9 Month Well Child Care



9 Month Well Child Care

AAP Board Content Specifications:

• Evaluate the motor developmental progress/status of an infant at 9 months of age, including recognition of abnormalities

• Evaluate the cognitive and behavioral developmental progress/status of an infant at 9 months of age

• Counsel parents regarding ways to prevent injuries in their children

• Provide age-appropriate home safety information

AAP priorities to assess for this visit:

• Family functioning

• Infant developmental changes, communication, infant independence, sleep

• Nutrition & feeding

• Safety

Questions:

1) What are some questions to ask the parents at this visit? What interactions should you observe?

2) What are some developmental milestones a nine-month old should have achieved?

3) What is an appropriate diet? What further recommendations should you give at this appointment?

4) What are sleeping expectations for this age group?

5) What safety topics should be addressed at this visit?

6) What anticipatory guidance is important at this age?

1) Family Functioning

Parental History:

• How are the family and the baby?

• Any changes since our last visit?

• Any concerns about baby?

• What new things is baby doing?

Parent-Child Interaction observations:

• Do parents stimulate the baby with language and play?

• Is baby free to safely explore environment with watchful parents and check back with the parents both visually and physically?

• Are parents’ developmental expectations appropriate?

2) Developmental Milestones:

|Age |Gross Motor |Fine Motor |Communicative |Social |

|9 m/o |*Pivot while sitting |* Immature pincer grasp |*Aware of emotions |*object consistency |

| |*Sitting without |or radial digital grasp of |*Babbling with |*Stranger danger |

| |assistance |cube |inflections & more |*Seeks parent for |

| |*Crawling |*begins to bang blocks |complexity |comfort, play |

| |*Pull to stand |together |(canonical babbling) |*understands verbal |

| |*Bear walks (all 4 limbs | |*mama/dada non |cues for practiced |

| |straight) | |specifically |routines (peek a boo) |

| | | |*Points to objects | |

| | | |*begins to imitate | |

| | | |speech sounds | |

3) Diet:

• Parents need to provide a variety of nutritious foods but baby decides how much to eat.

• It may take 10-15 tries before a baby will accept a new food.

• Most 9 mo olds eat 3 meal and 3 snacks each day.

• Give baby varied textures (pureed, blended, mashed, finely chopped, and soft lumps) to help baby learn to the change from gumming to chewing foods.

• Avoid mixed textures like broth with vegetables until baby is chewing well.

• Encourage baby to drink from a cup.

| |

|Growth & Caloric Requirements |

| | | | | | |

|Age |Daily weight |Monthly weight |Monthly |Monthly |Recommended |

|  |gain |gain |Lt |HC |Kcal/kg/day |

|  |g/day |lb/month |cm/month |(cm/mo) |Kcal/kg/day |

|0-3 months |25-35 |2 lb |2.6-3.5 |2 |115 |

|3-6 months |15-21 |1.25 lb |1.6-2.5 |1 |110 |

|6-12 months |10-13 |1 lb |1.2-1.7 |0.5 |100 |

|1-3 yrs |4-10 |13 oz |0.7-1.1 |0.27-0.15 |100 |

|4-6 yrs |5-8 |8 oz |0.5-0.8 | | |

|7-10 yrs |5-12 |6 oz |5-6 cm/yr | | |

|11-18 yrs |varies |  |M: 1.5-6cm/6 mo |  |  |

|  |  |  |F: 1.5-5cm/6 mo |  |  |

|Catch Up |Infant: 60-90 | | | | |

|(FTT) |Child: 30 | | | | |

4) Sleep expectations:

• At this age babies may start waking at night, continue to try to let baby settle himself back to sleep. You may check on him but do not turn on lights, feed baby, or initiate play/conversation.

• Get a routine established & try to minimize disturbances.

• Lower crib mattress to its lowest position before baby begins to stand and remove any bumper pads if used previously so they can not be used as steps.

5) Safety topics:

• Rear- facing car safety seat in back seat for all transportation until 2 years (see car seat guidelines)

• Turn handles of pans or dishes so they do not hang over edge of stove or table.

• Keep electrical cords out of your child’s reach.

• Drowning Prevention: “touch supervision” whenever young children are in or around water. Do not let siblings supervise infants in water. Empty buckets, tubs, or small pools immediately after use.

• Keep poisons, household cleaners, chemicals, and medicines locked up. The number for Poison Control is 1-800-222-1222

6) Anticipatory guidance:

• Model good behavior. Babies learn more by example than by words, yelling, or spanking

• Use descriptions of the desired behavior (eg, “Please sit” rather than “Don’t Stand”)

• Limit the use of “No” as much as possible. Can also use words such as “Stop” if baby is about to touch something dangerous.

• Redirecting and distracting the infant is the best form of discipline in this age infant as baby has short attention span.

• Remember consistency between all caregivers on what behaviors are allowed and not allowed.

• All parents need time alone and individual time with their partners. Choose a babysitter who is mature, trained, responsible, and recommended by someone you trust.

• Babies have a strong attachment to their caregivers at this age and can show separation anxiety if they can not see you while they are exploring/playing.

• Baby is learning that objects that he can not see still exist and the concept of cause and effect. Use toys and games to help him/her (eg, balls, blocks, “peek-a-boo”)

• Children younger than 2 years should not watch TV, DVD’s, videos or computers.

References:

1. American Academy of Pediatrics, Bright Futures 3rd edition. 2008: 367-380

2. Behrman, RE et al. Nelson Textbook of Pediatrics 16th edition. Philadelphia: WB Saunders Company, 2000

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