Well-baby examinations are scheduled regularly during the first two years
of life due to the rapid growth and change that occurs during infancy.
During each visit the pediatrician monitors, advises, and answers
questions on a baby's growth and development.
The American Academy of Pediatrics recommends the newborn infant see a
physician for a check-up at birth, two weeks, two months, four months, six
months, nine months, 12 months, 15 months, 18 months, and 24 months, and
annually thereafter. Most pediatricians follow this schedule, or some
variation of it, in prescribing a check-up regimen for their patients. A
well-baby exam consists of questions the parents will be asked about the
baby's general health and development, followed by a physical exam.
The exam includes measurements of length and height, weight and head
circumference (the distance around the head), vital signs, and a general
physical examination. Special attention is paid to whether
the baby has met normal developmental milestones. The physician will
question parents or guardians about the activities of the baby to help
assess developmental issues that are not observable by an office visit.
A pediatrician performs a thorough physical exam at birth to determine the
physical status of the newborn. This exam includes assessing size, weight,
head circumference, chest circumference, genitalia, physical mobility,
eyes, ears, nose, mouth, lungs, heart, elimination, presence of
, and much more. If the hospital pediatrician is not the same as the one
used for follow-up exams, it is important to obtain the birth records to
bring to the first office visit. Because the majority of states have laws
governing newborn testing, most hospitals do a hearing screen, metabolic
screen to assess thyroid activity, and screen for
(PKU), a genetic disorder than can be easily corrected by diet.
The first well-baby visit occurs at two weeks, and a
medical history is usually taken at this time. The baby's height,
weight, and head circumference will be measured. (Head circumference is an
indirect measure of brain growth.) Abnormally slow or fast growth may
indicate a problem that needs investigation. The health-care provider can
show parents a graph that indicates where the baby's measurements
are on a standard growth curve. The trend in growth over time is more
important than what a baby's weight and height are at any
particular visit. A complete head-to-toe exam will be performed, during
which the parent may want to ask questions related to birth marks or
anything that is perceived as unusual.
In addition to the physical exam, the physician will ask questions related
to what the baby can do physically, i.e., lift the head briefly, respond
to loud sounds, etc. These are developmental milestones that represent a
normal progression of physical and mental maturity. Although each baby
develops differently, these milestones indicate a child's progress
over time. The physician may want to observe development if possible. The
physician may provide guidance related to possible dangers in the home,
such as the importance of installing and maintaining smoke detectors,
keeping a baby away from plastic bags, and never leaving the baby
unattended while on a changing table. During this visit, the parent will
be asked about the stress of having a new baby and the situation at home.
It is a provider's responsibility to evaluate every child for
abuse, and this questioning should not be taken personally. Finally, if
hepatitis B vaccine
was not given in the hospital, the first shot may be given at this visit.
All other vaccines begin at the two-month visit.
The two-month visit will be a repeat of the two week visit with a physical
exam, developmental and behavioral
, guidance for upcoming developmental changes, and immunizations. During
the visit, a parent should never hesitate to ask any question that will
assure them the baby is healthy and progressing normally. It is a good
idea to make a list of questions before the office visit, because many
parents inevitably forget what they wanted to ask. Many parents inquire
about what could be given to the baby if there is a reaction to the
injections. The immunizations received at this time include:
The four-month exam proceeds in the same manner as the previous
two—a physical exam, developmental and behavioral assessment with
questions about what has been observed at home, and more immunizations. At
this period, the baby should be babbling and making noises,
turning over, and trying to put everything in the mouth. Parents and the
physician may discuss adding solid foods to the baby's diet,
usually in the form of cereal. The immunizations given will depend on how
and when the series was started.
The six-month exam is again similar. Generally the baby may be able to sit
alone by this stage and may be ready to add pureed food to the diet. Once
more the required immunizations will depend on the baby's history
and previous injections. In October 2003, the Advisory Committee on
Immunization Practices (ACIP) recommended universal influenza immunization
of all children six through 23 months of age. They also recommend
influenza immunization of household members and out-of-home caregivers of
children younger than 24 months. Children under eight years of age who are
for the first time should receive two doses separated by at least six
weeks. Children under five years of age should not be vaccinated with the
nasal-spray flu vaccine (LAIV).
The nine-month exam represents quite a change in baby from birth. The
parent usually has many questions by this time regarding the baby's
habits, feeding patterns, teething, standing up, and so on. Again, a list
is helpful to remind the parent of their own questions. The physical exam
is performed, plotted on the standard growth curve, and any deviations are
noted. Developmental assessment is commonly done by questioning. Does
he/she pay attention to small objects and try to pick them up using
his/her index finger and thumb? Can he/she locate sounds? Does he/she sit
by himself/herself? Does she/he transfer objects from one hand to another?
Does she/he show
? Guidance of what to expect over the next three months will again be
provided. For example, the baby may begin to walk alone, make sounds, say
the beginnings of words, or play peek-a-boo. The physician may discuss
ways to keep a baby safe, including placing gates at the top and bottom of
stairs; never leaving the baby alone in the bathtub; keeping the baby
rear-facing in the car seat until 20 lbs (9 kg) and one year of age; and
monitoring the temperature of the hot water heater to prevent
. If the hepatitis B injection was not completed at the six month visit,
it will be given at this exam.
Reaching the one-year exam is a big event in itself. The baby may be
walking (assisted or unassisted) and talking a bit at this stage. The
pediatrician will continue in the same manner as before—doing a
physical exam and noting changes, asking questions about development, and
inquiring about feeding and sleeping habits. A blood test for anemia may
be performed at this visit if it was not done at the nine-month exam.
Formula-fed babies are more at risk for iron deficiency than breast-fed
babies. If there is a risk of lead paint exposure, a test for this may be
done as well. The parent may have more questions relating to physical
changes or developmental changes, because the baby is now on the verge of
toddlerhood. Immunizations due at this time include:
Parents who may have to move during this first year or in any subsequent
years should have the child's immunization and health record with
them for a new provider to review.
The 15-month visit is very comparable to the previous visits but it does
mark a few milestones in the child's health. It is a time when the
little boy or girl that was in the baby you have known for the last 15
months can be seen. It is usually the last time immunizations are given
before the pre-kindergarten shots. The typical physical exam and
developmental evaluation will be performed and guidance on future
development will be given. It is important to now be certain that doors
and cabinets have locks, electrical sockets are covered, and objects on
which the child can choke are removed from reach. The immunizations given
at this visit will depend on those given at the prior visit.
The next exam will be at 18 months and will the same as the 15-month exam.
If any immunizations were missed, they can be caught-up at this time. The
same is true for the two-year check-up. Many pediatricians order various
tests during the first two years depending on the family's history
and the child's symptoms, i.e., urinalysis, tuberculin test, and
blood tests. The American Academy of Pediatrics recommends cholesterol
screening of children over age two whose parents have a history of
cardiovascular disease before age 55, or have blood cholesterol levels
There are essentially no precautions to take for a visit. However, parents
who may have a history of auto-immune disorders in their family should be
aware that a preservative, thimersal, which contains mercury and is used
in vaccines, has a possible link to
disorders. Many pharmaceutical companies now use a safer preservative
called 2-phenoxy ethanol.
The primary preparation for a well-baby exam involves the parent or
guardian making a list of questions for the pediatrician.
The only aftercare necessary is when an infant has a slight reaction to
the immunizations. The provider needs to inform the parent what to expect
and what can be done to alleviate symptoms.
at the immunization size and a slight
are often easily treated with
There are few risks associated with well-baby visits. The risks with the
preservative, thimersal, which is used in vaccines are mentioned above.
Serious reactions to vaccines are extremely rare. More common problems
associated with doctor visits are dealing with fears babies have of
strangers touching them, and managing the child's pain from
—A serious, frequently fatal, bacterial infection that affects
the respiratory tract. Vaccinations given in childhood have made
diphtheria very rare in the United States.
—An anaerobic bacteria associated with human respiratory
infections, conjunctivitis, and meningitis.
—An infection of the liver that is caused by a DNA virus, is
transmitted by contaminated blood or blood derivatives in transfusions,
by sexual contact with an infected person, or by the use of contaminated
needles and instruments.
—Whooping cough, a highly contagious disease of the respiratory
system, usually affecting children, that is caused by the bacterium
Bordetella pertussis and is characterized in its advanced stage by
spasms of coughing interspersed with deep, noisy inspirations.
—Poliomyelitis, an acute viral disease marked by inflammation of
nerve cells of the brain stem and spinal cord and can cause paralysis.
—A potentially fatal infection caused by a toxin produced by the
. The bacteria usually enter the body through a wound and the toxin they
produce affects the central nervous system causing painful and often
violent muscular contractions. Commonly called lockjaw.
Fine motor skills
Gross motor skills
Murkhoff, H., S. Hathaway, and A. Eisenberg.
What to Expect the First Year,
2nd ed. New York: Workman Publishing Co., 2003.
Immunization: The Reality Behind the Myth.
Westport, CT: Bergin & Garvey, 1995.
Osterrieth, Paul. "Oral polio vaccine: fact vs. fiction."
22 (2004): 1831–5. Available online at:
American Academy of Pediatrics.
141 Northwest Point Blvd., Elk Grove Village, IL, 60007. (847) 434-4000.
Web site: http://www.aap.org.
Center of Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA
2004 Childhood and Adolescent Immunization Schedule.
Available online at: