7.375 × 9.125 SPINE: 1.9063 NOW IN ITS SEVENTH EDITION! FROM THE AMERICAN ACADEMY OF PEDIATRICS, THE MOST UP-TO-DATE, EXPERT ADVICE FOR MOTHERS, FATHERS, AND CARE PROVIDERS THE COMPLETE AND AUTHORITATIVE GUIDE All parents want to provide the very best care for their children. This essential resource from CARI NG FOR the most respected organization in child health is the one guide pediatricians routinely recommend. CARING Parents can safely trust the guidance, which covers everything from preparing for childbirth to toilet training and from breastfeeding to nurturing your child’s self-esteem. Whether it’s resolving common childhood health problems or detailed instructions for coping with emergency medical situations, this FOR YOUR BABY AND new and revised edition of Caring for Your Baby and Young Child has everything you need, with information on: YOUR · Basic care from infancy through age five · Milestones for physical, emotional, social, and cognitive growth, as well as visual, YOUNG CHILD BABY hearing, language, and movement mileposts · Information on healthy development and disabilities, including what to watch for and AND when to seek help · Injuries, illnesses, congenital diseases, and other disabilities addressed in a complete YOUNG health encyclopedia · Updated content dedicated to environmental hazards and allergies MORE THAN CHILD · Guidelines for prenatal and newborn care, with spotlights on maternal nutrition, 4.7 MILLION exercise, and screening tests during pregnancy COPIES · An in-depth discussion of breastfeeding, including its benefits, techniques, and challenges BIRTH TO AGE 5 IN PRINT · Revised nutrition recommendations, including the importance of early introduction of allergenic foods and obesity prevention tips Seventh Edition · Updated safety standards: the very latest AAP recommendations, from CPR instruction, safe sleep, and immunizations to childproofing tips, car safety seats, and toy safety · Tips for choosing childcare programs · Cutting-edge research on early brain development and how babies and young children think · Updated media chapter, including the effects of media and technology exposure on children and how to make the most of screen time in the home TANYA ALTMANN, Caring for Your Baby and Young Child is an essential childcare resource—recommended by MD, FAAP, pediatricians and trusted by parents. Editor-in-Chief BIRTH TO AGE 5 DAVID L. HILL, $24.00 A BANTAM BOOKS TRADE PAPERBACK ISBN 978-1-61002-343-6 MD, FAAP, from the American Academy of Pediatrics CCoovveerr dpehsoitgong:r aRpuhbsy: SLehvuetsteqrusetock 52400 Associate Medical Editor NEW AND REVISED SEVENTH EDITION HealthyChildren.org is the official American Academy of Pediatrics web- Find your next great read, and get TANYA ALTMANN, MD, FAAP, Editor-in-Chief site for parents. Visit today for reliable, the latest on our books and authors. pediatrician-approved children’s health Sign up for the Random House newsletter. and safety information. randomhousebooks.com 9 781610 023436 DAVID L. HILL, MD, FAAP, Associate Medical Editor BANTAM amer_9781610023436_cvr_all_r2.indd 1 7/18/19 4:53 PM Caring for Your Baby and Young Child This invaluable volume was prepared under the editorial direction of distin- guished pediatricians Tanya Altmann, MD, FAAP, and David L. Hill, MD, FAAP, and draws on the contributions and practical wisdom of more than 100 pediatric experts and an editorial review board. Written in a warm, accessible style and illustrated with more than 300 helpful drawings and diagrams, this book gives you the information you need to safeguard your child’s most pre- cious asset: his or her health. In Caring for Your Baby and Young Child you’ll find: • A month- by- month guide to your baby’s first year that lets you know what to expect in terms of growth, behavior, and development • A yearly guide to ages one through five, with practical advice for dealing with sleeping, toilet training, and temper tantrums • “Health Watch” features that alert you to potential medical problems at each stage • “Safety Check” reminders for home, outdoors, and car travel • A discussion of family issues— from grandparents and siblings to single parenting and stepfamilies Plus reliable information on: • All common infectious diseases, from chickenpox and measles to flu and ear infections • Developmental disabilities, such as congenital abnormalities, cerebral palsy, hearing loss, autism, and intellectual disability • Skin problems, from birthmarks to head lice and sunburn • Emergencies, including bites, poisoning, choking, and CPR • Feeding and nutrition • Car safety seats The seventh edition of this book includes current AAP policy information and updated content on developmental disabilities, early brain development, breast- feeding and nutrition, obesity, and safety standards, as well as updated content on the effects of media and technology on children. Amer_9781984817709_4p_all_r1.e.indd 1 7/24/19 4:27 PM Additional Parenting Books from the American Academy of Pediatrics COMMON CONDITIONS Allergies and Asthma: What Every Parent Needs to Know The Big Book of Symptoms: A– Z Guide to Your Child’s Health My Child Is Sick! Expert Advice for Managing Common Illnesses and Injuries Sleep: What Every Parent Needs to Know Waking Up Dry: A Guide to Help Children Overcome Bedwetting DEVELOPMENTAL, BEHAVIORAL, AND PSYCHOSOCIAL INFORMATION ADHD: What Every Parent Needs to Know Autism Spectrum Disorder: What Every Parent Needs to Know NEWBORNS, INFANTS, AND TODDLERS Baby and Toddler Basics: Expert Answers to Parents’ Top 150 Questions Baby Care Anywhere: A Quick Guide to Parenting on the Go Dad to Dad: Parenting Like a Pro Guide to Toilet Training* Heading Home With Your Newborn: From Birth to Reality New Mother’s Guide to Breastfeeding Raising Twins: Parenting Multiples From Pregnancy Through the School Years Retro Baby: Cut Back on All the Gear and Boost Your Baby’s Development with More Than 100 Time- Tested Activities Retro Toddler: More Than 100 Old- School Activities to Boost Development * This book is also available in Spanish. Amer_9781984817709_4p_all_r1.e.indd 2 7/24/19 4:27 PM Understanding the NICU: What Parents of Preemies and Other Hospitalized Newborns Need to Know Your Baby’s First Year* NUTRITION AND FITNESS Achieving a Healthy Weight for Your Child: An Action Plan for Families Food Fights: Winning the Nutritional Challenges of Parenthood Armed With Insight, Humor, and a Bottle of Ketchup Nutrition: What Every Parent Needs to Know SCHOOL- AGE CHILDREN AND ADOLESCENTS Building Resilience in Children and Teens: Giving Kids Roots and Wings Caring for Your School- Age Child: Ages 5 to 12 Parenting Through Puberty: Mood Swings, Acne, and Growing Pains Raising Kids to Thrive: Balancing Love with Expectations and Protection with Trust FOR ADDITIONAL PARENTING RESOURCES, VISIT THE HEALTHYCHILDREN BOOKSTORE AT SHOP.AAP.ORG/FOR- PARENTS/. * This book is also available in Spanish. Amer_9781984817709_4p_all_r1.e.indd 3 7/24/19 4:27 PM Amer_9781984817709_4p_all_r1.e.indd 4 7/24/19 4:27 PM Caring for Your Baby and Young Child Tanya Altmann, MD, FAAP Editor- in- ChiEf Pediatrician and Founder, Calabasas Pediatrics Wellness Center Calabasas, California Assistant Clinical Professor of Pediatrics, UCLA Mattel Children’s Hospital Los Angeles, California David L. Hill, MD, FAAP AssoCiAtE MEdiCAl Editor Goldsboro Pediatrics Goldsboro, North Carolina Adjunct Assistant Professor of Pediatrics University of North Carolina School of Medicine, Chapel Hill, North Carolina Steven P. Shelov, MD, MS, FAAP founding Editor, EMEritus Founding Dean Professor of Pediatrics NYU Long Island School of Medicine Robert E. Hannemann, MD, FAAP AssoCiAtE MEdiCAl Editor, EMEritus Visiting Professor, Child Psychology, Biomedical and Chemical Engineering Purdue University BANTAM BOOKS New York Amer_9781984817709_4p_all_r1.e.indd 5 7/24/19 4:27 PM A note about revisions: Every effort is made to keep CARING FOR YOUR BABY AND YOUNG CHILD consistent with the most recent advice and information available from the American Academy of Pediatrics. In addition to major revisions identified as “Revised Editions” and “Seventh Edition,” the text has been updated as necessary for each additional printing listed below. 2019 Bantam Books Trade Paperback Edition Copyright © 1991, 1993, 1998, 2004, 2009, 2014, 2019 by the American Academy of Pediatrics All rights reserved. Published in the United States by Bantam Books, an imprint of Random House, a division of Penguin Random House LLC, New York. BAntAM Books and the HousE colophon are registered trademarks of Penguin Random House LLC. Originally published in the United States in hardcover in 1991 and in revised paperback editions in 1993, 1998, 2004, 2009, and 2014 by Bantam Books, an imprint of Random House, a division of Penguin Random House LLC. ISBN 978- 1- 9848- 1770- 9 Printed in the United States of America on acid- free paper randomhousebooks.com 2 4 6 8 9 7 5 3 1 Amer_9781984817709_4p_all_r2.p.indd 6 7/31/19 10:53 AM Reviewers and Contributors Editor-i n-C hief Council on Children with Disabilities Tanya Altmann, MD, FAAP Council on Community Pediatrics Council on Early Childhood Associate Medical Editor Council on Environmental Health David L. Hill, MD, FAAP Council on Genetics Council on Injury, Violence, and Poison AAP Board of Directors Reviewer Prevention Jane Meschan Foy, MD, FAAP Disaster Preparedness Advisory Council Section on Administration and Practice American Academy of Pediatrics Management Section on Allergy and Immunology CEO/Executive Vice President (Interim) Section on Breastfeeding Mark Del Monte, JD Section on Cardiology Section on Child Death Review and Chief Product and Services Officer/ Prevention (Provisional) SVP, Membership, Marketing, and Section on Clinical Pharmacology & Publishing Therapeutics Mary Lou White Section on Critical Care Section on Dermatology Vice President, Publishing Section on Developmental and Behavioral Mark T. Grimes Pediatrics Section on Emergency Medicine Manager, Consumer Publishing Section on Endocrinology Kathryn Sparks Section on Epidemiology, Public Health and Evidence Editor, Consumer Publishing Section on Gastroenterology, Hepatology Holly Kaminski and Nutrition Section on Hematology/Oncology American Academy of Pediatrics Section on Home Care Reviewers and Contributors Section on Hospital Medicine Committee on Drugs Section on Infectious Diseases Committee on Nutrition Section on Lesbian, Gay, Bisexual and Committee on Pediatric AIDS Transgender Health and Wellness Committee on Pediatric Emergency Section on Nephrology Medicine Section on Neurology Committee on Substance Use and Section on Neurological Surgery Prevention Section on Obesity Council on Child Abuse and Neglect Section on Ophthalmology Amer_9781984817709_4p_all_r1.e.indd 7 7/24/19 4:27 PM Section on Oral Health Subcommittee on Children and Section on Orthopedic Surgery Adolescents with Attention- Deficit/ Section on Otolaryngology— Head and Hyperactivity Disorder Neck Surgery Subcommittee on Type 2 Diabetes Section on Pediatric Pulmonology and Subcommittee on Febrile Infants Sleep Medicine Subcommittee on Hyperbilirubinemia Section on Plastic Surgery Subcommittee on the Management of Section on Rheumatology Infantile Hemangioma Section on Surgery Subcommittee on Screening and Section on Tobacco Control Management of High Blood Pressure in Section on Uniformed Services Children Section on Urology Subcommittee on Urinary Tract Infection Subcommittee on Bronchiolitis Task Force on SIDS Acknowledgments We thank Founding Editor Emeritus, Steven P. Shelov, MD, MS, FAAP, and Associate Medical Editor Emeritus, Robert E. Hannemann, MD, FAAP, and the countless contributors and reviewers for their work on the first six editions of Caring for Your Baby and Young Child: Birth to Age 5. Special thanks to Marc Weissbluth, MD, FAAP, for his review and consultation on the “Sleep” chapter and the “How to Tell a Nightmare from a Night Terror” chart, and to Alain Park for his dedicated work on this current edition. Illustrators: Wendy Wray/Morgan Gaynin, Inc. Alex Grey Amer_9781984817709_4p_all_r1.e.indd 8 7/24/19 4:27 PM Please Note The information contained in this book is intended to complement, not substi- tute for, the advice of your child’s pediatrician. Before starting any medical treatment or medical program, you should consult with your child’s pediatri- cian, who can discuss your child’s individual needs and counsel you about symptoms and treatment. If you have questions regarding how the information in this book applies to your child, speak to your child’s pediatrician. Products mentioned in this book are for informational purposes only. In- clusion in this publication does not constitute or imply a guarantee or an en- dorsement by the American Academy of Pediatrics. The information and advice in this book apply equally to children of both sexes (except where noted). To indicate this, we have chosen to alternate be- tween masculine and feminine pronouns throughout the book. Best efforts were made to use people first language, and as such, certain phrasing may not read as familiar. For example, “an overweight child” now reads as “a child with overweight” or “a child has overweight.” ~ ~ ~ The American Academy of Pediatrics constantly monitors new scientific evi- dence and makes appropriate adjustments in its recommendations. For exam- ple, future research and the development of new childhood vaccines may alter the regimen for the administration of existing vaccines. Therefore, the schedule for immunizations outlined in this book is subject to change. These and other potential situations serve to emphasize the importance of always checking with your child’s pediatrician for the latest information concerning the health of your child. For additional information on caring for your child and their health and well- being, visit HealthyChildren.org. Amer_9781984817709_4p_all_r1.e.indd 9 7/24/19 4:27 PM