Larsen & Talbert
There may be very clear right and wrong answers for much of newborn care, but once my baby was out of the first stages of infancy, the answers weren’t so obvious. “So, is it safe…now?” I found myself wondering every few weeks. Will it be safe when she reaches a certain age? Weight? Developmental stage?
Many of these issues have changed since we were kids, so asking my own mom wouldn’t do any good—back when I was a babe, either the category didn’t exist (sushi and jogging strollers) or the thinking was very different (putting babies to sleep on their stomachs).
Here, pediatricians—experienced moms themselves—share what you need to know about safe sleeping, eating, playing and more.
Sleep: “Is my baby ready to…”
…snooze on her tummy?
Since 1992, when the American Academy of Pediatrics (AAP) first recommended putting babies to sleep on their backs, the annual SIDS rate has decreased by about 50 percent. While some moms are ignoring the recommendation, most of us have gotten the message so loud and clear that the first time I discovered my 4-month-old on her stomach it was hard not to freak out.
What you need to know Once your baby has the upper-body strength to roll over regularly, at around 5 months, he has the strength to move away from a suffocation hazard, and the SIDS risk goes down. (The greatest risk is during the first six months.)
“I tell my patients: You should still put them down on their backs, but what babies do in the middle of the night is their business,” says Jennifer Shu, M.D., director of the newborn nursery at Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire and coauthor of Heading Home With Your Newborn.
…have a blanket in the crib?
The official line from the AAP is to avoid blankets (they’re a potential suffocation hazard) until your baby reaches her first birthday.
What you need to know Some pediatricians give the okay for babies as young as 6 months. “A small, crib-size blanket is fine for a child who can lift her head and can push it off or crawl out from under it,” says Jennifer Roche, M.D., a pediatrician in private group practice in Amherst, Massachusetts. (Whether or not it stays on her all night is another issue.)
…ditch the bumpers?
Who would have thought a simple decorative touch in the nursery would end up being controversial? Some experts say bumpers are suffocation hazards and shouldn’t be in the crib at all; others take a more pragmatic approach.
What you need to know To be on the safe side, avoid large, fluffy bumpers and remember to tie them to the crib as tightly as you can. Also, make sure there are no gaps—that way your baby can’t get his head stuck between the bumper and crib railings.
According to some doctors, you should take them out of the crib when your baby is sitting, around 6 months, but definitely no later than 9 months, when he begins to pull himself up to stand. Although it’s not very likely, he could use the bumper as a step and launch himself out of the crib.
…sleep with toys in the crib?
With all of the nervousness about possible SIDS hazards, parents might worry about putting stuffed animals or other playthings in their infant’s crib.
What you need to know depends on the plaything.
- Stuffed animals. While the AAP doesn’t recommend that babies sleep with plush loveys until they’re 1, Ari Brown, M.D., coauthor of Baby 411, says it’s okay once a baby is 6 months old, with these caveats: The stuffed toy is a small one (no bigger than the size of her head) and has no removable eyes or buttons. Your baby should also be rolling over and moving around on her own.
- Mobiles and other crib toys. You should remove the mobile from the crib at the 6-month mark—babies may then be able to make a grab for them when they sit up. As for attachable toys, as long as they don’t contain small, “choke-able” parts, the only consideration is whether your baby can handle the stimulation. “Some will push the buttons repeatedly until they get sleepy. Other kids will just get more and more wired,” says Dr. Shu, the mom of a 4-year-old.
- Books. Since babies are likely to chew on board books, doctors recommend giving them only fabric ones in the crib—after they turn 1.
Gear: “Is my baby ready to…”
…face front in a car seat?
When it comes time to turn your baby around in the car, which is more important: her weight or her age?
What you need to know Both are equally important: The American Academy of Pediatrics now advises parents to keep toddlers in rear-facing car seats until age two, or until they exceed the height or weight limit for the car seat, which can be found on the back of the seat. “If we all could travel facing backward, we’d be safer. As soon as you face the front, the chance of whiplash goes way up,” Dr. Shu says.
But what about kids who pitch a fit because they can’t see you? Dr. Brown, mom of a 10- and a 7-year-old, says she’s been there. “We flipped my daughter around when she was nearly twelve months old, but she was over twenty pounds at that point. I thought it was actually safer that way—otherwise, I worried I was going to get in a crash, what with all of the turning around I was doing to quiet her down. But I still tell all my patients to wait!”
…fit in various baby carriers?
The worry: fitting a too-small baby into one of these items.
What you need to know First, check the manufacturer’s specifications. After that, here’s what experts recommend:
- Front carrier. As long as your baby is above the carrier’s height and weight specs (depending on the model, usually eight pounds and 21 inches), you can carry him around facing in from the get-go. He’ll be ready to face out once his neck is strong enough to hold his head steady, usually when he’s about 3 months old. And don’t be overly concerned if his head slumps forward when he starts to snooze. It may look uncomfortable, but he’ll be able to breathe just fine.
- Backpack. No earlier than 3 months, and even as old as 6 months, depending on the type of backpack, say experts. A baby needs adequate head and neck control to keep his head stable and supported.
- Umbrella stroller. Six months at the earliest. A baby needs good trunk control—meaning the ability to sit up independently—because of the lack of support usually found in these strollers.
- Jogging stroller. While some manufacturers say that joggers are appropriate for babies as young as 6 months, Dr. Brown says she wouldn’t advise it for babies under 1. “The ride can be quite bumpy for immature spine and neck muscles, especially going over curbs or rocky paths,” she says.
- Bike trailer or bike seat. A baby should be at least 1 year old before being put in a trailer, say the AAP and other experts. Besides the bumpiness potential, there’s the risk of a spill, so your baby will need to wear a lightweight bike helmet while on the ride, and his neck won’t be strong enough to support one until his first birthday.
Food: “Is my baby ready to …”
…chew crackers, bagels and other breads?
Which of them are choking hazards for an infant with few teeth?
What you need to know “By nine months or a bit sooner, a baby is able to try all bready foods, as long as parents keep a close watch,” says Dr. Roche. The number of teeth babies have really has no bearing on their ability to chew; gums are mighty strong on their own.
…try something new without fear of allergies?
There’s a long list of potential allergens, including dairy, egg whites and nuts. But it’s hard to know whether those of us without a family history of allergies should be concerned.
What you need to know Your baby can eat most foods after his first birthday. The exceptions:
- Nuts. Many doctors think kids shouldn’t eat foods with peanuts or tree nuts, like almonds, cashews or walnuts, until they’re 3. The earlier they’re introduced, the more likely these foods are to become lifelong allergens for some kids. But if your toddler has already had a PB&J sandwich a few times and has not had any reaction, you’re in the clear, says Dr. Brown.
- Dairy foods. Processed products like cottage cheese, yogurt and cheese (all made with whole milk) are okay by 6 months. Just hold off on cow’s milk until he’s 1. Your baby’s still-developing digestive system would have a hard time processing the volume of milk he’d consume, compared to the smaller amounts of yogurt or cheese.
- Strawberries. Raw ones can cause some babies to break out in a rash, so if you’re concerned, feed yours cooked berries until he’s a year old.
…try a piece of sushi?
With all the stories about food poisoning, you’d think raw fish is something to keep away from your baby until grade school.
What you need to know You can introduce sushi after your child’s first birthday. “It’s true that with raw fish, you’re running a risk of food-borne parasites,” says Dr. Brown. “But you can catch one of those at a salad bar. Just make sure to go to a restaurant with a good reputation. My kids have had sushi for years.”
The biggest concern about sushi is mercury contamination. Doctors urge pregnant women and kids under 8 to stay away from albacore (white) tuna (but canned light tuna is okay), shark, swordfish, king mackerel, and tilefish—all of which have extremely high levels.
You may have heard that it’s best not to introduce water to a baby’s diet until she’s eating solids.
What you need to know It’s true, but you can start giving your 6-month-old four to six ounces of water a day so that she gets fluoride.
Outdoor safety: “Is my baby ready to …”
…be out in the cold?
Taking babies out in freezing weather isn’t anybody’s idea of a good time—unless you’re going stir-crazy indoors and yours seems eager to check out snowflakes.
What you need to know Let your common sense guide you: If you’re feeling cold, chances are your baby is, too—and he can’t warm himself by walking around the way you can. So dress him appropriately (with one more layer than you, plus a well-insulated snowsuit, a hat and mittens) and feel free to let him play a bit with you in the snow. Once you start feeling cold and wet, though, head in and get him out of his damp clothes.
…catch some rays?
With their thinner, more sensitive skins, babies get sunburned a lot more quickly than even the most fair-haired adult.
What you need to know Once your baby is 6 months old, it’s all right to have him in the sun for limited times, wearing sunblock. (Sunblock’s fine for babies younger than that, too, but it’s best to keep them out of the direct sun altogether.) In the summer, keep him indoors during peak sun hours—10 a.m. to 3 p.m.—but if you have to go out, dress him from head to toe in lightweight clothing, floppy sun hat, and all. (And sunglasses, too—if he’ll keep them on.)
…go for a dip?
When the weather gets warmer, when is it okay to expose a child to the chlorine in a pool or unknown funkiness in lake or ocean water?
What you need to know Six months is a reasonable age to take your child for a “swim” in your arms. Why wait that long? “I worry about younger infants getting too cold in the water, even in a heated pool. By six months they develop the ability to regulate their body temperature,” says Dr. Roche. No matter where you swim, just make sure she doesn’t swallow the water; bacteria, including those from other babies wearing (or not wearing) diapers, could be lurking. One concern to scratch off your list: your baby’s skin being affected by the chlorine.
…play in the sandbox?
Since a baby’s first instinct is to put things in his mouth, digging around in the sand can seem like a risky way to have fun.
What you need to know Dr. Roche, a mom of three girls, ages 5, 4 and 2, takes a relaxed approach. “Try not to let him swallow whole mouthfuls of the stuff or rub his eyes, and wash his hands afterward.” If yours does ingest some sand, offer him some water—and hope that he remembers how yucky it was next time he’s tempted. (And don’t be surprised by a sandy poop.)
…hit the playground?
When can she slide and swing?
What you need to know The size of the equipment is important, as are your baby’s motor skills. Once she’s able to sit on her own—usually by 6 months—she’ll probably enjoy a gentle ride in a bucket swing. And if she’s a pretty good climber and walker, she’ll probably be able to go down a small slide by herself by the time she’s 18 months.