2 Months of Age: Now it is Getting Real

You now have 2 months under your belt.  You have been through fussiness, gas, and colic.  You passed the peak of fussiness and your baby will start getting less fussy from here on out.

What are the top questions parents have for the 2 month check?

What are the top areas of advice you like to share?

Let’s go through the questions that parents have when they come in at 2 months of age.  It sounds like the biggest question is about how their baby is growing.

What are some options if weight gain isn’t going very well.  How do you know how much a breastfeeding baby is getting?

Okay—the baby is eating well—but what about pooping.  Some babies go a long time between bowel movements at this age

Is baby acne showing up by now?

Some advice parents get is to work on sleep training—what are your thoughts about this?

Vaccines are a big item at this visit—our first time getting vaccines in the office.  How do you handle the vaccine discussion?

How about the upcoming developmental stages for this 2-month old.

Any more safety items:

• Remember: Car seat, burn prevention, fall prevention, no infant walker
• Patient to sleep on back
• Avoid soft bedding and soft toys in the crib
• Careful with small and sharp objects and plastic bags
• Delay solids until 4 months of age, no cereal in bottles
• Water heater set at <120 degrees Farenheit

Final tips?

• Take time for yourself with spouse
• accept help and sleep when baby sleeps.
• FOLLOW-UP AT 4 MONTHS OF AGE.

Transcript

Episode #5—2 months of age

What are the top questions parents have for the 2 month check?

• Weight gain
• Vaccines
• Sleep training—no
• Baby acne
• Stooling—less frequent now and worried

What are the top areas of advice you like to share?

• Helping with weight gain—breast and bottle feeding
• Developmental milestones

Let’s go through the questions that parents have when they come in at 2 months of age.  It sounds like the biggest question is about how their baby is growing.

• We are measuring length and weight and head circumference at every visit and this is the first time we usually have a couple of data points to compare—is everything moving up well on the growth chart or not?
• Length and head circumference measurements can be subjective with the baby wiggling around a lot.  Weight is always objective and accurate, and the most important to me—if the baby is gaining weight well, then everything else will fall into place.  Their genetics were set 11 months ago, but the environment, their nutrition is what matters now.

What are some options if weight gain isn’t going very well.  How do you know how much a breastfeeding baby is getting?

• There can be some struggles with breastfeeding that show up now with less than ideal weight gain.  If a baby is moving along the weight gain chart and getting a double chin and thigh rolls then you know it is going great.  But that isn’t always happening. There can be problems with how milk is being transferred from mother to baby—how much milk is made, how good the baby is at doing their job, etc.  
  • Trial of some supplementing after breastfeeding attempts. Start to see some struggles with weight gain—especially with breastfed babies as the demand for calories increases but milk supply may not go up proportionally.
  •  Bottlefeeding: Goal to eat to fulness with each feeding.
  • Feed slowly, but feed them until they no longer want any more from the bottle.
  • There should be something left in the bottle when they no longer take the bottle vigorously.
  • When they begin to finish off bottles at feeding times, start putting  more in the bottle.
  • Only the baby knows how hungry they are.  They will eat more when they go through growth spurts.

Okay—the baby is eating well—but what about pooping.  Some babies go a long time between bowel movements at this age

• Stooling—It is normal for breastfed babies to stool once weekly and formula fed babies to stool every 3 days—big change from stooling several times daily as a newborn—many are concerned that this is a problem with the baby.
• I tell them to look at the baby and don’t look at the calendar—how many days between bowel movements.  If the baby is passing lots of gas, and that gas can be pretty stinky when they haven’t pooped in a few days, but they are happy and not bloated then we don’t have to fix anything.  If the baby is unhappy because of symptoms then we work on helping them stool more often with a combination of prune juice, benefiter, and miralax.

Is baby acne showing up by now?

• Yes, Baby acne starts at about 3 weeks of age, involves mostly the face and upper chest and back, and then improves by about 3 months of age.  It can be intermingled with eczema and some other infant rashes that it is good for us to look at with parents.

Some advice parents get is to work on sleep training—what are your thoughts about this?

• Sleep training is way too early at this age—the first developmental stage for infants is trust vs. mistrust and they don’t have the object permanence at this stage—the ability to know that you are still around when they cannot see you—and so they feel abandoned when they are alone and crying.  The book Baby Wise advocates for tough love sleep training at this young age and I don’t agree with that.  You can try to offer some routines and if they don’t readily respond then I don’t fight it—they aren’t usually ready for tough love sleep training until about 6 months of age and we will talk about that in the podcast for that age. 

Vaccines are a big item at this visit—our first time getting vaccines in the office.  How do you handle the vaccine discussion?

• Vaccines—stuck between the truth and a grandmother 
• I advocate actively for the health of a child through receiving childhood vaccinations—they have made such a difference in our health.  Do you remember the last friend you had that died from polio?  No, because parents vaccinate their children.
• Some are conflicted about vaccine administration, but most are not.
• For those that are conflicted, I want to know what their specific reason is because I want to validate that everyone’s questions and concerns have value and learn how I can help them in their decision-making.  I believe that this mother or father love this child more than any other person in the world and genuinely want what is best for their child when they make the decision to vaccinate.
• Sometimes they simply need a question answered—to have someone listen and discuss their concern, sometimes they have made a decision to modify the schedule of receiving vaccines and I believe it is important to work with each parent’s goals and objectives in order to not create a divide that will prevent a child from getting the protection from vaccines because a relationship with a doctor is all or none over the vaccines.  If a person is determined to modify the schedule and I create an adversarial relationship, that child may never get vaccinated because of how I treated the parent.

How about the upcoming developmental stages for this 2-month old.

• Kids mature from top to bottom 
• Consider having floor gyms and toys that hang down from car seat to help develop hand-eye coordination
• Tummy time frequently in small doses if needed.

Any more safety items:

• Remember: Car seat, burn prevention, fall prevention, no infant walker
• Patient to sleep on back
• Avoid soft bedding and soft toys in the crib
• Careful with small and sharp objects and plastic bags
• Delay solids until 4 months of age, no cereal in bottles
• Water heater set at <120 degrees Farenheit

Final tips?

• Take time for yourself with spouse
   
  • accept help and sleep when baby sleeps.
• FOLLOW-UP AT 4 MONTHS OF AGE.