Fillable General Pediatric Clinic/6 Month Visit (Page 2 of 2) in pdf

GENERAL PEDIATRIC CLINIC / 6 MONTH VISIT

ANTICIPATORY GUIDANCE FOR 6 MONTHS

F-01068D (01/11)

Page 2

Diet

Some non-edibles are actually poisonous and prevention includes

Cup can be introduced with small amounts (1/2 - 1 ounce) of milk

removing all these out of the child's reach. Treatment may include

to be given with solids. Juice and water can be given as snacks

vomiting. As soon as the parent realizes the child has eaten a

and on warm days. The baby may or may not hold the cup, but the

poisonous substance, the Poison Control or primary care health

adult does most of the tipping and guiding. The hand to mouth

professional should be contacted for instructions. If vomiting is desired

reflex is more developed and solids can be offered to the baby for

then the syrup of ipecac is available and ½ ounce can be given with

self-feeding. Stop pureed foods and introduce "Junior" foods or

as much fluids as possible. The parent should be warned that

mashed table foods on a spoon. Self-feeding solids should be

vomiting should occur 15-20 minutes (i.e., on the way to the hospital).

small enough to hold in the hand and not too small to be lost in the

The poisonous substance and the vomitus should be brought in and

palm. It should dissolve in the mouth and be swallowed and not

examined.

break into chunks which may get stuck since the baby does not

chew the food at this time. Teething biscuits are hard but as the

baby sucks they become very soft. This is made of flour and so

Safety

wheat cereals can also be started now.

Crawling may start around 8 months and the baby may stand up

holding onto furniture. Babies become very mobile and all objects up

Anticipatory Guidance

to about three feet are within their reach. Rolling to move around the

room is another form of locomotion that the baby may use. A few

Night awakening: after having slept for a long period (6-8 hours),

infants will stand and cruise holding onto furniture. With increase in

the baby may now start crying at night again. The baby wants to

mobility, the parents need to cover empty sockets, remove cords or

be held, nursed, and may not go back to sleep for a couple of

block them with pieces of large furniture or tape to the wall, table

hours. The best policy is to make sure the baby is okay, not

cloths may be pulled off. Remove all breakable objects and plants

change the diaper unless the baby had a bowel movement in

from the baby's reach. Coffee cups, pots, and pot handles must be

which case change the baby in a dim light and without vocal

deliberately put out of reach. The parents should use back burners on

stimulation. The parent should try not to pick up the baby at all.

the stove as much as possible. When the oven is on, the baby should

After a few nights the baby will give up crying.

not be left alone for even a few seconds in the kitchen. This is the age

when the playpen is really useful. If the parent has to leave the baby

Bedtime routine is definitely a good idea. Example: bathe, feed,

for a few seconds to answer the doorbell or telephone or get the

sing/tell story/read, and then place in bed before the baby is

laundry, then the baby should be placed in the playpen where there

asleep. Then the parents should turn off the light and leave.

are a few special toys. The length of the stay in the playpen should

never be longer than necessary.

Fear of Strangers

Cupboards should be cleaned out and rearranged with the empty

Babies by now may recognize the caretakers and view everyone

pots and pans, paper and plastic wares in the lower cabinets. Place

else as a stranger, including the doting grandparents. There are

breakables and cans above the counter and cleaning material in a

several reactions they can have to a stranger: 1) acceptance with

locked cabinet or closet.

only a glance to the parent, 2) anxiety and wanting the parents but

adapting rapidly to the situation and, 3) panic at the sight and

Car seats — some car seats only hold babies up to 20 pounds and

especially at the grasp of any stranger. This infant needs to stay

parents will have to be reminded to change models. If the baby has

with the parent, examines the stranger, and makes his own

always been in a car seat then they will probably not fuss. If they are

explorations and advances. If the strangers respond too vigorously,

starting now, they will be unhappy but still less likely to come to harm.

it will lead to more panic. Quiet or no response is more likely to lead

to more bold advance by the baby and eventual adaptation to the

Shoes are needed for protection against hot sidewalks, nails, bees,

stranger.

rocks, etc. Any shoe with a protective sole is okay as long as it is one

centimeter longer and about ½ centimeter wider than the feet when

Separation Anxiety

bought and changed as soon as this space is filled out.

This is expressed at about 6 months or later in some form by most

babies. What they see exists and if not visible then no longer

Teething

exists. Therefore, when the baby wakes at night and there is no

See four month visit.

parent, they cry with anxiety. Similarly during the day if Mom walks

into another room the baby cries. The parents need to vocalize

more so that the baby will recognize and find comfort in the voice,

Walker

even without seeing the parent.

If parents want to use a walker, they should beware of the dangers

involved. The walker should have wide wheel base and stairs mus t

Syrup of Ipecac — Give one ounce bottle to the parent.

be fenced off. The baby needs to be watched for falls!

Discuss development of the hand-to-mouth motion, which will bring

many non-edible objects into the mouth. Most will be non-toxic and

too large to be swallowed. Some foods will cause choking and/or

aspiration, e.g., carrot pieces, peanuts (also extremely dangerous

because of lipid pneumonia) and other nuts, or celery pieces. Some

non-foods can be as much trouble, such as safety pins, buttons,

pins, nails, or bolts.

General Pediatric Clinic/6 Month Visit Page 2

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