Your Baby At 2 Months:

At 2 months old, your baby is becoming more social. He or she is now smiling at you, cooing, and recognizing you as a parent. You have noticed that your baby can now follow you with his or her eyes, and can turn his or her head from side to side. Your baby is comforted most by your body and the touch and cuddles you provide. When you hold your baby, you may have noticed that he or she conforms to the contours of your body.

Caring for Your Baby:

Your baby’s feeding pattern has most likely improved since your last visit. Feedings will average every 3 to 4 hours with longer stretches at night. You may be wondering whether or not you should introduce solid foods such as cereal. There is no nutritional need for anything other than breast milk or formula. Also, babies don’t have the desire for variety of food that we as adults do. Holding, talking, reading and singing to your baby remain the most important ways to help your child’s development.

Your Baby’s Safety:

When selecting toys for your baby, choose items that are unbreakable, without sharp edges, or with detachable parts. Be aware of the size of the toys and choose only those that are too big to swallow. Start using a play yard after three months of age as a safe place for your baby to play. Avoid the temptation to place things around your baby’s neck. An innocent looking necklace can cause severe choking. We do not advise attaching a pacifier to your baby’s clothing.

Other Safety Tips:

Do not leave your baby unattended in a location where he or she may fall, such as a counter top or changing table.
Always use a car seat.
Make sure your child sleeps on their back with a firm mattress, and without stuffed animals, pillows, fluffy blankets or comforters.
Never prop baby’s bottle or put him or her to bed with a bottle.
Set your water heater thermostat at 120 degrees F or less and always check your baby’s bath water temperature.

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 4 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.

Prevention of Potential Sleep Problems

Definition
Parents want their children to go to bed without resistance and to sleep through the night. They look forward to a time when they can again have 7 to 8 hours of uninterrupted sleep. Newborns, however, have a limit to how many hours they can go without a feeding (usually 4 or 5 hours). By 2 months of age, some 50% of bottle-fed infants can sleep through the night. By 4 months, most breast-fed infants have acquired the capacity. Most breast-fed babies can sleep through the night by 5 months of age.

Good sleep habits may not develop, however, unless you have a plan. Consider the following guidelines if you want to teach your baby that nighttime is a special time for sleeping, that his or her crib is where he or she stays at night, and that he or she can put him or herself back to sleep. It is far easier to prevent sleep problems before 6 months of age than it is to treat them later.

Newborns

Place your baby in the crib when he or she is drowsy but awake. This step is very important. Without it, the other preventive measures will fail. Your baby’s last waking memory should be of the crib, not of you or of being fed. He or she must learn to put him or herself to sleep without you. Don’t expect him or her to go to sleep as soon as you lay him or her down. It often takes 20 minutes of restlessness for a baby to go to sleep. If he or she is crying, rock him or her and cuddle him or her; but when he or she settles down, try to place him or her in the crib before he or she falls asleep. Handle naps in the same way. This is how your child will learn to put him or herself back to sleep after normal awakenings. Don’t help your infant when he or she doesn’t need any help.
Hold your baby for all fussy crying during the first 3 months. All new babies cry some during the day and night. If your baby cries excessively, the cause is probably colic. Always respond to a crying baby. Gentle rocking and cuddling seem to help the most. Babies can’t be spoiled during the first 3 or 4 months of life, but even colicky babies have a few times each day when they are drowsy and not crying. On these occasions, place the baby in her crib and let her learn to self-comfort and self-induce sleep.
Carry your baby for at least 3 hours each day when he isn’t crying. This practice will reduce fussy crying.
Do not let your baby sleep for more that 3 consecutive hours during the day. Attempt to awaken her gently and entertain her. In this way, the time when your infant sleeps the longest will occur during the night. (Note: Many newborns can sleep 5 consecutive hours and you can teach your baby to take this longer period of sleep at night.)
Keep daytime feeding intervals to at least 2 hours for newborns. More frequent daytime feedings (such as hourly) lead to frequent awakenings for small feedings at night. Crying is the only form of communication newborns have. Crying does not always mean your baby is hungry. He or she may be tired, bored, lonely, or too hot. Hold your baby at these times or put him or her to bed. Don’t let feeding become a pacifier. For every time you nurse your baby, there should be four or five times that you snuggle your baby without nursing. Don’t let him or her get into the bad habit of eating every time you hold him or her. That’s called “grazing.”
Make middle-of-the-night feedings brief and boring. You want your baby to think of nighttime as a special time for sleeping. When he or she awakens at night for feedings, don’t turn on the lights, talk or rock him or her. Feed him or her quickly and quietly. Provide extra rocking and playtime during the day. This approach will lead to longer periods of sleep at night.
Don’t awaken your infant to change diapers during the night. The exceptions to this rule are soiled diapers or times when you are treating a bad diaper rash. If you must change your child, use as little light as possible (e.g., a flashlight), do it quietly, and don’t provide any entertainment.
Don’t let your baby sleep in your bed. Once your baby is use to sleeping with you, a move to baby’s own bed will be extremely difficult. Although it’s not harmful for your child to sleep with you, you probably won’t get a restful night’s sleep. So why not teach your child to prefer his or her own bed? For the first 2 to 3 months, you can keep your baby in a crib or cradle next to your bed.
Give the last feeding at your bedtime (10 or 11 pm). Try to keep your baby awake for the 2 hours before this last feeding. Going to bed at the same time every night helps your baby develop good sleeping habits.

Two-Month-Old Babies

Move your baby’s crib to a separate room. By 3 months of age, your baby should be sleeping in a separate room. This will help parents who are light sleepers, sleep better. Also, your baby may forget that his or her parents are available if he or she can’t see them when waking. If separate rooms are impractical, at least put up a screen or cover the crib railing with a blanket so that your baby cannot see your bed
Try to delay middle-of–the night feedings. By now, your baby should be down to one feeding during the night (two for some breast-fed babies). Before preparing a bottle, try holding your baby briefly to see if that will satisfy him or her. If you must feed your baby, give 1 or 2 ounces less formula than you would during the day. If you are breast-feeding, nurse for less time at night. As your baby gets close to 4 months of age, try nursing on just one side at night. Never awaken your baby at night for a feeding except at your bedtime.

Four-Month-Old Babies

Try to discontinue the 2 am feeding before it becomes a habit. By 4 months of age, your bottle-fed baby does not need to be fed more than four times per day. Breast-fed babies do not need more than five nursing sessions per day. If you do not eliminate the night feeding at this time, it will become more difficult to stop as your child gets older. Remember to give the last feeding at 10 or 11 pm. If your child cries during the night, provide him or her with soothing words instead of with a feeding. (Note: Some breast-fed babies will continue to need to be nursed once during the night.)
Don’t allow your baby to hold the bottle or take it to bed with him or her. Babies should think that the bottle belongs to the parents. A bottle in bed leads to middle-of-the-night crying because your baby will inevitably reach for the bottle and find it empty or on the floor.
Make any middle-of-the-night contacts brief and boring. All children have four or five partial awakenings each night. They need to learn how to go back to sleep on their own at these times. If your baby cries for more than a few minutes, visit him or her but don’t turn on the light, play with him or her, or take him or her out of his crib. Comfort baby with a few soothing words and stay for less than a 1 minute. If your child is standing in the crib, don’t try to make him or her lie down. He or she can do this him or herself. If the crying continues for more than 10 minutes, calm him or her and stay in the room until baby goes to sleep. (Exceptions: You feel your baby is sick, hungry, or afraid.)

Six-Month-Old Children

Provide a friendly soft toy for your child to hold in his crib. At the age 6 months, children start to be anxious about separation from their parents. A stuffed animal, doll, or blanket can be a security object that will give comfort to your child when he or she wakes up during the night.
Leave the door open to your child’s room. Children can become frightened when they are in a closed space and are not sure that their parents are still nearby.
During the day, respond to separation fears by holding and reassuring your child. This lessens nighttime fears and is especially important for the mother who works outside the home.
For middle-of-the-night fears, make contacts prompt and reassuring. For mild nighttime fears, check on your child promptly and be reassuring, but keep the interaction as brief as possible. If your child panics when you leave or vomits with crying, stay in your child’s room until he or she is either calm or goes to sleep. Do not take him or her out of the crib but provide whatever else he or she needs for comfort, keeping the light off and talking little. At most, sit next to the crib with your hand on him or her.

One-Year-Old Children

Establish a pleasant and predictable bedtime ritual. Bedtime rituals, which can start in the early months, become very important to a child by 1 year of age. Children need a familiar routine. Both parents can be involved at bedtime, taking turns with reading or making up stories. Both parents should kiss and hug the child “good night”. Be sure that your child’s security objects are nearby. Finish the bedtime ritual before your child falls asleep.
Once put to bed, your child should stay there. Some older infants have temper tantrums at bedtime. They may protest about bedtime or even refuse to lie down. You should ignore these protests and leave the room. You can ignore any ongoing questions or demands your child makes and enforce the rule that your child can’t leave the bedroom. If your child comes out, return him or her quickly to the bedroom and avoid any conversation. If you respond to his or her protests in this way every time, he or she will learn not to try to prolong bedtime.
If your child has nightmares or bedtime fears, reassure him or her. Never ignore your child’s fears or punish him or her for having fears. Everyone has four or five dreams every night. Some of these are bad dreams. If nightmares become frequent, try to determine what might be causing them, such as something your child might have seen on television.
Don’t worry about the amount of sleep your child is getting. Different people need different amounts of sleep at different ages. The best way you can know that your child is getting enough sleep is that he or she is not tired during the day. Naps are important to young children but keep them less than 2 hours long. Children stop taking morning naps between 18 months and 2 years of age and give up their afternoon naps between 3 and 6 years of age.

These measures will calm even a severely upset infant.

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

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