One child may be ready for solids at 4 months; another may not be ready at 6 months or even older. Both babies are in the “normal range.”
Start with infant cereal – rice, barley, oat and lastly mixed grains. Start by mixing ½-1 tbsp of cereal with breast milk or water. Offer this once a day for 3-5 days then work up to twice a day, slowly increasing the amount as tolerated.
Fruits and vegetables may be introduced after establishment of grain cereals. Vegetables are recommended before fruits.
It is important to start with small amounts and allow 3-5 days between introduction of each new food. This allows time to observe for any allergic reactions. Usual symptoms of an allergic reaction include rash (hives or eczema), trouble breathing, vomiting, or diarrhea. Stop the food if any of these symptoms are observed and if the baby is having trouble breathing or wheezing, call 911 and let them know that the baby may be having an allergic reaction.
Recommendations for introduction of high risk foods, ex. Eggs and peanuts, are changing. Earlier introduction may be recommended. Please discuss with your provider.
Babies need to learn how to eat from a spoon so it is common to see them thrusting food out of their mouths when you first start. With practice, he or she will learn how to properly swallow. It is important to keep the amount of formula or breast milk constant since this will be their major source of nutrition.
Start introducing sippy cups for drinking water and milk (formula or breast milk).
Don’t be alarmed if you notice a change in color and odor of your infant’s bowel movements after they start to eat solid food. Vegetables, such as beets, carrots, spinach, and peas are especially likely to cause changes in color. Yellow, green or red bowel movements are not unusual. What your baby eats can also affect the texture and consistency of their bowel movements. Banana stools can come out looking like tiny worms, pear stools like small stones. If, however, your baby has a lot of gas, diarrhea, or if their stomach is upset after eating a specific food, stop feeding it for a few weeks, then try again.
General Care and Common Concerns
Babies usually start tooth eruptions between 5-9 months of age. They normally gain one tooth per month until 12 months of age. Teething rings or plastic rings work great (especially frozen or cooled) to help alleviate any discomfort. Brushing with a finger toothbrush is the best way to clean new teeth. Toothpaste is not necessary but if you want to use one, make sure it is an infant preparation that does not include fluoride since swallowing large amounts of fluoride can be harmful.
Most infants are now sleeping through the night. Night-time wakening is common but it is important to allow them to soothe themselves back to sleep. An established, consistent bedtime routine is the best way to start the trend. Always place the baby in their crib when they are drowsy but awake. If the baby is crying, visit the baby briefly at 5-15 minute intervals to provide support without stimulation. Do not take the baby out of the crib – just whisper comforting words and touch the baby gently while providing them with their security object (small blanket etc.). With consistency, the baby will learn to sleep through the night.
Childproofing becomes essential at this age since mobility and intense curiosity about the environment is developing. Make sure all stairs are blocked off with gates, all medicines and cleaners are out of reach, electric outlets are plugged, and cabinets are locked. Poison control should be called immediately if you think the baby has gotten into something they should not have.
The number for Poison Control is 1-800-222-1222
Now that your child is becoming more involved in seeing, hearing, feeling, and experiencing new things, give them plenty of opportunities for safe exploration.
It is very common to exhibit stranger anxiety at this age – holding them and letting them know they are ok usually works to assuage fear.
At this age, they should sit independently, pick up small objects in hand, lean towards food or spoon, and can drink from cup held by feeder.
Talk to your baby as much as possible. They are learning to put facial expressions and voice intonation together, so every opportunity to fine tune will help them with social integrations and vocabulary. Reading and pointing to pictures is another great way to help them develop sound recognition and vocabulary.
The benefits of tummy time should be pretty evident now since some babies will be able to get themselves on all fours and rock back and forth. Mobility is just around the corner. Try allowing them to stand with support, sit with support and independently, and move around according to individual ability. Walkers are not recommended since they are considered a safety risk; exersaucers are a great alternative and provide plenty of opportunities to explore and develop strong leg muscles.
Discipline should mainly come from distraction since babies at this age are not able to discern right from wrong. Their curiosity sometimes gets the best of them, so putting their mind on something else is the best way to stop negative behavior.
Immunizations are a critical part of the baby’s well-being. Immunizations protect us from illnesses that have historically caused significant illness and death in children. Multiple studies are completed on the importance and safety of vaccines before they are added to the state’s mandatory list. Particular information on each vaccine is available on our website. The vaccines that are administered at the 6 month visit are the following:
Pentacel – vaccinates against diphtheria, pertussis, tetanus, haemophilus influenzae type B, and polio
These bacteria and viruses can cause severe respiratory infections, meningitis, epiglottitis, some ear infections, lockjaw, and paralysis
Hep B – vaccinates against hepatitis B which is a virus that can causes a serious liver infection
PCV-13 – vaccinates against the pneumococcal bacteria which can cause meningitis, pneumonia, and some ear infections)
Rotateq – oral live vaccine that vaccinates against bacteria that can cause severe vomiting, diarrhea, and dehydration
Your child is now old enough for a flu vaccine. If it is fall/winter, the flu vaccine is recommended.
You may give a dose of Tylenol to alleviate any discomfort from the shot administration – this can be given to your baby before you come in for the visit. Common side effects from these vaccines include fussiness, fever (usually less than 102 degrees), mild redness or swelling at the injection site.
Use of Tylenol for greater than 72 hours to control fever or fever greater than 102 with increased irritability warrants a call to the office.
As your baby gets older, their behavior is sometimes a better indicator of how sick they are as opposed to the actual number. A child who has a fever of 101 and is not eating, drinking, or interacting with their surroundings would be considered more sick that a child whose temperatures is 103 and is eating, drinking, and playful. As your baby gets older, it is important to get into the practice of examining how your baby is acting in addition to the number of their fever. Temporal and tympanic thermometers are very convenient and accurate and are a great alternative to axillary measurements.