Top 8 Questions Parents Ask at Baby’s One-Month Checkup
January 23, 2020
Baby is one month old! And while those first weeks may have flown by, you’re still getting to know your little one and learning what’s normal and what to expect in the coming months. As pediatricians, we hear tons of questions from parents during the standard one-month well visit. Here, we’re answering the top eight questions we get about one-month-old babies.
In the beginning, the pediatrician will have a bunch of scheduled visits with baby to make sure they’re gaining weight and growing appropriately, as well as meeting their developmental milestones. Most pediatricians will want to see baby two to three days after birth, and then again when they’re 2 to 3 weeks old to make sure they’ve gained back their birth weight, and again when they’re one month old. (There may be additional visits if your child has special concerns, like being jaundice or having trouble gaining weight). In fact, the American Academy of Pediatrics (AAP) has detailed guidelines for when to schedule routine check-ups from infancy through adolescence, and each of these routine healthy check-ups includes age specific screenings and assessments.
At the one-month visit, your doctor will want to know how much and how often baby is feeding, how their bowel movements are going, how they’re sleeping, what new tricks they can do (think: lifting up their head, focusing on or starting to track objects, startling at sounds they hear), and most importantly what concerns or questions you may have. Your pediatrician also will want to make sure that baby’s caretakers are adjusting well and may even administer a questionnaire to the mother to determine if she’s experiencing any postpartum depression.
Your pediatrician will examine baby, will put their measurements on a growth chart to make sure they’re growing appropriately, may give the Hepatitis B vaccine if it’s due, and will then tell you what developmental milestones to look for in the coming month, such as baby’s first smiles, visually tracking objects and seeing more clearly, better neck control and perhaps sleeping longer at night!
Infants will usually poop with every feeding, largely due to the rapid movement of food through the colon and a strong gastrocolic reflux (which promotes stooling every time food enters the stomach). Some babies, however, can often go a week without a bowel movement. This is normal and not a reason for concern, as long as the stool is soft, they’re passing gas, not vomiting and their belly is soft and not distended.
Sometimes infants at this age appear uncomfortable (making a face, bringing legs to the chest or turning red in the face) when they poop, even when passing a soft stool. When infants push to pass a stool when they’re lying down, the pelvic floor muscles don’t relax and the anal canal doesn’t straighten, making stools more difficult to pass. This is known as rectal confusion and is completely normal. In other words, it’s hard to poop lying down! Abdominal massage or bicycle leg exercises (moving baby’s knees to their chest in a bicycle-like motion) may be helpful, but we don’t recommend rectal stimulation (placing a thermometer or cotton swab in the anus) or suppositories unless you’ve discussed it first with your pediatrician.
We get tons of questions surrounding baby’s growth at the one-month visit. What is the expected weight gain? What percentile should baby be in? When are the next growth spurts? How should you track baby’s weight in between visits?
A one-month-old should gain approximately 1 ounce per day, 1 inch per month and head circumference should increase by 3/4 inch per month. Growth spurts usually occur when your child is about 2 weeks, 3 weeks, 3 months, 6 months and 9 months old.
At each visit your child’s pediatrician will take your child’s weight and measure their height and head circumference. They will plot the measurements on a growth chart and tell you your child’s percentile. But the percentile number isn’t super-important; what is important is that your child continues to grow along their own percentile.
Spit up, also known as gastroesophageal reflux (GER), is usually normal at this age. Infants who have GER are usually known as “happy spitters.” It usually starts at around two to three weeks of life and peaks between four to five months. The majority of infants will see symptoms completely resolve by the time they’re 9 to 12 months old. Happy spitters are not in pain when they spit up, and they typically eat well and gain weight. If your child has spit up associated with poor weight gain, frequent regurgitation, feeding refusal, crying with feeding, arching of the back and vomiting, they may require further workup or treatment.
Baby acne is very common and often can be seen on a one-month-old’s forehead and cheeks. It usually develops in the first few weeks after birth, but it goes away on its own and doesn’t need any special treatment or medications.
Seborrheic dermatitis is a red, scaly rash that can be seen on baby’s scalp (known as cradle cap) or behind the ears, on the eyebrows and down the chest and diaper area. It’s a very common rash that can be seen on many one-month-olds. The rash doesn’t usually cause any discomfort (although it may bother you to look at it) and can last for a few weeks to months. If the rash is only on the scalp , you can loosen the scales by washing baby’s hair with a mild baby shampoo and combing it with a soft cradle cap or baby brush. Your pediatrician may also recommend other treatments, such as an over-the-counter hydrocortisone cream or a medicated shampoo.
At one month of age, the typical formula-fed infant will eat approximately 3 to 4 ounces per bottle every three to four hours. Breastfed infants will feed on demand or approximately every two to four hours or seven to eight times per day. Every child is different, though, so follow your child’s feeding cues. If they’re gaining weight well, they’re likely eating enough.
There is no one right, “official” answer to when you can take your newborn out for the first time. We often tell parents to do it whenever they feel up to it, but since baby’s immune system is still developing, it’s always best to play it safe and exercise some precautions. A fever in a baby under 2 months, and especially under 1 month, is serious, and so you don’t want to take your newborn to places that might expose them to germs and potentially get them sick. For example, we wouldn’t feel comfortable taking our own newborns on a crowded subway during the height of flu season, but taking them on a stroll in the park when it’s not too cold out would help us feel less stir-crazy when spending so much time at home.
According to the AAP, all infants should have at least 400 IU of vitamin D per day, starting soon after birth. If you’re breastfeeding your child, either exclusively or partially, baby should be getting 400 IU of vitamin D supplementation each day, until they’re over one year old and drinking at least 1 liter (about 32 ounces) of whole milk a day, or if they’re breastfeeding and also drinking 32 ounces of formula a day. If baby is exclusively formula-fed, because formula contains 400 IU per liter of vitamin D, if they’re drinking 32 ounces of formula, you don’t need to give them extra vitamin D. If your formula-fed baby is drinking less than 32 ounces of formula a day, then they should also be getting 400 IU of vitamin D a day. You can buy the vitamin D supplement over the counter in most pharmacies without a prescription.
Dina DiMaggio, MD, and Anthony F. Porto, MD, MPH, are pediatricians, official spokespeople for the American Academy of Pediatrics and the co-authors of The Pediatrician’s Guide to Feeding Babies and Toddlers. They write about the latest AAP guidelines, studies and seasonal issues affecting babies and toddlers. Follow them on Instagram @pediatriciansguide.
Published January 2020
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.