Well Baby Visits
A well baby visit is when a newborn, infant, toddler, or young
child has a routine physical exam at the doctor's office or clinic.
This exam has several purposes.
One goal is to check a child's physical growth and development. This
can help the doctor find and address problems early. Another
goal is to teach parents about healthy growth and development milestones.
Regular exams are also a good time for the child to get
immunizations.
Childhood is a stage of physical and mental development.
Providing the proper health care and guidance helps a child have a
positive future. The chances of illness can be reduced with good preventive
care. Problems can be detected and treated early.
What is the information for this topic?
A well baby visit involves a number of standard procedures.
The American Academy of Pediatrics (AAP) recommends
well baby exams be done at these times:
within 24 hours of birth
2 to 4 days after birth, if a baby goes home less than 48 hours
after delivery
at age 2 to 4 weeks
at age 2 months
at age 4 months
at age 6 months
at age 9 months
at age 12 months
At each exam:
The doctor checks the child's head circumference,
height, and weight. These figures are plotted on a growth chart, and
the body mass index, called BMI,
can be noted. The doctor can then monitor the child's growth on
each visit and compare it to the last visit. This is a key factor in knowing
that a child is growing in a healthy way.
The doctor will feel the soft spots on the top and the back of the
baby's head. The soft spot on the back of the head usually closes between
the ages of 2 to 5 months. The spot on the top of the head closes by
18 months.
The baby's eyes, ears, and mouth will be checked for irregularities.
The doctor will also look for signs of infection and for new teeth coming in.
The doctor will listen to the child's lungs, chest, heart, and
belly. The belly is also pressed gently to feel for swelling in the internal organs.
The baby's reflexes, hearing, and vision may be checked. This will
depend on the baby's age.
The genitals will be checked for lumps, swelling, tenderness, or
signs of infection.
The baby's legs will be rotated and gently pulled apart to check for hip
dysplasia, congenital hip dislocation,
or other hip problems.
When the child can walk, the doctor will check the
child's gait.
It is also standard for the doctor to ask
about the child's development. During the baby's first year, he or she
will ask if the child sits up, rolls over, and pulls himself or herself to a
standing position. Other developmental milestones will also be talked about.
These include questions about:
bottle or breastfeeding
bowel movements
eating
crying
playing
cooing
babbling
following people with the eyes
These visits also give the caregivers a chance to
ask questions. Typical topics may include how the baby is
doing, what to expect in the future, what to do in cases of illness, and
other concerns caregivers have.
Another key part of the well baby visit is the
routine immunizations.
These are crucial for preventing life threatening illnesses. According to the
Recommended Childhood Immunization Schedule: United States, 2002, a child
should receive his or her shots at these times:
Hepatitis B:
The first shot in this 3-shot series should be given within 12 hours of birth,
before going home from the hospital. If the mother is known to be
HbsAg-negative, this shot can wait until the child is age 2 months. The second
dose should be given at least 4 weeks after the first dose, followed by a third
dose at least 8 weeks after the second dose. This last dose should not be
given at an age younger than 6 months.
DPT,
which is diphtheria, pertussis, and tetanus: These shots are given at
age 2, 4, and 6 months. A fourth dose is given between the ages of 15 and
18 months. It may be given as early as 12 months, if the child is not likely
to return for a visit between 15 and 18 months, but only if the third dose was given at
least 6 months before.
Polio vaccine:
The first two doses of this vaccine are also given at age 2 and 4 months.
The third dose can be given any time between age 6 and 18 months.
Somewhere between age 4 and 6, a fourth dose is given.
MMR,
which is the measles, mumps, and rubella vaccine: The first dose of this
vaccine is given between age 12 to 15 months. The second dose is usually
given between the ages of 4 to 6, but may be given earlier as long as there
are at least 4 weeks between the 2 doses.
Hib,
which stands for haemophilus influenzae type b: The first
three doses of this vaccine are also given at ages 2, 4, and 6 months. The fourth
dose can be given any time between age 12 and 15 months. NOTE: The
doctor may be able to skip the third dose at age 6 months, depending on
the brand of vaccine used.
Varicella, the chickenpox
vaccine: This one can be given at any time, but is often given around
the age of 12 months. Children getting the first vaccine at less than age 13
should also receive a second dose at least 4 weeks after the first.
Pneumonia vaccine (PCV-type): This vaccine is now
recommended for all children. It should be given at ages 2, 4, and 6 months.
Children in some high risk groups are now encouraged to also
get the following vaccines:
Influenza: This is a yearly vaccine that helps protect against that year's most
likely strains of influenza virus, commonly called the flu. This vaccine is often
recommended for those who have chronic respiratory illnesses, such as
asthma. Children who have sickle cell disease, diabetes, HIV, or heart disease may
also need a yearly flu shot. Children who get their firs flu shot ever at an age less
than 8 years should get two doses, separated by at least 4 weeks.
Hepatitis A: This vaccine may also be recommended for
some children who live in certain areas of the US, or for certain high risk groups. It is
usually given between the ages of 2 and 18.
Pneumonia vaccine (PPV-type): This form of pneumonia vaccine is
recommended for certain children in addition to the PCV vaccine. It can be
given at any time after the age of 2 years.
The doctor can tell parents if their children need to have one of these
special vaccines.
The 2002 immunization guidelines also recommend that doctors
check all children around age 11 or 12 to make sure they are up to date with
their immunizations. If they are not, they should be caught up at this time. This
is especially true of the following vaccines:
Hepatitis B
MMR
Varicella
PCV pneumonia
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