Well Visits: What Your Baby’s Doctor Looks for in the First Year

The basics of well visits are the same throughout childhood: evaluation of growth and development, physical examination and anticipatory guidance. These components will be a part of each well visit during the first year.

The CDC has published growth charts for height, weight and head circumference based on age and gender. It is important that a child’s growth is charted on these charts at each well visit. Looking at all the points on a growth chart gives much more information than a single height or weight. While some parents are concerned about which “percentile” their child is in for height or weight, the most important thing is that the child is growing appropriately. We would not expect a premature baby to be in the normal range of growth parameters, but rather to increase at a steady pace toward the normal range. A dramatic change in weight, up or down, might signal a problem that needs attention. This is easily identifiable when growth charts are used.

There are development goals at each well visit including speech, vision, motor skills and social interactions. Some of these milestones are fairly uniform in healthy children, for example, eyes not crossing after 3 months. Others, such as crawling, are more variable, which can start early (7 months) or may not happen until after children are walking. All children progress differently. Your pediatrician can help you determine whether your baby is developing normal or has a significant delay.

Anticipatory guidance is a doctor’s way of passing on information about what to expect from children at each stage while reminding you of general safety. Some items that are frequently discussed include feeding, proper car seat use, safe sleeping, sun protection, smoking cessation and appropriate play for developmental stage.

The well visit schedule may vary from physician to physician. What follows, however, is a possible scenario which covers the important elements of each visit.

4 Days

Most pediatricians ask parents to bring newborns to the office within 48 hours of leaving the hospital. This allows for the evaluation of skin color to check for jaundice and to answer any questions that have arisen about breastfeeding. The baby’s weight should be no more than 5-7% under birth weight. Reminders about smoke detectors and safe sleeping habits (always on the back) are appropriate. Parents and caretakers should be encouraged to get the Tdap vaccine for themselves to decrease the baby’s chance of getting pertusis (whooping cough). The health department and most doctors’ offices have this shot.

2 Weeks

Weight is the main focus of the two week visit. Newborns should be back to their birth weight by two weeks. In Alabama, the newborn state screen for genetic diseases is repeated at two weeks. The first screen is preformed before the baby leaves the hospital. You can see a list of the 9 congenital diseases included in the screen at www.adph.org – search newborn screen. This is a good time to repeat the guidance from the first visit since most parents have gotten a little more sleep now.

2 Months

Grandparents or friends are frequently encouraging parents to introduce cereal or mashed potatoes around two months. No other food besides breastmilk or formula is recommended at this stage for healthy growth. Immunizations generally begin at two months because babies have become more efficient at producing antibodies. This is a good time to start Vitamin D supplementation in exclusively breastfed infants. Based on my experience, many parents are already exposing their babies to educational videos or TV. I inform them that there is no value to these shows and the American Academy of Pediatrics recommends no screen time at all until 2 years of age.

4 Months

Now infants will have much improved head control. They should be able to make it through the night without milk. Some doctors suggest starting solid foods now. The AAP currently recommends exclusive breastfeeding until 6 months. I especially encourage families with a history of food allergies, asthma or eczema to wait until 6 months to start solids to decrease the possibility of food allergies. Most immunization schedules have shots at four months.

6 Months

Birth weight is frequently doubled by six months. Now all solid foods are fair game, except honey, which can cause botulism in children under 12 months. Yes, just like you, they like table food more than jar food – it tastes better! Just make sure that what you give them is not a choking hazard. As the search begins for the next car seat, remember to keep it rear facing until a year. There are typically more shots at six months.

9 months

This is an important visit for developmental screening because so much is happening. Nine month olds are pulling up and cruising around furniture. They are making “ma” and “da” sounds if not saying mama and dada or other words. They understand “no” and can play games like peek-a-boo and patty cake. Nine month olds also frequently start waking in the night after months of not waking. Depending on the vaccination schedule there may or may not be immunizations at this visit.

What to do to prepare for a well visit:

Make a list of your questions and bring it with you. This ensures that you remember all of your concerns and saves time. Bring a blanket for young babies, because you will be asked to leave them in a diaper only for measurement, examination and vaccination.

Dr. Traci Lynne Brewer is a wife and mother of two girls in Guntersville.  She is also a peditrician at Marshall County Pediatrics.