ALL patients are seen at our Portsmouth office on Saturday and Sunday for sick visits from 9-12 am

Offices:

Hampton

603.929.3838

55 High Street
Hampton, NH 03842

Portsmouth

603.436.7171

330 Borthwick Avenue Portsmouth, NH 03801

Well Child Visits

The 9 Month Visit

Development:
This is an age of active exploring. Many infants are starting to creep and crawl about. They soon will be able to assume a sitting position without help and will sit without support. They may pull themselves to a standing position and often can stand steadily and take some steps if you hold their hands. Unless you’re careful, they may start trying to climb the stairs. They will soon demonstrate a true “pincher grasp” using their thumb and index finger. With this new found skill, they will transfer objects from hand to hand and start showing an interest in small objects they find on the floor.

The next 6 months are a critical period for both parents and baby, since it is during this time that a cooperative working relationship between parent and child needs to be established. Your baby has a need to explore and move about without any interference, but as parent, you must protect him during these adventures. It is necessary for you to help him learn that only acceptable behavior will receive rewards and praises. In turn, your baby will learn that his need for approval and affection may be worth the effort of accepting these constraints. If you have questions about childrearing, discipline or what is appropriate to expect from your child, please consult with us.

To encourage communication skills, provide a toy phone; let your baby listen to the real phone. Use single names for toys, foods, names and animals. Name and point to body parts. Read books with simple, repetitive themes and rhymes. Expose your child to different textures with books and toys as well as walking on a variety of surfaces: grass, sand, sidewalk. Allow him to remove clothes, to climb when supervised, to put things in and out of boxes and build towers with cubes. Begin to provide push/pull toys.

Feeding/Elimination:
Most infants should now be on 3 meals per day and many will have decreased their intake of formula to 24 ounces. By nine months, your child should be able to use a cup fairly well, and gradual wearing from the bottle can take place over the next few months. Table foods may be introduced, starting with foods such as mashed potatoes, cottage cheese, yogurt, sweet potatoes cooked cereal and anything else you can strain or chop in a blender. No hot dogs, nuts, berries, raw carrots, grapes, or popcorn please. Due to the risk of allergy, wait until 12 months before starting eggs, milk, (OK to use both in cooking) chocolate, all citrus fruits and juices, fish and honey (botulism). If there is a family history of food allergy, hold peanut butter until age 2.

The baby may insist on feeding himself finger foods. Snacks such as cheese, bananas, crackers and other soft foods make good finger foods. Snacks are frequently wanted and basic foods such and cheese are healthy choices. Be sure to include fruit, vegetables, meat and whole-grain cereals and breads in the diet. Avoid junk foods. Avoid beginning unhealthy habits, like giving the child drinks of iced tea, coffee, or sodas every time he come to the table and pulls on your leg.
 
This is a good time to try feeding your baby in a high chair and letting him join the family for part of the meal. Babies this age have definite likes and dislikes and they let you know them! Do not get into a “food battle” — you’re bound to lose!
 
It is very normal for children to have increases and decreases in appetite. Even when they have decreased appetite, they still are active and unchanged in all other respects. It is common for children to have a significant appetite decrease in the last few months before their first birthday because their rate o f growth slows at this point. I f your child remains active and unchanged in other respects, it is likely that this is simply a predictable appetite change and should be of no real concern. Parents should not respond to this change by trying to get the child to eat by feeding him “junk food”. When a child is hungry, he will eat what he needs to eat to meet his requirements if he is simply offered high quality, nutritionally sound food.
 
Bowel movements will continue to vary in color and consistency with dietary changes. Your baby may show curiosity about his bowel movements. It is too early to begin toilet training as the muscles and sphincters are not mature enough for control.

Sleep:
Your baby may need help “slowing down” from all his activity. Establish a bedtime routine with a quiet time when you read or provide soft music. This is not a time for roughhousing.
 
At this stage, most babies are sleeping approximately 12 hours at night with naps during the day. Waking during the night may occur. Initially your child may need brief reassurance; further along, he should sleep soundly all night. Develop a routine for these periods, such as playing soft music or singing to him from your room. Use a nightlight. If your baby develops a pattern of waking at night, the habit is best broken by ignoring it as much as possible. By going to him and especially feeding him, you reinforce the behavior and reward him for behavior you would prefer to change.

Safety:
Crib:
Watch carefully for attempts to climb out of the crib. If your baby is climbing out leave the sides down so he can get out without a serious fall. Put a mattress on the floor or get a regular bed. Baby-proof the room, ensuring that window screens are secure and bureau drawers hooked closed. Put a gate on baby’s room door so he cannot roam the house while parents sleep.
The age period 9 months to about 3 years of age is an especially hazardous one. The principle fatal accidents in this age period are auto, accident poisoning, choking, falls, drowning and burns. You cannot watch your child every  minute, but you can make a careful check of his surroundings thereby anticipating and most home accidents. Wall plugs should be covered Stair doors should be closed or gates put up. Kitchen supplies should be out of reach and all medication locked up. You should check the garage (i.e., fertilizers and insecticides), as well as the basement (paint and cleaners). Children learn to go up the stairs before they can go down. If you have stairs, a gate put up on the second stair allows them to go up a short distance without the risk of a long fall down. When traveling in the car, BE SURE YOUR CHILD IS SECURE IN AN APPROPRIATE SAFETY SEAT. Any furniture the height of cocktail tables are best put away since babies at this age often bump into the edges.
 
Remember, accidents happen most frequently when the usual routine changes (holidays, vacations, illness in the family), following stressful events for caretakers, when caretakers are tired or ill, or late in the day.

You can prevent accidents by providing your child the freedom to explore, but with constant surveillance. Have a safe place to put your baby when you do need to be out of sight.

Common Concerns:

Infant shoes. The function of shoes for children is to protect their feet from hard or sharp objects and from catching cold. They do not need shoes in order to walk or “for support” When looking for shoes look for inexpensive, flexible, soft soled shoes such as sneakers.

Behavior:
Babies at this age are frequently very shy with strangers and cling to mother and cry if separated. This stage will pass, but is frequently misinterpreted to mean the child is spoiled. Children this age love to make noise and may constantly be squealing and babbling. They demonstrate their wants, likes and dislikes through gestures and facial expressions. This is probably the earliest age that it can be easily shown that behavior is learned. Your baby will repeat a performance if he is laughed at. The laughter serves to reinforce his performance. If, on the other hand, a behavior is ignored, it will be abandoned by the baby as a non-rewarding activity. This principle of teaching behavior by giving approval of desired behavior is even more applicable to older children (and spouses, too!) and is generally more productive than a negative approach using criticism and spankings.

 

                                                                                            adapted from John Chamberlain
                                                                                                                     Rose Boynton, et.al.
                                                                                                                              Barton Schmidt