Download Date __________Weight - Pediatric Associates

Date __________Weight __________ Height___________ OFC_________
DOSAGE OF FEVER MEDICATIONS
Acetaminophen (Tylenol) Infant Drops (80 mg/0.8 ml)
__________ Dropper Every 4 Hours
Ibuprofen (Motrin 100 mg per teaspoon) __________Teaspoon Every 6-8 Hours
Next well-child checkup __________________________________________________________
NINE MONTH CHECKUP
FEEDING: Breast-fed infants are now nursing 4-6 times a day while formula-fed babies
are taking 20-32 ounces a day. Water, less than 9 ounces a day, may be offered. Juice,
even unsweetened is full of simple sugar (fructose), and has no significant nutritional
value for children. It frequently interferes with obtaining adequate nutrition from other
sources, and is a common cause of dental cavities. This is a very active time for many
babies and presents an ideal time to begin to wean the bottle. Most infants should no
longer be using the bottle by 12-15 months. Please call the office or ask your doctor if
this is proving difficult.
An anemia test will usually be done at this checkup. Babies who are not anemic and who
are eating solid foods well will be ready to go on to whole milk at one year of age.
Many babies need fluoride supplementation at this age. Formula-fed babies do not need
other vitamins. Breast-fed babies continue to need vitamin supplementation and iron
supplementation until they are on adequate amounts of vitamin D fortified milk (after one
year of age).
Many babies are ready for table foods now, especially finger foods they can feed
themselves. They “chew” by mashing soft, small pieces of food between their gums, so
that teeth are not necessary. You may test new foods by mashing small pieces between
your finger and thumb and offering this to your child. They should eat in a high chair or
booster chair. A child eating while playing may trip and choke. Do not allow your child
to stuff many pieces of food in his mouth at a time as this may also result in choking.
Giving honey or corn syrup to an infant in the first year of life can cause serious
illness, and is not recommended until the baby is 1 year of age.
EATING HABITS ESTABLISHED NOW WILL LAST A LIFETIME: A balanced
diet with twice as many servings of vegetables and fruits as carbohydrates (breads,
noodles, potatoes, cookies, and crackers) is very important. Offer one plant protein such
as beans and one animal protein such as chicken each day. Fish is advised twice a week.
If your family has a history of food allergy, please ask your doctor for the most recent
recommendations. Sugary foods, even those that contain fruit juice, should be rare treats.
Avoid using food to calm an upset or bored child as this can lead to obesity. About onethird of a child’s calories at this age should come from fat such as in peanut butter. Large
amounts of acidic foods, such as tomatoes, may cause diaper rash. For other information
about this topic, please ask your doctor.
DEVELOPMENT: Crawling, pulling up, walking while holding onto furniture and
trying to climb are only the beginning of the changes in this period. Babies often wave
“bye,” recognize words and enjoy board or cloth books at this age. Reading to babies is
very important. It is beneficial to their development, their later appreciation of books,
and the relationship with you. There is very good evidence relating future use of
language and even I.Q. to these types of interactions between adults and young infants.
This is an excellent time to build good sleep habits. Although most babies wake up
several times a night, they can learn to put themselves back to sleep alone with the right
preparation. You can expect most babies to sleep through the night in their own room at
this age. An excellent resource for parents is the book, Solve Your Child’s Sleep
Problems, by Richard Ferber, M.D. If sleep problems continue, call the office for help.
SAFETY: As always, anticipation of new skills will help you protect your child.
Babies are becoming more active and are more likely to be injured at this age.
Please use an approved car seat for all car and plane trips. Recent recommendations are
to keep children rear-facing as long as possible through age two.
As babies become more mobile, the house becomes increasingly dangerous and accidents
occur more frequently. Electrical and thermal burns, falling down stairs or onto sharp
objects and poisonings are the most common types in the house. Many of these are
serious, some are fatal and most are preventable. Parents must be extremely vigilant in
their efforts to prevent accidents and poisonings, and children should be supervised at all
times. It is frequently helpful to go through the house on your hands and knees, which
puts you at the same level as young children, and look for any dangerous areas. Sockets
should be covered, cords should be tucked out of the way, and gates should be used
where there are steps. Do not trust “child-proof” caps on medications. All chemicals,
including medications and cleaning products, should be placed out of reach, or preferably
behind locked doors. Handles of pots and pans should be turned in on the stove, so
children will not pull them down. Watch for hot liquids on a table, curling irons, wood
stoves or fireplaces, irons, or heaters. Cool-mist humidifiers are preferable to steam
vaporizers, as steam can cause severe burns to a child who gets too close. Keep
bathroom doors shut and toilet lids closed. Pads for coffee tables and fireplace hearths
can help prevent lacerations.
There are a great deal of injuries associated with baby “walkers”. Most of these are due
to falling down stairs or getting to dangerous items that the baby might otherwise not be
able to reach. “Walkers” are not recommended for these reasons. It is helpful to have a
“safe” area in which babies can play without needing such close observation. This may
be a stationary walker, a playpen or, if possible, a room with nothing dangerous in it, and
a gate to prevent the baby from leaving the room. When possible, the baby will be better
supervised, plus benefit from the interaction, when the parent is also in the room.
It is hard to emphasize accident and poison prevention enough. Parents should also be
prepared to care for minor emergencies, should they occur. First aid for burns and
poisonings can make a big difference if these occur, although prevention is best. Keep
Syrup of Ipecac on hand for poisonings. However, this should not be given without
checking, as inducing vomiting may not be the right thing to do in all instances. Call the
Poison Control Center—1-800-392-9111 or 314-772-5200—if possible poisoning has
occurred. Write the number near your phone and call if your child has ingested anything
(including plants) which might be poisonous. The Poison Control Center is staffed 24
hours a day and can tell you what to do in case of poisoning.
IMMUNIZATIONS: Any immunizations recommended to be completed before 12
months of age may be given now. Further immunizations are due at 12-15 months.
ILLNESS: Many illnesses are caused by viruses and are best treated by keeping the
child comfortable while the body heals itself over several days. Fever (rectal temperature
over 100.4) is one of the ways the body fights illness. How the baby seems to feel is
much more important than the degree of fever. A baby, who has a rectal temperature
over 104, fever more than three days, difficulty breathing, irritability or lethargy even
when fever has gone down, should be seen in the office promptly. A child with fever or
pain can be helped to feel more comfortable with acetaminophen (Tylenol or Ibuprofen)
drops. Varying concentration of thee medicines are now available and can lead to
confusion and incorrect dosing. Please double check the product you are using. The
correct dose for your child is written on this pamphlet. More information is given in the
pamphlet “Your Child’s Fever” in your newborn packet and available at our office.
The symptoms of minor respiratory infections often improve with use of a vaporizer or
humidifier in the baby’s room, elevating the head of the bed, and cleaning the baby’s
nostrils with salt water (saline) drops. “Cold” medications, even those sold over-thecounter, may have serious side effects in this age group, and are generally
considered ineffective. Call the office for difficulty breathing, severe coughing or high
fever in a young infant with a cold. Marked irritability associated with a cold or fever is
also sufficient reason to call the office early in the illness. Otherwise, symptoms of
minor respiratory infections may last 7-10 days before clearing. Children with “colds”
lasting more than 10 days may have developed bacterial complications, and may need to
be seen by the doctor. Discolored mucus, by itself, is not a sign of bacterial infection.
Without other symptoms, as described above, it may represent a normal stage in the
respiratory illness.
Vomiting and diarrhea respond best to a brief change in diet. Mild diarrhea is managed
by limiting juices, fruits, sweets (including artificial sweeteners) and spicy foods, as well
as increasing starchy foods. It is not necessary to restrict breast milk or formula.
Diarrhea with frequent vomiting should be managed more strictly by limiting the diet to
appropriate mineral and water solution, such as Kaolectrolyte, Pedialyte or Infalyte. It is
actually dangerous to use too much water, tea or non-balanced drinks such as Sprite,
Gatorade or broth. Give 1-2 teaspoons at a time (actually using a spoon, instead of a cup
or bottle) every 2-3 minutes and gradually increasing the amount as tolerated.
If Pedialyte-type fluids are needed more than 24 hours, notify our office. There are no
medicines beneficial for vomiting or diarrhea. A pamphlet detailing further
management of diarrhea and vomiting is available from our office.
Regular exposure to cigarette smoke is harmful for your infant and contributes to ear
infections, colds, asthma, crib death and later cancer. Smokers should not smoke in the
house or car but should step outdoors to smoke. The American Cancer Society can
provide information on stop-smoking programs.
RECOMMENDED READING MATERIAL: An excellent resource for parents is the
book, Your Child’s Health, by Barton D. Schmitt, M.D. Another excellent,
comprehensive resource is The Children’s Hospital Guide to Your Child’s Health and
Development, from the Children’s Hospital of Boston. Other resources for parents
include Solve Your Child’s Sleep Problems by R. Ferber, nutrition books by Ellyn Sater,
and American Academy of Pediatrics parenting books (Caring for Your Baby and Guide
to Your Child’s Sleep). St. Louis Children’s Hospital’s web site now contains protocols
that parents can access when they have a sick child. You can take a look by logging on to
www.stlouischildrens.org and clicking on “Health Resources” then “Health
Information”. The American Academy of Pediatrics website is also an excellent source
for up-to-date information at www.aap.org.
APPOINTMENTS: Preventive care visits (well child checkups) are an essential part of
your baby’s care. These are an opportunity to discuss changes and concerns about diet,
sleep, developing skills, safety, and immunization issues. In the next year, visits are
recommended at 12 months, 15 months and 18 months. These are usually best
scheduled 6-8 weeks in advance.
REGULAR OFFICE HOURS:
Routine Phone Calls are Welcome
Monday – Friday
8:30 a.m. – 5:00 p.m.
Saturday
8:30 a.m. – 11:30 a.m.
Sunday
9:00 a.m. – 11:00 a.m.
AFTER HOURS URGENT CALLS:
1-877-599-8962
This line should be used for emergency and urgent medical concerns whenever our office
is closed.
THE ANSWER LINE (St. Louis Children’s Hospital):
1-800-678-KIDS (5437)
General pediatric information is provided by specially trained nurses until 11 p.m. This
time is not for emergencies.
POISON CONTROL
1-800-392-9111 or 914-772-5200
PHSICIAN VISITS
By appointment only
Monday – Friday
8:30 a.m. – 4: 10 p.m.
“WALK-IN” VISITS:
Monday – Friday
8:00 a.m. – 8:45 a.m.
Children with urgent conditions which should not wait for regular hours, or with brief
uncomplicated illnesses may be seen by the doctor on call without an appointment. This
clinic has limited capacity, and your child is not likely to be seen by his own doctor.
Whenever possible, please call for a regular appointment.
WEEKEND AND HOLIDAY VISITS:
Children with urgent conditions that might otherwise need to be seen in the emergency
room may be seen by the doctor on call weekend and holiday mornings. Please call as
early as possible so your child may be seen while the office is open.
NURSE VISIT
Monday – Friday
10:00 a.m. – 11:00 a.m.
2:00 p.m. - 4:00 p.m.
Immunizations, weight checks, and other minor procedures which do not require being
seen by the physician can be done at this time.
EMERGENCY ROOM:
We continue to be available to our patients on weekends and holidays because we
strongly believe we provide higher quality and more consistent care than urgent care
clinics. If you must use another after-hours provider, please send us a copy of your visit
records.