

None are needed today.

D.  FEEDING

Your baby should continue to take breast milk or infant formula until he is one year old.  Most babies this age take 6 to 8 ounces of formula 4 times a day. All children should be off the bottle by 12-14 months of age, so now is a good time to introduce a cup.

Most babies are also eating three meals of solid foods a day, which may include baby food vegetables and fruits, and well-mashed table foods.  Baby food meats may also be introduced now.  Do not give larger pieces of foods, such as whole grapes, raw carrots or apples, or pieces of meat, which produce a choking hazard.  Food should only be offered at meal times.  Constant between meal snacking or “grazing” is unhealthy.  Juice, even if watered down, is very hard on the enamel of the teeth, and should only be offered once or twice a day.

Do not leave your baby unattended while eating solid foods.  It is normal for children have a decrease in the amount of food they eat during the next 4-6 months.   Since growth is not occurring as rapidly now, food requirements become less.

E.  DEVELOPMENT AND BEHAVIOR

Nine month old babies are often crawling well, and are beginning to pull themselves up to stand and perhaps even cruise around the couch.  They begin to make “dada” and “mama” sounds.  They often become fearful of strangers.

At this age, babies learn the meaning of “no.”    Calmly tell him “no” and take away the item or remove your child from the situation.  Since babies need to explore and interact with objects in their environment to learn, try to keep anything you do not want your child to touch away from him, so that you do not have to repeatedly tell him “no.”

Offer your baby a choice of toys.  Talk to him about the toy and what he is doing as he plays with it.  Show him lots of affection.  Other favorite games at this age are peek-a-boo and pat-a-cake.

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

F.  SLEEP

Keeping a regular bedtime routine and bedtime hour are very important.  A security blanket or stuffed animal may help your baby feel secure at bedtime.  If your child wakes up frequently at night, please ask us for advice.

G.  GENERAL INFORMATION AND SUGGESTIONS

(1)  DENTAL CARE: 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.  We are pleased to offer an optional Fluoride Varnishing Program to further protect your child’s teeth.

(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.

(3)  SHOES: The main purpose of shoes is to provide protection for your child’s feet while she is outside.  Hard soled shoes will not help her walk any better.  Inside the home it is perfectly fine for her to simply wear socks or go barefoot.  Do not fit your child with corrective shoes, except on the advice of an orthopedic surgeon.

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 HAZARDS:  Do not give your child certain foods which may cause choking, such as hard candy, hot dogs, popcorn, and peanuts.  Cut foods into small pieces. 

(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 hot appliances and cords out of reach, especially curling irons.  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.  Get in the practice of using the back burners and keeping the pan handles turned inwards.  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, including toilets, buckets, wading pools, and even water standing in low-lying areas in the yard.

(5)  FALLS:  Keep windows closed or have screens that cannot be pushed out.  Restrict your baby’s access to steps.  Do not underestimate your child’s ability to climb.

(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.  Their number is on the inside cover of your phone book or dial 911.  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 12 months of age.  Your child will be receiving immunizations at that visit.

Last modified: Monday February 16, 2015