Nurturing Care -9 to 12 months


(from Malawi Guidelines for Community-Based Management of Acute Malnutrition, 2nd Edition)

At this stage, your baby is growing fast so he requires more food frequently, but in small quantities that meet his growth and developmental needs. At this age, your baby needs to start the day with a meal in the morning.

Continue to breastfeed your baby and increase the amount of food given until you feed him a standard cup (250 ml), or 8 tablespoons, per meal. Feed your baby additional foods at least three times per day. Be sure to include foods that your baby can pick up as this helps him grow and develop. 

Mothers and caregivers should:

  • Feed thick phala (porridge) made from the six food groups. These should include fortified foods such as Likuni Phala, ufa wa mgaiwa, groundnut or soya flour, or futali in the morning.
  • Give soft nsima with mashed beans or any other relish (according to what you have) to start the baby on family meals.
  • Bring some food for the baby, including snacks like fruits or chikonda moyo made from enriched flour, when taking your baby away from home.
  • Wash hands and your baby’s hands with soap and clean fresh water before feeding him.
  • Stay with your baby during meals. He will eat better when someone is there to encourage him.
  • Feed your baby before other family members until he has eaten enough.

Responsive Caregiving

You are the most important person in your baby’s life.  Learn what your child likes and dislikes so you can meet his needs better.  Hug, laugh, smile, and clap for your baby when he does something new.  If your child is moving towards something dangerous or forbidden, pick him up and move him to a safe place while calmly and clearly saying ‘no’.

All children should make an appointment at 9 months for developmental evaluation.

Development for 9 months (from Road to Health by the Department of Health in the Republic of South Africa)

Hearing/CommunicationVision and adaptiveCognitive/behaviourMotor skills
Babbles (‘ma-ma’ ‘da-da’)Eyes focus on far objectsThrows, bangs toys or objectsSits without support
Turns when called Reacts when caregiver leaves. Calms when he/she returnsMoves objects from hand to hand

Development for 12 months (from Road to Health by the Department of Health in the Republic of South Africa)

Hearing/communicationVision and adaptiveCognitive/behaviourMotor skills
Uses simple gestures (e.g. lifts arms to be picked up)Looks for toys/ objects that disappearImitates gestures (e.g. clapping hands)Stands with support
Has one meaningful word (dada, mama although sounds may not be clear)Looks closely for toys/ objects and picturesUnderstands ‘no’Picks up small objects with thumb and index finger
Imitates different speech sounds   

Make an appointment to see the pediatrician for further evaluation if your child cannot do these milestones listed above at 9 months and 12 months. 

Early Learning

Play– Hide your child’s favourite toy under a cloth or a box.  See if your child can find it.  Play peek-a-boo.  Give your baby a doll.

Communication– Tell your child the names of things and people.  Show your child how to say things with hands, like “bye bye”. 

Security and Safety

Car seats– Your baby should be safely restrained in a car seat in the back of the car, facing the back each time you are in the car.

Falls– Babies fall a lot as this age as they are learning to crawl and beginning to walk.  Teach your baby to roll over on his stomach to climb out of a chair.  Secure furniture that is wobbly and may fall over if baby pulls up on it.

Burns- Teach your baby that the fire is “hot!” and he should stay away. Keep hot drinks away from the edges of tables where baby can pull it down.

Choking- Don’t let baby play with small objects such as caps, coins, or hard candy. If baby chokes, turn him across your arm on his abdomen with his head pointing down and hit his back between the shoulder blades with the heel of your hand several times until the object comes out.

Good Health

Fever– All fevers should be evaluated to make sure your child doesn’t have malaria.  Your child should sleep under a long-lasting insecticide treated mosquito net every night to help prevent malaria. Many childhood fevers are caused by viruses. Your baby’s body can fight off viral infections without antibiotics. DO NOT give your child an antibiotic unless ordered by a qualified clinician.

Diarrhea– Increase fluids right away if your child has diarrhea.  Give ORS by mixing 1 packet with 1 liter of clean water. Give 50 to 100 ml (less than half a cup) for each diarrhea episode. Go to the clinic if your child has a fever, blood or mucus in the stools, or your child has signs of dehydration (dry mouth, sunken eyes, decreased energy level, or less wet nappies.)

Trouble breathing- If your child has fast breathing (about a breath every second), in-drawing (you can see the skin sucking in between the ribs when breathing), wheezing, or fever then bring your child to the clinic to be seen. 

Chifuwa– If your child has a runny nose and little cough with no fever or no trouble breathing, then you can watch him from home. He should get better in about 10 days. Bring him in if not improving.

Teeth- Clean your baby’s teeth with a soft toothbrush with a rice grain size of toothpaste that contains fluoride morning and night. Do NOT let your baby go to sleep with a bottle as this will damage the teeth.

Immunizations– Vaccines protect your child from serious diseases.  Remember to go to the government immunization sites for your child’s MR vaccine at 9 months of age. Make an appointment with reception if following a different country’s schedule.

Click on the links above to see more detailed articles. Here is a printable copy of the above information:

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