Medical Care & Your Baby

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby’s weight, length, and head circumference and plot the measurements on the growth charts.

2. Administer a screening (test) that helps with the early identification of developmental delays.

3. Ask questions, address concerns, and offer advice about how your baby is:

Eating. Your baby should be eating a variety of baby foods, in addition to regular feedings of breast milk or formula. Your baby can probably drink from a cup and may try to self-feed with his or her fingers.

Peeing and pooping. You may notice a change in the color and consistency your baby’s poopy diapers as you introduce new foods. Tell your doctor if your baby has diarrhea or has stools that are hard, dry, or difficult to pass.

Sleeping. The average amount of daily sleep is about 14 hours. Your baby is probably still taking two naps a day — one in the morning and another sometime after lunch — but every baby is different. Waking at night is common at this age.

Developing (milestones). By 9 months, it’s common for many babies to:

• say “mama” and “dada” (not specific to parents)
• understand “no”
• sit without support
• pull to stand
• walk along furniture (“cruising”)
• start to use thumb and forefinger to grasp objects (pincer grasp)
• wave bye-bye
• enjoy playing peek-a-boo

There’s a wide range of normal, and children develop at different rates. Talk to your doctor if you’re concerned about your child’s development.

4. Perform a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby’s heart and feeling pulses, checking hips, and paying attention to your baby’s movements.

5. Update immunizations. Immunizations can protect babies from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect

6. Order a blood test. Your doctor may check for lead exposure or anemia.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 12 months:

Feeding

1. If you are breastfeeding, continue for 12 months or for as long as is mutually beneficial. Breastfed babies weaned before 12 months should be given iron-fortified formula. Wait until 12 months to switch from formula to cow’s milk.
2. If you give juice, limit it to 4 ounces (120 ml) a day. Always give juice in a cup.
3. Introduce combinations of foods previously given as single foods.
4. If there’s a history of food allergies in your family, talk to your doctor before introducing new foods.
5. Pay attention to signs your baby is hungry or full.
6. Pull the highchair up to the table during meals. Your baby will start to show interest in table foods. Give your baby a variety of tastes and textures, including foods that are pureed, mashed, and in soft lumps.
7. Give your child soft finger foods. Avoid choking hazards, including:
   • raw vegetables, hard fruits, chunks of meat, or hard cheese
   • whole grapes or cherry tomatoes (OK to peel and cut in quarters)
   • raisins, popcorn, pretzels, or nuts
   • hot dogs or kiddie sausages (OK to peel and cut in very small pieces)

Routine Care & Safety

1. If your baby wakes up at night and doesn’t settle back down, offer reassurance that you’re there, but try not to pick up, play with, or feed your baby.
2. Separation anxiety often starts around 9 months. Keep good-byes short but loving. Your baby may be upset at first, but will calm down soon after you’re gone.
3. Continue to keep your baby in a rear-facing car seat in the back seat until age 2, or whenever your child reaches the weight or height limit set by the car-seat manufacturer.
4. Avoid sun exposure by keeping your baby covered and in the shade when possible. You may use sunscreen (SPF 30) if shade and clothing don’t offer enough protection.
5. Brush your child’s teeth without toothpaste twice a day. Schedule a dentist visit soon after the first tooth appears or by 1 year of age.
6. Be vigilant about childproofing:
   • Install safety gates and tie up drapes, blinds, and cords.
   • Keep locked up/out of reach: choking hazards; medicines; toxic substances; items that are hot, sharp, or breakable.
   • Keep emergency numbers, including poison control, near the phone.
   • To prevent drowning, close bathroom doors, keep toilet seats down, and always supervise around water (including baths).
7. TV viewing (or other screen time, including computers) can interfere with the brain development of young children. Therefore, TV is not recommended for those under 2 years old.
8. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
9. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect

In the hospital, your baby’s doctor and/or nurse will probably:

1. Check your baby’s weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address any concerns, and offer advice on taking care of your baby:

Feeding. Breast milk is the best form of nutrition for infants, but formula also provides the nutrients they need. Newborns should be fed on demand (when they’re hungry), which is about every 1 to 3 hours. Your doctor or nurse may observe breastfeeding and help with technique. Formula-fed babies take about 1–3 ounces (30–90 ml) at each feeding. Burp your baby midway through a feeding and at the end. As infants grow, they start to eat more at each feeding, allowing for less frequent feeding times.

Peeing and pooping. A breastfed baby may have only one or two wet diapers a day until the mother’s milk comes in. Expect about six wet diapers by 3–5 days of age for all babies. Newborns may have just one poopy diaper a day at first. Poop is dark and tarry the first few days, then becomes soft or loose and greenish-yellow by about 3–4 days. Newborns typically have several poopy diapers a day if breastfed and fewer if formula-fed.

Sleeping. A newborn may sleep 18 hours a day or more, waking up often (day and night) to breastfeed or take a bottle. Breastfed babies usually wake to eat every 1 to 3 hours, while formula-fed babies may sleep longer, waking every 2 to 4 hours to eat (formula takes longer to digest so babies feel fuller longer). Newborns should not sleep more than 4 hours between feedings until they have good weight gain, usually within the first few weeks. After that, it’s OK if a baby sleeps for longer stretches.

Developing. Newborn babies should:

• pay attention to faces or bright objects 8–12 inches (20–30 cm) away
• respond to sound — they may turn to a parent’s voice, quiet down, blink, startle, or cry
• hold arms and legs in a flexed position
• have strong newborn reflexes, such as:
  • rooting and sucking: turns toward, then sucks breast/bottle nipple
  • grasp: tightly grabs hold of a finger placed within the palm
  • fencer’s pose: straightens arm when head is turned to that side and bends opposite arm
  • Moro (startle response): throws out arms and legs, then curls them in when startled

3. Perform a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby’s heart; feeling pulses; inspecting the umbilical cord; and checking the back, hips, and feet.

4. Give first immunizations. While in the hospital, your baby should receive his or her first immunizations. Immunizations can protect infants from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary, so talk to your baby’s doctor about what to expect.

5. Perform screening tests. Your baby’s heel will be pricked for a small sample of blood to test for certain harmful diseases. Your baby also may get a hearing test.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 1 week:

Feeding

1. If you breastfeed:
   • Help your baby latch on correctly: mouth opened wide, tongue down, with as much areola in the mouth as possible.
   • Don’t use a bottle or pacifier until nursing is established (around 1 month).
   • Pay attention to signs that your baby is full, such as turning away from the nipple and closing the mouth.
   • Continue to take a prenatal vitamin or multivitamin daily.
2. If you formula-feed:
   • Give your baby iron-fortified formula.
   • Follow the formula package’s instructions when making and storing bottles.
   • Don’t prop bottles or put your baby to bed with a bottle.
   • Pay attention to signs that your baby is full, such as turning away from the bottle and closing the mouth.

Routine Care

1. Wash your hands before handling the baby and avoid people who may be sick.
2. Hold your baby and be attentive to his or her needs. You can’t spoil a newborn.
3. Keep the diaper below the umbilical cord so the stump can dry. The umbilical cord usually falls off in 10–14 days.
4. For circumcised boys, put petroleum jelly on the penis or diaper’s front.
5. Girls may have vaginal discharge that may include a small amount of blood during the first week of life.
6. Give sponge baths until the umbilical cord falls off and a boy’s circumcision heals. Make sure the water isn’t too hot — test it with your wrist first.
7. Use fragrance-free soaps and lotions.
8. Call your baby’s doctor if your infant has a fever, is acting sick, isn’t eating, isn’t peeing or pooping, isn’t latching on or sucking well when nursing, doesn’t seem satisfied after breastfeeding, looks yellow, or has increasing redness or pus around the umbilical cord or circumcision. Do not give any medication without consulting a doctor first.
9. It’s common for new moms to feel sad, moody, or anxious after the birth. Call your doctor if feelings are intense or last more than a week or two.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):
   • Breastfeed your baby.
   • Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.
   • Avoid overheating by keeping the room temperature comfortable.
   • Don’t overbundle your baby.
   • Consider putting your baby to sleep sucking on a pacifier. If you’re breastfeeding, wait until breastfeeding is established before introducing the pacifier.
2. Don’t smoke or let anyone else smoke around your baby.
3. Always put your baby in a rear-facing car seat in the back seat.
4. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
5. Never shake your baby — it can cause bleeding in the brain and even death.
6. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don’t offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

Babies are born with protection against certain diseases because antibodies from their mothers were passed to them through the placenta. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is temporary.

Immunization (vaccination) is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease.

Microorganisms can be viruses (such as the measles virus) or they can be bacteria (such as pneumococcus). Vaccines stimulate the immune system to react as if there were a real infection — it fends off the “infection” and remembers the organism so that it can fight it quickly should it enter the body later.

Types of Vaccines

There are a few different types of vaccines. They include:

• Attenuated (weakened) live viruses are used in some vaccines such as in the measles, mumps, and rubella (MMR) vaccine.
• Killed (inactivated) viruses or bacteria are used in some vaccines, such as in IPV.
• Toxoid vaccines contain an inactivated toxin produced by the bacterium. For example, the diphtheria and tetanus vaccines are toxoid vaccines.
• Conjugate vaccines (such as Hib) contain parts of bacteria combined with proteins.

The American Academy of Pediatrics (AAP) recommends that kids get combination vaccines (rather than single vaccines) whenever possible. Many vaccines are offered in combination to help reduce the number of shots a child receives.

The Vaccines Your Child Needs

The following vaccinations and schedules are recommended by the AAP. Please note that some variations are acceptable and that changes in recommendations often occur as new vaccines are developed. Your doctor will determine the best vaccinations and schedule for your child.

Recommended vaccinations:

• Chickenpox (varicella) vaccine
• Diphtheria, tetanus, and pertussis vaccine (DTaP)
• Hepatitis A vaccine (HepA)
• Hepatitis B vaccine (HepB)
• Hib vaccine
• Human papillomavirus (HPV) vaccine
• Influenza vaccine
• Measles, mumps, and rubella vaccine (MMR)
• Meningococcal vaccines
• Pneumococcal vaccine (PCV)
• Polio vaccine (IPV)
• Rotavirus vaccine

Vaccine Concerns

Some parents may hesitate to have their kids vaccinated because they’re worried that the children will have serious reactions or may get the illness the vaccine is supposed to prevent. But because the components of vaccines are weakened or killed — and in some cases, only parts of the microorganism are used — they’re unlikely to cause any serious illness.

Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare. The risks of vaccinations are small compared with the health risks associated with the diseases they’re intended to prevent.

Immunizations are one of the best means of protection against contagious diseases.