Your Baby Week Twenty One

1
By the Book Baby Summary

Baby jumping on jumper
Matt Carr/Digital Vision/Getty Images

Although there aren't really any complete or formal rules for what makes a good parent, these are some of the things that most people would agree that you should do 'by the book' when your baby is 4 1/2 months old:

  • Breastfeeding - if nursing, try to exclusively breastfeed your baby for the first 6 months and avoid supplements of water, formula, or juice. Your baby will likely be nursing about 7 or 8 times a day now.
  • Baby Formula - if not breastfeeding, feed your baby about 24 to 32 ounces of iron-fortified infant formula each day.
  • Starting Solids - an iron-fortified rice cereal can be started once your baby is ready and is about 6 months old (typical range for starting is from 4 to 8 months).
  • Vitamins - unless your baby was born premature or has other health problems, you likely won't need to give him vitamins, except for exclusively breastfeeding babies who need Vitamin D drops beginning before they are 2 months old.
  • Back To Sleep - to help reduce your baby's risk of SIDS, be sure to put your to sleep on her back in a safe crib.
  • Safety Outside - you can use insect repellents once your baby is 2 months old, but it is best to keep them out of the sun and use sunscreen until they are 6 months old.
  • Baby Car Seats - until she is 12 months old AND is over 20 pounds, your baby should sit in the back seat facing backwards when riding in the car.

Things to Avoid with your Baby

Just as important as what you do with your baby are the things you don't do, including that you:

  • never shake your baby, which could lead to shaken baby syndrome.
  • do not feed your baby honey, cow's milk, or goat's milk.
  • do not leave your baby where she could fall.
  • do not let your baby get overheated when she is sleeping, which is a risk factor for SIDS.
  • do not expose your baby to secondhand smoke.

2
Bath Time

A bath, whether it is every day or just twice a week, can be a fun time for your baby.
A bath, whether it is every day or just twice a week, can be a fun time for your baby. Stockbyte / Getty Images

How often should you give your baby a bath?

That may seem like a silly question for some parents. After all, if your baby enjoys her bath time, then a daily bath is probably a great idea.

But some infants don't necessarily like bath time or their skin may seem to dry out when they take a bath each day.

How Many Baths?

Fortunately, your baby probably doesn't really need a daily bath. In fact, you probably only need to give your baby a bath every two or three days.

Some babies, especially those who spit up very often, may need a bath every day though. Or you may just need to "spot wash" those areas that get dirty.

Baths and Dry Skin

Won't a daily bath dry out your baby's skin?

Maybe, but it usually won't if you have a good bath time routine.

This can include using a mild, soap-free, fragrance-free soap substitute, such as Aquaphor Gentle Wash for Baby, Cetaphil Gentle Skin Cleanser, Dove Sensitive Skin Body Wash, or Purpose Gentle Cleansing Wash.

Other baby bath washes, may also be soap free, but may include a fragrance or dyes that can irritate your baby's skin.

If you prefer a bar "soap," then consider using Dove Sensitive Skin Unscented Beauty Bar or Cetaphil Gentle Cleansing Bar.

Baths and Moisturizers

Most importantly, whether you give your baby a bath every day or just twice a week, to help prevent her skin from drying out, it is important to moisturize her skin properly.

And the best way to do that is to dry her skin quickly and then apply a very generous amount of moisturizer all over. Good choices include Aquaphor Baby Healing Ointment, Cetaphil Moisturizing Cream, or Eucerin Original Moisturizing Lotion. The key though, is applying it while her skin is still a little wet to help trap in some of the moisture, which usually means trying to apply the moisturizer within two or three minutes of ending the bath.

3
Constipation

Your baby's bowel movements may begin to change when he is 4 to 5 months old.

This can especially become an issue when your baby starts solid foods. Surprisingly to many parents, rice cereal, can be quite constipating.

What is Constipation?

Instead of how often a baby is going, constipation is often diagnosed based on how firm their bowel movements are.

So if a 4-month-old baby is having soft bowel movements every 2 or 3 days, then he likely isn't constipated. On the other hand, if he has a very large bowel movement twice a day that seems painful and hard, or are like hard little balls, then he is.

Simply straining or even crying when your baby has a bowel movement is not necessarily a sign of constipation though, especially if the bowel movement is soft.

Breastfeeding and Constipation

One of the most confusing things for parents is when their exclusively breastfed baby stops having bowel movements every day. These babies may go from having bowel movements 3 or 4 times a day to going once a week or even every other week. Again, if their bowel movements are soft when they finally have one and they don't seem to be bothered by any symptoms of constipation, such as fussiness, abdominal pain, or bloating, then this pattern is likely normal.

Infant Constipation Treatments

Initial treatments for infant constipation usually include switching from rice cereal to a single grain oatmeal, barley, or wheat cereal, which have more fiber than rice cereal.

Other treatments that you might discuss with your pediatrician can include giving your infant two to four ounces of water or diluted apple or prune juice (mixed half and half with water) once or twice a day.

A formula switch for babies drinking baby formula is also sometimes helpful for babies with persistent constipation, with the change usually from a milk-based one to a soy formula.

4
Infant Q&A - Does Standing Cause Bowing?

Bearing weight on her legs can be fun for your baby and won't cause leg bowing.
Bearing weight on her legs can be fun for your baby and won't cause leg bowing. Photo © Andraz Gregoric

Q. Now that my baby is four months old and can put weight on her legs, she likes to stand up on my lap while I sit and hold her up. Is that OK? My parents say that it will make her legs bowed.

It is common developmental milestone that babies begin to bear weight on their legs by about 2 to 5 months. They won't be able to actually stand up while holding on to things until they are 6 to 9 months old, but at this age, they can often put weight on their legs while you support their body.

Does standing up at this age lead to bowed legs?

No. Most infants have bowed legs because of the way that they were positioned in their mother's uterus before they were born. This bowed appearance is especially noticeable once the child is walking and typically goes away when they are about 15 to 24 months old.

In fact, their bowed legs may seem to over correct so children seem almost knock-kneed by the time they are 3 or 4 years old. This too usually goes away on its own by the time a child is 5 to 8 years old, when your child's legs will finally appear straight.

Bowlegs

Having bowlegs (genu varum) is not always normal though.

None of these conditions are very common, but they do include:

  • tibia vara (Blount's disease), in which the tibia, one of the lower leg bones isn't growing correctly
  • Vitamin D deficiency (rickets)
  • skeletal dysplasias, in which bones don't form normally, and usually include other issues, such as short stature, in addition to bowed legs

Instead of slowly improving, as most infants with normal or physiological bowing do, infants who have a medical condition causing their bowed legs will get worse. Still, letting your baby bear weight on her legs will not cause the bowing.

Talk to your pediatrician if your think your baby's bowed legs are a problem.

Sources:

Behrman: Nelson Textbook of Pediatrics, 17th ed.

5
Health Alert - Antibiotic Overuse

Parents can often have different expectations when they go and see their pediatrician when their baby is sick. Most just want to make sure their child is OK.

Some parents expect a prescription for an antibiotic at the first sign that their child has a runny nose or cough. Most of these kids have simple viral infections though and don't need an antibiotic though.

This unnecessary or overuse of antibiotics can make it more likely that antibiotics won't work when your child has a bacterial infection does really need them.

Viral Infections vs Bacteria

While antibiotics can work to treat most bacterial infections, viruses are a different type of germ and don't respond to antibiotics.

Common viral infections that children get and for which you should not usually get an antibiotic prescription include:

  • the common cold, even if your child has a yellow or green runny nose, which can last 7 to 10 days when your child has a cold
  • the flu
  • sore throats, unless your child has a positive strep test
  • acute bronchitis, although sometimes chronic bronchitis, with a cough that has lasted for more than two weeks, is treated with antibiotics
  • having middle ear fluid (otitis media with effusion), which is common for a few months after an ear infection

Antibiotic Overuse

If your child has a virus, taking an antibiotic won't help him get better any faster, won't make him less contagious, and usually won't keep it from getting worse.

And in addition to the issue of antibiotic resistance, when bacteria become harder to fight and common antibiotics don't work anymore, and the cost of the antibiotics, taking an antibiotic when it isn't needed puts your child at risk for side effects from the medicine. These include diarrhea, rashes, and allergic reactions.

6
Baby Product Safety - Rainforest Jumperoo

The Rainforest Jumperoo has a spinning seat, lots of toys, and can be placed on the floor.
The Fisher-Price Rainforest Jumperoo has a spinning seat, lots of toys, and can be placed on the floor, so you don't need a doorway. Photo © Vincent Iannelli, MD

At four to five months, your baby is likely able to hold her head up without assistance and may be getting tired of laying around all of the time.

A swing or bouncer might be fun for a little while, but since this is also the age when infants can bear weight on their legs, it can make trying a jumper a lot of fun.

Baby Jumper

A baby jumper or doorway bouncer used to mean a device that included a seat, some straps, a spring and clamps that you attached to a doorway frame. Your baby then jumped and bounced and could play with the toys that were attached to the seat.

And while these types of baby jumpers are still available, the newer jumpers are more like entertainment centers and don't have to be attached to a door frame. The Fisher-Price Rainforest Jumperoo, for example, has a spinning seat, lots of toys, and can be placed on the floor, so you don't need a doorway.

Baby Jumper Safety

To use a jumper safely with your baby, be sure to:

  • always supervise your baby in the jumper.
  • wait until your baby is able to hold her head up without assistance and can bear weight on her legs before putting her into a jumper.
  • don't leave your baby in a jumper if she doesn't seem to like it or after she gets tired or bored in the jumper. Most babies should only be allowed to use a jumper for 10 to 15 minutes at a time anyway if they are actively bouncing for most of the time.
  • stop using the jumper once your baby is walking, is able to climb out, or reaches the maximum height and weight (usually about 24 to 25 pounds, depending on the manufacturer) restrictions.
  • check your door frame measurements to make sure it meets your jumpers requirements and that it is secure if using a doorway jumper.
  • make sure that only your baby's toes can reach the floor when using a doorway jumper. Her feet should not be flat on the floor.

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