Your Baby at 12 Months:

Your baby has reached a milestone -- his or her first birthday! This is a great age. Though they may require hand holding, one year olds are beginning to walk, saying a couple of words, coming when called (sometimes). Your baby is starting to throw a ball, and cooperating with dressing (sometimes). In short, your one year old is doing more than watching or even exploring his or her environment. He or she is actively interacting with the world around them.

Caring for Your Baby:

At this age, your baby is ready to wean from the bottle to a cup. Limit his or her juice intake to no more than one cup everyday, and avoid sweetened drinks like Kool-Aid or soda. You can now change to whole milk and begin daily tooth brushing if you haven’t already. At mealtime, offer bread and a variety of adult foods. Avoid battles over particular foods. These battles may contribute to your child becoming a picky eater.

Your Baby’s Safety:

Safety continues to be an important concern at this age. One year olds have tremendous mobility with blinding speed. Stairs, cords, outlets, household supplies, even a bucket of water is a hazard to our innocent one year old. To “toddler proof” your house, imagine yourself as an innocent one year old. It is up to your imagination as a parent to avoid exposing your child to danger while trying not to hinder his or her own imagination and curiosity. Other safety tips include:

Cut the loops in mini-blind controls or curtain pulls.
Move all poison chemicals, medications, poisonous plants, and breakables out of the reach of your child.
For any poison ingestion, call Poison Control first at 1-800-222-1222. If your child is unconscious or in distress, call 911 immediately.

Disciplining your 1 year old

Even at 12 months old, your child may already need discipline. Discipline means teaching appropriate behavior with a goal of self discipline/control. It is not another word for punishment. You need to set limits for your child and communicate these limits clearly using language appropriate for his or her age. Use one or two key words for children under two and add one word to your explanation for each year of age. For example, say “Hot!” to a 1-2 year old, or “No, hot, ouch!” to a 2-3 year old child. Verbal limits should be reinforced if necessary by removing child from the dangerous or conflictual situation he is in, by picking him up and holding him, or by removing the dangerous or breakable object he wants to touch. Reinforce good behavior with praise. Always try to give your child more positive messages than negative messages to help build self-esteem. Above all, be consistent. Work together with all the adults caring for your child to set reasonable limits and enforce them consistently.

Immunizations

The immunizations your child may receive at this age have been discussed. By now you have read the information about them that we have supplied you. Most babies do not have a reaction to these immunizations. If there is a reaction, most likely it is a slight fever or fussiness. You may give your baby Tylenol or other acetaminophen products for these symptoms. If you feel the Tylenol has not helped or you are concerned about other symptoms let us know. If your baby’s temperature exceeds 104 degrees F. rectally, let us know.

Your Next Appointment:

Your baby’s next appointment will be at 15 months. We will continue to evaluate your baby’s development and discuss additional information. He or she will also be due for the next round of immunizations at that time. Also, let us know if there are any risk factors for tuberculosis including family members with a positive skin test, travel, or exposure to someone with a chronic cough. If so, a TB skin test may be required.

Preventing Unnecessary Use of Antibiotics

Antibiotics are strong medicines that can kill bacteria. They have saved many lives and prevented many serious complications. However, antibiotics have no impact on viral infections. One of the more important decisions made daily by every physician is whether a child’s infection is viral or bacterial. Parents can learn to make some of these decisions themselves.

Viral Infections:
Viruses cause most infections in children. These include:

All colds
All cases of croup
Most (99%) coughs
Most (95%) fevers
Most (90%) sore throats
Ninety-nine percent of diarrhea and vomiting

Bacterial Infections:
Bacterial infections are much less common than viral infections. Bacteria cause:

Most ear infections
Most sinus infections
Ten percent of sore throats (strep throat)
Whooping cough (pertussis)
Some pneumonia (lung infection)

Some symptoms are overrated as indicators of a bacterial infection. Yellow nasal discharge is more likely to be a normal part of the recovery from a cold than a clue to a sinus infection. Yellow phlegm (sputum) is a normal part of a viral tracheitis or bronchitis, not a sign of pneumonia. High fevers can be due to a virus or bacteria.

Prevention of Bacterial Infections
Another false belief is that children with colds need antibiotics to prevent ear or sinus infections. In some cases the antibiotic does work, but in most cases the antibiotic just selects out a resistant germ to cause a secondary bacterial infection. It’s smarter to save the antibiotic for those children who go on to develop a bacterial infection. After a cold, about 10% of children develop an ear infection (otitis media) and 1% develops a sinus infection (sinusitis). Why give antibiotics to the other 89% who don’t need them?

Bacterial Resistance
When bacteria become resistant to an antibiotic, that antibiotic can no longer kill that type of bacteria. Excessive use of antibiotics is the number one cause of resistant strains of bacteria, and research shows that 50% of prescriptions for antibiotics are inappropriate (mainly when they are given for coughs and colds). This makes future treatment of bacterial infections more difficult. Many bacteria are now resistant to antibiotics that used to control them. When we turn to newer and more expensive antibiotic, bacteria develop resistance to them as well. In the battle between antibiotics and bacteria, the bacteria seem to be winning.

Side Effects of Antibiotics
If your child doesn’t need an antibiotic, giving him or her one is a bad idea, because all antibiotics have side effects. Some children taking antibiotics develop diarrhea, nausea, vomiting, or a rash. If a rash occurs, we are left with the difficult question: is it a drug allergy or an unrelated viral rash (such as roseola)? Since it’s difficult to be sure, many children are mislabeled as allergic to a family of antibiotics, and a potentially useful antibiotic is not available when the child really needs it.

Summary
Most illnesses in children are viral and will not respond to antibiotics. If your child has a viral illness, an antibiotic will not shorten the course of the fever or help the other symptoms. If your child develops side effects from the antibiotic, he or she will feel worse instead of better.

Let us save antibiotics for ear infections, sinus infections, strep throat, and other bacterial infections. Let us not waste them on yellow nasal discharge, yellow phlegm, high fevers, and other normal symptoms associated with coughs and colds. Treat your child’s symptoms with over-the-counter medicines or home remedies. Many just need extra tender loving care until they feel better. Call back if your child develops any new symptoms or worsens. Usually antibiotics are not the answer when your child becomes sick.

Adapted from Instructions for Pediatric Patients, 2nd edition, 1999 by WB Saunders Company. Written by Barton Schmitt, M.D., pediatrician.

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