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Medical Care and Your 8- to 12-month-old

As your baby becomes more independent and mobile, your questions for your child's doctor may have more to do with bumps, bruises, and behavior than with anything else. You can't protect your baby from every knee-bump suffered while learning to walk or finger-pinch received while investigating her room. But you can make sure poisons and medicines are kept where she can't possibly get to them, and you can try to give her a safe environment in which to satisfy her budding curiosity about the world around her.

Your baby is probably hearing "no" a lot these days as she explores boundaries; you'll hear that word from her a lot later on. It's your job to remain consistent but loving while teaching her the difference between acceptable and unacceptable behavior. Although you may have depended on your child's doctor primarily for medical advice until this point, he or she is also a wealth of information on the emotional and social aspects of childhood.

When Will We See the Doctor?
Doctors often have their own schedules for well-baby visits, but most will generally see a baby twice during this stage, once at 9 months and again at 12 months. If you have missed any immunizations, or if a problem has been detected that needs special attention, additional visits may be scheduled during this time.

What Will Happen During the Office Visit?
The well-baby visits at 9 and 12 months are pretty similar to the exams that have taken place so far, although your discussions with your child's doctor about behavior and habits may become more detailed as your baby becomes more mobile and independent.

You can expect these common procedures and questions:

• Measurement of your baby's length, weight, and head circumference. Her growth will be plotted on her own growth chart, and you will be advised of her progress.
• A physical examination checking for normal function of the eyes, ears, heart, abdomen, hands and feet, reflexes, etc. The doctor may check your baby's soft spot. The soft spot may be closed or much smaller (the size of a fingertip). The doctor will check your baby's mouth for new teeth and signs for the appearance of others to come.
• A review of your baby's physical and emotional development through both observation and your report of her progress. Can she sit on her own by now? Do you discover her pulling up on things to stand? Does she recognize her own name and the names of other family members? Does she enjoy interacting with you through games like "peekaboo"? Your doctor may ask you these questions and others.
• You may be asked how you are doing with your baby and how the rest of the family is functioning. Your child's doctor may go over safety questions with you: have you babyproofed your home? Is your baby in an appropriate car seat while riding in the car?
• A discussion of your baby's eating habits. Is she eating more table foods? Is she interested in finger foods on the tray of her highchair? Can she use a cup? Is she being weaned from the breast or bottle? Most doctors advise a switch from bottle to cup by the first birthday or before to be sure the bottle doesn't interfere with normal tooth development, and to avoid a struggle with a determined toddler later on. By 1 year, most babies can be given foods that were off-limits before, such as cow's milk, citrus fruits, and eggs. Your doctor can discuss these additions to your baby's diet with you.
• Advice on what to expect in the coming months.
• Your baby will receive immunizations during some visits (see below).

It is recommended that babies at about 1 year of age undergo a tuberculin skin test, especially those at risk for tuberculosis. You'll be given instructions on how to monitor the test and report results to the doctor's office. Discuss possible vaccine reactions with your child's doctor, and get advice on when to call with unusual problems.

Bring to your child's appointments any questions or concerns you may have at this time. Make sure to write down any specific instructions the doctor gives you regarding special baby care. Keep updating your child's permanent medical record, listing information on her growth and problems or illnesses.

What Immunizations Will My Baby Receive?
If your baby missed immunizations at previous visits because of illness or scheduling problems, she will probably be brought up-to-date during this stage. Because she is becoming more and more mobile and is coming in contact with other children more often, you'll want to make sure her immunizations are given as close to the recommended times as possible. This is especially true if she goes out of your home for child care.

Because more immunizations than ever (20 injections, or shots) are being given to children before the age of 2 years, doctors are spacing vaccinations so that infants will not need more than three to four shots per well-baby visit.

From the Recommended Childhood Immunization Schedule of the American Academy of Pediatrics:

• At your baby's 12-month visit, he or she may receive his or her first measles, mumps, and rubella (MMR) vaccine (it can be given between 12 and 15 months of age).
• The varicella (chickenpox) vaccine is currently given as a single injection between 12 and 18 months of age.
• The fourth pneumococcal conjugate vaccine (PCV) is given between 12 and 15 months of age.
• The fourth Haemophilus influenzae type B (Hib) vaccine is given between 12 and 15 months of age.

Your baby may also receive:

• the third hepatitis B vaccine (Hep B), which can be given at any time during 6 to 18 months of age
• the third polio vaccine (IPV), which can be given at any time during 6 to 18 months of age

The schedule of these immunizations can vary depending on what combined vaccines your doctor uses.

When Should I Call the Doctor?

You should feel comfortable enough with your baby's doctor to call with questions and concerns that can't wait until the next scheduled visit. If you have questions that can wait until the next visit, write them down so you don't forget. Of course, call your child's doctor immediately if your child has an injury or illness that needs attention.

Call your child's doctor right away if your baby seems especially sluggish, is refusing food or drink, is vomiting or has diarrhea, or has a temperature of 102 degrees Fahrenheit or higher.

At this age, developmental delays may cause concern, so contact your child's doctor if you suspect your child is not developing within the range of normal. Each child has their own timetable for crawling, talking, and walking, so keep that in mind when checking for these signs of developmental progress by your child's first birthday. Make sure your child:

• has said a first single word (mama, dada)
• uses gestures (waves bye-bye, shakes head no)
• responds to familiar pictures or toys
• stands when supported and pulls up on things to stand

Again, the absence of any of these signs may or may not be cause for concern. Share them with your baby's doctor. Problems caught early can be treated more successfully.