Nine Month Visit

Development

Nine month olds are increasingly aware of people and can understand parts of conversation. You will hear more complex babbling and they will mimic sounds such as dada, mama and uh oh. Over the next few months they will wave bye-bye, imitate use of objects such as the telephone and play peak-a-boo.

Motor skills are expanding at this age. Infants are able to pull to stand and starting to cruise. They sit well with good head control. They can get into a hand-knee position and may be crawling.

Infants this age have the ability to pick up small objects between their thumb and pointer finger (called "pincer grasp").

Activities

- Talk and read! Identify body parts.
- This is great age for hide and find games. Try in and out of container toys.
- Start to teach a few sign language words such as eat, more, all done.
- TV and video are not recommended. Early screen time is not beneficial to development.

Sleep

Your child may resist going to bed as separation anxiety intensifies. This is very normal. Continue your reassuring nighttime routine. If/when night-wakening occurs, respond as you did when teaching your child to sleep through the night. Make a brief, reassuring visit but let him/her stay in the crib. Don't turn on the light. If visiting makes matters worse consider not going into the room. Do not start middle of night feedings or bringing your child to bed unless you want to teach him/her that is the way all nights will be.

Safety

Now is the time to do some serious childproofing. As your baby becomes more mobile and has developed his/her pincer grasp choking becomes more of a hazard. Watch play areas carefully for small objects since your explorer will find every little thing that drops on the floor. Keep away from balloons and plastic bags. Check toys carefully for breakage, sharp or small parts as everything goes in mouth!

Protect from falls: secure stairways, doors, windows and screens. Secure heavy objects such as bookshelves, TV's and furniture. Put away coffee tables for the next few months.

Always supervise closely in the tub. Never leave the room, even for a brief moment to answer the door or phone.

Use a properly fitting rear facing car seat until your child is at least one year of age. If they outgrow the infant seat, transition to a larger rear-facing seat. The center rear seat is the safest position.

Never hold a baby while drinking a hot beverage or smoking.

Check your smoke detectors and fire extinguishers on a regular basis. Have a family fire exit plan with ladders in upstairs bedrooms.

Avoid direct sunlight; sunburns happen easily. Use light cotton clothing. If direct sunlight is unavoidable use a baby sunscreen!

Do not use walkers with wheels. They are associated with serious injury. Stationary devices such as Exersaucers or Johnny Jump Up exercisers are good substitutes.

Poisoning are common events. Lock up medicines, cleaners, detergents, & antifreeze. Syrup of Ipecac is no longer recommended for home treatment of poisoning by the American Academy of Pediatrics, although some experts continue to recommend its use in certain situations. In case of ingestion of poisons, call the Poison Control Center (1-800-222-1222) immediately prior to giving Ipecac.

Parenting

During the next few months your child will want to touch, taste and play with everything that is within reach. Curiosity is vital to development. Your job is to allow him/her to explore safely. Distraction is usually a successful way to deal with undesirable behavior at this age.

Now is the time for parents to discuss what is and is not important, what is and is not off limits.

Consistent messages are important. The message must be simple, clear and supported with action if needed. For example if an object is a real danger say "no" and take the object away and offer a safe substitute.

Your child has a short memory; so do not expect learning to occur after one or two incidents.

Take time for yourself and to be alone with other family members. Try to get back to an exercise program for your own mental and physical health. Get a baby jogger or backpack, join a fitness club with child care or take turns with childcare with another parent or spouse.

Nutrition

Continue introducing new tastes to your baby. Start family meals. Let him/her taste foods off your finger. Mashed/mushy food being served to the rest of your family can be placed on your baby's plate. Let your baby play with food and use his/her fingers.

Three meals and day with two healthy snacks is typical. Soft fruits and vegetables or dry cereal are good snacks. Other "finger foods" include steamed chopped vegetables, ripe thinly sliced fruits, chopped/shredded meats, rice, pasta, toast with humus, tofu.

Avoid foods that present a choking or aspiration hazard until at least three years of age. Examples include raw apple, raw carrot, nuts, hotdogs, grapes, popcorn, raisins, hard candy, gum and marshmallows.

Encourage cup use. Remember to not put your baby to bed with a bottle.

To prevent iron deficiency and vitamin D deficiency, breastfed infants should take 1 ml daily of Tri-Vi-Sol WITH IRON (available over the counter) unless they are taking at least 24 oz. of iron-fortified formula or 2 servings of ΒΌ cup iron-fortified rice cereal daily.

Ask for a fluoride vitamin if your child does not receive water with fluoride.

Wait until your child is one year of age to introduce foods that are more likely to cause allergies: dairy products, egg whites, peanuts, tree nuts (almond, cashew), fish and shellfish. We recommend waiting until 3 years of age to introduce peanut-containing products if there is a strong family history of allergy.

Next Visit

Please make an appointment after your child's first birthday as you leave today.

Books/Resources

- Child of Mine: Feeding with Love and Good Sense by Ellyn Sater
- Healthy Sleep Habits, Happy Child by Marc Weissbluth MD
- Solve Your Child's Sleep Problems by Richard Ferber, MD
- Sleeping Through the Night, Revised Edition: How Infants, Toddlers and Their Parents Can Get a Good Night's Sleep by Jodi A. Mindell PhD
- The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night by Elizabeth Pantley
- How to Get Your Kid to Eat But Not Too Much by Ellyn Satter