Did you know you can potty train your six months old infant? Dr. Carole Keim MD talks about potty training, babyproofing, routines, and stranger anxiety. Your six-month-old should be recognizing familiar faces and reacting to their own name. Now is also a good time to use your support network to help with tasks, get a babysitter and go on a date. It is ok to leave your infant for a few hours and ask for help when overwhelmed. 

Dr. Carole Keim MD goes into great detail about the power of routines. Routines for feeding, winding down, sleeping, and leaving the house. Your infant will start to recognize these patterns and know what you are doing. Check out this episode for more information about your six-month-old infant. 

Parents: (00:43)

• For many this is a “golden” age - you’ve got a good handle on things, sleeping fairly well, have routines down, parents show confidence with infant (it’s ok if you’re not! But also keep postpartum depression in mind.)
• Establish routines 
• Interact with baby, respond to cues 
• Talk/sing, read, play peek a boo
• Use support networks, balance parent roles/responsibilities 
• Date night with trusted babysitter 

Development: (02:25)

• Socially interactive
• Happy feet 
• Recognizes familiar faces 
• Babbles
• Takes turns babbling / making sounds like squeals, blowing raspberries, rrr
• Starts to know own name
• Visual and oral exploration to learn about environment
• Rolls over both ways 
• Tripod sit / sit with support (baby seat, high chair)
• Stands and bounces (johnny jump up / activity center)
• “Swims” on land (pre-crawling)
• Turns while sitting to look at things
• Raking grasp
• Can bring hands together, transfer hand to hand, and put objects in mouth
• No object permanence yet
• Toys: soft toys, crinkly toys, rubber/silicone toys, rattles no hard eyes/noses, no small parts (choking hazard)

Sleep: (09:14)

• Safe sleep: alone, on their back, in a crib. 
• Crib should be in parents’ room until 1 year of age
• Lower crib mattress (pull to stand)
• No blankets until 1 year, no pillows til age 2 - very high risk at this age - rolling
• Maintain a bedtime routine;  feed, brush teeth/gums with water, read, sing, set down awake but drowsy 
• Things that can help, but only if they need it: blackout blinds, white noise machine, music

Nutrition: (11:48)

• Primarily breastmilk or formula; starting solids
• How to start solids: 
  • Baby-led weaning vs. purees (traditional)
  • rice/oat cereal optional (pros/cons)
  • progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow’s milk (dairy products are ok)
  • one new food every 3-4 days 
  • signs of food allergy: rash, vomiting
• give water (ounce per ounce with foods)
• Start consolidating meal times
• Consider 3-5 “meals” of breastmilk/formula with 1-3 “snacks” of baby food
• Expect them to eat about 1-2oz of food at a sitting when starting out; soon will go up to 4oz, watch cues
• Gagging is normal, choking is not

Teeth: (19:30)

• Teeth can appear anytime; brush 2x per day with water and soft toothbrush
• Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
• Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel
• Fluoride: check if it’s in tap water, if not, can consider using fluoride toothpaste (grain of rice sized amount)
• Avoid laying them down with a bottle, never prop a bottle

Peeing/pooping: (24:49)

• Peeing about 4-6x per 24h
• Poop is now more solid because they are eating foods; can consider starting potty training now

Skin: (26:40)

• Bathing 2-4x per week; wipe skin folds a few times per day
• Can use lotion or cream or ointment after baths - watch those folds for rashes though
• Sunscreen, insect repellant: any baby sunscreen is ok, citronella works for insects and is safe 
• Diaper rash and drool/food/skin fold rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
• Cradle cap - olive oil / vaseline / aquaphor at night, soft baby brush in the morning

The 6 month checkup: (30:23)

• Baby should have gained about 2-3lbs since last checkup, should be more than twice birth weight
• Third round of vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)
• Anticipatory guidance: 
  • Safety: use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns, no infant walkers, remember safe sleep, start baby proofing, bathroom and kitchen are most dangerous rooms (burns, sharp objects, poisons, drowning), choking hazards, avoid plastic bags / balloons, limit finger foods to those soft enough to crush easily with fingers
  • Development:  Stranger anxiety can inspire crawling/rolling with toys placed just out of reach. Anticipate sitting on their own and crawling
  • Next WCC in 3 mos; no vaccines (might get flu shot)
  • Reminder: flu shot is given in 2 doses, 1 mo apart, for baby’s first flu season, then 1 annually
  • Past few visits were q2mo, now q3mo (9, 12, 15, 18 mos)

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• Edinburgh Postnatal Depression Scale - Downloadable

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