Medical Care

The four- to seven-month-old baby girl is a medical marvel. The healthy infant kicks, rocks, and rolls with vigor and gusto during all waking hours. But when she’s not feeling well, she can’t tell you about it, so you’ll have to notice the change in feeding and activity level, which will tip you off. Sometimes you can handle the problem yourself. Other times you’ll need to call your daughter’s doctor. The information in this section will help you distinguish between normal childhood discomforts (like teething and overheating) and those that require a professional’s care. You work hard every day to keep your little girl comfortable and happy. You change her diaper before her bottom gets red; you feed her tummy before she screams from hunger pains; you rock her, sing to her, and hold her close. Here are some pointers about keeping that comfort level high as the seasons change and also as the pain of teething begins.Seasonal Care: Fresh air and a change of surroundings are good for you and your daughter, so take her out for walks if the weather is nice. Just be careful to dress her properly—not too much and not too little. An infant’s body loses heat more readily than an older child’s or adult’s. This makes it difficult for her body to regulate temperature when she’s exposed to excessive heat or cold during the first year or so of life. In general, she should wear one more layer (of clothing or a blanket) than you do when it is cold. If it is uncomfortably cold, keep your daughter inside if possible. If you have to go out, dress her in warm sweaters or put bunting bags over her other clothes, and place a warm hat over her head and ears. You can shield her face from the cold with a blanket when she’s outside, but hold it far enough from her nose and mouth so she can breathe easily. To check whether your daughter is clothed warmly enough, feel her hands and feet and the skin on her chest. Her hands and feet should be slightly cooler than her body but not cold. Her chest should feel warm. If her hands, feet, and chest feel cold, take her into a warm room, unwrap her, and hold her close so the heat from your body warms her. In warm or hot weather, you can ease up on the layers. Dress your daughter as you dress yourself to feel comfortable—and, of course, protecting her from direct sun rays. Babies less than six months old should be kept out of direct sun entirely because they are prone to sunburn and heatstroke, both of which can be dangerous at this age. Keep them in the shade of a tree, umbrella, or stroller canopy. For years, the American Academy of Pediatrics recommended against putting sunblock on babies under six months because of concerns about the way their skin might absorb the chemicals. But in 1999, the Academy changed its position, saying that if clothing and shade to block the sun are not available, it may be reasonable to apply sunscreen to small areas, such as the face and back of the hands. Still, the best way to protect your daughter from the sun’s ultraviolet rays is to keep her out of the sun. Teething: Although it’s not time to bring on the steak, your daughter will probably cut her first teeth during this infant period. By the time babies are born, they have a full set of primary teeth (commonly called baby teeth) hidden below the gum line, as well as the beginnings of the permanent teeth that will come later. The firstbaby tooth usually breaks through when your daughter is between four and seven months, although the big event may occur as early as three months or as late as twelve months. Your daughter will let you know when she’s teething. There’s no mistaking the drool that will run down her chin all day long. She also is likely to chew on anything she can get her hands on, to ease the discomfort. Some babies have short bursts of irritability, while some may seem cranky for weeks, crying frequently, waking more often, and eating fretfully. For others, the process seems to be almost completely painless. As the gums grow tender and swollen, her body temperature may be a little higher than normal, but as a rule, teething does not cause high fever, diarrhea, earaches, runny noses, or coughing (as some well-intentioned friends and relatives may tell you). To make teething more pleasant for your daughter try these simple teething strategies: Wipe your daughter’s face often with a soft cloth to remove the drool and prevent rashes or irritation. Place a clean, flat cloth (such as a diaper not used for diapering) under her head when you lay her down to sleep. If she drools, you can replace it with a dry cloth without having to change the whole sheet. Try rubbing your daughter’s gums with a clean finger. (Do not coat your finger with sugar or honey.) Give your daughter something firm to chew on, but be sure it’s not small enough to swallow and can’t break into piecesthat might pose a choking risk. (Bagels, which are used as teething rings by some parents, are not a good choice for this reason. Neither are teething biscuits, despite their name, or frozen bananas.) Hard rubber teething rings can be good; look for one-piece models. Make it cold. Many babies seem to enjoy teething on objects that have been chilled but aren’t rock-hard. Try freezing a clean wet washcloth for thirty minutes, then let your daughter chew on it. If your daughter seems to be in a lot of pain, it may be worth giving her acetaminophen drops, but consult her doctor first. Ditto for painkillers that are applied to the gums (such as Baby Orajel or Baby Anbesol). These provide relief for a short time that may be just long enough to let her fall asleep. Never use old home remedies such as placing an aspirin against the gum or rubbing the gum with any type of alcohol. And don’t clean those little teeth with a fluoride toothpaste. She may swallow some paste, which can result in tooth staining or surface irregularities on the enamel. Lots of adults do not arrange for periodic routine medical checkups for themselves as they should. We put them off and plan to keep the appointment next year—hopefully with no major harm done. But when it comes to our babies, there’s no putting it off. Infants need regular checkups on a rather strict schedule so that theirdoctor can monitor their medical and developmental progress, give required inoculations, and catch any problems early on. I never missed an infant checkup with my kids, but I can’t say that I really knew why they were so important. So I’ve again asked Stephen Muething, M.D. at Cincinnati Children’s Hospital Medical Center to tell us what happens at these checkups that most physicians will schedule for your daughter at four and six months of age. Dr. Muething says the physician will give your daughter a thorough physical as he did in previous visits. Again he will weigh and measure her (see the growth chart information in Appendix A for expected measurements), and then measure her head (a baby’s head will grow about one-half inch every month for the first six months). He will listen to your daughter’s heart and lungs with a stethoscope. He will examine her legs, feet, and overall skin color and condition, as well as her genital area. Finally, he will examine your daughter’s eyes, nose, ears, and throat for signs of good health. Your daughter will probably be given immunizations at one or both of these visits. The typical infant gets twelve immunization shots within the first six months. This is far more than your parents may remember. These shots protect children against hepatitis B, polio, measles, mumps, rubella (German measles), pertussis (whooping cough), diphtheria, tetanus (lockjaw), Haemophilus influenza type b, pneumococcal infections, and chickenpox. Be sure to follow your doctor’s instructions on when these inoculations are due. The recommended schedule does change from time to time, but you can find the most up-to-date recommended immunization schedule on the website of the American Academy of Pediatrics at www.aap.org, or the Centers For Disease ControlThe four- and six-month visits are also the time when your daughter’s doctor will want to hear about her feeding schedules. Many moms who started nursing will now be adding some formula or switching entirely to formula. During this period, many parents introduce some kind of solid foods. The doctor will discuss your daughter’s feedings and offer some advice on how to continue to introduce new foods and watch for possible bad reactions. Sleep is another subject that often concerns parents when babies are between four and seven months. “Some parents come in,” says Dr. Muething, “with that look of fatigue, and I know that sleep is an issue we need to talk about.” If your daughter is not yet sleeping through the night, now is the time to talk about that. After the basics are covered, Dr. Muething notes that parents should be prepared to ask any questions they have. “After the first few visits where parents are concerned about the baby’s physical health,” he says, “they now start to focus on the baby’s development. They want to make sure their daughter is doing what she’s supposed to be doing at the right time. Is she developing physically and intellectually as she should be? Most often, moms know something is wrong before the doctor says anything. They know it in their heart, but don’t want to say it.” These routine checkups give you an opportunity to make sure your daughter is progressing as she should: At four to six months, she should be able to sit with some support. She may also be able to roll over from her back to her side and from stomach to back. Your daughter should now have some hand-eye coordination and be able to grab at things she sees. She grabs at objects andbrings her hands or the objects close to her face to her mouth. She also opens and closes her hands so that she can pick up and look at objects. All babies this age should begin to be social, and be able to track visually, interact with parents, smile responsively, coo, and make noise.