Well Child Care, 6 Months

PHYSICAL DEVELOPMENT

The 6 month old can sit with minimal support. When lying on the back, the baby can get his feet into his mouth. The baby should be rolling from front-to-back and back-to-front and may be able to creep forward when lying on his tummy. When held in a standing position, the 6 month old can bear weight. The baby can hold an object and transfer it from one hand to another, can rake the hand to reach an object. The 6 month old may have one or two teeth.

EMOTIONAL DEVELOPMENT

At 6 months, babies can recognize that someone is a stranger.

SOCIAL DEVELOPMENT

The child can smile and laugh.

MENTAL DEVELOPMENT

At 6 months, the child babbles (makes consonant sounds) and squeals.

IMMUNIZATIONS

At the 6 month visit, the health care provider may give the 3rd dose of DTaP (diphtheria, tetanus, and pertussis-whooping cough); a 3rd dose of Haemophilus influenzae type b (HIB) (Note: This dose may not be required, depending upon the brand of vaccine the child is receiving); a 3rd dose of pneumococcal vaccine; a 3rd dose of the inactivated polio virus (IPV); and a 3rd and final dose of Hepatitis B. In addition, a 3rd dose of oral Rotavirus vaccine may be given. A "flu" shot is suggested during flu season, beginning at 6 months of age.

TESTING

Lead testing and tuberculin testing may be performed, based upon individual risk factors.

NUTRITION AND ORAL HEALTH

  • The 6 month old should continue breastfeeding or receive iron-fortified infant formula as primary nutrition.

  • Whole milk should not be introduced until after the first birthday.

  • Most 6 month olds drink between 24 and 32 ounces of breast milk or formula per day.

  • If the baby gets less than 16 ounces of formula per day, the baby needs a vitamin D supplement.

  • Juice is not necessary, but if given, should not exceed 4-6 ounces per day. It may be diluted with water.

  • The baby receives adequate water from breast milk or formula, however, if the baby is outdoors in the heat, small sips of water are appropriate after 6 months of age.

  • When ready for solid foods, babies should be able to sit with minimal support, have good head control, be able to turn the head away when full, and be able to move a small amount of pureed food from the front of his mouth to the back, without spitting it back out.

  • Babies may receive commercial baby foods or home prepared pureed meats, vegetables, and fruits.

  • Iron fortified infant cereals may be provided once or twice a day.

  • Serving sizes for babies are ½ to 1 tablespoon of solids. When first introduced, the baby may only take one or two spoonfuls.

  • Introduce only one new food at a time. Use single ingredient foods to be able to determine if the baby is having an allergic reaction to any food.

  • Delay introducing honey, peanut butter, and citrus fruit until after the first birthday.

  • Baby foods do not need seasoning with sugar, salt, or fat.

  • Nuts, large pieces of fruit or vegetables, and round sliced foods are choking hazards.

  • Do not force the child to finish every bite. Respect the child's food refusal when the child turns the head away from the spoon.

  • Brushing teeth after meals and before bedtime should be encouraged.

  • If toothpaste is used, it should not contain fluoride.

  • Continue fluoride supplement if recommended by your health care provider.

DEVELOPMENT

  • Read books daily to your child. Allow the child to touch, mouth, and point to objects. Choose books with interesting pictures, colors, and textures.

  • Recite nursery rhymes and sing songs with your child. Avoid using "baby talk."

  • Sleep

  • Place babies to sleep on the back to reduce the change of SIDS, or crib death.

  • Do not place the baby in a bed with pillows, loose blankets, or stuffed toys.

  • Most children take at least 2 naps per day at 6 months and will be cranky if the nap is missed.

  • Use consistent nap-time and bed-time routines.

  • Encourage children to sleep in their own cribs or sleep spaces.

PARENTING TIPS

  • Babies this age can not be spoiled. They depend upon frequent holding, cuddling, and interaction to develop social skills and emotional attachment to their parents and caregivers.

  • Safety

  • Make sure that your home is a safe environment for your child. Keep home water heater set at 120° F (49° C).

  • Avoid dangling electrical cords, window blind cords, or phone cords. Crawl around your home and look for safety hazards at your baby's eye level.

  • Provide a tobacco-free and drug-free environment for your child.

  • Use gates at the top of stairs to help prevent falls. Use fences with self-latching gates around pools.

  • Do not use infant walkers which allow children to access safety hazards and may cause fall. Walkers do not enhance walking and may interfere with motor skills needed for walking. Stationary chairs may be used for playtime for short periods of time.

  • The child should always be restrained in an appropriate child safety seat in the middle of the back seat of the vehicle, facing backward until the child is at least one year old and weights 20 lbs/9.1 kgs or more. The car seat should never be placed in the front seat with air bags.

  • Equip your home with smoke detectors and change batteries regularly!

  • Keep medications and poisons capped and out of reach. Keep all chemicals and cleaning products out of the reach of your child.

  • If firearms are kept in the home, both guns and ammunition should be locked separately.

  • Be careful with hot liquids. Make sure that handles on the stove are turned inward rather than out over the edge of the stove to prevent little hands from pulling on them. Knives, heavy objects, and all cleaning supplies should be kept out of reach of children.

  • Always provide direct supervision of your child at all times, including bath time. Do not expect older children to supervise the baby.

  • Make sure that your child always wears sunscreen which protects against UV-A and UV-B and is at least sun protection factor of 15 (SPF-15) or higher when out in the sun to minimize early sun burning. This can lead to more serious skin trouble later in life. Avoid going outdoors during peak sun hours.

  • Know the number for poison control in your area and keep it by the phone or on your refrigerator.

WHAT'S NEXT?

Your next visit should be when your child is 9 months old.