We LEAP illnesses in a single bound!

We LEAP illnesses in a single bound!

For your Information:

Vaccine Information

Prevnar (Pneumococcal Vaccine)

MMR and Autism (our parent handout)

Seatbelt/Carseat Recommendations

Potty training help (and lots more)
Check out this site:
keepkidshealthy.com

Backpacks are a Pain!

US Consumer Product Information
cpsc.gov

You can also find some very good information at the Norton Children’s Hospital site

Immunization Schedule

More Information from the AAP

Printable Version

Checkup Schedule

Well Child Visit

What to expect…CHECKUPS!!

2 Weeks

FEEDING: Breastmilk and/or formula should be your child’s sole source of nutrition. We recommend feeding on demand. If formula feeding, let your baby take what he will within 20 minutes. Breastmilk may be digested rather rapidly so your baby may want to nurse frequently. About every 2-4 hours is normal. Feeding should be limited to 20-30 minutes. Offer both breasts at each feeding. Nursing mothers should drink at least 2 quarts of fluids per day. Give your baby vitamins with iron and fluoride starting at 8 weeks of age if you are breastfeeding or if you are using a “Ready to Feed” formula.

ELIMINATION: Urinary stream should be forceful. If not, bring this to our attention. Stools may vary greatly. For breastfed babies, the stools are often quite frequent, and generally mustard yellow in color with a consistency from watery to seedy to mushy. Formula fed babies have less frequent, pale yellow to light brown stools that are firmer and more odorous. Frequency may be one with every feeding to one every 2-4 days or so. As long as they are not hard or pellet-like, this is normal for both breast and formula fed babies. Contact us before attempting any treatment for hard stools.

SLEEP: Sleep requirements vary considerably. For the first few months, the average is 18-20 hours per day, and 3-5 hours between feedings. Babies learn how to fall asleep. Because of this, we recommend that you allow your baby to fall asleep in his own bed. This will avert problems in the long run.

SLEEP POSITION: The American Academy of Pediatrics now recommends placing babies on their backs to sleep. Sleeping on the belly has been linked to SIDS (Sudden Infant Death Syndrome) and since the new recommendations have been made, the incidence of SIDS has dropped significantly. Side sleeping (on the right, using a wedge) may be acceptable if your baby has reflux.

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2 Months

FEEDING: Your baby will grow well on breast milk or formula. It is too soon to begin solid foods. Continue to feed baby on demand, and keep the feeding time to 20-30 minutes total. Limit your baby to 32 ounces per day. You may give some water also, but it is not necessary. However, tap water does provide fluoride, so 2-4 ounces per day in a breastfed baby can eliminate the need for vitamins with fluoride.

ELIMINATION: Urinary stream should still be forceful. Stools may vary greatly, but as long as they are not hard or pellet-like, this is normal for both breast and formula fed babies. Contact us before attempting treatment for hard stools. Most babies strain and grunt when passing even soft stool, and this is not usually an indication of difficulty or pain. Avoid using suppositories unless directed by a physician.

SLEEP: Sleep requirements vary. Put baby to bed at a regular time each night. Some babies sleep through the night by 2 months, but most do not until they are 3-4 months old or weigh 12 pounds. Don’t awaken baby for a night feeding…let him wake you. Your baby should sleep in his own bed, preferably out of the parent’s room. This will avert many problems in the long run.

SLEEP POSITION: The American Academy of Pediatrics now recommends placing babies on their backs to sleep to reduce the risk of SIDS.

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4 Months

FEEDING: Your baby will grow well on breast milk or formula. You may start juices at this time (except citrus), but it is now recommended to limit such to one serving (2-4 ounces) per day. You may notice that your baby has become interested in noises and may jerk away from the breast or bottle in order to locate the sound. He may cry or be easily distracted at the slightest interruption. When this occurs, going to a quieter room to decrease distractions may help.

If your baby is requiring more than 32 ounces of formula per day to be satisfied, you can begin spoon feeding rice cereal. We recommend the dry cereal that you mix with water, juice, formula or breast milk. Start with one teaspoon and work up to 1- 2 Tablespoons, 2-3 times per day.

ELIMINATION: Stools may vary greatly (several per day to one every 2-4 days), but as long as they are not hard and are easily passed, this is okay. Contact us before attempting treatment for hard stools. Most babies strain and grunt when passing even soft stool, and this is not an indication of difficulty or pain. Avoid using suppositories unless directed by a physician. Keep in mind, addition of cereal to the diet will cause more formed stools.

SLEEP: Sleep requirements vary. Put baby to bed at a regular time each night. While some are sleeping through the night by now, some may not. Don’t awaken baby for a night feeding … let him wake you. Your baby should sleep in his own bed, preferably out of the parent’s room. This will avert many problems in the long run. Most still take a morning and afternoon nap.

Still place your baby on her back to sleep to start out, but if she rolls to her belly on her own, that is okay.

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6 Months

FEEDING: Now is the time to introduce your baby to solid foods, such as:
Cereals: Rice, oatmeal, barley
Fruits: Applesauce, bananas, pears, etc
Vegetables: (Yellow) carrots, squash, sweet potatoes
(Green) green beans, peas, etc

Offer solids prior to offering the breast or formula. Introduce one new food at a time at intervals of 4-5 days to allow for identification of possible food allergy or intolerance. Begin spoon feeding by gently putting food on the middle third of the tongue. Start with 1-2 teaspoonfuls and gradually increase to 1-2 Tablespoons per feeding, usually 3 times a day.

Do not mix foods by mixing with breastmilk or formula in the bottle. Formula need will decrease to 24-28 oz per day as the amount of solid food increases.

Do not put your child to bed with a bottle. This has been found to increase the incidence of ear infections and cause dental cavities and decay.

Begin to introduce your child to the sippie cup.

ELIMINATION: Stools may vary greatly as you introduce new foods.They still should be soft and easy to pass.Pear, Prune, and White grape juices may be helpful if stools become hard or pellet-like.

SLEEP: Sleep requirements vary.Put baby to bed at a regular time each night.Most are sleeping through the night. Your baby should sleep in his own bed, preferably out of the parent’s room. Put baby to sleep when awake or slightly drowsy so he will learn to fall asleep on his own.This also helps teach him that he does not need you in order to get back to sleep if he awakens during the night. This will avert many problems in the long run.

Many babies awaken 1-2 times during the night at this time.If you are certain the child is not hungry, and is safe, warm, and dry, let him cry it out and comfort himself. This could last up to 45 minutes.

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9 Months

FEEDING: We recommend that your baby stay on an iron-fortified formula until one year of age. You may begin meats now if you haven’t done so already. Begin with 1 teaspoon and gradually increase to 1-2 tablespoons per serving. You may offer ½ to 1 jar per day. We also encourage finger foods at this time. This helps develop your child’s pincer grasp.

Some suggested finger foods:

Cheerios (or Kix) Graham crackers
Scrambled Eggs Soft cheeses

Remember, AVOID PEANUTS, RAISINS, HOT DOGS, POPCORN OR RAW VEGGIES

Formula need will continue to decrease as the amount of solid food increases. Continue to encourage use of a sippie or straw cup, and consider offering formula in a cup during the day to get your child used to drinking “milk” from a cup. This makes the transition away from the bottle easier in the long run.

Do not put your child to bed with a bottle. This has been found to increase the incidence of ear infections and cause dental cavities and decay.

ELIMINATION: Stools may vary greatly as you introduce new foods. They still should be soft and easy to pass. Again, your child may have from 2-4 stools/day to one every 3-4 days.

SLEEP: Sleep requirements vary. Put baby to bed at a regular time each night. Most are sleeping 8-12 hours per night. Your baby should sleep in his own bed, preferably out of the parent’s room. Put baby to sleep when awake or slightly drowsy so he will learn to fall asleep on his own. This also helps teach him that he does not need you in order to get back to sleep if he awakens during the night. This will avert many problems in the long run.

Many babies begin to awaken 1-2 times during the night at this time. This seems to be related to separation anxiety often occurring at this age. If you are certain the child is not hungry or ill, and is safe, warm and dry, we do encourage letting him cry it out and comfort himself back to sleep. This is easier said than done, especially at 2 am! But, consistency does pay off! Holding, rocking, giving him a bottle (when he isn’t hungry) and putting him into bed with you reinforces his waking up and prolongs the experience!

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12 Months

FEEDING: Now is the time to wean your baby from formula to whole milk. The fat content is important for brain development. We do not recommend 2% milk until 18-24 months of age

Finger foods and table foods are the preferred food at this age. You will notice a tremendous decrease in your child’s food intake. This is normal…most one year olds are too busy to eat, but will do so when they are hungry. Mealtimes should be positive social experiences, where the child is learning new tastes, textures, and fine motor skills. Do not force your child to eat when he is not hungry!

Offer foods from the basic four food groups. Avoid junk foods, but encourage small, nutritious snacks between meals. Remember, still AVOID PEANUTS, RAISINS, HOT DOGS, and POPCORN.

Now is the time to make the transition away from the bottle. Most children will wean from the bottle between 10-15 months. Sippie or straw cups are recommended.

Do not put your child to bed with a bottle. This has been found to increase the incidence of ear infections and cause dental cavities and decay.

ELIMINATION: Stools continue to vary greatly as you introduce new foods. Frequency is not as important as consistency of the stool…they still should be soft and easy to pass. We do not recommend active toilet training until 18 months to 2 ½ years of age.

SLEEP: Most are sleeping 8-12 hours per night. Your baby should sleep in his own bed and bedroom. Some still nap 2x/day, but many give up the morning nap.

Many babies begin to awaken 1-2 times during the night at this time. This seems to be related to separation anxiety often occurring at this age. If you are certain the child is not hungry or ill, and is safe, warm and dry, we encourage letting him cry it out and comfort himself back to sleep. This is easier said than done, especially at 2 am! But, consistency does pay off! Holding, rocking, giving him a bottle (when he isn’t hungry) and putting him into bed with you reinforces his waking up and prolongs the experience!

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15 Months

FEEDING: Table foods are the preferred food at this age. Adjust consistency to chewing ability, and avoid foods high in fat, sugar and salt. Mealtimes should be positive social experiences, where the child is learning new tastes, textures and fine motor skills. Do not force your child to eat when he is not hungry. Also don’t be frustrated if his current preferred foods number only 3-5, and that your child may eat voraciously one day and virtually nothing the next. THIS IS NORMAL! You can give a vitamin supplement if you wish.

Your child should be drinking mainly from a cup by this time.

ELIMINATION: Stools continue to vary greatly as you introduce new foods. Frequency is not as important as consistency of the stool … they still should be soft and easy to pass. We do not recommend active toilet training until 18 months to 2 ½ years of age.

SLEEP: Sleeping needs will decrease gradually, but 8-10 hours solid is the norm for this age group. He should sleep in his own bed and bedroom. Naps vary from none to one, or even two short ones. A favorite doll or blanket may be needed as a security object, and may help him fall asleep on his own.

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18 Months

FEEDING: By now, your child should be eating most of the same foods that you are.Still avoid choking hazard foods (nuts, hard candy, popcorn, gum, raisins). Your child may still alternate between eating well one day, and being picky the next.This is still normal. The bottle should be gone by this age.

ELIMINATION: Bowel movements will vary from several per day to one every 3-4 days. Frequency is not as important as consistency of the stool…they still should be soft and easy to pass. Some children are ready to begin toilet training at this age. However, they must be able to recognize the urge to hold and to go, and be able to communicate this to the parents. Also important is that the sensation of a “dirty diaper” is recognized as negative to the child. If not, they have no real reason to want to go in the toilet. Try not to rush the process, and allow the child to watch the same sex parent use the toilet, and mimic if desired. There are numerous “potty books” that are good to add to your reading routine at this age to introduce the idea.

SLEEP: Sleeping needs will decrease gradually, but 8-10 hours solid is the norm for this age group. He should sleep in his own bed and bedroom. Naps vary from none to one, or even two short ones. A consistant bedtime routine is important. Providing time to help the child slow down is recommended an hour before bedtime. Quiet activities include: reading stories, playing in the bath, listening to music or appropriate TV. We do not recommend having a TV in the child’s bedroom.

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2 Years Old

FEEDING: Appetite and food preferences are sporadic during the toddler years. Many become picky, fussy eaters, with strong taste preferences. They may eat a lot one day, and virtually nothing the next. In general, what is eaten is much more significant than how much is consumed. Do be certain that the child is not filling up on milk or juice, blunting their natural appetite.

Mealtimes should be enjoyable rather than times for discipline or family arguments. Limit the time the toddler must sit at the table. Once they are fidgety or disruptive, they should be allowed to get down.

Offer small amounts of food. Don’t force the child to eat something they don’t want, or more than they desire. Do not give too many choices either. If the child is not hungry, that is okay, but they cannot simply eat only what they want all the time. Do not use food as reward or as a sign of approval…this contributes to overeating later in life.

A supplemental vitamin may be given if desired.

ELIMINATION: Bowel movements will vary from several per day to one every 3-4 days. Frequency is not as important as consistency of the stool…they still should be soft and easy to pass. Some children are ready to begin toilet training at this age. However, they must be able to recognize the urge to hold and to go, and be able to communicate this to the parents. Also important is that the sensation of a “dirty diaper” is recognized as negative to the child. If not, they have no real reason to want to go in the toilet. Try not to rush the process, and allow the child to watch the same sex parent use the toilet, and mimic if desired. There are numerous “potty books” that are good to add to your reading routine at this age to introduce the idea.

SLEEP: Sleeping needs will decrease gradually, but 8-10 hours solid is the norm for this age group. He should sleep in his own bed and bedroom. Naps vary from none to one, or even two short ones. A consistant bedtime routine is important. Providing time to help the child slow down is recommended an hour before bedtime. Quiet activities include: reading stories, playing in the bath, listening to music or appropriate TV. We do not recommend having a TV in the child’s bedroom.

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Kindergarten Checkup

The Kindergarten Checkup is very important for several reasons.First of all, it is a time that your child can get all the necessary immunizations to begin school. Usually this means he or she will receive at least three shots, so this may be something you will want to prepare your child for. Remember to stress that they need these shots not just to go to school but also to keep them healthy! Also, at this visit we will be doing a CBC (complete blood count) and a Urinalysis. Hearing will be checked also, and your child screened once again to assess development and school readiness. Because of a new KY law, we no longer will be screening vision at the Kindergarten check up. Bring any special school forms with you, and make sure you get a copy of the immunization certificate before you leave! We try to make this a fun visit, and also do our best to encourage excitement about starting school.If you have any special concerns, or know of anything your child is worried about that we can address, please let us know!!!!!

Adolescent Checkup

The Adolescent Checkup encompasses ages 12 to 17.  We encourage every two year checkups after the sixth grade, which works out to be ages 13, 15, 17.  If immunizations need to be updated, we will do so at these visits, but generally after the 11 year old  (sixth grade) visit your child is done with shots for awhile!

What can you and your teen expect?  Well, first off, you have your choice of either a male or a female doctor, so make sure if your child has a preference that you ask for who you want.  This isn’t always an issue, but when it is, it is nice to let your child have a choice!

We will ask many questions at this visit, including some which may require us to ask mom or dad to step out of the room.  We want your teen to feel comfortable enough to ask the questions that they may have without feeling embarrassed, “stupid”, or concerned with “getting in trouble” with their parents.  In our opinion, not asking the questions is usually a big part of the “trouble” to begin with!

Things that will be addressed include menses, diet, exercise, family history of heart problems, weight, school, safety, smoking, sex and/or sexual development, and drug usage.  If you have specific concerns, let us know and we can address them also.

Physical exam will be head to toe, and we may choose to screen vision, hearing, urine, or blood as deemed necessary or appropriate for your child.  If you have concerns about conditions that run in your family, make sure we are aware of them, so we can answers your questions!