DIET

Infants should not receive anything except breast milk, formula, water or rice cereal until 4 months of age. Rice cereal may be given at this age, but not oatmeal, rye or barley cereals. Remember feeding other foods too early could lead to allergies. At the next check up, you will receive a teaching sheet just like this one that covers how to start your baby on fruits and vegetables. A little diluted fruit juice (non-citrus) may be used for constipation, but do not give very much. If you give full strength fruit juice, then your baby could get diarrhea. If you give too much juice (more than a few ounces per day), then this could suppress your baby’s appetite for formula or breast milk, and could lead to failure to gain weight adequately. Also, make sure that the juice is pasteurized as many infants have become sick from non-pasteurized juice.

BREAST FED INFANTS: All infants should receive 200-400 micrograms of Vitamin D. Vitamin D is essentially for Calcium metabolism and bone strength. Infants who are Vitamin D deficient can get Rickets (severe weakness of the bones). Breast milk does not contain Vitamin D. 12 ounces of formula contains the minimum requirement of Vitamin D (200 micrograms). If you are supplementing with more than 12 ounces of formula per day, then no additional vitamins are necessary for the baby. If you are exclusively breast-feeding or giving less than 12 ounces of formula, the buy TRI-VI-SOL vitamins (over the counter) and give the amount recommended on the bottle for your infants age.

 COMMON ILLNESSES & PROBLEMS

                The most common question at this age is still about nasal congestion. Please refer to your newborn booklet for how to handle this and how to tell it from a cold. The newborn booklet does cover what signs to watch for. The difference between a cold and nasal congestion actually doesn’t matter much, since we treat them the same. I never recommend cold medicines until 8 years of age since there is no scientific evidence that they do any good at all, and roughly 100,000 children end up in the emergency room because of cold medicine side effects every year. Cold medicines that have antihistamines do help allergies, which many people confuse with colds. Thankfully, most children will not show signs of allergies until 6 months of age. The next most common question is about getting you baby to sleep through the night; this again is covered in detail in your newborn booklet. Many parents also ask about teething.  Children can teeth at a very early age, but most will not cut a tooth until 5 to 10 months. I see many children cut teeth at 3 months, and almost always one of their parents did the same thing. Teething will resemble ear infections in that both can give fevers up to 102, increased nasal mucus, pulling on the ears. Teething will have EPISODIC fussiness and will often be accompanied by loose stool. Ear infections will have continuous fussiness that worsens to the point of requiring a trip to the doctor. If you suspect that your child has an ear infection, and the pain is bad, then call anytime for what to do. If the pain is mild to moderate, give your child Tylenol or Motrin for pain (see newborn booklet for dosing), put a heating pad on the ear, and call the office during business hours for what to do. For teething, give Ambisol, Oragel or Numzit as directed along with Motrin for the pain.

SAFETY

                If you haven’t already, please crawl around your house, and look for anything that can hurt your baby. The newborn booklet contains a good start for what to look for:

• Water heater should be set at 120 degrees F
• All electrical outlets should have safety plug
• All poisons should be locked up
• All small objects should be out of baby’s reach
• Fire extinguishers should be in strategic locations
• Guns should be secured
• Bedclothes should be fire retardant
• Hand me downs should be double checked for safety
• Window blind cords should not be able to hang your baby
• Walkers should never be used
• Gates should secure stairs

Many parents buy walkers about this time, or accept one from a friend or relative. When the walker supports your child, the muscles that move the leg side to side are not needed.  This actually causes a delay in walking by an average of 3 weeks. Walkers also cause about 3-500 deaths and 30,000 emergency room visits per year, mainly due to a child going through a locked gate, down a flight of stairs, or by pulling something onto them. The stationary walkers are a better alternative for safety reasons, but still delay walking. If you use any of these devices, please make sure to watch the baby very closely and NOT USE THE WALKER AS A BABY SITTER. Even though I give this message to everyone, I still see walker injuries. I remember one incident very well where I was giving this message to a family during a well child check up and was called out of the room, not once, but twice, during that exam because 2 children had been injured by a walker.

NEXT VISIT

The next check up will be a 4 months of age. At that visit, your child should get exactly the same vaccines as they did today. We will also cover how to start fruits and vegetables, but they should not be started below 3.5 months of age as this might cause allergies. For premature babies, we do not give these foods until the child would have been 3.5-4 months if they were born on time (3.5-4 months from the original due date).

  ã2005 Joe Matusic, MD