Your Six-Month Old

     If your sanity survives the fussing, problems sleeping and worry of the first four months of life, then six months is your payoff. Six-month olds are always laughing and babbling and they can charm the socks off any adult. They look at everyone intently for a few seconds and then decide that you are either a “mom-thing” or a “dad-thing” and then give you a big smile.

     Six months of age is a time of transitions. Many doctors recommend not starting solid foods until four to six months of age, especially if there is a strong family history of allergy. But now is time to start if you haven’t already done so. You do not have to start one new food every three or seven or ten days to “see if he has allergies”. We develop allergic reactions only after we have been exposed to whatever protein we are going to be allergic to. In other words, you don’t have an allergic reaction to a food the first time you eat it. This is what makes diagnosing food allergy difficult – if your child develops hives, it could be from the carrots you started last week or the kumquats you started six weeks ago. It’s just not likely that it is from the squash you fed to him for the first time today.

     You also do not have to follow some other commonly heard rules about starting solids. It doesn’t matter if you start with cereal or what kind. It makes no difference if you feed yellow vegetables before green, fruit before vegetables, cereal before fruit or anything else. All humans prefer the taste of sweet because our tongues have a lot of sweet taste buds. Every two-year old prefers ice cream to broccoli, no matter what he was fed at six months of age. Starting your infant on vegetables before fruit is not going to change the anatomy of his tongue. It’s up to all of us to monitor the amount of sweets that our children eat in the first years of life.

     Six months of age is the time to start a gradual transition towards eating a variety of foods and having a “breakfast/lunch/dinner schedule by nine months of age. The best way to vary the kinds of food is to simply feed him what you are eating. Don’t worry about likes and dislikes because what he hates today, he’ll love tomorrow. Don’t worry if he doesn’t seem interested in solids at any given meal – at this age, he still is getting his primary nutrition from breast milk or formula. Don’t try to feed him if he doesn’t act hungry.

     Six months is the age when the pacifier needs to stay in the crib. Junior can have it at nap and night times, but not when he’s awake and up. He’ll never miss it – he’ll just put the next closest thing in his mouth. And by not giving it to him during the day, you will avoid all future pacifier problems.

     Six months can be a time for sleeping problems. Even an infant who has slept well may begin waking up. Six months is the time when your infant should be sleeping through the night without a feeding, but, if he is going through a growth spurt, he may start to need night feedings again even if he hasn’t needed them. If you are in the habit of rocking and holding your infant until he goes to sleep, six months is when that system falls apart. He is now alert enough to know he is being laid down and so, when you try, he wakes up and starts screaming again. You may have to decide between putting him in the crib awake and letting him cry himself to sleep or holding him all night long.

SIDS And Safe Sleeping For Infants

       Sudden Infant Death Syndrome (SIDS) is still the leading cause of death for infants between the ages of 1 month and one year, with the peak incidence between 2 and 4 months. Researchers are not certain about the biologic reasons for SIDS, but studies have given us clear ways to decrease the risk of SIDS for our children.

     The most important thing parents can do is to always place their infants on their backs for sleep - nap and nighttime. Since the American Academy of Pediatrics recommended “Back to Sleep” in 1992, the incidence of SIDS has decreased over 50%. This is sometimes difficult for parents because infants sleep better and are less fussy on their tummies. But it is very important that infants never be allowed to sleep on their tummy, especially infants who were premature or had a low birth weight. Infants who were premature or had low birth weight and are allowed to sleep on their tummies have 15 to 24 times more likelihood to have SIDS than term infants.

     Having an infant sleep on his back can cause people to worry that the infant will choke even though that doesn’t happen. There are devices that are advertised to hold the infant in a “side-sleeping” position, but these have been associated with an increased risk of SIDS and shouldn’t be used.

     Exposure of the developing fetus to drugs, alcohol or cigarette smoke early in pregnancy increases the risk that the infant will have SIDS as does exposure to cigarette smoke after birth. The risk of SIDS is increased by a soft sleep surface like sheep skin, along with loose, soft items in the crib like blankets, pillows and stuffed animals.  The risk from bumper pads is questionable. Overdressing the infant increases the risk for SIDS but swaddling does not as long as the infant sleeps on his back when swaddled.  

     Sleeping on the parent’s bed or falling asleep in a chair, sofa, car seat or swing increases the risk of SIDS. This is why the American Academy of Pediatrics recommends against co-sleeping. There have been many reports of infants being smothered by the adult they were sleeping with.

     Recent studies suggest that using a pacifier for sleep decreases the risk of SIDS. In a previous article on pacifiers, I said that a child may use a pacifier at night and naptime for as long as he wants to. If the pacifier doesn’t leave the crib, your child will never have a pacifier problem. Breast-feeding also decreases the risk of SIDS.

     Some infants have apnea – they have episodes where they stop breathing.  These can be so severe that they are called “Apparent Life-threatening Events”. However, there is no good connection between these spells and SIDS. This is one reason why placing an infant on an apnea monitor does not decrease the risk of SIDS.

     There is no correlation between vaccines and SIDS – neither the timing nor the type nor the number of vaccines.

     Breast feed, don’t allow smoking around the baby, always put you infant on his back to sleep and avoid the plush toys in the crib.  Get tummy-time practice when your infant is awake and alert. We haven’t found a way to prevent SIDS yet, but we certainly know ways to decrease the risk.

Roseola - A Common Cause Of Fever With A Rash

     A child’s fever is always of concern to parents. Many diseases that cause fever can also cause a rash. Some of these diseases are very serious (meningitis) and some are not. Diagnosing what disease is causing the fever and rash involves considering other symptoms the child has along with the timing and appearance of the rash.

     One very common cause of fever and rash in children between the ages of 6 months and 3 years is called roseola, or, more correctly, roseola infantum. This disease is not a serious illness, but, because it is so common, parents should be aware of it.

     Roseola occurs most often in spring and fall. With roseola, the child develops a fever – sometimes a high fever above 103 F – but the child feels otherwise well, maintains normal activity level, continues to eat well and has no other symptoms. Physical examination will be normal. Because the fever in roseola often lasts longer than the usual 3 days (see previous articles on fever) the child's doctor may do some tests looking for a source of infection, but these tests will be negative.

   The diagnosis of roseola is revealed when, as the fever goes away, a rash develops. The rash consists of pink, small blotches that are flat or only slightly raised. The rash occurs mostly on the back and chest and less on the face and extremities. As the fever disappears, the rash can spread or become more red but it does not itch, burn or cause any dryness or irritation of the skin. The rash then goes away in a matter of days without any complications.

     In many of the more serious illnesses involving fever associated with a rash, the rash occurs at the same time that the child has the fever. Roseloa is one of the very few illnesses in which the rash develops when the fever begins to resolve.

     The only treatment for roseola is to give fever medication to make the child more comfortable.

How To Deal With Whining

     Since retirement, I play golf very early every morning. Today, at 6 am, in 50-degree, misting rain I asked myself why I was doing this. I realized that I hit about one good shot in every four swings. That is called intermittent reinforcement and it is very addictive to human beings. It is what causes people to keep coming back to casinos – you don’t win every time, but you win once in a while and that hooks you.

     Babies start life totally helpless and their only way of surviving is to cry and annoy the adults around them enough to take care of their needs. Crying when we perceive that we need something is our earliest and most basic form of communication with our parents. As infants get older, they learn to do more things by themselves, but they still whine and cry as the first response to the feelings of frustration or need.  Parents know that responding to this initial whining is enforcing it and will result in more whining in the future, but occasionally a parent will say, “He just wore me down. I know I shouldn’t have, but I just gave in”. However, when the whining meets with occasional success, that is intermittent reinforcement and it’s certain that the first thing the child will try next time is whining again. In fact, intermittent reinforcement can create a child who whines all the time and also continues to whine because the child knows that continued whining sometimes works. Children also know which adults it will work with and which ones don’t respond. If Grandma never gives into whining, the child will often immediately move to Plan B without even trying whining.

   Before a year of age, the appropriate parent response to whining is, “Don’t whine”. After a year, it is, “Don’t whine, show me what you want”. After two years of age, it is, “Don’t whine, tell me what you want”. After three years of age, it is, “Don’t whine”.

     It is frightening how much children watch us and mold their behavior in accordance with our responses. I always have to remind myself that a child learns something from every interaction he has with an adult and, when I ask myself, “What did I just teach him?” it is often not what I wanted to teach him.

     If you need me, I’ll be on the golf course.