We're first time parents. How do we know when to worry and what to worry about?

We're first time parents.  It seems like every time we turn around we find something more to worry about. It's hard to sort out all the information we are getting, and to figure out what we should worry about, if anything!

Most first time parents take great delight in watching their baby’s development, day by day, week by week, and month by month. (It's not that second time parents don't enjoy watching their babies, it's just that they usually don't have as much time or sense of awe the second time around!)  This month, I'll describe some of the predictable milestones you'll see during your baby’s first year and what you should and should NOT worry about along the way.  Of course, your baby might be a little behind or ahead of these milestones, especially if he arrived early.  Unless you're grooming him to be completely average in every way, don't worry if his baby book doesn't match the "usual" rate of development.

Newborn:  When you put your baby on her tummy on a flat surface, she will turn her head to the side.  Her neck will barely lift her head, so her nose will touch the surface as she moves.  She'll lie with her limbs flexed at elbow and knee much of the time.  When you hold her facing you, she'll gaze at your face.  She will grasp your finger tightly and will keep her fists clenched most of the time.  She will attend to sounds and you will see her blink or startle to a loud noise.  Her movements are symmetrical and she is equally strong on both sides of her body. She may “startle” easily if she’s not held or wrapped well.

What to worry about: Getting enough rest, support, and help with household chores and meals.  Moms (and dads) who try to do it all without help are at risk for postpartum depression and illness and babies wind up suffering.

What NOT to worry about: Your baby snorting, sneezing and grunting in her sleep.  Newborns have flat noses and the air passing through their nostrils can sound like a jet engine.

 

One month:  When your baby is placed on his tummy, he will turn her head and clear the surface with his chin up.  If you pull him from his back to an angled sitting position, his head will still lag behind the rest of his body.  His limbs are relaxed when he lies on his back, but if he is looking off to one side it's likely that his arm on the opposite side will be flexed.  He can track your face or a brightly colored object in movement. He can probably smile by now, and no, it's not just gas!

What to worry about: A baby who often cries before and after feedings.  He might be taking in too much or not enough, but you need the advice of a knowledgeable person to help you figure this out.

What NOT to worry about: A baby who feeds well and sleeps well in between, but wants to be held all the time when awake.  Babies this age need a lot of holding time!

 

Two months:  When you place your baby on her tummy at this age, she can lift her head and her chest off the surface.  Her head still lags a bit when she is pulled to sitting from her back.  Her grasp is still strong but is not as automatic and her hands are not clenched in fists any more.  When she gazes at you or an object, she can track your movement in a 180 degree arc.  She will pay attention to your voice, to high pitched cooing sounds, and to singing.  She smiles when you talk or play with her.

What to worry about:  Your family and friends will want to cuddle your baby and may need reminders to wash their hands and keep a distance if they have any cold symptoms.  Babies this age have limited immune responses and can become very sick from contact with an adult or child with a respiratory infection.

What NOT to worry about: Stimulating your baby with mobiles or toys, or activities.  Babies this age need to see your face and hear your voice more than they need the distraction of objects.

 

Three months:  Now, when your little one is placed flat, she extends her arms and pushes her head and chest up off the surface!  On her back, or in a reclining position, she may bat or reach for objects that you hold in front of her,  but she may not be able to grab yet. When you pull her to a sitting position, her head lags momentarily, but she has more control than she did a month ago.  Now, she can look at you, smile at you, and have a sustained social "conversation" as she responds to your voice and expression.  She enjoys and pays attention to music and singing and clearly recognizes familiar people.  She may be cooing and making vowel sound vocalizations.

What to worry about:  Providing so much entertainment that your baby doesn’t take a nap every two to three hours during the day.  An overtired baby is not a happy baby.

What NOT to worry about: Your baby sucking her thumb or fingers.  Babies who can soothe themselves this way are usually calmer during the day and sleep better at night.

 

Four to five months:  Your baby can now push herself up from her position on her tummy, fully extending her arms and looking around.  When she is lying on her back, she can bring her hands together at the midline of her body.  She can reach for an object you hold in front of her, grasp it, and bring it to her mouth.  Her head doesn't lag when you pull her to a sitting position, and she has good head control when she sits in your lap or you pull her to a stand.  She probably enjoys being held upright and pushing down to "stand up".  Her vision is getting more acute, and she will faze at a dark or shiny small object in your hand or on a light surface.  She is now smiling in delight and laughing out loud.  If you stop talking or playing with her before she is ready, she will frown or complain.

What to worry about:  If your baby can only be soothed by nursing, a bottle, or sucking on a pacifier you may be leaping to comfort her too quickly.  Babies shouldn’t be left to cry, but fussing and fretting because they are a little bored or tired won’t hurt them for a few minutes.

What NOT to worry about: If your baby doesn’t seem as outgoing as other babies when you are away from home, she may be sensitive to new experiences or too much stimulation. As long as your baby is social and interactive with family, she’s just fine.

 

Six to eight months:  By now, your baby can roll herself over, although she may have done so earlier.  She is moving her legs and arms to propel herself forward or backward, and she may begin to crawl, using just her arms, or creep-crawl, using arms and legs together.  A quiet baby may be content to stay in one place, and does not need to be encouraged to move more.  She can sit with some support, but can't get to sitting on her own.  Her trunk may bend forward if she is not given enough propping support for her back.  She can lean forward on her hands.  If she sees a small object she can lean towards it and rake it with her hand until it is closer to her.  When she has an object in one hand, she can transfer it to the other, often putting it in her mouth along the way. (These developmental achievements make it especially important for parents to keep small objects out of their baby's reach.)  If an object is placed under a cover, she acts as though it has disappeared.  Your baby now will show a preference for the people who usually care for her over strangers.  She is eager to "talk" to other people, especially children, using vowel sounds and body movements to express herself.  She makes noises such as "rasberries" or gurgles, and likes to create sound by banging.

What to worry about: A baby who is feeding every two to three hours day and night is probably snacking rather than learning to fill up at meals.  Stretching out feedings during the day to every three hours  and then offering baby both breasts or an eight ounce bottle (he doesn’t need to finish!) actually encourages a baby to self regulate and get into a day/night pattern.

What NOT to worry about: If your baby is sleeping well at night and deciding for himself how much to nurse or drink at each feeding, you can ignore his growth chart.  Some babies move to higher or lower growth percentiles than at birth during the second half of their first year.

 

Nine to eleven months:  Your baby can now sit up with a straight back and can stand with support.  She may be interested in "cruising" by holding onto a table while she walks along its side.  She is likely to be creeping or crawling, although some children bypass this step.  Her grasp is more refined, and she can pick up objects with her thumb and forefinger.  She can poke and prod and manipulate a toy or object, and continues to put things in her mouth as she explores her environment.  She responds to the sound of her own name and words for people in her family, pets, and important items such as bottle, nursing, or a transitional object.  If she sees an object placed under a towel or blanket, she will lift the cover to find it.  She enjoys playing peek-a-boo, patty-cake, and other interactive, repetitive games.  She babbles, using consonant sounds such as "da-da-da" or "ba-ba-ba."

What to worry about: Childproofing AND supervision!  A baby on the move can get in serious trouble fast.  If your baby is smart, he’s always looking for a new experience, and he may find dangers you can’t even imagine.

What NOT to worry about: If your baby starts to cry as if he’s been abandoned forever the moment you leave the room, it’s not because he’s insecure.  He’s at the age now when he notices you are leaving but isn’t quite sure where you are when you are gone.  Every time you leave and return, he practices getting through his anxiety about being separate--yes, that’s why it’s called separation anxiety, and it may go on for couple of months. 

 

Twelve months:  At the end of babyhood, the sequence of most developmental milestones will be similar among children, but the pace can be quite different.  By now, a baby may have mastered standing, cruising holding on, or even walking--all are normal for her age.  She may have one or two words or none at all.  She may be shy with strangers or eager to meet new people.  A “typical one-year-old” isn’t easy to describe.  What matters now is that your baby continues to develop skills, explore, learn and grow, all in her own way.

What to worry about:  Your own sleep and energy.  A one-year-old  will keep you busier than you have ever been, so it’s time to take even better care of yourself.

What NOT to worry about: Your baby becoming a toddler who expresses his independence by being uncooperative.  Enjoy the close connection you have now and don’t take it personally when he squirms, protests, and learns to say, “No!” It’s all part of growing up.