The Two Month Old

dearborn-peds-first-year-visits

Robert Levy, MD    Joel Moses, MD

Houda Dagher-Rodger, MD       Melissa Hoisington, MD

Tiffany A. Harris, CPNP   Kerri Bernard, CPNP

2845 Monroe    Dearborn MI  48124    Telephone:  313-730-0070

 

Two Month Visit

 

Today’s Measurements:  Height: _________ Weight: _________    Head:  _________

 

Feeding:

  •     We recommend continued nursing or feeding with an iron fortified formula.  Water is still not required at this age.  Do not begin cereals or any other solid foods until four months of age.  Cereal in the bottle increases the risk of choking and has not been shown to help babies sleep through the night sooner.  There are rare exceptions to the cereal recommendations, which will be discussed on an individual basis.
  •     Continue to feed your baby in a semi-upright position.  Do not prop bottles for a baby to take while lying down on his/her back.  This can lead to choking, increase the risk of ear infection, and cause the swallowing of excess air and spitting up.  Always check the temperature of the formula after heating.
  •     Spitting up is common occurrence and is not harmful to infants.  Try to hold your baby upright at a 30 degree angle for fifteen to twenty minutes after a feed to help prevent this.  Also, you may need to burp the baby between each ounce to prevent the accumulation of gas and a subsequent forceful spit up.  Check that the baby has a tight seal between his/her lips and the nipple.  Some babies are in the habit of latching on/off frequently to a bottle/breast and swallow air in between.  If your baby is spitting up frequently, appears to be in pain (screaming prior to, during spit ups or feeds, arching his/her back) please let us know.

Vitamins:

  •     Babies who are breastfed exclusively or receive more than half of their intake from breast milk need to start taking a daily vitamin.  Tri-vi-sol, which is sold over the counter and widely available, provides the additional Vitamin D that is lower in concentration in breast milk versus formula.  The recommended dose is 1 cc once a day via dropper.
  •     Infants do not need fluoride until six months of age.  Therefore, infants also do not need to drink water until six months of age.  Formula and breast milk are sufficient for hydration.  If you live in an area supplied with well water get the water tested for quantity of fluoride.  If you use any kind of filter, read the manufacturer’s insert regarding what is filtered out, including any possible fluoride filtration.

Elimination:

  •     There is a wide variety of normal patterns.  Six wet diapers per day is average.  Frequency of stools can be once a day or every two to five days.  Breast fed babies tend to absorb milk more efficiently and stool less frequently.  Grunting, turning red, pushing and pulling with legs are not necessarily signs of constipation.  If the stool is soft, the baby is not constipated.  If your baby has hard stools, blood, grey or white appearing stools, let us know.

Sleeping:

  •     Continue to place your baby to sleep on his/her back.  This has significantly reduced the rates of sudden infant death syndrome.  Alternate the head position between both sides to avoid uneven flattening of the head.  Note if your baby prefers to turn his/her head to one side and let us know.  Give your baby supervised tummy time throughout the day to prevent flattening of their head.  It will also encourage upper body motor development.  Length of time spent on the tummy will vary with each infant.  Let your infant’s cries signal that it’s time to change positions.
  •     Your baby’s sleeping pattern may be more predictable.  Some babies are sleeping for four to six hour stretches overnight at this time.  Sleeping sixteen or more hours per day is normal for infants.  Please note that these patterns can easily change and that this is normal.

Development:  Your baby is blossoming.  The following are milestones for this age.

  •     Motor:  Holds head up for short periods; briefly holds a rattle.
  •     Sensory:  Tracks and follows objects; looks at face in line of vision; responds to sounds by becoming quiet and alert.
  •     Verbal/Communications:  Coos (musical, vowel-like sounds); parents begin to distinguish different crying patterns for different needs.
  •     Social Skills:  Smiles in response to people/other stimulation; responds to voices by cooing; may begin to relate differently to mother, father, siblings, other caregivers.

Safety:  Accidents are the leading cause of death in children.

  •     The vast majority of accidents occur in motor vehicles.  It is essential that every car seat undergo an inspection by a certified car seat inspector.  In the hospital, you may see such a person and receive instructions on how to secure your baby in the car seat itself.  Please note that seventy percent of bases are improperly installed in motor vehicles.  Having a properly installed base is as essential to your baby’s safety as proper positioning in the car seat.
  •     Whenever possible, car seats should be positioned in the middle of the back seat.  The handle on the carrier should be down and locked when the vehicle is in motion.  Do not attach toys to the car seat while the vehicle is in motion as these can act as projectiles during a collision.  Do not place any objects in the back seat, such as groceries, as these also can act as projectiles.  Do not use a car seat cover that also fits underneath your baby as it creates a barrier between the car seat and the back of the baby’s body.  During a collision even an inch of fabric can decrease the efficacy of the straps to hold your baby securely.
  •     Remember that all infants need to be placed rear facing until two years of age. This is a Michigan State law.  Most car seat inspectors recommend keeping a child rear facing for as long as possible, even after the age of two years.  Check the manufacturer’s limits on height and weight for your infant car seat as they do vary.
  •     If your child outgrows the infant car seat prior to two years of age, he/she should still face the rear of the car in a large car seat until two years of age.  Please note that a child should remain in a car seat until he/she weighs about forty pounds.  After this, a child should be in a booster seat until he/she reaches a height of 4’9” and/or is between the ages of eight to ten years.
  •     All children twelve and under should be in the back seat at all times.  When getting a car seat inspection, take your infant/child with you in order to check for proper fitting/positioning.  Members of AAA can contact your local office and request a free inspection.  Others can call local car dealerships and inquire about inspections.  You may also call 313-586-5488 and ask about getting an inspection through resources at Oakwood Hospital and Medical Center.  Local fire and police departments also frequently have certified car seat inspectors.

Other things to keep in mind:

  •     Newborns and infants can easily roll off of changing tables.  Always have your supplies ready and keep one hand on your baby.
  •     Do not place car seats on tables, sofas or counters with your baby inside.  They can easily slip off and cause injury.
  •     Never let go of your baby in a bath.  Babies can easily drown in an inch of water.  Do not rely on older siblings to keep an eye on a baby in the tub.
  •     Supervise older children and pets closely around your baby.
  •     The space between the slats of the crib should be 2 & 3/8 inches apart.  This is standard on new cribs.  Avoid any toys with long strings or pacifiers that hang from a string around the baby’s neck, as these may cause strangulation.
  •     The temperature on the water heater thermostat should be set at 120 degrees Fahrenheit to avoid accidental scalding.
  •     Install and maintain smoke and carbon monoxide detectors in your home.  They should be checked once a month and the batteries changed once a year.
  •     Exposure to second hand smoke is a significant health hazard.  This includes smoke that is on the skin and hair after the smoker has smoked outside.  Exposure to second hand smoke increases the risks of sudden infant death syndrome by as much as fifteen times.
  •     NEVER shake your baby.  If you feel overwhelmed or depressed, ask for help.  The baby blues occur in eighty percent of women.  Feeling of sadness, frequent crying or loss of control should not last beyond two weeks.  If they do, let your obstetrician or general physician know.
  •     All guns in the home should be stored safely.  Lock up ammunition and guns in separate locations.