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. Your baby can shake, bang, and throw objects; feed self with fingers; have a crude pincer grasp; and 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, babies become anxious or cry when parents leave (stranger anxiety). Babies generally sleep through the night, but may wake up and cry. Babies are interested in their surroundings.

SOCIAL DEVELOPMENT

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

MENTAL DEVELOPMENT

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

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.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Doses only obtained if needed to catch up on missed doses in the past.)

  • Haemophilus influenzae type b (Hib) vaccine. (Children who have certain high-risk conditions or have missed doses of Hib vaccine in the past should obtain the Hib vaccine.)

  • Pneumococcal conjugate (PCV13) vaccine. (Doses only obtained if needed to catch up on missed doses in the past.)

  • 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 infants and 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 receive 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

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 24–32 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.

  • 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 4–6 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.

  • 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. 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 high chair at table level and engage the child in social interaction at meal time.

  • 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.

  • Allow your baby to handle 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."

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

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

SLEEP

  • Use consistent nap and bedtime routines and place your baby to sleep in his or her own crib.

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

SAFETY

  • Lower the mattress in the baby's crib since the baby can pull to a stand.

  • 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 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 cannot 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.

  • 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 12 months old.