Well Child Care, 9 Months

PHYSICAL DEVELOPMENT

The 9 month old can crawl, scoot, and creep, and may be able to pull to a stand and cruise around the furniture. The child can shake, bang, and throw objects; feeds self with fingers, has a crude pincer grasp, and can drink from a cup. The 9 month old can point at objects and generally has several teeth that have erupted.

EMOTIONAL DEVELOPMENT

At 9 months, children become anxious or cry when parents leave, known as stranger anxiety. They generally sleep through the night, but may wake up and cry. They are interested in their surroundings.

SOCIAL DEVELOPMENT

The child can wave "bye-bye" and play peek-a-boo.

MENTAL DEVELOPMENT

At 9 months, the child recognizes his or her own name, understands several words and is able to babble and imitate sounds. The child says "mama" and "dada" but not specific to his mother and father.

IMMUNIZATIONS

The 9 month old who has received all immunizations may not require any shots at this visit, but catch-up immunizations may be given if any of the previous immunizations were delayed. A "flu" shot is suggested during flu season.

TESTING

The health care provider should complete developmental screening. Lead testing and tuberculin testing may be performed, based upon individual risk factors.

NUTRITION AND ORAL HEALTH

  • The 9 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 9 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.

  • Introduce the baby to a cup. Bottles are not recommended after 12 months due to the risk of tooth decay.

  • Juice is not necessary, but if given, should not exceed 4 to 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.

  • 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. Foods with more texture can be introduced now.

  • Toast, teething biscuits, bagels, small pieces of dry cereal, noodles, and soft table foods may be introduced.

  • Avoid introduction of honey, peanut butter, and citrus fruit until after the first birthday.

  • Avoid foods high in fat, salt, or sugar. Baby foods do not need additional seasoning.

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

  • Provide a highchair at table level and engage the child in social interaction at meal time.

  • 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.

  • Allow the child to handle the spoon. More food may end up on the floor and on the baby than in the mouth.

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

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

  • Continue fluoride supplements 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."

  • Name objects consistently and describe what you are dong while bathing, eating, dressing, and playing.

  • Introduce the child to a second language, if spoken in the household.

  • Sleep.

  • Use consistent nap-time and bed-time routines and encourage children to sleep in their own cribs.

  • Minimize television time! Children at this age need active play and social interaction.

SAFETY

  • Lower the mattress in the baby's crib since the child is pulling to a stand.

  • 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 falls. Walkers may interfere with skills needed for walking. Stationary chairs (saucers) may be used for brief periods.

  • Keep children in the rear seat of a vehicle in a rear-facing safety seat until the age of 2 years or until they reach the upper weight and height limit of their safety seat. 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 medicines 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 furniture, bookshelves, and televisions are secure and cannot fall over on the baby.

  • Assure that windows are always locked so that a baby can not fall out of the window.

  • Shoes are used to protect feet when the baby is outdoors. Shoes should have a flexible sole, a wide toe area, and be long enough that the baby's foot is not cramped.

  • 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 12 months old.