Your Baby Week Nineteen

1
Baby Food Next Steps

After rice cereal, parents usually try oatmeal cereal and then vegetables and fruits.
After rice cereal, parents usually try oatmeal cereal and then vegetables and fruits, such as Gerber Peaches and Peas or Earth's Best Carrots or Peas. Photo © Vincent Iannelli, MD

After your baby is doing well eating rice cereal for a while, you will likely want to try other baby foods.

Although there are no absolute rules on how to do this, some general guidelines include that you:

  • not be in a big rush to start other baby foods, such as vegetables, fruits, and meats, since you have started rice cereal on the early range of normal (4 to 6 months).
  • start other foods once your baby isn't satisfied just eating cereal, for example, she is already eating 3 or 4 tablespoons of cereal once or twice a day and still seems hungry.
  • wait 2 or 3 days in between starting new foods, such as carrots, peas, or peaches, so that you will recognize symptoms of a food allergy or intolerance, such as diarrhea, gas, vomiting, or skin rashes.
  • after your baby is tolerating an iron-fortified rice cereal for a few weeks or months, you can then try oatmeal, barley, wheat, and then mixed cereal, in that order.
  • experts usually advise adding a vegetable to your baby's diet, before you start fruits, just because your baby might prefer the sweeter taste of fruits if you start them first.
  • slowly work your way up to 4 ounces of baby food three times a day, in addition to 24 to 36 ounces of breast milk or formula. Unfortunately, how much your baby eats at each age varies quite a bit, so you will have to play it by ear a little to figure out how much to feed your baby. For example, a sample menu for a baby might include nursing 7 times a day and just eating 2 ounces of cereal once a day, while another might be nursing 8 times a day and eating 4 ounces of cereal for breakfast, 2 ounces of veggies and fruit for lunch, and 2 ounces of veggies and meat for dinner.

Also, remember that many babies don't start any baby food until they are 6 or 7 months old, so don't be discouraged if your baby doesn't seem ready for solids yet.

2
Supplemental Bottles for Nursing Babies

Even moms who are exclusively breastfeeding will occasionally have times when they may need to supplement with a bottle.

Taking a bottle, even if it is a bottle of breast milk, can be a problem though if your baby has never taken a bottle up to this point. They may have an aversion to a bottle's nipple or such a strong preference for nursing that they may refuse to take a bottle.

So what do you do if you are going to be away for more than a few hours during the day or night? And how about if you have to go away for an extended period of time, like a long weekend and won't be home at all to nurse your baby?

Fortunately, you can do some things that may help all but the most stubborn babies to take a bottle, including:

  • feeding your baby in a different position than she usually uses to nurse. You might even try to feed your baby a bottle while you are walking around with her.
  • having someone besides her mother feed her a bottle, since she may be resistant to take a bottle from her mother.
  • trying different bottles and nipples.
  • not waiting until you baby is overly hungry before offering a bottle.
  • feeding pumped breast milk if your baby won't take baby formula from a bottle.

Most importantly, be patient and be prepared to experiment a little with different techniques and methods to see what works best for your baby.

3
Safety Alert - Rolling Over

Rolling over means a little more mobility and a big risk of falls and other safety hazards.
Once your baby is rolling over, it means a little more mobility and a big risk of falls and other safety hazards. Photo © Vincent Iannelli, MD

While some babies begin to roll over as early as two months of age, about 75% of infants are rolling over by nineteen weeks.

And about 90% are rolling over by the time they are five and a half months old.

That makes it very important to work to avoid falls and getting things childproofed around your home. Now that your baby is rolling over, you can't simply childproof her immediate surroundings and still be safe. She may roll over and find something to choke on, fall off the couch, or get into other things that you didn't expect she could reach.

To keep your baby safe as she is rolling over, you should:

  • be sure that you don't leave your baby for even a second when she is somewhere that she can fall, such as a changing table, bed, couch, etc. If you have to leave for whatever reason, even for a few seconds, pick up your baby and take her with you.
  • keep one hand on your baby at all times whenever she is up high on a changing table or a place that she can fall
  • check the floor regularly for small items and toys that your baby could choke on. This includes marbles, balls, uninflated or broken balloons, small magnets, small Lego pieces and other toys with small pieces.
  • teach older children to keep their toys away from the baby and to put them away when they are done playing with them. You might even set up a toy-free zone around the baby, just to be safe that siblings don't leave small toy pieces around her.
  • make sure you have gotten your home well childproofed. Don't wait until she is crawling or walking. If she is mobile, it is time (if you haven't already) for childproofing everything so that one of her "first steps" doesn't end up in your first visit to the emergency room.

4
Infant Q&A - SIDS and Rolling Over

A baby monitor can help you feel more reassured as your baby is sleeping.
A baby monitor can help you feel more reassured as your baby is sleeping, especially once she starts rolling over. Photo © Vincent Iannelli, MD

One big issue with rolling over is that your baby may not longer be sleeping on her back as she sleeps. Even if you continue to put her to sleep on her back, as you know to do to reduce her risk of SIDS, she may quickly roll over on to her side or stomach.

What do you do?

Well you can't stay up all night continuing to roll her to her back every time she rolls over to her stomach. In addition to being impractical, it is usually unnecessary, as once infants are rolling over well, they are usually at much less risk of SIDS.

What about crib sleep positioners, nests, and wedges? Most are only supposed to be used until your baby rolls over, so they won't help either.

You should still put her to sleep on her back though, especially since that is the way she has learned to go to sleep by now, and then let her find the position that she is most comfortable in to sleep by herself.

Although the highest risk for SIDS has past now that your baby is over four months old, you should still take steps to reduce her risk of SIDS, including not letting her get overheated, not exposing her to secondhand smoke, and:

  • Always putting your baby to sleep on her back on a firm crib mattress that is covered by a sheet, without any soft objects, loose bedding, pillows, or other soft objects in the crib.
  • Having your baby sleep in a crib that is close to the your bed in the same bedroom, but not in your bed.
  • Consider leaving bumper pads off the crib, but if you do use them, make sure they fit all around the crib, are secured in place, and remove them once your baby can stand.
  • Making sure that all caregivers are aware of these recommendations.

Rolling Over and Bassinets

The other issue with rolling over is that it is usually time to move your baby out of her bassinet and into a crib. She will also be ready to move to her nursery soon.

5
Pink Eye

When caused by a bacteria, children with pink eye (conjunctivitis) will have green or yellow discharge from their eyes and the white parts of their eye and the inside of the lower eyelid will be red. In addition to being matted when they wake up, with bacterial conjunctivitis, you will have to frequently wipe away the drainage from your child's eyes.

Children can also have pink eye from allergies (allergic conjunctivitis), which will cause their eyes to be red, itchy, and tearing.

Viral infections can also cause pink eye. In addition to being intensely red, children with a virus that causes pink eye will have tearing and a white discharge. Pink eye can also be caused by irritants, like smoke and dust.

Treatments for Pink Eye

Bacterial causes of pink eye require an antibiotic, either topical drops or ointments or an oral antibiotic if your child has another bacterial infection (like an ear infection).

Allergic conjunctivitis can be treated with typical allergy medications, and topical drops, like Patanol, although allergy eye drops aren't approved for use on infants.

Viral causes of pink eye do not usually require treatment.

Whatever the cause, you should usually wipe away any eye discharge with a warm moist cloth and wash your hands frequently in case it is contagious.

If your child with pink eye doesn't respond to typical treatments, or if he also seems to have pain (fussiness, not sleeping, etc.) or vision problems, an evaluation by a pediatric ophthalmologist can be a good idea.

Preventing Pink Eye

Pink eye often seems to be one of the more contagious childhood infections, especially for kids in day care. That is likely because younger kids often rub their eyes, which can easily spread the infection. Preventing pink eye revolves around good hand washing, especially after wiping matting from your child's eyes.

6
Ear Pulling vs. Ear Infections

Many babies pull at their ears.

Is it a sign of an ear infection?

Sometimes it is, but often, if your baby is pulling at her ears and has no other symptoms, then it is likely normal. Some of those other symptoms that might indicate your baby has an ear infection include:

  • fussiness
  • fever
  • decreased appetite
  • waking up at night
  • having a runny nose and cough or just getting over a cold, since ear infections are often associated with colds

Without some of these other ear infection symptoms, your baby may be tugging at her ears because she has simply found them, when she is overtired, or because she is teething.

If you think that your child has an ear infection, see your pediatrician to confirm the diagnosis. In addition to ear infection symptoms, your baby should have signs of inflammation of her ear drum on physical exam, such as a red, bulging ear drum, which your pediatrician can see when looking inside your her ears.

If your child does indeed have an ear infection, then she will likely need an antibiotic. The latest ear infection treatment guidelines from the American Academy of Pediatrics does offer an "observation option" for older children so that they can be observed without antibiotics for up to 48 hours to see if they get better on their own, but they state that children under six months of age should always be treated with antibiotics when they have an ear infection.



Source:

American Academy of Pediatrics. Clinical Practice Guidelines. Diagnosis and Management of Acute Otitis Media. PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465.

7
Getting a Second Opinion

"Getting a second opinion" is a popular phrase that parents often mention to each other.

Unfortunately, although it is sometimes important to get a second opinion when your child is sick or when you disagree with your pediatrician, you shouldn't misuse this tool.

How can you misuse getting a second opinion?

Isn't it always better to get see another doctor when you think you need to?

While it usually is good to get a second opinion, you should usually think about why are seeking a second opinion first. Is your child not getting better after multiple visits? Does your child have a complicated problem and needs to see a specialist? Do you simply disagree with your pediatrician?

The main problem with a second opinion, is what do you do when the two opinions are the opposite to each other. Do you get a third opinion? Do you go with the doctor who is telling you what you want to hear?

Your Pediatrician as a Second Opinion

One of the most overlooked places to look for a second opinion is your own pediatrician. There are very often more than one right way to do things and if you don't agree with your pediatrician's plan of care for your child, don't be hesitant to ask questions and see if there is something else you could try first. If there isn't, at least you could hear your pediatricians explanation of why and have a better understanding of things.

Getting a Second Opinion

In some circumstances, if you aren't getting answers from the pediatrician that you are seeing, then you may need a second opinion from another pediatrician or a pediatric specialists. For example, if your child has severe eczema and his rash isn't responding to traditional treatments, then it might be a good idea to see a pediatric dermatologist. Or if your child has a heart murmur, then she might need to be evaluated by a pediatric cardiologist.

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