Health Supervision Visit, 9 Months

Assess

• Anthropometric measurements
• Physical examination
• Adequacy of human milk or formula and complementary food intake, which should be continued until 12 months of age
  • Infants should be taking complementary foods from all food groups.
  • High-protein intakes from formula and complementary foods may be a risk factor for excessive infant weight gain; recommendations have been proposed (though not yet made) to limit total protein to 15% of energy intake. 
• Iron intake
  • If iron intake is inadequate, especially for breastfeeding infants, then supplements of iron should be continued (1 mg/kg/d).
  • Research indicates that complementary foods of >50% of infants in the United States do not meet iron requirements.
    • This applies to >95% of breastfed infants.
• Screen for food insecurity using the validated 2-question Hunger Vital Sign tool
  • 1 in 7 children live in a household experiencing food insecurity.
  • Rates of food insecurity are higher in households with children younger than 6 years, single-parent households, and immigrant, Black, or Latinx families
    • Provide resources for families experiencing food insecurity. (Table 3)

Discuss

• Continue vitamin D at 400 IU/day.
• Discourage use of whole milk and continue human milk or iron-fortified formula.
• Avoid honey.
• If infants are weaned from breast before 12 months, iron-fortified formula should be used.
  • There is little evidence that partially or extensively hydrolyzed formula prevents atopic disease, even in high-risk infants
• Avoid soy milk, cow milk, and goat milk before 12 months of age, unless medically indicated.
• Limit whole milk to <16 oz per day.
• Avoid juice.
• Continue breastfeeding.
• If bottle-feeding advise parents not to put baby in bed with a bottle (for a nap or the night).

Calculations

Estimated energy requirements (kcal/d) for infants 6 months to 2.99 years (weight in kg; height in cm):

• Males:  −716.45 − (1.00 × age) + (17.82 × height) + (15.06 × weight) + 20
• Females: −69.15 + (80.0 × age) + (2.65 × height) + (54.15 × weight) + 20/15
  • Energy cost of growth for girls: 6 to 11.99 months: 20 kcal/d; 12 to 35.99 months: 15 kcal/d.