Even babies who are perfectly healthy go to the doctor a lot. That’s because the first two years are a crucial time in baby’s growth and development, and your doctor will want to keep close tabs on your baby’s progress. Some pediatricians’ schedules will vary slightly, but the American Academy of Pediatrics (AAP) recommends babies get checkups at birth, 3 to 5 days after birth and then at 1, 2, 4, 6, 9, 12, 15, 18 and 24 months. Here’s what will likely happen at each of them.
At Every Appointment, Starting at Birth
A pediatrician should examine baby in the hospital within 24 hours of birth. “We do a full exam, looking for normal body function. We look for basic newborn reflexes, skin tone, alertness and hip stability,” says Anita Chandra-Puri, MD, a pediatrician at Northwestern Memorial Physicians Group in Chicago and a spokeswoman for the AAP. This is to make sure that baby is looking healthy and responding well. Here’s what else to expect during the first checkup — and each one thereafter too:
Taking measurements: The doctor will always measure baby’s length (which later will be referred to as his height), weight and head circumference. These measurements will be recorded on a growth chart, so you’ll be able to see how baby compares to other infants his age to make sure there are no signs of problems.
Developmental surveillance: At most visits, the doctor will also gauge whether baby’s development is on track. They’ll make observations of your child’s behaviors, ask you about baby’s milestones (like sitting up and rolling over) typical to his age at the time and ask you if you have any concerns.
Psychosocial/Behavioral assessment: Some of the questions the doctor will ask will be about baby’s behavior, and they’ll also observe the child’s actions and reactions. This helps rule out psychological or behavioral issues.
Physical exam: Baby will get a head-to-toe exam from the doctor at each visit too — ears, eyes, mouth, skin, heart and lungs, abdomen, hips and legs, and genitalia will all get examined to be sure they look healthy. In the beginning, the doctor will check the soft spots on baby’s head (fontanels), which typically disappear within 12 to 18 months when the skull bones fuse together. They’ll also check the shape of baby’s head to make sure it’s rounding out nicely.
Also at Birth
Hearing screening: The pediatrician will make sure baby’s hearing is A-OK. There are two different tests for this: otoacoustic emission (OAE) and auditory brainstem response (ABR). The OAE test involves placing a mini earphone and microphone in baby’s ear to measure sound reflection in the ear canal. For the ABR test, electrodes are placed on baby’s head to measure how the hearing nerve responds to sound. Both tests can detect hearing loss.
Newborn metabolic/hemoglobin screening: Baby will need to have a blood test — drawn from her heel — between birth and her two-month birthday. “The metabolic screening checks for sickle-cell disease, hypothyroidism or other inherited disorders,” says Chandra-Puri.
Immunizations: Baby will receive a hepatitis B shot at birth too.
3 to 5 Days After Birth
Your pediatrician will likely ask to see baby sometime in his first week to make sure everything still seems to be going well. The doctor will measure baby to make sure his growth is on track (and he’s eating enough), observe his development and behavior, and perform another physical exam. If your baby hasn’t gone through a metabolic/hemoglobin screening yet, he will at this appointment.
At baby’s one-month visit, your pediatrician will do all the basics — take measurements, do developmental surveillance, conduct a psychosocial/behavioral assessment and perform a physical exam. Here are other things baby could potentially get:
Tuberculosis test: Your pediatrician may test baby for tuberculosis (TB), an airborne infection that can cause fevers, a persistent cough, heavy and fast breathing, swollen glands, night sweats, weight loss and poor growth. The test involves your doctor injecting an inactive strain of TB into the skin of baby’s arm. If your infant tests positive, redness and swelling will appear at the site of the injection about 48 to 72 hours later.
Immunizations: Baby will get a second dose of the hepatitis B vaccine at either the one-month or two-month checkup.
During the two-month visit, your doctor will examine the basics as usual — measurements, development, behavior and baby’s body. The only difference is that this time, baby will get a heck of a lot of shots!
Immunizations: Baby will get a second dosage of the hepatitis B vaccine if she didn’t get it at last month’s checkup. She’ll also get the rotavirus vaccine (RV) in two to three doses between the ages of two months and six months (depending on the brand of vaccine), the diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), the Haemophilus influenzae type b conjugate vaccine (Hib), the pneumococcal vaccine (PCV) and the inactivated poliovirus vaccine (IPV). Luckily, doctors can combine some shots so there’s less pricking and hopefully less crying.
Baby’s getting bigger! He’s four months old now, and it’s time for another appointment. At baby’s four-month checkup, expect the standard procedures — measuring baby, developmental, psychosocial and behavioral observations, and a physical exam. Also, expect baby to get:
Hematocrit or hemoglobin screening: Your infant may receive this blood screening that helps indicate anemia.
Immunizations: Baby will receive second doses of RV, DTaP, Hib, PCV and IPV.
Around baby’s half birthday, her exam will include all the usual stuff, plus:
Immunizations: Baby will receive RV (may be needed; check with your pediatrician), third doses of DTaP, PCV and possibly Hib. Baby will need a third dose of IPV between the ages of 6 months and 18 months. Baby can receive the final hepatitis B dosage between now and age 18 months. Also, if this appointment falls during flu season, consider getting baby the influenza vaccine (flu shot). It’s recommended yearly for children between the ages of 6 months and 19 years old.
Other tests your doctor may do: Baby may get a lead screening to make sure she hasn’t been exposed to dangerous levels of lead, which can affect her developmental and behavioral growth. The doctor also may give baby a tuberculosis test and check her oral health — she may have her first tooth by now!
At this doctor’s appointment, expect the same procedures — taking and recording measurements, a psychosocial and behavioral assessment, and a physical examination. Plus:
Development screening: This is a more formal developmental test than baby’s had before. The doctor will ask you a series of questions about baby’s growth and behavior, and also may ask you to play with him during the screening to see how he behaves and moves. The intent is to see if baby is learning basic skills at a normal rate. The results will determine whether baby should receive more testing for developmental delays. Your child may receive these screenings more frequently if he’s at a higher risk for developmental problems because of preterm birth or low birth weight, or has a sibling who has an autism spectrum disorder (ASD).
Immunizations: Baby may receive the final hepatitis B dosage if he hasn’t yet. Baby may also get a third dose of the IPV if he didn’t get it at the last checkup.
Other tests your doctor may do: The pediatrician may check baby’s oral health.
Baby will celebrate her first birthday with another trip to the pediatrician. This is like any normal visit, with your doctor taking measurements, observing baby’s development and behavior, and performing a physical exam. Baby will also have a hematocrit or hemoglobin screening. And she’ll get another slew of vaccines:
Immunizations: Baby will get her final hepatitis B dosage (if she hasn’t gotten it yet), possibly the third or fourth dose of Hib between now and 15 months, a fourth dose of PCV between now and 15 months, a third dose of IPV (if she hasn’t gotten it yet), a first dose of measles, mumps and rubella vaccine (MMR) between now and 15 months, the varicella vaccine between now and 15 months, and one dose of the hepatitis A vaccine between now and 23 months (baby will need another dose six months after the first).
Other tests your doctor may do: Baby may get a lead screening, a TB test or an oral health examination.
As usual, baby will be measured, checked for developmental growth and any behavioral problems, and will get a physical examination.
Immunizations: If baby hasn’t received these doses yet, he’ll need hepatitis B, Hib, PCV, IPV, MMR, varicella and hepatitis A. Baby will need to get his fourth dose of DTaP between now and 18 months.
Your doctor will perform the regular checkup procedures at the 18-month visit, along with:
Autism screening: The doctor will check for signs of autism spectrum disorders (ASDs), a group of developmental disorders that can affect a child’s behavior, social skills and communication skills. “We normally give the autism screening between one and two years old,” says Chandra-Puri. “We’re looking at baby’s reaction to certain things. I also observe the child by asking her parents various questions.” If your child does show signs of an ASD, your doctor will recommend services or programs that can help with her development.
Immunizations: More doses for hepatitis B, DTaP, IPV and hepatitis A if baby hasn’t received them yet.
Other tests your doctor may do: Your baby’s pediatrician may give her a hematocrit or hemoglobin test to check for anemia, a lead screening, a TB test or an oral health examination.
Happy second birthday! Your two-year-old will go through the same checkup procedures as usual — he’ll be measured, undergo a developmental surveillance, a psychosocial/behavioral assessment and an autism screening, and he’ll get a physical exam. Plus, expect:
Immunizations: It’s recommended that high-risk children between the ages of 2 and 10 years old receive two doses of the quadrivalent meningococcal conjugate vaccine (MCV4) within eight weeks of each other.
Other tests your doctor may do: Your baby’s doctor may give him a hematocrit or hemoglobin screening, a lead screening, a TB test or an oral health examination. Another possibility is a dyslipidemia screening, which tests for signs of a lipid disorder. It’s done through a blood test.
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