Growth & Development: 9-11 Months

Development

Your child will begin to display certain physical and mental developmental skills, also known as developmental milestones. Please keep in mind, development is slightly different for every child. If you have concerns about your child’s development, please talk to his or her healthcare provider. At 9 to 11 months, your child can:

• Crawl or scoot around well
• Pull themselves up by holding onto furniture and walking around (legs can often appear bowed until about 18 months)
• Sit steady for a long period of time
• Repeat sounds that parents make
• Bang things together and play peek-a-boo
• Say “mama” or “dada” (or related phrases)
• Use the index finger and thumb to pick up small objects (i.e., pincer grasp)

Diet & Feeding

At 9 months, your child may be taking three to four meals per day of formula or breast milk plus baby foods and/or table foods. Appetite often decreases since the rate of growth is less now. The average intake of formula at this age varies widely: 16 - 32 ounces per day. Giving whole milk before one year of age is associated with anemia and lower I.Q. Encourage your child to take fluids from a cup, to encourage weaning from a bottle by 12 - 15 months of age. Water is acceptable with solid foods in small amounts.

Many children are experimenting with table foods at this age. Others may still prefer baby foods. You can select “second” or “third” stage baby foods based on how chunky your child likes his or her food.

Cook table foods until soft, with no added salt or spices. Mash or chop these foods very fine. Your child can manage to chew these even if no teeth have erupted.

You may try introducing the following foods. Please note, only introduce one new food every three to four days in order to rule out food allergies.

• Cooked vegetables: Carrots, peas, sweet potatoes, white potatoes, squash, into beans, kidney beans, lima beans
• Fresh fruits: Sliced or mashed bananas, peaches, pears, etc.
• Meats: Small strips of lunch meat, sliced Vienna sausages, tender chunks of boiled or baked chicken, small pieces of cooked hamburger and fish
• Miscellaneous: Small pieces of sliced cheese or cheese cubes, toast in strips, crackers (whole wheat crackers are recommended), cooked macaroni
• It is okay to have your child try peanut butter, but monitor your child for any changes or reactions.

To prevent choking, avoid giving larger pieces of food. Do not offer your child pieces of hard foods such as chunks of raw carrots, apples, nuts, fruits with seeds, raisins, whole grapes, stringy vegetables, popcorn, hard candy or gum until your child is 3-4 years of age. Do not give your child honey before 12 months of age.

Resist feeding your child desserts, pudding, sweets, chips or carbonated sugar-sweetened drinks. These things give calories with little nutrition, spoiling your child’s appetite for healthier foods.

Juice is not necessary to meet nutritional requirements if your child is eating two to three fruit servings per day. If you choose to give your child juice, limit it to four to six ounces one time per day.

Teething

Brush your child’s teeth twice daily with fluoride-free toothpaste or a tooth cleaner.

Do not allow your child to go to bed with a bottle. A drink before bed is acceptable, but drinks in bed can increase ear infections and tooth decay, as well as encourage the idea that nights are for eating instead of sleeping. One way to stop the need for bottles at nap and bedtime is to slowly dilute each bottle with more and more water until it is all water and no formula. The process can be done over a one to two week period. Your child will soon be less interested in the bottle.

Teething should not cause a fever over 101°F or diarrhea. It may cause drooling. Parents report looser stools and restlessness. Avoid teething gels, as these may cause choking. Instead, treat with a cold teething ring or the appropriate dose of Tylenol® (Acetaminophen) infant drops in the appropriate amount may be helpful.

Crying & Sleep

As part of normal development, infants at this age develop stranger anxiety and separation anxiety (fear of being away from their parents). This leads to worry, clinginess and nighttime awakening. If your child awakens crying, you may check on him or her, but resist the urge to pick up your child. In time your child will learn that he or she is safe and will put himself or herself back to sleep. Your child will still need to sleep about 14 hours per day, including two one to two hour naps during the day. At this age, a regular bedtime hour and routine are very important.

Playtime

Encourage your child to copy the sounds you make. Babies enjoy playing games, such as peek-a-boo, pat-a-cake and bye-bye. They also like looking for objects you show them and then cover with a cloth.

Toys your child might like now include: nesting toys that fit inside each other, such as a set of measuring cups or spoons, stacking toys and blocks, graduated rings on a stand, or toys on a string. Let your child put objects (big enough not to be swallowed) inside containers and take them out again. Read short stories to your child. Give your child a choice of toys. Talk with your child about the toy and what he or she is doing with it.

Nine month olds have a lot of energy. Make sure that you get enough rest. Ask friends and family to help so you can take a break and rest yourself.

TV viewing and the use of other media devices (e.g., cell phones, iPads, iPods, or video games) should still be minimized. Many experts recommend restricting these types of activities until your child is 2 years of age.

Discipline

Discipline is a way of teaching your child how to gain self-control, to respect other’s rights and to learn rules that govern our society. Obviously, babies cannot understand all of these ideas, so we must help protect them from dangerous situations and thus teach them family rules. Spanking is definitely not understood at this age and may be emotionally harmful.

Set limits for your child. A regular bedtime is one such goal. When your child is approaching a dangerous situation, a loud “NO” and removal from the immediate area are preferable over spanking or scolding. If your child continues to do what you asked him or her not to do, put your child in the playpen for one minute without any toys or attention from you.

Your child may resent and protest your actions. Praise your child by smiling and giving your attention when he or she does things you like. Be Consistent - Avoid situations that lead to conflict. For example, remove breakable or valuable objects from your child’s reach instead of constantly saying “No.”

Safety

Hundreds of children younger than 1 year old die every year in the U.S. because of injuries, most of which are preventable. Often injuries happen because parents are not aware of what their children are capable of doing. Your child is a fast learner and will suddenly be able to crawl and stand. Your child may climb before walking or grasp at almost anything and reach things they could not reach before. No matter how safe we think we have made our homes, babies need constant watching. The safest place for a child is in the crib with the side rails up or in a playpen when the parents are busy.

Preventing Falls & Related Injuries. Remove breakable or valuable objects from low tables and shelves, and remove sharp-edged or hard furniture from the room where your child plays. Do not use a baby walker. Use gates on stairways and doors. Install operable window guards on all windows above the first floor.

Preventing Choking. Your child will explore the world by putting anything and everything into his or her mouth. Never leave small objects or balloons within your child’s reach. Choose toys carefully. Avoid toys with small or removable parts that can be swallowed. Be prepared if your child starts to choke. Learn how to save the life of a choking child.

Poison Safety. Keep all detergents, soaps, household cleaners, medicines, and poisons out of reach and locked in cabinets. Also, remove plants from your child’s reach. Syrup of ipecac, which you can buy without prescription at your drugstore, is NO LONGER RECOMMENDED. If you are concerned that your child has ingested poison, call the American Association of Poison Control Centers at 800.222.1212.

Preventing Burns. To avoid scalding, set your hot water heater at no more than 120°F. Do not leave your child alone in the tub. Your child could turn on the hot water faucet or drown. Do not carry your child around when you have a hot drink in your hand. Be sure to keep hot foods and liquids off tables and counters where your child may be pulling to stand. Turn handles of skillets away from the stove’s edge. Cover electrical outlets or place large pieces of furniture in front of them. Remove all tablecloths and dangling electrical cords from your child’s reach (e.g., cords on coffeepots, irons, and kitchen appliances). Test the batteries on your smoke alarm often and change them at least twice a year on a date that you will remember. Enclose space heaters with protective fences.

Car Safety. Because motor vehicle accidents are the number one killer of children ages 1 - 14, it is important to transport children in the safest way possible. This sobering statistic reminds us that even if you are a careful driver, you cannot eliminate the possibility of an auto accident. Child safety seats are made to properly restrain a child in the safest way possible. Below are some of the most common car safety tips:

• Select a car seat based on your child’s age and size, choose a seat that fits in your vehicle and use it every time.
• Always refer to your specific car seat manufacturer’s instructions (check the height and weight limits) and read the vehicle owner’s manual on how to install the car seat using the seat belt or lower anchors and a tether, if available.
• To maximize safety, keep your child in the car seat for as long as the child fits within the manufacturer’s height and weight requirements.
• Keep your child in the back seat at least through 12 years of age.
• Never leave your child alone in the car.

Preventing Strangulation & Suffocation. Place you child’s crib away from any windows. Cords from window blinds and draperies can strangle your child. Tie them high and out of reach. Plastic wrappers and bags form a tight seal, if placed over the mouth and nose, could suffocate your child. Keep them away from your child.

Water Safety. At this age children love to play in the water. Never leave your child alone in or near a bathtub, pail of water, wading or swimming pool, or any other water, even for a moment. Drowning can happen in less than two inches of water. Empty all standing water immediately after use. If you have a swimming pool, now is the time to install a fence that separates the house from the pool. The pool should be fenced in on all four sides. Most children drown because they fall into a pool that is not fenced off from the house.

Smoking Hazards. Do not smoke around your child. Smoking can cause increased risk of respiratory infections, ear infections, as well as burns for an active child. Many home fires are caused by improperly extinguished cigarettes.

Immunizations

Between 9 and 11 months there are no routine immunizations. However, the flu vaccine is recommended for everyone older than 6 months of age as soon as the vaccine becomes available, usually in September or October each year. If your child is getting a flu shot for the first time and is under 9 years of age, two injections, four weeks apart, are required.

Illnesses

We would like to see your child for the following illnesses:

• A fever over 101° F for 48 - 72 hours
• Difficulty breathing; i.e. wheezing, croup, rapid breathing
• Less than three to four wet diapers in a 24 hour period
• Your child seems unusually ill to you
• Diarrhea for more than 10 days or blood in the stool
• Cold symptoms that are not improving after 10 - 14 days

Medicines

It is best not to use over-the-counter cough and cold medicines, especially cough suppressants. It is best to use nasal saline, your bulb syringe and a cool mist humidifier for nasal congestion and/or runny noses.

Topics to Discuss with Your Pediatrician by Age

Your child's next wellness visit should occur at 12 months of age. Keep in mind these topics to discuss with your physician in your upcoming appointments.

1 Year (12 Months) Old

• Behavior
• Language development
• Safe play
• Consistent rules
• Hitting, biting
• Self-quieting

15 Months Old

• Curiosity
• Power struggles
• Negative behavior

18 Months Old

• Appropriate language
• Power struggles
• Praising positive behavior
• Night waking, night fears, nightmares