GROWING UP GREAT! Series developed by Dr. LORI RAPPAPORT

 

FOUR TO SIX MONTHS

 

Ø  Starting Solid Foods

Ø  Choosing Toys for Baby

Ø  Your Baby’s Physical Development

Ø  Childproofing Your Home

Ø  Does Baby Have the Nighttime Munchies?

 

Starting Solid Foods

Starting at about six months, most babies are ready for solid foods.  Depending upon your baby and your pediatrician, you may experiment with solids a bit earlier.   It is a lot easier on you and better for your baby if you wait to start solid foods until she is ready for them.  Some parents are eager to start their children on solids because they believe their babies will be “more satisfied” and will sleep through the night.  Studies suggest this is not the case.   Somewhere between four and seven months, your baby will be sitting up with good head control, drooling, and opening his mouth when he sees something approaching.  These are all signs that your baby may be ready for solid foods.

      Most babies begin with one feeding a day of rice cereal mixed with breast milk, formula or water to an almost liquid consistency.   Once baby gets the hang of moving the food back on her tongue and swallowing, you can thicken the consistency of the cereal as well as increase the frequency to two meals a day.  After this, it’s on to strained foods, either commercial or home prepared.   While there is no particular order that is best when introducing solid foods (although some pediatricians believe introducing vegetables before solids helps prevent baby from a preference for sweet tastes), it is important to introduce only one new food at a time, for three days.  This is to allow you to monitor any reactions (stomach aches, diarrhea, skin rashes or wheezing) your baby might have to that food.

      Sugar and salt are not necessary additions to Baby’s diet.  While he might eat his cereal sooner if sweetened, it is better if he has the chance to experience and enjoy the taste of grain.  Similarly, babies accept unsalted food as well as salted.  Caution: Avoid honey in any form for the first year.  This includes honey that has been baked into a cookie or bread.  Honey at times is contaminated with spores of clostridium botulinum, which can cause severe illness and even death.

      Eating is a learning experience at this stage as the bulk of Baby’s calories and vitamins are still being supplied by the milk feedings.  Approach this new experience with love, patience and a respect for your baby’s needs.  Pay attention to his cues, let him control the feeding, that is, the amount and the pace.  Now is the time to lay the foundation for a healthy feeding relationship between parent and child. 

 

Choosing toys for Baby

 

Your first stroll through the aisles of Toys-R-Us and the eye-catching packages and colorful displays, while exciting, might be a bit overwhelming!  So many toys, what to buy for baby?  Although there exist a vast array of alluring toys for this age group, babies are perfectly happy with objects most adults don’t consider “toys”.     Babies can play for hours with pots,  plastic bowls of assorted sizes, wooden spoons and cardboard boxes.  At six months of age, babies don’t engage in fantasy play, but are most interested in banging,  pushing, stacking and making things disappear and reappear again. 

      When contemplating a purchase, or whether your baby is ready for a toy received as a gift, consider the following guidelines:

 

Is it safe?

         

¨     Check to see if the toy is sturdy or breaks apart easily.

 

¨     Make sure the finish is non-toxic

 

¨     Get a small parts choke tube, or use a cardboard toilet paper roll to check small parts.  If it fits in the tube, it is a choking hazard.  So are toys with sharp edges or breakable parts.

 

¨     Can you wash it?  Babies spit up, sneeze, etc. and toys can become a breeding ground for germs.

 

¨      Toys with strings, cords or ribbons represent a strangulation hazard.  Toys can be attached to cribs and strollers with plastic links that are safe and attractive playthings themselves.

 

Is it stimulating? Not every toy baby plays with needs to be intellectually stimulating—they can just be fun.  But most babies have more fun playing with toys if they are stimulating to the sense of sight, hearing, touch or taste.  As your baby grows, you will want to look for toys that help foster hand-eye coordination, gross and small motor control, the concept of cause and effect, color and shape identification and matching, auditory discrimination, and spatial relationships. 

 

Is it age appropriate? The basic reason for this is so your baby will appreciate and enjoy the toy fully now.  More importantly, age grading of toys takes into account safety considerations.  Although he may play with it, giving baby a toy before he is ready may result in him being bored with it when he is ready for it. 

 

Parents make the best toys!

Babies at this age just love a good game of peek-a-boo or pat a cake.   They also like listening to your voice, and naming games—objects, body parts, their name— grab their attention and help to build language skills.    This is a great age to begin finger games and nursery rhymes if you haven’t already introduced them.  Try hiding objects and making them reappear, or guide your baby through touching materials of different textures.  

 

Your Baby’s Physical Development

 

You may have noticed what a big difference there is between the tiny, sleepy newborn you brought home and the active, alert baby who now smiles and coos at you!  As your baby progresses from the fourth through the sixth month you will be amazed at the new skills he will quickly grasp. 

 

Four Months. Baby begins to coordinate all of her senses as well as her muscles.  This is   best demonstrated when she turns her head in order to see the person when she hears them call her name.   Babies at this age usually:

·          raise themselves up on their arms

·          roll over

·          when on back, kick feet in air

·          grasp a rattle

·          squeal in delight

 

At four months give your baby:

·          a variety of objects to examine and explore (a cube, ball, rattle, mirror)

·          more dangling toys to watch and swipe at with hands and feet

·          Music and nursery rhymes

·          A change of scenery both inside and outside of her home.

 

Five Months.  Around this time head control becomes much better and baby enjoys being held or propped in a sitting position.   He will also spend time following moving objects with his head and eyes and may even become upset if you take an object away from him. 

     You may have noticed your baby trying to move himself about on the floor in what looks like a “swim”, a rocking motion on his tummy while kicking his legs and moving his arms.  He may already be grasping objects between his thumb and fingers, and reaches for objects placed in front of him with one hand, usually bringing it to his mouth for further exploration!

      After mastering grasping, your baby will begin to transfer an object from hand to hand, and eventually to release his grasp, usually by throwing the object—something to look forward to!  When learning these skills, your baby will use both hands equally well, as he needs lots of practice before developing a preference. 

 

At five months give your baby:

·          a toy to kick

·          rattles to play with

·          a  teether to hold in his mouth

·          sounds to listen to (try booties and wristbands with rattles in them).

 

Six Months.   Most six-month old babies can sit unsupported for 5-10 seconds before taking a nosedive.   When your baby learns to sit alone, she will develop a whole new view of the world.  For baby, the best part of sitting upright is having both hands free.  He will use these to grasp objects, shake them back and forth, throw them, and of course, the ever popular “banging.”   Once discovered it is never forgotten!  Babies love to bang and they don’t need fancy toys to do so (see Don’t babies need toys? page 3).  Pots, wooden spoons, Tupperware or a box will all suffice to amuse your baby’s musical inclinations!   Babies at this age love to stand on your lap and bounce, be pulled to a sitting position, sit upright  (propped with pillows if necessary), roll over and smile at familiar faces.   Moreover, they enjoy the stimulation they get from exploring new places, like the supermarket, post office, mall or park.

 

  At six months give your baby:

·          household objects such as plastic cups, spoons, and small pots

·          a soft ball to roll and clutch

·          toys to mouth and teethe on

·          ample opportunity to be on the floor and free (that is, from strollers, bouncer seats, walkers, etc. )

·          places to see

·          opportunity to listen to your voice

Most of all enjoy his new discoveries for they will all happen very quickly!

 

Helpful hints to encourage your baby’s physical development

 

As your baby begins to become more mobile, it is important to give her every opportunity to develop the strength and coordination she needs to progress to independent sitting, standing and walking.  This means she must be free to move:  too many clothes and tightly tucked in covers keep her from experiencing the range of motion she needs to in order to learn.

*          Crib bumpers protect his head and keep his arms and legs from dangling between the bars.  Bumpers should be removed when Baby can stand, since he may use it as a stepping-stone to get out of the crib.  Toys and large stuffed animals have also been known to make great stepping-stones!

*           Toy mobiles encourage Baby to look straight ahead and reach.  When Baby is able to sit or stand it is best to remove them as he can become entangled in such a low hanging plaything.    Instead, put a mirror or busy box in baby’s crib where she can see and reach it.  Some busy boxes also contain music, which responds to contact from Baby’s hand, foot or voice.   You might also consider moving Baby’s mobile over her changing area, making sure it is out of her reach.

 

Childproofing Your Home

 

Accidents, not illness, cause most child deaths—some 400 children under four years old die of accidents every month in the United States.  The major causes of death or injury to children under 14 are car accidents, drownings, burns, falls and choking/poisoning.

      Two major elements are involved in keeping your child safe from harm in your home.  First, careful, thoughtful childproofing of every room in the house.  And second, your constant, loving vigilance.  Never underestimate the powers of a child.  “I didn’t think she could do that,” is the tragic cry of many parents of bright, curious children who were only investigating their environments. 

      The best way to find the dangers that can cause harm to your child is to look at your house from the child’s vantage point.  Get down on your hands and knees and examine everything carefully and check for potential hazards.  You’ll find a world of fascinating things to pull on, squeeze, throw, crawl into and under, chew and swallow.  You’ll see sharp edges and corners that can cut, objects that can break and turn into weapons of destruction, furniture that can be climbed on.

      Your object as a parent is to make your house safe for your baby to explore.  You want to eliminate dangers without being over-protective or inhibiting your child.  No parent can prevent all accidents.  As long as you prevent the serious ones—the fatal ones—you’ll have done your job.  The time to childproof your house is before your child needs it; otherwise it might be too late!  You can do this yourself in a couple of hours, or contact a baby-proofing service which will come in, assess your home and install all necessary safety locks, latches and gates.     

 

Steps to take to make your home safe: 

·          Childproof locks on all cabinet doors in kitchens and bathrooms.

·          Affix safety covers on all electrical outlets and make plugged in electrical cords inaccessible.  Be careful not to leave cords dangling from countertops where a baby could accidentally pull it down. 

·          Gate all stairways securely, at both the top and bottom, with the safety gate bar latch on the side away from Baby.

·           Be sure the gaps between upright posts on a stair rail are less than 5 inches, to avoid the chance of

·          baby’s head getting caught between them.  If the gaps are too wide, install plexiglass, or a fine, heavy netting along the railing.  

·          Put decals on sliding glass doors so your mobile child won’t run into them.

·          Put a doorknob cover on a door you don’t want your child to open.

·          Attach door stoppers to the tops of doors or to their top hinges.  They prevent lock-ins and have the side benefit of preventing pinched fingers if a baby puts his fingers between the door and the door jam.

·          Babies love to play with door stoppers, listening to the springing sound and watching it go back and forth.   Remove doorstoppers with rubber caps as they can be easily removed by baby and eaten, becoming a choking hazard.  Replace them with one-piece plastic screw in doorstoppers.

·          Tie up the cords to blinds and curtains by clipping them high up with clothespins or wrapping them around cleats mounted high, so your baby can’t reach them.  Babies can easily wrap them around their necks, creating a strangulation hazard.

·          Put away any unstable furniture your baby could pull over in an attempt to pull himself up.  Fasten to the wall high bookcases or other pieces a baby might be able to pull down.


Bathrooms:

·          Use toilet locks in addition to keeping the bathroom door closed.  Baby’s head is disproportionately heavy as compared to the rest of his body and if leaning g over can easily cause him to fall into the toilet and drown. Babies can drown in just a few inches of water so beware of all water sources including pools (both large and kiddie size), Jacuzzi’s, bathtubs, fountains and even buckets of water.

·          Move under the sink chemicals from t he bathroom and kitchen to a higher location.  Remember high is not necessarily safe, so be sure to install a childproof lock on the cabinet as well.   Get rid of any chemicals you can, including pesticides and liquid plumbing aids.

·          Put non-skid appliqués on the bottom of the tub to prevent slips, or use a rubber mat.  Never leave water in the tub when it’s not in use.

·          NEVER  leave your baby or child unattended, even for a second, when she is in the bath.   If you must leave the room for any reason, wrap your baby in a towel and take him with you.

·          Medicines are usually best kept under lock and key and/or in another room other than the bathroom despite the inconvenience.   Be sure that all medicines are in child resistant containers (not all pharmacies automatically put prescriptions in these, you may have to ask).

 

Does Baby Have the Nighttime Munchies?

 

Most parents find that by the age of five to six months the pieces of their lives seem to fall back into place.  The intensity of the newborn period is behind them and Baby’s sleeping and eating schedule is more predictable.   Most babies at this age sleep anywhere from thirteen to fifteen hours per day.   This is typically divided into two, one-two hour naps, and then a ten-thirteen hour stretch at night.

 

Naptime rituals.  Overall parents find it is best not to let their babies become used to an elaborate sleep ritual during the daytime.  You probably could use every moment baby is asleep to get some things done.  You should be able to put your baby in his crib awake, leave the room and have him fall asleep on his own.  Save the books, stories and games for bedtime. 

Power nappers. Since individual babies vary enormously, there are no set rules for how many hours your baby should spend napping.  Just make sure her daytime naps don’t interfere with nighttime sleep.  If your baby insists on watching David Letterman with you every night, or wakes up too early in the morning, these are good indications that you should cut down on her daytime napping.  You can do this simply by waking her up after a set amount time.  Don’t be intimidated if she isn’t gracious about your wake up call—give her a week or so to get used to the new schedule.

 

Energizer babies.   If you have a baby who refuses to nap at all, or recharges after only twenty minutes here and there (typically the car), put him in his crib for quiet time for at least forty-five minutes a day, once or twice a day.  This will give him a chance to relax, unwind and rest even if he won’t take a nap.  Give him some quiet toys like books to amuse himself in his crib.  Try to do this at the same time every day, so it becomes an expected part of his routine, as well as a consistent break for you. 

 

Nighttime munchers.  Provided your baby is growing well, you can be sure he no longer needs to be fed at night.  If he continues to wake in the night demanding to be fed, it is likely the result of habit, not of hunger.  The following are a few guidelines to help eliminate this feeding.

      1. Don’t encourage grazing.  Babies who feed at intervals through the night often eat continuously during the day.  By five months your baby should be able to go three or four hours between feedings.  By spacing out feedings he should be able to increase the size of each meal and therefore feel satisfied for a longer time.

      2. Encourage independent sleeping.  Your goal is for to put your baby in her crib awake and have her fall asleep on her own.  She should not have to depend on nursing/bottles to fall asleep.  Help her to disassociate nursing/bottle with sleep: shift daytime feedings to right after your baby has awakened from a nap and other wakeful periods. 

      3. Don’t use your breast or the bottle as a pacifier. Use other means of comfort such as touch, rocking, talking, walking or distracting the baby with a toy. 

      4. Don’t allow your baby to fall asleep with a bottle or at the breast.  If she falls asleep with her last memory of sucking a bottle or nursing, she is conditioned to depend on the same to fall back asleep as she naturally wakes during the night.  Put your baby to bed awake without a bottle and allow her to find other ways of settling herself down.   Although your baby may cry at bedtime for several nights, you can at least be sure she is not crying out of hunger.       

      5.  Nighttime feeding.  When your baby cries in the middle of the night, let him cry for five minutes—watch the clock it will seem like an eternity.  If he continues to cry, go in, check on him, pat him for a minute and go out.  Do not feed him.   Let him cry for ten minutes, then go in and do the same.  If he continues to cry, let him go for fifteen.  He will soon tire and give up, and after a few nights will cry very little if at all.

Lori Rappaport, Ph.D. is a  Licensed Clinical Psychologist specializing in child and family issues.  Dr. Rappaport has over 15 years of experience working with children and families experiencing chronic and life threatening illness.  She is a consultant to the Jenna Druck Foundation which provides support to families that have lost a child (www.jennadruck.org).  
In addition, Dr. Rappaport has a private practice in Del Mar, CA.
  (858) 481-2188.
 
www.growingupgreat.com