What to Expect the First Year (28 page)

BOOK: What to Expect the First Year
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Some babies will be able to …

• Stand alone momentarily

• Stand alone well

• Say “dada” or “mama” with meaning

• Say one word other than “mama” or “dada”

• Point to something to get needs met

A few babies will be able to …

• Indicate wants in ways other than crying

• Drink from a cup independently

• Play ball (roll ball back to you)

• Pick up a tiny object neatly with tips of thumb and forefinger (keep all dangerous objects out of baby's reach)

• Use immature jargoning (gibberish that sounds as if baby is talking in a made-up foreign language)

• Respond to a one-step command with gestures (“Give that to me,” said with hand out)

• Walk well

10 to 11 Months

Most babies will probably be able to …

• Pick up a tiny object with thumb and finger (as always, make sure dangerous objects stay out of baby's reach)

• Understand “no” (but not always obey it)

• Look at what you're pointing at and then look back at you with a reaction

Half of all babies will be able to …

• Walk holding on to furniture (cruise)

• Point or gesture to something to get needs met

• Clap hands or wave bye-bye

• Drink from a cup independently

Some babies will be able to …

• Stand alone momentarily

• Say “dada” or “mama” with meaning

• Say one word other than “mama” or “dada”

• Respond to a one-step command without gestures (“Give that to me,” said without hand out)

A few babies will be able to …

• Stand alone well

• Walk well

• Play ball (roll ball back to you)

• Use immature jargoning (gibberish that sounds as if baby is talking a made-up foreign language)

• Say three or more words other than “mama” or “dada”

11 to 12 Months

Most babies will probably be able to …

• Walk holding on to furniture (cruise)

• Use a few gestures to get needs met—pointing, showing, reaching, waving

• Respond to name when called

• Drink from cup with help

• Bang two blocks or other toys together

• Cooperate with dressing by offering a foot or arm

• Raise arms when want to be picked up

Half of all babies will be able to …

• Clap hands or wave bye-bye (most children accomplish these feats by 13 months)

• Drink from a cup independently (assuming baby has been given practice)

• Pick up a tiny object neatly with tips of thumb and forefinger (many babies do not accomplish this until nearly 15 months—continue to keep all dangerous objects out of baby's reach)

• Stand alone momentarily (many don't accomplish this until 13 months)

• Say “dada” or “mama” with meaning (most will say at least one of these by 14 months)

• Say one word other than “mama” or “dada” (many won't say their first word until 14 months or later)

• Copy sounds and gestures you make

Some babies will be able to …

• Play ball (roll a ball back to you, though many don't accomplish this feat until 16 months)

• Stand alone well (many don't reach this point until 14 months)

• Use immature jargoning—gibberish that sounds like a foreign language (half of all babies don't start jargoning until after their first birthday, and many not until they are 15 months old)

• Walk well (three out of four babies don't walk well until 13½ months, and many not until considerably later. Good crawlers may be slower to walk and when other development is normal, late walking is rarely a cause for concern)

• Respond to music with body motion

A few babies will be able to …

• Say three words or more other than “mama” or “dada” (a good half of all babies won't reach this stage until 13 months, and many not until 16 months)

• Respond to a one-step command without gestures (“Give that to me,” said without hand out; most children won't reach this stage until after their first birthday, many not until after 16 months)

• Respond to another person's upset by becoming upset (beginnings of empathy)

• Show affection, particularly to mommy and daddy

• Show stranger and/or separation anxiety (some children never will)

Growth Charts

How does your baby's growth measure up? By plotting measurements of length, weight, and head circumference at each well-baby visit, the doctor can see how your baby stacks up percentage-wise against other babies of the same age and gender.

More important, tracking growth allows the doctor to compare your baby against him- or herself and follow your baby's growth trends over time—a more important measure than which particular percentile he or she falls into at a given time. For instance, if your little one has been consistently hovering around the 15th percentile month after month, he or she may be destined to be on the small side (or may be destined to have a dramatic growth spurt later on in childhood). On the other hand, if your baby has been in the 60th percentile for months and then abruptly dips to the 15th percentile, that sudden deviation from the usual growth pattern might raise questions: Is baby sick? Getting enough to eat? Is there some underlying medical reason for the sudden growth slow-down?

Assessing how your baby grows isn't just a simple numbers game. To get a really clear picture of growth, the doctor will also consider the relationship between weight and length. While the percentiles for length and weight don't have to match up precisely, they should be within a 10 to 20 percent range of each other. If length is 85th percentile but weight is 15th percentile, your baby might be underweight. The other way around? Your baby may be overfed. Figuring out whether your little one is overweight, underweight, or more likely, just right becomes easier when you plot your infant's progress on the length/weight charts used by most pediatricians. The charts that follow, which come from the World Health Organization (WHO), are based on the growth of almost 19,000 breastfed babies (in five cities in five different countries who grew up in optimal living conditions). Both the CDC and the AAP recommend that doctors use the WHO charts for babies under age 2.

These days more and more babies are measuring either above or below
standard length and weight ranges. In other words, they're “off the charts”—or hovering very closely to its edges. Experts say the number of extra-large babies is due to rising obesity rates (obese or overweight expectant moms are more likely to have babies who are considered overweight), while the number of undersize babies is a result of the increasing number of premature infants who are born tiny and survive. Formula-fed infants are also more likely to be overweight.

You can plot your baby's progress on these charts. Notice that one set of the charts that follow calculates the relationship between weight and length (plus records head circumference), and the other keeps track of weight and length separately. There are also separate charts for boys and girls. That's because even at this age, boys tend to be taller, heavier, and grow faster than girls do.

The print edition of this book includes
Growth Charts
.
Please download a PDF of the charts here:
workman.com/ebookdownloads

Chapter 5
Your Newborn

The long wait is over. Your baby—the little person you've been eagerly expecting for 9 months—is finally here. As you hold this tiny, warm, sweet-smelling bundle in your arms for the first time, you're bound to be flooded by 1,001 emotions, ranging from over-the-moon thrilled to over-the-top nervous. And, especially if you're a first-time parent, by at least 1,001 questions, ranging from … well … you name it. Why is her head such a funny shape? Why does he have acne already? Why can't I get her to stay awake long enough to breastfeed? Why won't he stop crying?

As you search around for the operating instructions (don't babies come with them?), here's something you need to know: Yes, you've got a lot to learn (after all, nobody's born knowing how to bathe a slippery baby or massage a clogged tear duct), but give yourself half a chance and you'll be surprised to find how much of this parenting thing actually comes naturally (including the most important operating instruction of all: Love your baby). So find the answers to your questions in the chapters that follow, but as you do, don't forget to tap into your most valuable resource: your own instincts.

Your Baby's First Moments

You've labored and pushed, and you're finally meeting your new bundle of joy face-to-face. Once the initial meet-and-greet is over, baby will need to be checked over. You can expect that a doctor, midwife, or nurse will do some or all of the following:

• Clear baby's airways by suctioning his or her nose (which may be done as soon as the head appears or after the rest of baby is delivered).

• Clamp the umbilical cord in two places and cut between the two clamps—although dad may do the cutting honors. (Antibiotic ointment or an antiseptic may be applied to the cord stump, and the clamp is usually left on for at least 24 hours).

• Assign baby an Apgar score (rating of baby's condition at 1 and 5 minutes after birth,
click here
).

• Administer antibiotic ointment to baby's eyes (
click here
) to prevent infection.

• Weigh baby (average weight is 7½ pounds; 95 percent of full-term babies weigh between 5½ and 9½ pounds).

• Measure baby's length (average length is 20 inches; 95 percent of newborns are between 18 and 22 inches).

• Measure head circumference (average is 13.8 inches; normal range is from 12.9 to 14.7 inches).

• Count fingers and toes, and note if baby's body parts and features appear normal.

• Put baby on your tummy, skin-to-skin (aka kangaroo care;
click here
), for some getting-to-know-your-baby time.

• Before baby leaves the delivery or birthing room, place ID bands on baby, mom, and dad. Baby's footprints and mom's fingerprint may also be obtained for future identification purposes (the ink is washed off your baby's feet, and any residual smudges you may note are only temporary).

Delayed Cord Clamping

Cutting the cord is a momentous moment for new parents, but one you're probably best off waiting on—at least for a few more moments. Studies show that the optimal time to clamp (and then cut) the cord is when it stops pulsating—around 1 to 3 minutes after birth—instead of the immediate clamping and cutting that was once done routinely (and still is sometimes done). There seem to be no drawbacks and many potential benefits to delaying cord clamping—a good reason to consider adding this protocol to your birth plan.

Planning to bank baby's cord blood? Cord blood collection can be done after the cord stops pulsating, which means that it doesn't necessarily interfere with delayed clamping. But just to be sure your practitioner's on the same page about this, talk over the plan well before your baby's arrival.

The baby's doctor (or a staff pediatrician if your chosen doctor doesn't have privileges at the hospital where you delivered) will perform a more complete examination of the new arrival sometime during the next 24 hours. Try to be on hand for this exam—it's a good time to start asking the many questions you're sure to be collecting. The doctor will check the following:

• Weight (it will probably have dropped since birth and will drop a little more in the next couple of days), head circumference (may be larger than it was at first as any molding of the head begins to round out), and length (which won't actually have changed, but might seem to have because measuring a squirmy baby isn't exactly an exact procedure)

• Heart sounds and respiration

• Internal organs, such as kidneys, liver, and spleen, examined externally by touch

• Newborn reflexes (
click here
)

• Hip rotation

• Hands, feet, arms, legs, genitals

• The umbilical stump

Testing Your Baby

A few drops of blood can go a long way. Those drops, taken routinely from babies' heels before hospital discharge, are used to test for 21 (or more) serious genetic, metabolic, hormonal, and functional disorders, including PKU, hypothyroidism, congenital adrenal hyperplasia, biotinidase deficiency, maple syrup urine disease, galactosemia, homocystinuria, medium-chain acyl-CoA dehydrogenase deficiency, and sickle-cell anemia. Though most of these conditions are very rare, they can be life-threatening if they go undetected and untreated. Testing for these and other metabolic disorders is inexpensive, and in the very unlikely event that your baby tests positive for any of them, your baby's pediatrician can verify the results and begin treatment immediately—which can make a tremendous difference in the prognosis.

Since 2009, all 50 states and the District of Columbia require newborn screening for at least 21 disorders and more than half of all states test newborns for all 29 disorders for which the American College of Medical Genetics (ACMG) recommends testing. Check with your doctor or state health department to find out what tests are done in your state. You can also look up your state's requirements at the National Newborn Screening & Genetics Resource Center (NNSGRC) website:
genes-r-us.uthscsa.edu
. If your hospital doesn't automatically provide all 29 tests, you can arrange with your doctor to have them done. For more information about newborn screening, contact the March of Dimes at
marchofdimes.com
.

The CDC also recommends, and some states require, screening tests soon after birth for congenital heart disease (CHD). This condition, which affects 1 in 100 babies, can lead to disability or death if not caught and treated early (happily, early treatment can reduce those risks significantly—and in most cases, completely). Screening for CHD is simple and painless: A sensor is placed on your baby's skin to measure your little one's pulse and the amount of oxygen in his or her blood. If the results of the screening test seem questionable, the doctors will be able to do further testing (echocardiogram—an ultrasound of the heart—for instance) to determine if anything is wrong. If your hospital doesn't routinely perform the test, ask the doctor if it could be given to your baby anyway.

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