Well Child Care, 6 Months

PHYSICAL DEVELOPMENT

The 6-month-old can sit with minimal support. When lying on the back, your baby can get his or her feet into his or her mouth. Your baby should be rolling from front-to-back and back-to-front and may be able to creep forward when lying on his or her tummy. When held in a standing position, the 6-month-old can bear weight. Your 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 1–2 teeth.

EMOTIONAL DEVELOPMENT

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

SOCIAL DEVELOPMENT

Your baby can smile and laugh.

MENTAL DEVELOPMENT

At 6 months, a baby babbles, makes consonant sounds, and squeals.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (The third dose of a 3-dose series should be obtained at age 6–18 months. The third dose should be obtained no earlier than age 24 weeks and at least 16 weeks after the first dose and 8 weeks after the second dose. A fourth dose is recommended when a combination vaccine is received after the birth dose. If needed, the fourth dose should be obtained no earlier than age 24 weeks.)

  • Rotavirus vaccine. (A third dose should be obtained if any previous dose was a 3-dose series vaccine or if any previous vaccine type is unknown. If needed, the third dose should be obtained no earlier than 4 weeks after the second dose. The final dose of a 2-dose or 3-dose series has to be obtained before the age of 8 months. Immunization should not be started for infants aged 15 weeks and older.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (The third dose of a 5-dose series should be obtained. The third dose should be obtained no earlier than 4 weeks after the second dose.)

  • Haemophilus influenzae type b (Hib) vaccine. (The third dose of a 3-dose series and booster dose should be obtained. The third dose should be obtained no earlier than 4 weeks after the second dose.)

  • Pneumococcal conjugate (PCV13) vaccine. (The third dose of a 4-dose series should be obtained no earlier than 4 weeks after the second dose.)

  • Inactivated poliovirus vaccine. (The third dose of a 4-dose series should be obtained at age 6–18 months.)

  • Influenza vaccine. (Starting at age 6 months, all children should obtain influenza vaccine every year. Infants and children between the ages of 6 months and 8 years who are receiving influenza vaccine for the first time should obtain a second dose at least 4 weeks after the first dose. Thereafter, only a single annual dose is recommended.)

  • Meningococcal conjugate vaccine. (Infants who have certain high-risk conditions, are present during an outbreak, or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

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 24–32 ounces (700–950 mL) of breast milk or formula each day.

  • If the baby gets less than 16 ounces (480 mL) of formula each day, the baby needs a vitamin D supplement.

  • Juice is not necessary, but if given, should not exceed 4–6 ounces (120–180 mL) each 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 ½–1 tablespoon of solids. When first introduced, the baby may only take 1–2 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 your baby to finish every bite. Respect your baby's food refusal when your baby turns his or her head away from the spoon.

  • Teeth should be brushed after meals and before bedtime.

  • Give fluoride supplements as directed by your child's health care provider or dentist.

  • Allow fluoride varnish applications to your child's teeth as directed by your child's health care provider. or dentist.

DEVELOPMENT

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

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

SLEEP

  • Place your baby to sleep on his or her back to reduce the change of SIDS, or crib death.

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

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

  • Use consistent nap and bedtime routines.

  • Your baby should sleep in his or her own cribs or sleep spaces.

PARENTING TIPS

Babies this age cannot 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 baby. Keep home water heater set at 120° F (49° C).

  • Avoid dangling electrical cords, window blind cords, or phone cords.

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

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

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

  • Your baby should always be restrained in an appropriate child safety seat in the middle of the back seat of your vehicle. Your baby should be positioned to face backward until he or she is at least 2 years old or until he or she is heavier or taller than the maximum weight or height recommended in the safety seat instructions. The car seat should never be placed in the front seat of a vehicle with front-seat 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 baby.

  • 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 baby at all times, including bath time. Do not expect older children to supervise the baby.

  • Babies should be protected from sun exposure. You can protect them by dressing them in clothing, hats, and other coverings. Avoid taking your baby outdoors during peak sun hours. Sunburns can lead to more serious skin trouble later in life. Make sure that your child always wears sunscreen which protects against UVA and UVB when out in the sun to minimize early sunburning.

  • 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.