Well Baby Visits

Definition of Well Baby Visits

A well baby visit is when an infant (an infant under one year of age) has a routine history and physical exam at the healthcare professional's office or clinic. This exam has several purposes. One goal is to check a child's physical growth and development. During the exam, the healthcare professional can detect any of a number of genetic, nutritional, or other developmental problems that need early intervention in order to prevent worse problems later. A second goal is to teach parents about healthy growth and developmental milestones as well as reinforce basic principles of parenting. The child's risks of injury and illness can be reduced if parents take careful note of the things the professional emphasizes in the office. The well baby visit is also an ideal time for the child to receive any needed immunizations. It is important not to wait until the child is old enough to register for school before catching up on shots. Many of the diseases for which vaccines are recommended are most serious if caught during infancy or the preschool years.

What is the information for this topic?

A well baby visit involves a number of standard procedures. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommend that 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 and each year thereafter.

At each exam:

• The healthcare professional checks the child's head circumference, height, and weight (BMI percentile or Body Mass Index Percentile). In the past, healthcare professionals used a growth chart that compared weight and height. Now, it is recommended that healthcare professionals utilize the body mass index percentile, called BMI percentile.

The healthcare professional should 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 healthcare professional 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 healthcare professional will also look for signs of infection and for new teeth coming in.
• The healthcare professional 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 healthcare professional will check the child's gait.

It is also standard for the healthcare professional 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 2006, a child should receive his or her shots at the times detailed below. Only the vaccines recommended during the first year of life are listed here:

• 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.
• DTaP (diphtheria, tetanus, and (acellular) pertussis): These shots are given at age 2, 4, and 6 months…
• (Inactivated) Polio vaccine (IPV): 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.
• 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 healthcare professional may be able to skip the third dose at age 6 months, depending on the brand of vaccine used.
• Pneumonia vaccine (PCV, also called Prevnar): This vaccine is now recommended for all children. It should be given at ages 2, 4, and 6 months.
• Rotavirus vaccine. Three doses of this oral vaccine against a serious cause of infant diarrhea are given between 6 weeks and 32 weeks of age.
• 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 all children 6 months through 5 years. In a child's first flu season after turning 6 months of age, he or she should receive two doses of the flu vaccine separated by one month.