IMMUNIZATIONS: NONE

• Hemoglobin test for anemia performed
• Test for lead toxicity performed

Well, mom, if you would have gotten pregnant as soon as this little one was born, you could now have two bundles of joy!

At 9 months, the baby should be starting to pull up to a stand and walk holding on. He/she should be starting to use a pincer grasp, rather than a whole hand grasp. Pat-a-cake, bye- bye, and peek-a-boo are great ways to have the baby show off. Around 9 months, he/she also will begin saying a non-specific "mama" and "dada" that you will surely reinforce so that he/she will learn their meaning.

With regard to feeding, you should now start to introduce table food if you have not already done so. However, we recommend that you continue to nurse or use infant formula until your baby is 12 months old, at which time you may switch to whole milk. Also, the training cup should be introduced as, at your next visit, we will suggest stopping the bottle by 13 months. If you prefer baby food and your baby does well with strained food, but refuses junior food, you may need to go directly to table food. Some infants have difficulty with junior food as they seem to have difficulty determining whether to chew it or to swallow it.

It is best to avoid giving raw vegetables, popcorn, nuts, and hot dog slices to your baby at this age, as babies can easily aspirate these foods and choke. Actually, ANY small, loose object that the baby can lay his/her hands on is at risk for being put in the mouth, and is, therefore, a potential choking hazard. Be sure, as much as possible, that such objects are out of the baby's reach. If the baby does choke on either food or an object, the recommendation is to lean the child forward and pull in on either the abdomen or chest enough that the child loses his breath. The most recent recommendations do not include back blows or placing your fingers in the child’s mouth as this may force the object in further.

Child should be rear-facing in the car seat until 12 months or 20 pounds, whichever is later. Remember that ALL passengers in the car should wear a seat belt or the child will resent having to wear his/hers when others will not wear theirs.

Never leave a child unattended in a tub or baby pool. Also, do not leave buckets of water unattended. All of these are open invitations to the baby drowning.

At around this age, if your baby sucks his/her thumb or uses a pacifier, some well-meaning people may tell you that this habit will cause damage to the teeth. In reading on this subject and discussing it with pediatric dentists, the feeling is that this is not a great problem. The teeth do not suffer from these activities usually until children are to 5 years old. For now, just limit these activities to quiet times such as bed time, but do not yell at the child or become upset by it.

Your baby may-or may not-give up his/her morning nap at about this age. (Some children continue taking two naps a day until age 18-24 months.) The total number of hours of sleep that your child will need varies. Children, like adults, vary. Just as one parent may need 12 hours of sleep and the other only 5 hours, the children are similar. The important thing is to maintain a consistent nap and bed time. It is equally important to lie your baby down for the night (and for naps) while he/she is drowsy but still awake. If your baby's last waking thought is of the crib, not of being held or being fed, the result should be a baby who can sleep through the night more often and with less crying. The child may cry or play when first laid down, but as long as the time and rules are consistent, he/she will learn at least, that these are his/her times for sleep or at least to be left alone. If he/she cries, reassure him/her for 1 or 2 minutes. Then, leave the room again for another 20 to 30 minutes. Hang in there and the child will get used to the rules.

As your child starts to walk, you may question the best shoes for him/her. In the end, as long as the shoes fit well, it does not really matter. High tops are better only because they are harder to take off for the child, but do not add support. Soft vs. hard soles again do not make the child walk. Realize most children turn their feet in or out as they start to walk and this usually resolves by 4 to 5 years of age. If, however, you have a question, please ask.

PREVENTION STRATEGIES FOR INJURIES - 9 MONTHS

CHOKING/ASPIRATION/SUFFOCATION

• Learn what to do when a child chokes.
• Allow no cords near crib or around
• Keep plastic bags, balloons, and baby powders out of reach.
  Keep all small, hard objects out of reach.
• Use only unbreakable toys without sharp edges or small parts that can come loose.
• Avoid foods on which child chokes easily (hot dogs, peanuts, popcorn, chewing gum, and hard fruits and vegetables).
• Cut food into small pieces.
• Store toys in a chest without a dropping lid.

FIRES AND BURNS

• Never eat, drink, or carry anything hot near or while holding a baby or child.
• Turn down water heater so water from the hot water tap is no more than 120 degrees Fahrenheit.
• Develop and practice a fire escape plan.
• Install and maintain smoke detectors.
• Keep a fire extinguisher in or near the kitchen.
• Treat a burn immediately with cold water, and then call your doctor.
• Check formula, food, and drink temperatures carefully.
• Don't smoke near the baby.
• Keep hot foods and liquids out of reach.
• Put shock stops in unused electrical outlets; put cords out of reach.
• Keep hot appliances and cords out of reach.
• Keep all electrical appliances out of the bathroom.
• Don't cook with child at feet, use playpen, high chair or crib as a safety area for small child.
• Provide non flammable barriers around hot home heating surfaces and fireplaces.
• Insulate junctions of extension cords with electrical tape.
• Use back burners on stove with pan handles out of reach.

FALLS

• Never step away when the baby is on a high surface.
• Keep crib sides up.
• Use playpen with sides locked in up position as an "island of safety".
• Avoid using walkers.
• Install safety gates (NOT accordion style) to guard stairways.
• Lock doors to dangerous areas like the basement and garage.
  Check stability of drawers, tall furniture, and lamps before child cruises; remove tablecloths.
• Make sure windows above first floor are closed or have screens or guards that cannot be pushed out.

ANIMAL BITES

• Don't leave a child alone with pets.

PEDESTRIAN/PEDAL CYCLE INJURIES

• Avoid carrying child as a passenger on adult's bike except in special seat, helmeted and off street.

DROWNING

• Make sure that an adult bathes the baby.
• Remain in the room during every second of a bath.
• Provide unbreachable barrier around pool or spa.
• Continuously supervise child around any water.

INJURIES FROM FIREARMS

• Unload and lock away all firearms.

POISONING

• Keep all medicines, vitamins, cleaning, plumbing, gardening, painting, refinishing, and agricultural chemicals and supplies out of reach, preferably locked away, or dispose of after use.
• Remove all poisonous plants from the home.
• Install safety latches to delay access to cabinets.
• Put poison center number on all phones; call if child puts something in his mouth that may be poisonous.
• Buy syrup of ipecac; use only if directed to do so.
• Purchase all medicines in containers with safety caps.
• Do not transfer toxic substances to drink bottles, glasses, or jars.

MOTOR VEHICLE ACCIDENTS

• Never leave a child unattended in car.
• Parents should wear their seat belts.

CUTS

• Remove (or pad) low furniture with sharp corners from child's living area.
• Keep sharp objects Out of reach (safety latches or locks help to delay access).