• Your baby will take formula or breast milk four to six times per day until about six months of age.
• Formula or breast milk is still the major part of the diet.
• Continue to hold your baby when breast or formula feeding--this is a warm cuddly time for both of you.
• Do not prop the bottle.
• Solid foods such as cereal can be started at about four to six months of age.

  Signs of readiness for solids

• Able to hold head upright well
• Can sit up with help
• Watches you eat and opens his mouth
• Does not push food out of his mouth with his tongue (a normal reflex called tongue thrust)
• If he continues to have tongue thrust--wait another week or so and try again.

  Learning to eat solid foods

• Learning to eat solids is a slow process.
• Use a spoon to feed your baby.
• It may take time for him to adjust to the new feeling of offering food with a spoon.
• Do not put solid food in your baby's bottle.
• When your baby turns his head away or closes his lips he is showing you he has had enough to eat.
• Never force your baby to eat more food than he wants.

  Cereal first

• Rice cereal with iron is usually the first solid food.
• First offer a small amount of cereal once a day.
• Mix one tablespoon of cereal with one or two tablespoons of formula or breast milk--make it like thin gravy.
• Slowly increase the amount you offer your baby as he begins to enjoy the cereal and eats better.
• Offer cereal two times a day and gradually make it thicker.
• Try one new kind of cereal such as barley or oatmeal at a time.
• If your baby dislikes or is allergic to one type of cereal, you will know which one he is having problems with.
• Extra sugar and salt are not needed for baby food and may lead to bad habits.

Teeth

• Keep teeth healthy--use a water supply with fluoride--or use a prescribed fluoride supplement.
• Do not leave a bottle of formula, breast milk, or juice in the crib with your baby.
• Babies start drooling now, but the first teeth do not usually appear until six or eight months of age.

Sleep

What you can expect from your baby:

• Sleep about 13 to 15 hours a day with four to five sleep and awake cycles
• Have longer alert periods during the day
• Sleep longer periods of time at night

  What you can do

• Put your baby to bed when he begins to get sleepy, but before he falls asleep, without rocking, feeding, or a pacifier--no bottle in bed. (This will start good sleep habits and prevent problems in the future.)
• If at all possible, have your baby in his own room.
• In his own room, he will learn ways to get himself back to sleep and learn to sleep through the night.
• Delay your response to fussing for several minutes.
• Do not waken your baby if you hear him rustling when he is in light sleep. (He needs to learn to self-calm--find his own thumb--to return to sleep on his own.)
• Make middle-of-the-night feedings brief and boring--gradually make feeding time and amount shorter
• If your baby cannot return to sleep, make sure he is all right.
• Be loving but firm and try to calm him without picking him up.
• If it is necessary to pick him up, hold him briefly before returning him to bed.

Development

Every baby develops at his own rate and with his own style. This is not a strict timetable, but rather a guideline of things to expect between now and the six-month visit.

What you can expect from your baby

• Hold his head high and steady without support when held upright
• Hold his head in line with his body when pulled to a sitting position
• Raise his body on his hands when lying on his stomach
• Roll from stomach to back
• Discover and play with hands and feet
• Hold rattle or small toy
• Look at mobile and wave arms
• Follow objects or people at 180 degrees range of vision
• Form attachments to parents and have interest in the human world
• Respond to a social interaction with varying reactions
• Show affection and get attention with smiles, coos, laughing, and squealing
• Notice when parent leaves and may cry (called separation anxiety)
• Recognize caregiver preparing feeding

  What you can do

• Talk and sing to your baby often (when dressing, feeding, changing diaper, etc.).
• Look and smile at your baby often--have a conversation with "smile talk".
• Provide brightly colored mobiles and textured objects for your baby to look at and hold.
• Use play that helps your baby use both sides of his body and both eyes.
• Lay him on his back, cross his arms over his chest, straighten them out, and gently stretch them up and down.
• Lay your baby on his back, hold his legs by the ankles, bend one knee, then the other and then both knees.
• Shake a rattle above his head until he looks and reaches for it, then reward him with a kiss.
• Read baby books with board, cloth, or vinyl pages.

Safety

Your baby is learning to grab and put objects in his mouth.

Preventing accidents and falls

• Use a safety strap to secure your baby in an infant seat, swing, or stroller.
• Keep the car windows and doors locked on the side of the car when your baby is riding in his car safety seat.
• Put a fence around outside stairways, decks with wide slats, and areas near water (swimming pools).
• Restrain your baby when he is in a grocery cart.

  Prevent fires and burns

• Do not handle, eat, or drink hot liquids (coffee) when near your baby.
• Do not hold your baby when cooking at the stove.
• Keep hot food and liquids away from the edge of the table or counter.
• Use cool mist vaporizers and keep them out of your baby's reach.
• Place guards around all open heaters, registers, floor furnaces, and fireplaces.

  Prevent choking and suffocation

• Remove all small objects that your baby may pick up and swallow from the floor, counters, and table tops.
• Encourage any older children to put toys with small parts away after playing with them, or keep such toys in the older child's room.
• Keep diaper pins out of your baby's reach.
• Do not tie a pacifier around your baby's neck.
• Do not leave your baby alone in a tub.

  Car safety

• Always use the car safety seat when your baby is in the car.
• Never let a fussy baby out of a safety seat while the car is moving.
• If your baby needs a break, stop the car and calm him.
• Keep soft toys, rattles, or pacifiers on hand in the car to entertain or distract your baby.
• Never leave your baby alone in the car.
• Protect your baby from a hot safety seat by covering it with a cotton blanket or towel in warm weather.
• Use a car window shade to protect your baby's eyes from the sun.

  Toy safety

• Choose toys that are right for your baby's age.
• Make sure your baby's toys are too large to swallow.
• Buy sturdy toys--check for loose parts, sharp edges, or strings.
• Remove buttons or hard objects used as eyes or decorations on dolls or stuffed animals--or put the toy up until your child is older.
• Examine toys for small parts that could be removed and swallowed by your baby.

References:

Algranati, P.S. & Dworkin, P.H. (1992). Infancy problem behaviors. Pediatrics in Review, 13(1), 16-22.

American Academy of Pediatrics (S.D. Shalov, Ed.) (1991) Caring for your baby and young child: birth to age five (pp. 191-214). Bantam Books: New York.

Chow, M., Durand, B., Feldman, M., & Mills, M. (1984) Handbook of pediatric primary care (2nd ed.) (pp. 36-319). New York: John Wiley & Sons.

Committee on Psychosocial Aspects of Child and Family Health, 1985-1988. American Academy of Pediatrics 91988). Guidelines for health supervision (2nd ed.) (pp. 33-36). Elk Grove Village, IL: Author

Green, M. (ed.) (1994). Bright futures: Guidelines for health supervision of infants, children, and adolescents ([[. 49-55). Arlington, VA: National Center for Education on Maternal and Child Health.

Iowa State University Cooperative Extension Service (1985) Zero to one news about infants during the first year. Ames, IA: Iowa State University.

National Association of Pediatric Nurse Associates and Practitioners (1994). Starting solids.

Shamansky, S., Cecere, M.C., & Shellenberger, E. (Eds.). (1984). Primary health care handbook: Guidelines for patient education. (p. 42-44). Boston: Little, Brown and Co.

Schmidt, B.D. (1991). Your Child's Health. (pp. 162; 183; 201-205; 246-246). Bantam Books; New York.