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Understanding Pediatrics: Must know milestones

  • After delivery, 10 % weight loss is expected
    • Normal infants stop losing weight at 5 days post-partum and regain birth weight within 1-2 weeks
  • All breast-fed infants must take 400 IU/day of vitamin D supplementation immediately
  • Feeding must be done on demand
    • On each feeding the breast must be alternated
    • Breastfeeding can be 8 to 12 times per 24 hours
    • Decreases with age
  • 4-6 months – introducing solid foods with continued breast/formula feeding
    • Recommended solids
      • Single-grain infant cereal fortified with iron, oats
      • Pureed single ingredient foods (meats, vegetables and fruits without any additives like salt or sugar)
    • Start with solids once or twice per day
    • Avoid honey due to risk of botulism
    • Avoid whole cow’s milk, hard, round foods that can cause choking (e.g. nuts, grapes, raw carrots)
  • 6 months – teething
    • Start cleaning teeth with pea sized low-fluoride toothpaste (no scrubbing, just circular motions)
  • 8 months – food advancement
    • Lumpier foods can be introduced in order to allow for incremental increase in texture variety
    • Finger foods can be introduced due to development of fine grasp
      • Finely chopped fruits, vegetables, cheese, pasta
      • Avoid choking hazards (peanuts, grapes, raisins, carrots and popcorn)
  • 9 months – begins to crawl
  • 12 months – walks with support, perhaps time to start weaning off of breastfeeding at this point if you haven’t already done so
    • Drop one feeding every 3-4 days so it takes around 2 weeks to wean completely
  • 18 months – runs
  • 2 years – Babinski reflex disappears

What is healthy sleep for infants?

  • Sleep on the back, never on stomach
  • Keep soft objects and loose bedding away from infant while sleeping
  • Pacifier recommended
  • Avoid bed-sharing
  • Infant’s crib should be placed in parents’ bedroom until 1 year of age
    • Room sharing recommended
    • Bed sharing is NOT recommended

What about car seats in Ontario?

  • Rear facing car seat until 9 kg (20 lb) – around 12 months of age
  • Forward or rear facing car seat until at least 18 kg (40 lb) – around 5 years of age
  • Booster seats are required for children
    • Between 18 to 36 kg (40 to 80 lbs)
    • Under 1.45 m (4’9″)
    • Under the age of 8

When do fontanelles close?

  • Posterior fontanelle closes 2 to 3 months after birth
  • Anterior fontanelle closes 12 – 18 months after birth