Months 4-5-6


Help Baby to Be a Good Communicator

 Enjoying language not only helps baby learn to communicate better, it also helps you to communicate better with your baby.

The naming game. By four months, most babies respond consistently to their names. Baby will also notice words that obviously refer only to him, such as cutie, sweetie or pum'kin. Baby also recognizes the unique tone of voice you reserve for him.

Matching. Engage baby in face-to-face dialogue. Start with an open-mouthed, wide-eyed, expressive "ah." Wait for baby to mimic the sound. Then slowly circle your lips down into the "oh" sound and see if baby matches the sound. Baby's ability to match your sounds indicates that speech is an intelligent activity that your baby recognizes and voluntarily attempts to reproduce. 		NEWSLETTER
Table of Contents

Help Baby to Be a Good Communicator

What Your Baby May Be Doing.

Baby's Checkups

Keeping Baby Safe

Common Concerns

Home-Prepared Baby Foods

Playing - Baby's Social Skills

Support Groups
Labeling. Give names to familiar toys,
  persons, or pets. Start with one-syllable
    words such as "mom," "dad," "dog," or
      "ball." Notice what baby is looking at. If it
      is the family dog, move your eyes slowly
    toward the dog, allowing baby to follow your
    eyes. When you are both looking at the dog,
      point and say "dog!" in a very excited tone.
      Baby will most likely not make the
    connection to the dog without your pointing
  gesture and saying "dog." In the next development stage,
from six to nine months, baby may turn and point toward the dog as it walks by with no cues from you other than your saying the word "dog." If baby expresses interest in the dog, such as gazing at him while he is walking by, say, "There's a dog!" Learning initiated by baby is more likely to be remembered. After many repetitions of this response, baby will look to you for a verbal response the next time the dog walks by.

Echoing. Another way to capitalize on baby's initiated language is to echo his sounds back to him. Mimicking his sounds reinforces that you hear what he says and are interested in his sounds-therefore, in him.

Take turns. Dialogue has a rhythm of listening and responding. Try to develop rhythm in your conversation with baby. Encouraging him to listen is important, and taking turns in conversation fosters attentive stillness, also important in learning language.

Mutual gazing. Watch baby orient his head toward yours, smile, wiggle, vocalize and, with these cues, invite social exchange. Baby is now able to initiate, maintain, or stop a social interaction by simply moving his head. Mutual gazing is a potent interpersonal magnet. Babies often outlast their caregivers at the blinking game, focusing their eyes much longer than the adult.

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What Your Baby May Be Doing
By the end
of Month 		your baby should be able to... your baby may be able to...
4
  • on stomach, lift head 90 degrees
  • laugh out loud
  • follow an object in an arc about 6 inches above the face for 180 degrees
  • hold steady when upright
  • reach for an object
  • grasp a rattle held to backs or tips of fingers
5
  • hold steady when upright
  • on stomach, raise chest, supported by arms
  • roll over
  • pay attention to a raisin or other very small object
  • squeal in delight
  • reach for an object
  • smile spontaneously
  • grasp a rattle held to backs or tips of fingers
  • razz (make a wet, razzing sound)
  • keep head level with body when pulling to sitting
6
  • keep head level with body when pulled to sitting
  • say "ah-goo" or similar vowel-consonant combinations
  • bear some weight on legs when held upright
  • sit without support
Please Note:  premature infants generally reach milestones later than others of the same birth age.

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What you can expect at baby's checkups
Your baby will receive a checkup at four months and again at six months. In addition to the basic questions regarding baby's behavior, eating, sleeping and general progress, the physician will do a basic physical examination and developmental assessment. (See Recommended Immunization Schedule in issue one).

During baby's six-month checkup, baby will receive his third round of immunizations. Your doctor will discuss any concerns regarding baby's behavior, eating, sleeping, and general progress with you.

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Keeping Baby Safe
Observe the following safety tips when using a high chair, stroller, or playpen:

High Chair Safety
  • Position chair away from hazards such as stoves, windows, dangling drapery cords and shelves.
  • Use the safety belt attached to the chair. Don't depend on the tray to restrain baby.
  • Be sure the tray is properly latched on both sides, as babies tend to push against the tray when seated.
  • Do not allow baby to stand in the chair.
  • The chair should have wide base for stability, otherwise it may topple over when baby tries to climb into it.
  • Periodically check for splinters, loose screws, and a wobbly base.
Stroller Safety
  • Choose a stroller with a wide base and rear wheels well behind the weight of the baby, so it will not tip when baby leans over to the side or rocks backward.
  • If the stroller adjusts to a reclining position, be sure it will not tip backward when baby is lying down.
  • Test the brakes. Brakes on two wheels are safer than on one.
  • Be sure that latching devices fasten securely. Latches can be accidentally tripped, causing a stroller to collapse.
  • Periodically check for loose nuts and bolts, sharp edges, and unsafe wheels.
Playpen Safety
  • If using a wooden playpen, make sure the bars are not so widely spaced that baby's head could get stuck. The same slat safety applies to playpens as to cribs (bars no more than 2-3/8 inches or six centimeters apart).
  • If using a mesh playpen, check that the netting is small enough that it cannot catch the buttons on a child's clothing. Avoid mesh with large openings which make easy toeholds for climbing.
  • Never leave a child in a mesh playpen with the side down. Baby can become trapped and can strangle in the pocket of mesh between the floor of the playpen and the lowered side.
  • Avoid dangling strings from the side of the playpen.
  • Remove large toys, boxes, or blocks that can be used as steps for climbing out.
  • Cover exposed nuts and bolts.
  • Secure latching mechanisms that may act like a scissors and pinch baby's fingers.
Safe Toys
  • Before buying a toy, check to make sure it has no small parts that could cause baby to choke (e.g., doll shoes, buttons, beads, squeaker buttons in squeak toys, toys stuffed with small pellets). Testing tubes for checking toy size are available at toy stores. If the part fits through the tube, it can enter baby's airway.
  • Make sure toy has no sharp edges or splinters; inspect frequently for loose parts. Safe toys can become worn and parts can become loose and unsafe.
  • Avoid toys with dangling strings longer than 8 inches, or remove the strings.
  • Make sure unsafe toys are out of reach (balloons, beads, Legos).
  • Make sure toys fit baby's stage of development and temperament. If baby is a thrower, get cloth or foam toys.
  • Be careful of crib toys that are fastened between two side rails and hang over the side of the crib. These should be removed when baby is old enough to push up on hands and knees.
  • Throw away plastic wrapping as quickly as possible when unpacking toys. Babies love to play with this type of wrapping and may suffocate.
  • Store toys properly. Avoid toy chests with attached lids that fall and cause injury or strangulation. Hinged lids should stay open by themselves without propping. Shelves are much safer than toy boxes and teach the child a sense of order.

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You may be concerned about...
Teething
Teething seldom causes trouble in babies under four months. There is no set dates for cutting teeth. When a tooth is nearly due, it is still unlikely to cause anything more notable than a slightly inflamed gum, a bit of drooling, and a lot of chewing. The first teeth are cut very easily. It is the first molars, cut at around a year, which can announce their arrival with real pain.

Teething cannot cause fever, diarrhea, vomiting, loss of appetite, convulsions, or "fits." So if your baby exhibits any of these symptoms, consult the doctor. If the baby seems well, all you need to do is wipe the dribble off his chin so that the continual wetness does not make it sore. Give baby a hard teething biscuit or teething ring if he seems to want to bite a lot.

Rubbing the gums with your finger will probably help ease baby's discomfort, or purchase a teething ring that can be kept in the refrigerator. The coolness can be very soothing on baby's tender gums.

When should you introduce solid foods?
You and your baby are comfortable with breast-feeding or bottle-feeding, and baby seems to be getting enough to eat. So when do you introduce solid foods? Baby's tongue movements and swallowing skills are the first clues to delaying solid foods. In the early months, babies have a tongue-thrust reflex that causes the tongue to automatically protrude outward when any foreign substance is placed upon it.
This may be a protective reflex against choking on solids given too early. Between four and six months, baby's tongue-thrust reflex diminishes. However, coordination of tongue and swallowing movements does not appear before four months.

Baby's digestive tract is not designed for early solids, nor are his intestines equipped to handle a variety of foods until around four to six months when many digestive enzymes seem to click in. Pediatric allergists discourage early introduction of foods, especially if there is a strong family history of food allergies. As the intestines mature, they become more nutritionally selective, filtering out offending food allergens. Babies whose systems tend to be allergy prone actually show delayed willingness to accept solids-a built-in self-protective mechanism.

Baby will let you know when he or she is ready for solids. He may start begging (reaching for your food on your plate or grabbing your spoon, or opening his mouth wide when you open your mouth to eat). However, sometimes babies are more interested in the utensils than the actual food. If your baby shows interest in watching you eat, try offering him just a spoon to play with. If baby is satisfied, then the toy is desired more than the food. When baby shows a continued interest in food, then it is time to begin. Baby's ability to sit in a high chair and pick up food with his thumb and forefinger are other signs he is ready for solids.

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Home-Prepared Baby Foods
If you have the time, energy, and the motivation, you might want to make your own baby foods. Here are some suggestions while preparing baby's food:
  • When introducing a new food, prepare and serve it without any other ingredients.
  • Don't add sugar or salt. If you're cooking for the whole family, remove baby's portion before adding salt and spices.
  • Don't add fat to baby's food, either in cooking or at the table.
  • Don't cook in copper pots, as this may destroy vitamin C.
  • Don't cook acidic foods (such as tomatoes) in aluminum, since this can cause small quantities of aluminum to dissolve and be absorbed into the food.
  • Steam, pressure cook, or waterless-cook vegetables, exposing them to a minimum of light, air, heat, and water.
  • Boil, microwave, or bake potatoes in their skins and peel after cooking.
  • Never add baking soda; it may preserve color, but depletes vitamins and minerals.
  • Don't soak or boil dried legumes (peas or beans) overnight; bring to a full boil, boil for two minutes, then let them stand for an hour, and cook in the soaking water.
  • Peel vegetables and fruit, when possible, unless certified organically grown.
  • Wash fruits and vegetables you don't peel in dish detergent and water, scrubbing with a stiff brush when practical. Rinse well to remove all traces of detergent.
  • Prepare a batch of carrots, peas or other vegetables, then freeze in ice cube trays. Keep individual cubes stored in airtight freezer bags. Before being used, thaw in the refrigerator, in a double boiler, in a microwave, or under cold water-not at room temperature.

Age Food Sequence Food Presentation Developmental Skills
Implications for Feeding
Birth to
6 months
  • Breast milk and/or iron-fortified formula satisfies all nutritional requirements
  • Solid foods not nutritionally needed, but infant may want (i.e., teething biscuits)
  • Breast and/or bottle
  • Designed to suck, not chew
  • Rooting reflex; searches for food source
  • Tongue-thrust reflex pushes out solid foods
  • Sensitive gag reflex
6 months
  • Starter foods: bananas, pears, rice cereal, applesauce
  • Strained, pureed
  • Fingertipful, spoonful
  • Tongue-thrust and gag reflexes lessen; accepts solids
  • Sits erect in high chair
  • Begins teething
7 to 9
months
  • Avocados, mashed potatoes, peaches, carrots, squash, barley cereal, teething biscuits, pear and apple juice
  • May drink from cup
  • Finger foods
  • Pureed and mashed foods
  • Holds bottle
  • Thumb-and-forefinger pick-up begins
  • Fascinatiokn with tiny food morsels
  • Begins mouthing chokable food, objects
  • Bangs, drops, flings
  • Reaches for food and utensils
  • Munches food
9 to 12
months
  • Lamb, veal, poultry, bagel, rice cakes, egg yolk, cheese, yogurt, tofu, noodles, beans, peas, yams, oatmeal
  • Lumpier consistency
  • Finger food mastered
  • Bite-sized cooked vegetables
  • Holds training cup
  • Self-feeding skills improve
  • Holds bottle and cup longer
  • Points and pokes, smears, enjoys mess
  • High chair gymnastics increase
  • Tries to use utensils, spills most

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Playing - Baby's Social Skills
During the fourth through sixth months, baby's social, motor, and language skills blossom. Approximately in the fourth month, baby will begin to use both eyes together, giving him better depth perception-the ability to judge the distance between his eyes and the things he sees. The development of long-range vision is a prelude to an important hand-eye skill-visually directed reaching, meaning the eyes lead the hands to accurately grab the desired object or person. Watch your baby's eyes follow his hands as he reaches for a toy. It seems as if his hands and eyes are finally saying, "Let's move together to improve our aim."

Now that baby's eyes have a clear depth perception, he may constantly play with 		his ever-present toy--his hands. Sucking on fingers and fists now becomes a treasured pastime. Most babies cannot yet reach accurately with one hand. If you hold out an interesting toy, baby will most likely embrace the toy with both hands and pull it toward himself. Or, he may miss the toy entirely, join his hands together, and bring them toward his mouth. If you move the toy in front of him, he will most likely miss it or turn away, because he has not yet mastered the "in-flight" corrections to grab moving toys.

Be careful. Keep baby beyond the reach of harmful objects such as hot beverages or sharp or fragile items. Babies have lightning-fast reaches.

At 4 months At 5 months At 6 months
Grab and shake. Offer baby rattles, 4" rings, rag dolls, or small, cuddly blankets.

Sit-and-hit. Dangle interesting toy or mobile in baby's reach. He will punch at it or try to gather it into his arms.

Kick toys. Pompoms, rattles, and pleasant noisemakers can be attached to baby's ankles for him to activate with his kicking. He can also kick at mobiles or balls within range -- under supervision, of course.

Sofa sitting. Sit baby in the bend of a sofa pillow. He may spend 5 to 10 minutes enjoying this new vantage point.

Mirror play. Babies love to sit or be held in front of mirros, enjoying their own movements.

Gitchee-gitchee-goo. Tickling games that use tactile and vocal gestures can get you both laughing.

Rolling games. Drape baby over a large beach ball and roll it slowly back and forth to help to help him develop balance.

Peekaboo. This favorite can be played by hiding behind a piece of cloth or popping out from behind a sofa. Be sure to talk to your baby and make exaggerated faces. "Where's mommy? Here I am!"

Pull-up games. Hold a thin bar, such as a golf club or baton, in front of baby's chest. He will grab on, tighten his grip, and gradually pull himself up. 		Grab-and-pull games. Any part of your body is fair game for reaching. Baby can now reach for and hold on to the bottle or the breast during feeding. Baby may grab parts of your face, such as your nose, chin and lips. He may grab your chin with his mouth and suck on it.

Block play. Sit your baby in a high chair, propping him up with pillows until he is old enough to sit steadily in the chair unsupported. Place the starter blocks on the tray or table in front of him and observe the amazing play skills. Manipulating blocks is a valuable play and learning exercise for baby. He has complete control of this toy, and it helps encourage thumb-and-forefinger grasping that will continue to develop over the next few months.

Table fun. Sit baby on your lap at the dinner table and allow him to play with paper or cloth napkins and spoons.

Cushion play. Cylindrical and wedge-shaped cushions can be fun for baby. Baby can practice trunk, head and reaching exercises using the cushions. He can push himself forward by digging his toes into the carpet and learn to rock himself back and forth on the cushion using his own foot power.


Chest rest. While baby likes to play on his tummy, frequent push-ups can tire the young athlete. Place a three-inch foam-rubber wedge under baby's chest. This prop will free his hand to play with toys in front of him more comfortably and for longer periods without getting tired.

First scoots. Place an enticing toy just beyond his reach. Watch him dig in with toes and fingers and squirm, scoot or crawl toward his target.

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Support Groups for New and Experienced Parents





Opinions published in BEGINNINGS newsletters are those of individual authors and do not necessarily represent those of Verdugo Hills Hospital or its medical staff. If you have any questions regarding your baby's health, contact your physician.


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