Infant Medical Checkups

 
Each physician will have a different approach and schedule for regular checkups, and will further vary with each individual child's needs. Routine infant checkups, often referred to as well baby visits, typically occur at the age of two weeks, two months, four months, six months, nine months, and twelve months. During these exams the physician is checking to see whether the baby is reaching basic developmental milestones that occur at each age, and whether there are any obvious signs of abnormalities or problems.

The physician will check the baby's physical growth at each visit by measuring his weight, length, and head circumference. These measurements are carefully plotted and recorded in order to provide a reference for future visits, allowing the physician to see if the baby is growing at an adequate rate.

As well, the physician will question the baby's caregivers about his vision, hearing, and motor and sensory development. Immunizations will be given at these visits. Immunizations will be discussed separately in another section (see Immunizations).

The physician will observe how the baby and his caregivers interact to see how he has progressed socially and emotionally. Questions will be asked regarding the baby's sleeping and eating patterns, his behavior, how the rest of the family is doing, and if there are any changes or developments, physically or mentally, with the baby that have been noticed.

Well baby visits provide the mother with a comprehensive assessment of the baby's health and development since birth. Additionally, well baby visits provide the mother with a fabulous opportunity to ask the physician any questions that have come up.

In addition to the general questions, measurements, and physical examination that constitutes a well baby visit, the physician will be monitoring specific developments and areas during each visit. This section is meant to provide the mother with a basic understanding of the procedure and purpose of the routine infant medical exams during the first year of life. Each regular visit that typically occurs during the year will be outlined.

Two-Week Checkup

This checkup should be a fairly relaxed visit. The physician and his/ or her staff will take their time getting to know the mother and the baby better. In doing so, they will ask the mother numerous questions, which she should be prepared to answer. Some of the questions that are more likely to be asked include:

- How are you doing as new parents?

- How well is the baby eating?

- What has the baby's sleeping schedule been like?

- Does the baby seem to hear and see fine?

- Can you describe the baby's personality? Is he active? Does he cry often? Does he settle down easily after crying?

- Do you have any concerns?

The two-week checkup will provide the mother with a good opportunity to ask the baby's physician and questions that may have arisen in the short period since the baby has been at home. It will also offer the mother the chance to gain better knowledge of the baby and his body by watching the exam up close. Some of the topical areas that the mother may want to discuss at the meeting include:

- circumcision and foreskin concerns

- The baby's bowel habits

- Umbilical-cord healing

- Immunizations (which are needed, schedule, etc. )

- Colic

- The baby's personality/behavior and how to deal with it

- The baby's eating habits

- The baby's weight and growth since birth

- Sleep patterns and needs

In his/her line of questioning, the baby's physician will explore the medical history of the mother's pregnancy and labor, as well as the family medical history of both parents. For this reason it is best that both parents attend the exam. As well, it is a good idea to send all medical records to the physician if he does not already have them.

Once the initial consultation between physician and parents is complete, the physical examination begins. Typically, the first stage of the physical exam is measurements. The baby's head circumference, length, and weight will be taken. Head circumference is measured by wrapping a cloth or paper tape-measure around the largest part of the baby's head. Head circumference is taken because this measurement is an indirect measure of brain growth. Length is measured by stretching the baby out flat - extending the otherwise tucked-up legs. Weight is taken on a scale designed specifically to weigh infants. These measurements will be used to compare measurements taken in future visits. This will allow the physician to monitor growth and development, and watch for any sudden changes which might indicate a problem or abnormality. The physician will likely show the parents where the baby's measurements fall on a standard infant growth and development curve. The mother should not be worried if the baby is relatively low or high on the curve. What is important is that the baby grows and develops at a normal, regular pace. The baby's growth is not going to parallel that of other babies. Factors such as heredity, size at birth, illness, and growth spurts will all affect the rate at which the baby grows and develops. To see the height and length of an average infant at each age, see the DEVELOPMENT GUIDE.

The next stage of the checkup will be a developmental and behavioral assessment. The mother will be asked whether the baby is able to perform a variety of different actions such as lifting his head, or moving his head from side to side; whether he looks at human faces and stares; if he is able to focus on objects eight to 12 inches from his face; and whether he responds to lights and sounds. Again it should be stated that not all infants develop at the same rate. Thus, if the baby is unable to do all of these, the mother should not worry.

The next stage of the checkup is the head-to-foot physical examination. Not all physical examinations will be similar. They will vary greatly depending on the physician, the baby's mood, questions that have been answered during the exam, significant findings during the checkup, and how soon the baby is to be examined again. Some of the common parts of the physical exam include:

- Observing the baby's responses to the exam; does he respond as normal infants do?

- Looking in the ears and mouth

- Feeling the size and softness of the fontanelles

- Looking in the eyes with a special device

- Observing the baby's chest for signs of labored breathing

- Listening to the baby's heart. Is the beat normal, or worrisome? Is there a murmur?

- Observing the way the baby moves his arms and legs. Does muscle tone and strength seem to be normal?

- Listening to the baby's lungs to see if breathing sounds normal

- Testing the baby's hips for ease of movement, and to see whether the hips are in their correct position in the hip socket.

- Looking over the baby's skin for signs of jaundice , rashes, birthmarks, or other abnormalities

- Palpating the abdomen for tenderness or masses

- Checking to see that the baby's navel is healing properly

- Examining the baby's genitals for defects or hernias

- Evaluating circumcisions on boys

The physical exam generally concludes the first checkup. If the mother has any other questions or concerns that she would like to discuss, it can be done now. The physician will also inform the mother of what she can expect between now and the next checkup, and educate the mother on various things that she should be doing for the baby during that time.

The mother should at this time book the baby's next checkup, and arrange for any tests or exams that were deemed necessary during the checkup. If the baby did not receive his first Hepatitis B shot after birth, he will be given it now.

Two Month Checkup

This checkup will follow the same format as the two-week checkup. The baby will be weighed and measured, and the results plotted on his chart. Again, it should be reminded that where the baby sits on these growth charts compared to other babies (what percentile he sits in) is no where near as important as his steady rate of growth and development.

This checkup, like the last will begin with a lengthy discussion between the mother and the physician or aide. The discussion will revolve around topics such as sleeping, feeding, schedules, development, immunizations, safety, the baby's personality, and any concerns or questions that the parents may have. The physician will also ask the mother to detail and discuss any changes or notable happenings since the last checkup.

The physician will then assess the baby's developmental and behavioral growths. He will ask whether the baby is smiling; whether he follows objects with his eyes; whether he can lift his head when placed on his stomach; and if he has begun to make noises such as coo. Again, the mother should not worry if the baby is not able to do all of these tasks. Infants develop at different rates.

The physician will again perform a head-to-foot physical exam, identical to the one given at the two-week checkup. The mother should not be afraid to ask any questions at this point in the checkup. There is no such thing as a stupid question. Some times the most innocent question can lead to the discovery of a serious condition or ailment. Simply because a concern seems insignificant, does not mean that it is. The physical exam will include:

- Checking the baby's head to make sure that the fontanelle is still open, soft and flat

- Checking hip movement

- Looking over the baby's skin for signs of cradle cap and other rashes

- Observing the baby's movements and evaluating his reflexes

- Evaluating the baby's sucking reflex and inquiring whether the baby seems to be producing more saliva

- The baby's genitalia will be examined to ensure circumcision has healed properly, and the testes have descended into the scrotum (if the child is male)

- The baby's eyes will be examined to ensure that he is following objects passed in front of him, that his tear ducts are not blocked, and that there is no worrisome discharge

- The baby's abdomen will be palpated to ensure there are no enlarged organs or unusual growths or softness

- The baby's navel will be inspected to ensure proper healing

- The baby's heart and lungs will be listened to

Four Month Checkup

This checkup will again follow the same pattern as those before it. The checkup will begin with a long discussion of any notable happenings with the baby since the last visit, and any questions or concerns that the mother may have.

The baby will then be measured and weighed, and the results will be plotted on his growth chart. Again, what is important to see is steady growth and development, rather than where on the chart the baby rates.

The physician will then attempt to assess the baby's developmental and behavioral growth by asking the mother a number of questions regarding the baby. These questions will include:

- Is the baby sleeping through the night?

- Does the baby seem to hear well?

- Is the baby able to roll over yet?

- Is the baby exploring the world around him by putting anything he can into his mouth?

- Can the baby follow a moving object by rotating his head from side to side?

- Is the baby babbling (attempting to speak but making no sense)?

Again, if the baby is unable to do any of these, the mother should not worry. Infants develop at different rates. He will be able to do these actions soon enough.

The checkup will conclude with the same head-to-foot physical exam that has been administered at the previous checkups. This will include:

- The baby's head will be checked again to see that the fontanelles are smooth, flat and still open

- The baby's genitalia will be checked

- The baby's eyes will be checked. If they had been crossed earlier on, they have likely straightened themselves out naturally

- The baby's skin will be examined for any birthmarks or rashes

- Muscle tone and strength will be assessed

- The baby's hands and feet will be examined, and the movement of his legs and hips will be monitored

- The baby's nose will be inspected (inside)

- The baby's abdomen will be palpated

- The baby's heart and lungs will be listened to

This exam may end with a blood test for anemia, particularly if the baby was born prematurely.

Six Month Checkup

This checkup will be no different from the previous exam. It will follow the same basic routine. As usual, the checkup will begin with a lengthy discussion between the mother and the physician. The subject of which will include any important and noteworthy events surrounding the baby since the four month checkup. The mother should also, as usual, come with a list of prepared questions for the physician regarding the baby's health, parenting, etc.

After the preliminary discussion the baby will be weighed and measured - both his length and head circumference will be measured as always. These measures will then be plotted on the baby's growth chart and the physician will explain to the mother how the baby is developing and growing. Again, it should be remembered that where the baby sits on the growth chart compared to the average spread of children his age is not as important as a demonstrated steady and normal rate of growth.

The physician then administers a developmental and behavioral assessment of the baby. This is done primarily by asking the mother what actions/movements the baby is now capable of, and by physically testing the baby for these movements. At this checkup, the physician will be interested to know if the baby is able to:

- Pay great attention to small objects?

- Roll over and back, from side to side?

- See across the room?

- Sit upright with little support?

- Babble?

- Transfer objects from one hand to the other?

- Reach for, and grasp objects?

Once again, there is no need for the mother to worry if the baby is unable to do any or all of these actions. Different infants grow and develop at different rates. Thus, the baby may simply be slower than the average child in terms of development.

As usual, the checkup will conclude with a head-to-foot physical examination of the baby. At this checkup, the focus of the physical exam my switch from growth and physical development, to an evaluation of the baby's abilities, activities, and motor development. It can be expected that the exam will include the following:

- Listening to the baby's heart and lungs

- Discussing sleeping and feeding issues

- Examining the baby's skin for rashes and other indicators of health issues

- Testing the baby's sight and hearing capabilities

- Feeling the baby's fontanelles

- Testing the ability of the baby's eyes to focus straight ahead

- Feeling for incoming teeth

- Evaluating the baby's ability to grasp and release objects

- Testing the baby's head control

- Evaluating the baby's reaching skills

- Assessing the baby's muscle tone and strength

- Examining genitals

- Testing the baby's ability to stand and sit with little or no help

The physician will end the checkup with a brief discussion of the developments and changes that the mother can expect to see in the baby between now and the next checkup. The physician may also begin discussing some general infant safety with the mother if he has not already.

Nine Month Checkup

Although the checkups have become routine, this particular checkup may be the most traumatic for the baby. As the mother may remember from the Weekly/Monthly Guide to Development and growth, this is the age at which many infants develop a fear of strangers and a definite unwillingness to be away from their mothers or caregivers. Thus, the checkup may require the mother to be very involved, and even hold the baby on her lap for a portion of it.

As always, the checkup will begin with a discussion between the mother and the physician regarding any questions, and any significant and noteworthy events that may have arisen since the last checkup. The baby will then be measured and weighed, and the results will be plotted on his growth chart. Once again, the appearance of steady growth and development is more important than where the baby sits relative to an average child at his age.

The physician will then move on to a developmental and behavioral assessment of the baby. The mother will be asked a variety of questions and the baby will be tested for various traits. Some of the developments that the physician will be looking for include:

- Does the baby reach and grab objects?

- Is the baby able to pick up objects, even small one, between his thumb and index finger?

- Is the baby able to sit upright by himself?

- Is the baby showing signs of separation anxiety and fear of strangers?

- Is the baby able to pinpoint the source of sounds?

If the baby is unable to do some or all of these, the mother should not worry. Infants develop at different rates. These abilities are common in the average infant at this age. The baby may simply be below the average but will catch up in time.

Again, the exam will be concluded with a head-to-foot physical exam of the baby. The mother should remember to ask any questions that she may have no matter how trivial or unimportant they may seem. This exam is meant to evaluate the baby's general health and test his motor skills and development. These goals will be achieved by:

- Listening to the baby's heart and lungs

- Feeling the baby's head (fontanelles)

- Feeling for new teeth

- Checking the baby's hip movement

- Testing to see if the baby can sit without support

- Examining whether the baby palms objects to pick them up or if he uses his fingers

- Inquiring if the baby has sleeping problems

- Inquiring what the baby eats and drinks

- Evaluating the baby-babble that the baby uses to communicate

- Is the baby able to pull himself up into a standing position while supporting himself on something?

- Can the baby walk sideways while supporting himself on furniture?

- Is the baby able to stand when supported?

Again the checkup will close with the physician providing the mother with some guidance regarding what can be expected of the baby in the time before the next - and final - checkup of his first year.

One Year Checkup

As usual, the checkup will begin with a lengthy discussion between the mother and the physician regarding any questions that she has, and any significant events that happened to the baby since the last visit.

The baby will then be measured and weighed, and the results will be plotted on the baby's growth chart. The mother should not worry that the baby is above or below the average height and weight for his age. What is important that the baby displays normal and regular growth between every checkup. Regular growth of the circumference of the baby's head is also important. Slow growth in this area may be an indication of greater problems with the brain or skull.

The physician will then perform a developmental and behavioral assessment on the baby. This assessment is done primarily by questioning the mother on the baby's specific abilities, but is aided by physically testing the baby. This assessment will include questions and tests such as:

- Does the baby wave good-bye?

- Can the baby stand using an object to pull himself up?

- Does the baby imitate sounds?

- Does the baby walk while using an object to support himself?

- Is the baby able to say any words?

- Is the baby demonstrating any signs of separation anxiety or fear of strangers?

If the baby does not demonstrate some or all of these traits, there is not a great reason for concern. Infants all develop at different speeds. The baby may be slightly ahead or behind the development of an average infant at this age.

The exam will conclude with a thorough head-to-foot physical exam of the baby. This exam will mimic those of past checkups. The exam will conclude with a discussion of what the mother can expect in terms of developments from the baby until the next visit.

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