Mt. Ascutney Hospital and Health Center

9 Month Well Child Visit

Your Baby
 

PROFILE:  By 9 months of age a lot of babies are creeping and crawling well and picking up small objects with forefinger and thumb.  Most are very persistent in exploring, but it’s also normal if your baby is fearful about strange people and new places, and even about some very familiar ones.  Around this age a baby might get attached to a “transitional object” (also called a “security blanket” or “security toy”).  The transitional object can help your baby soothe herself when she awakens during the night, or when in an unfamiliar situation.  It may be a stuffed animal, blanket, doll, etc., but should not be a bottle or pacifier.
 

FEEDING:  We do not recommend regular cow’s milk until 1 year.  Babies should get breast milk and formula by cup regularly now, so they will be ready to come off the bottle around a year of age.  Some breast-fed babies seem to lose interest in nursing as they get more active, others nurse more (for comfort rather than for hunger).  Either way, it’s wonderful to breast-feed at least for a year.  If you and the baby are ready to stop, however, we can discuss ways to help wean your baby.

By 9 months a baby should be eating regular balanced meals at the table with the rest of the family.  Try to keep meal times pleasant.  Offer mashed table foods and soft finger foods.  Avoid foods that may cause choking such as stringy foods like strips of meat, sticky/lumpy foods, and round/smooth things like grapes and hot dogs.  Anything that turns to “mush” in baby’s mouth is probably OK.  Babies should not have whole milk, eggs, peanut butter or other “nut” butters, fish or honey until one year of age because of concerns about allergies (and botulism).  Use hugs and praise to reward or pacify a child instead of giving a bottle, other food, or a pacifier.  You want the child to grow up knowing that food is used for hunger.  Comfort and happiness come from love, approval and closeness.
 

TEETHING:  More than half of babies will have at least one tooth by 9 months of age, but a few normal babies don’t get their first tooth until after their first birthday.  When teeth do erupt, gums may appear red and swollen, your baby may get more fussy than usual, and she may start thumb or finger sucking.  You can help keep your baby’s gums healthy by massaging her gums regularly using your finger rather than a brush.  Contrary to popular belief, teething usually doesn’t cause fever, diarrhea, colds, etc.  If teething does seem to cause discomfort, use acetaminophen by mouth (Tylenol, Tempra, etc.), at the same dose as for fever, or give your baby something cold to chew on.  Keep a couple of fluid-filled teething rings in the refrigerator.  We don’t recommend medicines for teething, like Baby Ora-gel or Numzit, because they occasionally cause allergic irritation of the gum.  Remember to continue giving your baby fluoride drops if your water supply is not fluoridated.
 

TOYS AND ACTIVITIES:  Your 9 month old enjoys toys and simple games more than ever.  We recommend simple safe toys such as cardboard or cloth books, small blocks, kitchen pots and pans, plastic measuring cups and spongy bath toys.  Language games are especially important now, like waving and saying “bye-bye”, simple songs, nursery rhymes, and books.  Playing peek-a-boo and pat-a-cake will be as much fun for you as your baby.  Make books part of your daily routine.  Many families find that relaxing with a book every night is a great way to get ready for bed.  Infants at this age should not watch television or videos.
 

HOME SAFETY:  Nine month old babies are at risk for falls, choking, smothering, scalds, drowning and electrical burns.  Be alert!  Your home should already be child-proofed but going over it again now is a good idea.  Keep the Poison Control Center’s phone number 1 (800) 222-1222 near the phone.  When you are cooking, place all pots and pans on the rear burners so that your child can’t pull hot food or water onto himself.

Place cabinet locks on cabinets that contain knives and breakables.  Read labels on all containers.  You’ll be surprised at what is “harmful if swallowed”!  Place all household cleaning products including dishwasher detergent and laundry soap on high shelves and use a cabinet lock (but don’t rely on a cabinet lock alone on a cabinet within baby’s reach).  At this age babies are fascinated with water, and even small amounts can be dangerous.  Watch out for toilets (consider a toilet lock), pet dishes, water-filled buckets, and of course bathtubs and pools.

Always use a car safety seat and buckle the car seat belt tightly through the safety seat, following the directions exactly.  Your child should be rear racing until one year of age.  Check the weight limit on the car seat you have; soon you may need to buy a seat for a bigger baby.  The back seat is safest.  Never put a child in the front seat if your car has a passenger side airbag.
 

SHOES:  Doctors used to think babies needed shoes to support the feet and ankles, but now they think it’s better to talk with bare feet.  When the baby starts to walk, get inexpensive, soft, well-ventilated baby shoes for when it’s cold and to prevent cuts and other injuries.  Socks without shoes are OK, but they’re too slippery for walking on wood or linoleum floors.  A baby’s shoes must not be tight.  Check them often, because a baby’s feet grow fast.  There should be ¼” or more at the toe of the shoe.
 

SEPARATION AND STRANGER ANXIETY:  About this age babies show “stranger anxiety” around new people and even around relatives they haven’t seen for a while.  Depending on your child’s temperament, this may be a short stage or may last many months.  Help your baby through this by giving her time to warm up and get acquainted.  Also around this age babies begin to understand that mother/father is a separate person, and could disappear – so they may get scared when mother/father is out of sight.  You can make it easier for her by leaving her with people she knows, visit a new sitter/new place with her a few times before leaving her there, get to the sitter’s a little early and hold her a little while in the sitter’s presence before you leave.  Say you’re leaving and leave cheerfully.  She’ll cry when you go, but she’ll learn to trust you sooner than if you lie to her, and she’ll worry less in the long run.
 

SETTING LIMITS:  Your baby needs lots of attention to thrive and to be safe, but you can over do it if you cater to her every whimper.  She should be left alone to play in a safe spot like her crib or play pen for short periods.  She should be guided into a reasonable nap and sleep schedule.  Limit nursing time, bottle and snacking so she isn’t feeding off and on all day.  Accept a few temper tantrums when you say “no”.  If it is hard for you to set those limits on your baby, ask us for help now. (A demanding toddler is much harder to handle than an independent 9 month old!)
 

FOLLOW-UP:  Your baby’s next visit is at 12 months of age.