• Six-month immunizations are:
  third DTP and HIB combination shot
• The third polio vaccination can be given anytime between the six-month and 18month visit.

Feeding Your Baby

• Your baby will take less formula or breast milk as he eats more solid foods (between 24-32 oz. a day).
• Your baby should remain on formula or breast milk and not drink cow's mild until one year of age.
• Solid foods become more important in your baby's diet as your baby shows more of an interest in solid foods.
• After you offer cereal, you can offer your baby other types of foods.
• Always start with small amounts of a new food and increase slowly as your baby wants more.
• You may use steamed and mashed homemade foods or baby foods from jars.

  Order to introduce foods

• Begin with one to two spoonfuls of a strained or mashed orange vegetable such as squash, carrots, or sweet potatoes.
• Try green vegetables such as peas or green beans next.
• Start pureed or mashed fruits such as apples, peaches, pears, or prunes next.
• Ripe bananas are also a good choice.
• Add only one new food at a time.
• Wait three days before trying a new food to help you to know your baby's likes and to know if your baby has an allergy to any food.
• Signs of a possible food allergy (which is rare) are diarrhea, vomiting, or a rash.
• If these signs occur, stop feeding your baby the new food and tell your health care provider.

  Feeding tips

• Feed your baby when he is in a good mood and is more likely to accept the foods.
• If he does not want a food, don't force it, but try it again at a later time.
• Begin to offer juices or water from a cup (a good place to practice is in the tub during bath time).
• Avoid tomato or orange juice, eggs, and anything with peanuts until 1 year of age--these foods are more likely to cause problems such as allergies.
• Don't be alarmed if your baby's stool changes color when he eats new foods (this is normal).

  Weaning from breastfeeding

• Many infants nurse for a year or longer until they are able to drink cow's milk.
• When you are ready to wean, do it slowly over a one- to two-week time period.
• You may change one breastfeeding for a formula feeding.
• A day or two later, you may change another breastfeeding for a formula feeding.
• A breastfed baby can often be weaned right to a cup and not need a bottle.
• Once your baby stops nursing, your breast milk will slowly dry up.

Teeth

• First teeth usually appear about six to 10 months of age, but may come any time from three to 13 months.
• Lower front teeth usually appear first, then upper front teeth.
• Signs of teething are different for each baby, your baby may have little pain and few signs that he is teething, or he may be fussy and uncomfortable--rub his gums, suck on his fingers, or a pacifier more than usual.
• Gums may become red and sore when a tooth is breaking through.
• Fever, vomiting, or excessive irritability are not due to teething and may require medical attention.
• Drooling, fussiness, difficulty in sleeping, separation anxiety, and reaching for and mouthing objects are developmental changes and not due to teething.
  
  Management
  
• Chewing on clean, hard, cold objects may soothe sore gums.
• Use teething rings, teething toys, or frozen pacifiers.
• If your baby is uncomfortable, you can use Acetaminophen (see Fever Management for correct dose).
• Do not use teething lotions, powders, whiskey, or paregoric (because it has opium in it).
  
  Prevention of tooth decay
  
• Develop good dental habits to keep teeth healthy by taking care of the teeth right from the start.
• Use a water supply with fluoride or use a prescribed fluoride supplement.
• Keep sugar off the teeth--do not leave a bottle with formula, breastmilk, or juice in the crib with your baby.
• If he does take a bottle of formula or breastmilk at bedtime, hold him and make this a warm cuddly time for both of you, then settle him in the crib when he is done.
• Use water if your baby needs a bottle in the crib to go to sleep.
• Clean teeth with a wet washcloth after meals, with his bath, or at least nightly.

Sleep

What you can expect from your baby

• Sleep about 14 hours per day with up to 12 hours of sleep at night
• May take one- to three-hour naps in the morning and afternoon
• May not want to go to sleep at bedtime due to separation anxiety
• Cry at night due to teething or trouble settling down

  What you can do

• Develop daily routines to prevent your baby from becoming overtired, which increases fussiness.
• Begin to establish a bedtime routine.
• A favorite toy or blanket to cuddle may help your baby separate from you.
• Put your baby to bed drowsy but awake, to let him learn his own way to fall asleep.
• Rocking your baby to sleep may make it more difficult for him to fall asleep on his own.
• Move your baby to his own room if you have not done so by now.
• If your baby wakes and 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.
• Do not feed him or put him in your bed.
• If there is no other problem, your baby may need to be allowed to cry.

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 nine month visit.

What you can expect from your baby

• Roll over
• Hold head in line with the body when pulled to a sitting position
• Be able to sit with support
• Lean forward on hands when helped to sit
• Bear some weight on legs when helped to stand
• Reach for and grasp objects
• Turn toward sounds
• Is aware of strangers and may be fearful of them
• Laugh, squeal, coo, and babble
• Beginning to learn what "no" means
• Beginning to see objects farther away
• May pass toy from hand to hand
• May try to move toward an object
• May wave bye-bye

  What you can do

• Play peek-a-boo and pat-a-cake.
• Touch and cuddle with your baby.
• Smile and look in your baby's eyes.
• Provide different sounds and noises for your baby to listen to.
• Provide bright colored toys and object for your infant to look at.
• Take your baby on walks, to the mall, or to visit friends.
• Help your baby to sit with support.

Safety

Preventing accidents and falls

Your baby is just beginning to move about on his own power and may be rolling over by now and attempting to sit alone. He will need closer supervision now that he is beginning to explore on his own.

• Restrain your baby in a car seat whenever you drive.
• Fasten your baby with a seat belt when feeding in the high chair.
• Walkers are not safe and do not help your baby learn to walk--do not use them.
• Use gates on all stairs top and bottom.
• Install user-friendly hinge mounted gates at the top of the stairs--your baby might push down an expansion type gate.
• Be sure the crib mattress is at its lowest level.

  Prevent fires and burns
  Your baby has very quick hands and may suddenly pull on things

• Keep all candles, hot drinks, and cigarettes out of reach.
• Never smoke around your baby.
• Remove table cloths--your baby may pull on them to get up.
• Insert plastic plugs into unused electrical outlets.
• Hide all electrical cords that your baby could chew on.
• Keep appliances such as an iron or curling iron out of reach.
• Don't leave your baby alone in a room with a fire burning in the fireplace.
• Place guards around all open heaters, registers, floor furnaces, and fireplaces.

  Prevent choking and suffocation

• Do not let your baby suck or chew on a latex balloon.
• Do not leave your baby alone in a tub or wading pool.

  Prevent poisoning
  Your baby is full of curiosity and examines everything he picks up by placing it in his mouth. At this age he may not be able to reach the counter or medicine cabinet but he can easily get into a mislaid purse that may contain medicine.

• Keep medicine in safety-capped bottles in a locked medicine cabinet.
• Clean out under your sinks--all detergents, cosmetics and cleaning products should be kept in a high cabinet.
• Put paint, gasoline, or gardening products stored in the garage in a high cabinet.
• Crawl on the floor to see what your baby can see and grab.
• Have the number for the poison control center by the telephone. UIHC number is 1-800-272-6477 and toll free in Iowa only.
• Call your health care provider or the poison control center immediately if your baby ingests some medicine or other toxic substance.
• Keep syrup of Ipecac (makes your baby vomit) on hand--but do not use unless told to do so by the poison control center or your health care provider.

References:

Chow, M., Durand, B., Feldman, M., & Mills, M. (1984) Handbook of pediatric primary care (2nd ed.) (pp. 306-319). New York: John Wiley & Sons.

Committee on Psychosocial Aspects of Child and Family Health, 1985-1988. American Academy of Pediatrics (1988). Guidelines for health supervision (2nd ed.) (pp. 37-40). Elk Grove Village, IL: Author

Dworkin, P. (1982). Pediatric group practice manual of anticipatory guidance (pp. 12-130. (Available from West Virginia University School of Medicine).

Gunderson Clinic, Ltd. 91987). The baby book (pp. 32-33). La Crosse, WI: Author.

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. 44-46). Boston: Little, Brown and Co.