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. But you can make sure poisons and medicines are kept where kids can't possibly get to them and provide a safe environment for exploration.

Your baby is probably hearing "no" a lot these days while exploring boundaries; soon, you'll hear that word back from your little one! Be consistent but loving while teaching the difference between acceptable and unacceptable behavior.

When Will We See the Doctor?

Your doctor will see a baby twice for routine well baby visits during this period, once at 9 months and again at 12 months.

If you have missed any immunizations, or if a problem has been found that needs special attention, additional visits may be scheduled.

What to Expect 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 doctor about behavior and habits may become more frequent.

Your baby's check up will include:

• Measurement of your baby's length, weight, and head circumference. Growth will be plotted on the growth chart and you will be advised of your little one's progress.
• A complete physical examination.
• A review of your baby's development through both observation and your report: Can your baby get into a sitting position alone? Pull up on things to stand? Pick up small objects? Say mama and dada? Enjoy games like peek-a-boo? Your doctor may ask you these questions and others.
• You may be asked how you're doing with your baby and how the rest of the family is doing. Your doctor may review safety with you: Have you babyproofed your home? Is your baby in an appropriate car seat while riding in the car?
• A discussion of eating habits: Is your baby eating more table foods? Interested in finger foods on the tray of the highchair? Able to use a cup? Being weaned from the breast or bottle? Most doctors advise a switch from bottle to cup between 12 and 18 months.
• Advice on what to expect in the coming months.
• Your baby will receive immunizations during some visits.

At 12 months, your doctor may recommend a blood test checking for anemia and lead poisoning. Depending on where they live and the potential risk of tuberculosis, sometimes babies at about 1 year of age undergo a tuberculin skin test. You'll be given instructions on how to monitor the test and asked to return to the office for the nurse or doctor to check the results of the test.

During appointments, raise any questions or concerns you have and jot down any instructions the doctor gives you about special baby care. Keep updating your child's permanent medical record, listing information on growth and any problems or illnesses.

Vaccines

Immunizations recommended may include:

• the first measles, mumps, and rubella (MMR) vaccine (given between 12-15 months of age)
• the first dose of chickenpox (varicella) vaccine, given as a single injection between 12-15 months of age
• the fourth pneumococcal conjugate vaccine, given between 12-15 months of age
• the third or fourth (Hib) vaccine (Haemophilus influenzae type B), given between 12-15 months of age, depending on the type of vaccine used
• the first dose of hepatitis A vaccine, which may be given at 12 months of age or older

Your baby also may get:

• the third hepatitis B vaccine (HBV), which can be given at any time during 6-18 months of age
• the third polio vaccine (IPV), which can be given at any time during 6-18 months of age
• the flu vaccine (given every year)
• the meningococcal vaccine for children at risk of developing meningococcal disease, which can lead to bacterial meningitis and other serious conditions

This immunization schedule can vary depending on what combined vaccines your doctor uses.

When to Call the Doctor

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

Call the doctor if your baby has a fever, is acting sick, is refusing food or drink, is vomiting, or has diarrhea.

At this age, developmental delays may cause concern. Babies follow their own timetable for crawling, talking, and walking, so keep that in mind when checking for these signs of developmental progress by the first birthday. At the 9-month visit, the doctor will give your child a screening test to help identify any delays.

By 12 months, most children:

• have said their first single word (mama, dada)
• use gestures (wave bye-bye, shake head no)
• respond to familiar pictures or toys
• stand when supported and pull up on things to stand

Talk to your doctor if you have concerns about your child's development.