Wow! Can you believe your baby is already half a year old? Little babies sure do grow up fast! What used to be a cuddly little wrapped-up bundle has now grown into a laughing, babbling, interactive baby who can roll and squirm his way around the living room floor. So much has happened over the last six months, and the next six months will bring even more exciting changes.

Here is Dr. Sears' guide to helping you understand the important aspects of this wonderful age, and what will occur at your six-month visit to the pediatrician.

• Weight gain - babies should have gained anywhere from two to four pounds over the past two months. Most babies will have doubled their birth weight by age six months.

• Length - this will fluctuate on the percentile curve, but should continue to steadily increase.

• Head circumference - typically this continues to grow consistently on a similar percentile on the growth curve. Small fluctuations are normal.

• Write baby's measurements here. Then plot them on your growth chart to view baby's growth pattern. Ask your pediatrician for a copy of baby's growth chart for you to use at home.

  Wt. ________ lb.	______ % ile
  Ht. ________ in.	______% ile
  Head circ. _______ in.	______% ile

• Head - check to make sure the soft spot is still open (although it will be smaller).

• Eyes - check to see how the pupils reflect light. You should no longer see baby ever going cross-eyed, except when staring at very close objects. Tell your doctor if you think baby seems occasionally cross-eyed in one or both eyes.

• Mouth - check to see if any teeth have erupted yet. It is normal for teeth to come in as late as one year of age.

• Ears - check for too much earwax or congestion in the ears.

• Heart - check for heart murmur and heart rate.

• Abdomen - check for enlarged organs or any abnormal masses.

• Hips - check to make sure they are properly in their sockets. Rarely, the hips can be out of joint at birth. This requires special treatment with leg braces.

• Genitals - check for normal appearance and presence of testicles. For girls, your doctor will make sure the inner labia aren't sticking together permanently. If they are, he or she may gently pull them apart.

• Feet - check for abnormal shape.

• Skin - your doctor will review any birthmarks.

• Spine - check for any abnormal curves.

• Strength - review baby's motor strength and developmental milestones (see end of article).

• Starting solid foods
  The long-awaited moment has arrived. You can now introduce solid foods to baby. Signs that baby is ready to start solids include eagerly watching you eat, reaching for your food, and able to sit erect in a high chair. If your baby is not showing this interest, then you should probably wait until she does. Not all babies are ready to eat solid foods at this age. Other signs that baby is not ready for food include strong tongue-thrust or gag reflex. If baby keeps turning her head away and pushing the spoon away, then she is clearly not ready. Trying to coax a baby to eat when she is not yet interested is a sure way to create a picky eater. On the other hand, waiting until baby is practically squirming out of her high chair and crawling across the table to get at your food can encourage baby to become a good eater. Remember, foods at this age are mainly for social and motor development, not for nutrition. Babies don't need foods nutritionally until a year of age. Some common starting foods include rice cereal, applesauce, banana, or pears. Introduce one new food every 3 to 7 days. You can use fresh fruit - it doesn't have to be actual baby food from a jar. Start off with small amounts once or twice a day. Increase this according to baby's level of interest. There is really no set amount or number of times a baby should eat. Just do what feels natural to you. Another approach to starting foods is to begin with vegetables, such as carrots, squash, or avocado. Some people feel that this way baby doesn't develop a preference to the sweeter fruits. This may be true, but no one knows for sure. You can decide.

  Click here for a full discussion on starting solids.

• Making your own baby food
  Click here for some tips on how to make homemade baby food for your little one.

• How much and how often?
  How much and how often you feed your baby is really up to you. There is no set amount that baby should eat everyday. Baby gets all the nutrition she needs from breastmilk or formula. Food is just for development, fun, and a little extra nutrition. Read your baby's mood. She may want 20 bites of a favorite food one day, and only 2 bites the next. She may enjoy sitting in the highchair many times a day to eat, or may fuss and squirm in anything you try to put her in.

• Warning - do not give baby honey until one year of age.
  This can cause infant botulism, a very serious condition. After age one, this is no longer a concern.

• Beware of constipation
  Babies often become constipated when starting solid foods. The four foods listed above can be especially constipating. If this happens, stop the foods and give baby some pureed prunes or peaches until he is more regular. Continue giving these while you slowly reintroduce the foods again. Diluted prune juice is also very effective. Click here for more on treating constipation in the beginning eater.

• Shaping young tastes
  This concept is that whatever types of foods baby becomes used to eating in the early months and years, his tastes buds will develop an affinity to such foods. But this means more than just getting your baby used to fruits and vegetables. It means getting your baby used to FRESH foods. Babies who grow up on bland, processed, jarred baby foods will likely become used to bland foods. When it comes time to explore the wide variety of flavorful foods over the years, your child’s taste buds may reject these. On the other hand, a baby who grows up enjoying real fruits and veggies that you mash or blend yourself, and who experiences the real flavor of foods, is more likely to enjoy a wide variety of flavors and textures over the years. Click here to read more about Shaping Young Tastes.

• Go organic
  I know it costs a little more, but feeding your baby organic food as much as possible is extremely important. Here is why. Babies’ brains are growing and developing rapidly in the first three years of life. These brain cells and nerves are very susceptible to injury. Non-organic fruits and veggies (or any other foods) have pesticides in them, no matter how well you scrub and cook them. Pesticides kill insects by damaging the insects’ nervous system. So what do you think pesticides do to the fragile nervous system of a developing child?

• Allergies
  Remember, if allergies (not just food allergies, but also asthma, eczema, and nasal allergies) run in your family, you should consider delaying foods until eight or nine months of age. If baby is REALLY interested, then go ahead and start now, but do not introduce new foods too quickly. Add only 3 or 4 new foods each month.

• Breastfeeding
  The American Academy of Pediatrics recommends breastfeeding for a minimum of one year. This should continue as the main ingredient in baby's diet until age one. Do not let baby slow down too much. Most babies will become more efficient at nursing, so do not be surprised if feedings are shorter than they used to be. Remember to get your DHA!

• Formula
  Continue giving baby 2 to 2 ½ ounces per pound of body weight per day. This would typically be around 32 to 40 ounces at this age. Remember, baby needs formula to be the main part of her nutrition until age one, so don't let her formula intake decrease too much as the food increases.

• Water and juice
  Water is an important part of how our bodies work. Getting baby into the habit of drinking several glasses of water each day starting at this age is very healthy. Baby does not need juice. Juice is mostly sugar and water, with a few vitamins thrown in. If you want to give baby juice, be sure to dilute it to 1/3 juice and 2/3 water (add even more water if you choose).

• What about vitamins?
  Taking a liquid multivitamin is generally not necessary. Baby gets all the vitamins she needs from your breastmilk or formula. Using a multivitamin certainly won't hurt, and it may provide a little extra nutrition for baby. If you choose to use a vitamin supplement use an over-the-counter infant liquid multivitamin such as poly-vi-sol. As previously discussed in Your One Month Old, Vitamin D supplementation is a new recommendation by the American Academy of Pediatrics. The reason for this is breast milk has very little Vitamin D, which is important for growing strong bones. My feeling, however, is babies don’t need extra Vitamin D in their diet. Baby’s own skin generates Vitamin D when sunlight shines on the skin. The main reason the AAP feels breastfed babies need a supplement is that most parents vigorously protect their baby from the sun. If baby is NEVER in the sunlight, then he or she may not produce enough Vitamin D. The logical answer is simply to allow some sunlight exposure to naturally produce Vitamin D, instead of supplementing with an artificial source. Three or four times a week, take baby on a short walk outside with the sun shining on baby’s exposed arms, legs, and head for about 15 minutes. This, along with brief sun exposure that occurs naturally on a daily basis, will allow baby to produce the Vitamin D needed to grow strong bones without harming baby’s skin.

• Adding new foods over the next two months
  After baby is used to eating the above-mentioned foods for the sixth month, you can continue to add one or two new foods each week. Some suggestions include avocados, peaches, carrots, squash, potatoes, and barley cereal. Baby can start trying soft finger foods. And remember, it doesn't have to be actual baby food. You may find your baby enjoys mashed fresh foods more.

• Keep feeding time a positive experience
  One surefire way to create a picky eater is to spend months and months coaxing bite after bite of bland, tasteless baby food into the unwilling mouth of your baby three meals a day. Taking a more relaxed approach will create a more relaxed eater. We recommend sitting baby in a highchair around the kitchen table at mealtime and start eating your own food. Let baby show you signs that he wants to be involved. Give baby one bite and watch his reaction. He may eagerly want bite after bite, or he may spit it out and refuse to eat any more. His reaction will vary according to what you are giving him and what his mood is. By watching his cues and letting him decide when to eat, you encourage his involvement in a positive feeding experience. Place only one or a few small bites in front of baby at any one sitting. Piling the food in front of baby may either turn baby off or invite a messy playtime experience. Remember, your baby doesn't need a certain amount of food to grow. He gets all the nutrition he needs from your breastmilk or formula. By keeping the early feeding months casual, you will enjoy a well-rounding positive eater in the months and years ahead.

• Teething
  Many babies will have their first teeth come in during this month. Usually the first teeth to come in are the bottom center two, followed by the top center two. Over the next several months the teeth adjacent to the center two will push through. See our discussion in "Your Four Month Old" for more on teething, or click on teething for a complete discussion. Now that baby is six-months-old, you can try ibuprofen instead of Tylenol if the Tylenol doesn't seem to work - ibuprofen isn't necessarily better, but it lasts longer. Save the medicines for nighttime though. Try not to routinely give baby medications for teething during the day.

• Night waking
  This will continue to occur as teething pain comes and goes. Click on nighttime parenting for more information, or see our discussion in "Your Four Month Old".

• Isn't my baby supposed to sleep through the night by now?
  In my experience, when it comes to sleep, there is no "supposed to" about it. Every baby is different, and has different nighttime needs and sleep patterns. Babies don't read baby books. So they don't know that they're "supposed" to do anything. I find that most babies at this age will wake up 2 or 3 times a night to feed or just to cuddle. Whoever says that babies are supposed to sleep through the night has not considered the normal sleep physiology of an infant. Every hour or two, babies enter a period of light sleep when even the slightest disturbance can wake them. During the teething stages, sore gums are sure to wake baby during this light sleep period. Adults also have light sleep stages that cause us to stir and then re-settle. Some babies need help to resettle and some don't.

  So realize that it IS NORMAL for a baby to wake up a few times during the night.

• Stranger anxiety
  Between six and nine months of age stranger anxiety may set in. This is a very normal stage that may last as short as one or two months or as long as a year or more.

• Start recruiting alternate caregivers
  During the first six months of age, most babies can be left happily with a family member or babysitter. This may change, however, over the next few months. Many babies develop stranger and separation anxiety and cry for hours if left with someone besides mom or dad. Start establishing a few friends or family members as potential babysitters. Have them come over frequently to play with you and the baby. If baby sees you interact in a very friendly and loving manner with this other potential caregiver, then she may feel more comfortable when left alone with them.

• Gross motor - rolls over easily both ways, stands briefly holding onto furniture, may sit up briefly by herself or may use arms for balance, squirms forward on tummy.

• Fine motor - reaches out precisely, grabs objects with palm, fingers and thumb, may point to objects.

• Language - babbles (ba-ba-ba-ba, ma-ma-ma-ma), experiments with different sounds.

• Social - mimics facial expressions and sounds, interacts with self in mirror.

DEVELOPMENT-PROMOTING ACTIVITIES

• Playing with blocks
• Banging toys
• Floor play
• Propping up to sit
• Peek-a-boo

AT SEVEN AND EIGHT MONTHS

• Bouncing to music
• Pat-a-cake
• Rolling balls
• Picking up small objects (supervised)
• Catching bubbles
• Placing toys just out of reach to encourage leaning forward into crawling position.

• Babyproofing
  Over the next few months, baby's mobility will increase from rolling across the floor, to crawling forward on her tummy, to eventual crawling, around nine months of age. The main thing you need to keep in mind at six months of age is that baby will start picking up any little object on the floor she can get her little fingers on. And where does everything go once she gets it in her hands? Straight into her mouth! This is a very big choking hazard. Every time you set baby down on the floor to play, take a good look around and pick up all small objects, potential choking hazards, nearby. Vacuum the floor at least twice a week. As baby becomes more mobile and begins crawling, you will need to baby proof the entire house. Click on baby proofing for a complete discussion.

• Ipecac syrup
  This is a syrup that causes your child to throw up, and can be given in the event of a poisoning accident or overdose. It used to be recommended that parents keep a bottle of this syrup on hand at home. However, in 2003 the American Academy of Pediatrics changed this policy because sometimes giving the syrup can do more harm than good. There are some types of poisonings where giving ipecac can actually be dangerous. The AAP now suggests that parents don't even keep ipecac at home. The best thing to do in the event of a poisoning or overdose is to call poison control.

• Poison Control Hotline phone number
  Have this phone number on a sticker near the phone. We recommend that if your child ever swallows any dangerous medicine or other substance, or accidentally overdoses on medicine, you should call the poison control hotline first, instead of your doctor. The poison control hotline professionals are often better trained to help you than your doctor's office staff. You can call your doctor after you have talked with poison control if you want to confirm with your doctor that the advice you were given is correct. Ask your doctor for the poison control phone number for your area. There is a national toll-free number to call that will connect you to the nearest poison control center. It is 1-800-222-1222.

• Lose the coffee table
  One of the biggest causes of bumps, bruises, and cuts on the head and face is the corner and edge of the coffee table. As baby begins to pull himself up on the couch or coffee table, he will invariably fall. Although a coffee table is great for baby's developmental learning, the risk may not be worth it. It's much safer for baby to learn to pull himself up on something soft like a couch. Consider putting the coffee table in the garage or attic for a couple of years, or attach padding to the edges and corners, and avoid one of the most common causes of ER visits for stitches.

• Sun protection
  Now that baby is six-months-old, you can safely use suntan lotion up to 30 SPF. Remember, suntan lotion is not just for a day at the beach. Apply lotion before long walks or trips to the park too. Remember, as stated above under Vitamins, baby does need some sunlight (without the protection of suntan lotion) to make Vitamin D, so don't worry about lotioning baby up for quick walks. Equally important is to get baby used to wearing a hat with a rim that covers the ears and neck. By wearing hats throughout infancy and childhood, you will save your baby's face and eyes from many years of sun damage. Click here for a full discussion.

The shots that most doctors will give at this check up are:

• DTaP - Diphtheria, Tetanus, Pertussis
• Hib - for meningitis
• Prevnar - for another form of meningitis

Click here for a full discussion on immunizations.

Flu shots for infants. Prior to 2003, flu shots were not officially recommended for infants. However, starting for the 2003/2004 flu season the Centers for Disease Control and the American Academy of Pediatrics are planning to recommend that all infants should get a flu shot to prevent any fatalities from this disease (which are extremely rare). If your infant is between 6 months and 24 months of age at the start of flu season (November) you can get him a flu shot.

• Roseola - this harmless and untreatable virus is probably the most common cause of fever with no other symptoms during the first years of life. If your baby gets a fever for a few days, and a red lacy rash appears on the head, neck and trunk on the fourth day, then this is probably Roseola. Click here for more info.

• Rashes - your infant can get a variety of different rashes during the first years of life. Most of them are harmless. Click here to figure out what's causing your baby's rash.

• Ear infections - unfortunately, along with colds and coughs occasionally come ear infections. It is often hard to tell if your baby is fussy just because he has a cold, or because he has an ear infection. Click here to read more about how to recognize the symptoms of ear infections and how to decide if you need to see your doctor.

• Drool rash on the face - this ever-present rash may plague your baby's beautiful face for many months as teething comes and goes. Click here to read how to identify and minimize facial rashes.

• Croup - this viral illness causes a cough that sounds like a seal barking, fever, labored raspy breathing, and a hoarse voice. Click here to read more.

Your next doctor's visit is at nine months of age.

Dr. Sears' Virtual Office Visits are intended for educational purposes only. They contain general information on infant and childcare that may not specifically apply to each individual child. They are not intended to replace the valuable checkups that your child's pediatrician provides. If any medical information in the Dr. Sears Virtual Office Visits conflicts with the medical information your own doctor provides you, we urge you to discuss such discrepancies with your doctor and follow your doctor's advice.