Caring for our future, one child at a time


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2 Month Visit

Development

Two month olds have had a tremendous growth in personality. They'll smile and coo, turn to your voice, and listen intently. He/she will also start recognizing other people and voices, plus the cadences of different languages. The baby's visual tracking is improving as well as the ability to perceive objects. The baby's hands and mouth are its favorite toys - providing a flood of sensory input. The baby will have much more head control, and will push up on his/her arms.

Crying

Around this time, a baby's cry becomes more focused. Parents will recognize the hungry cry, the pain cry, the frustration cry and the "I'm tired and want to be left alone........" When babies are tired, they often have a 'whiny' cry. It is thought that his/her nervous system is fatigued - in much the same way two years olds will start to cry and whine after a couple of hours at a birthday party - or adults will want to retired to a quiet place after a half a day at an amusement park.

Sleep: Teaching the Baby to Self Soothe

This is the time to start sleep training. Try to develop a short go to bed ritual, complete with lullaby and gently put the baby into his/her crib/bassinet. Try to help the baby sense his/her surroundings, and teach the baby that the crib is a "warm/cozy" place. Turn on a music box, or sing a song, rub the baby's tummy. Then slowly slow up the lullaby to a whisper and slow the tummy rub. Slowly pull your hands away and creep out of the room. The baby might toss/turn or fret. You can go back into the room and try to calm the baby again. . (See the article on Sleep Issues)

Vaccines

Two month olds will start their major infant vaccines. These are very important in that the diseases they cause are potentially serious and life threatening.

DTaP: diptheria, tetanus and acellular pertussis:

These three illnesses are among the worst known to man.

Diphtheria

Diptheria has a very high case fatality rate and can strike otherwise healthy children. Even with today's antibiotics, diphtheria can be deadly. Besides airway obstruction, it can cause cardiac arrhythmias. In many underdeveloped countries, and war zones where public health networks break down, many people go unvaccinated. Several years ago there was a notice in the New York Times that a college age student from Scarsdale NY died of diphtheria in Florida. According to report, the person had received only one vaccine in early infancy and no others.

Tetanus

Tetanus has been a dreaded killer striking active, healthy people. At the turn of the 20th century, it was common to know someone who had died of tetanus, especially among pioneer children, manual workers and especially soldiers. Tetanus is another illness that today's doctors have rarely seen and have never treated.

Pertussis (whooping cough)

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Pertussis is a particularly horrible disease for children, especially young infants. Infants can go into respiratory failure and have to be hospitalized. At the 2005 American Academy of Pediatrics convention, there was a case presentation of a 2 month old in Pittsburgh who had recently died of pertussis despite being admitted to the pediatric ICU at Pittsburgh Children's Hospital. The source of the whooping cough wasn't determined. Older children with pertussis are usually not as sick, but they can have severe wracking coughs that can last for months, even with antibiotic treatment.

Haemophilus influenza

Is a commonly encountered and easily transmitted germ. It can appear as a green conjunctivitis or purulent runny nose. It can sometimes take on a virulent form, causing infection of the epiglottis (the flat at the top of the trachea) or traveling from the nasal passages to the blood stream, causing meningitis. The vaccine was released in l985 after several years of stunningly successful clinical trials. The rates of meningitis and serious forms of Haemophilus plummeted.

Polio

Before the vaccine was released about l955, polio was a well known and greatly feared disease. Even the president of the United Stated, FDR, was struck by it. Polio would give severe fever, chills and headache, i.e. summer flu like symptoms. Not everyone would develop the life threatening paralytic forms of it. Doctors who did their training in the days before polio vaccine have horror stories to tell of children in iron lungs and those who survived, paralysis. Polio used to affect pregnant women, and there were special maternity areas in some urban hospitals to accommodate the paralyzed women. Many people think that polio is a thing of the past. It's incidence has declined because of world wide vaccination campaigns. There are some 'anti-vaccine' people who feel comfortable with their children being unvaccinated against polio, but there are few people with a background in medicine or biology who would want their children using a bathroom in an international airport without having had polio vaccine.

Pneumococcal pneumonia

Pneumococcus, otherwise known as strep pneumoniae, is a very common bacterial pathogen. Many children in nursery school will have it in their nostrils and not be sick at all. However, in the setting of viral infections such as influenza, which disrupt the mucosal barrier, pneumococcus can sometimes proliferate and become pathogenic. It is a cause of bacterial ear infections, sinusitis, bronchopneumonias and blood stream infections (sepsis). People with sickle cell disease, weakened immune systems and those who have had a splenectomy are especially susceptible to severe forms of the disease.

Rota virus

Rota virus is a major cause of vomiting and diarrhea. It can make infants and young children really sick and leads to thousands of hospitalizations every year for IV fluids. In third world countries, where IV fluids are not as available, Rota virus is a major cause of death.

Hepatitis B

Hepatitis B is endemic in many parts of the world. Although it often causes a mild, self-limited disease in young children, about 8% of people who acquire Hepatitis B go on to become chronic carriers and are also at risk for developing liver cancer in middle age. Hepatitis is transmitted by body secretions (blood, menstrual pads, semen). It can contaminate untreated water systems (menstrual blood), and food (an accidental cut in a restaurant worker who is a chronic carrier).

After the baby receives his/her two month vaccines, a dose of tylenol can be given 0.4mL = 40mg. The baby can experience "soreness" of the legs, and this can minimize this feeling

Other tips for parents of two month olds

Many parents start to feel housebound. They don't go out, or get together with friends as much. They feel they have to stay home at nap time so the baby can get on a schedule. Younger babies are a lot more flexible and portable than a toddler. Babies can "bond" to a baby blanket or cloth diaper and with a theme lullaby, the parents can induce a nap at a friend's house or in the car. Baby carriers and slings allow parents to go to museums, restaurants, even the movies (if you sit near an exit and have ear puffs for the baby). If it's cold or rainy, the baby can go for walks up nestled up against your chest, with a rain coat, or parka wrapped around you and the baby. The baby will be heated by your body, but will need a hat. When walking with the baby in a carrier, always keep a hand free to protect the baby's head if you were to slip and fall. If it's sunny, the baby sling as as a sun shield.

Baby carriers also protect the baby from respiratory viruses. The baby is in your air zone, rather than in a stroller or on the floor an infant seat where people can come up and touch.

Tip: It's easy for babies to bond to grandparents, aunts/uncles, close family friends at this age. The baby can even recognize a grandmother's perfume. This is a good time for the grandparents and others to babysit for short periods of time. It doesn't have to be at the baby's home. An attachment blanket or burp pad can be used as a cue to the baby that it's time for bed. It's harder on the baby if the parents wait until the baby is over six months old for relatives to babysit.



2 Month Exam
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