DIET
We now change from formula to cows milk. When you do start milk, please use whole milk (3% fat), because your child needs a high fat diet (50% of calories from fat compared to 30% for an adult) until 2 years of age. If your child does not like the taste of milk at first, then taper the taste. Do this by mixing 1/4 milk and 3/4 formula for the first few days, then 1/2 milk and 1/2 formula for a few days, then 3/4 milk and 1/4 formula, and so on, until your get your child all the way on whole milk. If your child just won't take whole milk, then use 2% or skim, but add a lot of extra fat in the diet by giving a lot of cheese, peanut butter, butter on all foods, etc. You may also give eggs at this age. There is good evidence that feeding oranges, peanuts, oatmeal and shellfish may cause allergies in a child who has a strong family history of allergies Avoid them until 1 to 2 years in that case. Continue to give your child foods that are thicker so that he or she may be on table foods at 12 to 15 months. Most dentists agree that the bottle should be removed by 12 to 15 months, but so long as your child is not sleeping with the bottle in the mouth, then a little extra time can be taken to remove the bottle. Pacifiers should be taken away by 2 to 3 years or sooner if the front teeth appear to be molding to the shape of the pacifier. Vitamins are only necessary if your child does not get a balanced diet. Many children who seem to not get a balanced diet, do get one if your average what they eat over a 2-3 day period. In other words, they eat meats good one day and fruits and vegetables the next. You may still give a vitamin if you wish. Only give liquid vitamins until you are sure your child will not choke on a chewable. Vidalyn and Polyvisol are two liquid brands. Make sure to get the one with iron and follow the directions on the box for the dose. If you have well water, please let the doctor know.
COMMON ILLNESSES & PROBLEMS
If your child is not already walking, then he or she soon will be. Your child will be able to reach over 2 feet tall and may soon be climbing. Thousands of children each year are injured or die from electrical outlets, choking on small objects, falling down stairs, pulling things like cords and table cloths and pot handles onto themselves, etc. Accidents are now the most common potential cause of death for your child, therefore, go over every inch of your house and always watch your child closely.
Approximately 25 to 30% of children will walk well by 12 months, while all children should walk by 15 months. Remember that shoes are not necessary for walking. Shoes should fit properly and should not be tight in any way. Some children who wear their shoes too much may have sweaty feet. The sweaty feet will appear to have dry or peeling skin (a form of eczema). These children should either not wear shoes as much, should wear shoes that breathe (like canvas) or should change their socks often. Remember that shoes only protect the feet, keep the feet warm, look good and cost you money. No child should ever limp when they walk even when they are just starting. A limping child may not show pain but rather may just favor that leg. About one third of children with a hip dislocation will not be detectable until they start walking and develop a limp or have one leg longer than the other.
One of the vaccines your child may receive today is the Chicken Pox vaccine (Varivax or included with the MMR).This vaccine is a LIVE vaccine. About 2% of children may break out with a few spots of Chicken Pox like rash 5-42 days from the date of the vaccine. This rash is tiny FLUID FILLED blisters, like acne but with clear fluid. The spots are usually at the site of the vaccine but could be anywhere on the body. If someone with an immune system disorder touches the blister fluid, then they might have a severe case of Chicken Pox and that could be harmful to them not your child. Immune system disorders mean someone on Chemotherapy, AIDS, Cancer, or on a biologic agent that significantly lowers the immune system like Remicade or similar used for Inflammatory Bowel, Arthritis or Psoriasis.
SAFETY
Infants must face backwards in the car seat until 2 year of age AND 20 pounds in weight and should never ride in the front seat of a car, especially one with an air bag. Most children can now eat thicker and bigger bites of foods. Children are still very prone to choking on food. The most likely things for a child to choke on are; hot dogs, baloney chunks, grapes, nuts and pieces of meat. Make especially sure to crush up hot dogs and baloney.
NEXT VISIT
The next check up will be at 15 months of age. Typically, I give 3 shots at the 12 month visit, none at the 15 month visit, and 2 at the 18 month visit, unless you wished to space them out. Obviously, the Influenza vaccine is not included in this because it is a seasonal vaccine.
After the next visit, we have a check up at 18 months, 24 months and then yearly after that.
