What are the key topics to discuss with parents during a 6-month well-child check for a breastfed or formula-fed infant?

Key Topics for the 6-Month Well-Child Visit

At the 6-month well-child visit, prioritize discussion of safe sleep practices, exclusive breastfeeding or formula feeding patterns, introduction of complementary foods, developmental milestones, and maternal mental health screening.

Feeding and Nutrition

Breastfeeding Status

• Confirm whether the infant is exclusively breastfed and encourage continuation through 6 months, as exclusive breastfeeding for approximately 6 months is the AAP recommendation, with any breastfeeding being more protective against SIDS than no breastfeeding 1.
• If breastfeeding is not exclusive, assess what supplements are being given and why, as the protective effect increases with exclusivity 1.
• Discuss plans for continued breastfeeding beyond 6 months alongside complementary foods, as the AAP supports breastfeeding until 2 years or beyond as mutually desired 1.

Vitamin D Supplementation

• Verify that breastfed infants are receiving 400 IU of vitamin D daily, as this should have been started in the first few days of life 2.

Introduction of Complementary Foods

• Discuss introducing iron-rich complementary foods at approximately 6 months, including finely ground meats, chicken, fish, and iron-fortified cereals as first choices 2, 3.
• Emphasize that breast milk or formula should remain the major component of the diet as solid foods are gradually introduced 2.
• Advise against introducing complementary foods before 4 months, as early introduction may reduce breastfeeding duration and displace valuable nutrients 2.
• Discuss introducing fruits and vegetables alongside protein-rich foods 2.

Allergenic Foods

• For infants at moderate or low risk of peanut allergy, discuss introducing peanut-containing foods at 6 months 2.
• For infants with severe eczema or egg allergy, recommend evaluation before peanut introduction between 4-6 months 2.

Dental Health

• Discuss limiting or avoiding juice entirely, as juice should be avoided before one year of age 4.
• Advise weaning to a cup by 12 months to improve dental health 4.

Safe Sleep Practices

Sleep Position and Surface

• Confirm that the infant is always placed on their back to sleep on a firm surface (safety-approved crib mattress with fitted sheet only), as this reduces SIDS risk 1.
• Verify no soft bedding, pillows, or toys are in the sleep space, as these increase suffocation risk 1.

Room-Sharing

• Strongly recommend that the infant sleep in the parents' room on a separate surface for at least the first 6 months, ideally the first year, as this decreases SIDS risk by as much as 50% 1.
• Emphasize placing the crib close to the parents' bed to facilitate feeding and monitoring 1.
• Advise against bed-sharing, as it increases risk of suffocation, strangulation, and entrapment 1.

Sleep Equipment Safety

• Verify the crib meets Consumer Product Safety Commission standards with slat spacing less than 2-3/8 inches and no missing hardware or drop sides 1.
• Check that the product has not been recalled, particularly important for used cribs 1.

Developmental Surveillance

Developmental Milestones

• Perform developmental surveillance at this visit, asking about motor skills (rolling, sitting support, reaching for objects), social interaction (responding to name, recognizing familiar faces), and communication (babbling, responding to sounds) 4.
• While formal developmental screening is recommended at 9,18, and 30 months, surveillance should occur at every visit 4.

Reading and Language Development

• Discuss the importance of reading to the infant daily, as this supports vocabulary and social development 5.
• Encourage talking, singing, and verbal interaction throughout daily activities 5.

Maternal Mental Health

• Screen the mother for postpartum depression, as this is recommended for mothers of infants up to 6 months of age 4.
• Provide resources and referrals if screening is positive 4.

Safety Guidance

Car Seat Safety

• Verify the infant remains in a rear-facing car seat and will continue rear-facing until at least 2 years of age or until reaching the height/weight limit for the seat 4.
• Confirm proper installation and that the infant is never left unattended in the car seat with straps unbuckled 1.

Burn Prevention

• Discuss burn prevention strategies, as this is an area of unmet need reported by parents 5.
• Cover topics like testing bath water temperature, keeping hot liquids away from the infant, and setting water heater temperature to 120°F or below.

Injury Prevention

• Discuss childproofing as the infant becomes more mobile (covering outlets, securing furniture, removing choking hazards) 4.

Growth Monitoring

• Plot weight, length, and head circumference on WHO Growth Charts, as routine growth monitoring assesses infant health and nutrition 3.
• Address any concerns about growth patterns or feeding adequacy 3.

Immunizations

• Review and update immunizations according to the current CDC schedule 4.
• Address any parental concerns or questions about vaccines 4.

Common Pitfalls to Avoid

• Do not recommend introducing solid foods before 4 months, as early introduction is associated with childhood obesity and reduced breastfeeding duration 4, 2.
• Do not advise stopping breastfeeding unnecessarily for maternal medications or minor illnesses, as most are compatible with breastfeeding; use resources like LactMed for guidance 1.
• Do not overlook maternal mental health screening, as postpartum depression affects infant care and development 4.
• Do not assume all topics are covered—parents report unmet needs in areas like discipline strategies, child care, and developmental topics, so explicitly ask what questions they have 5.