What Are They Looking For In All Those Checkups Anyway?
"Well child" checkups are designed to monitor your baby's health and growth during the first year. The first nine months of life are often called "the fourth trimester," as your baby will undergo incredible growth and development in that first year that sets the foundation for the rest of her life.
The first checkup
Before you even leave the hospital with your newborn, your nurse will make sure that you have scheduled your baby's first checkup with his or her care provider. The first checkup at two or three days after your baby's birth is critical because the doctor will screen for jaundice — which usually peaks around day three of life — as well as weigh the baby to ensure that he or she is eating properly. Those first few days, especially if the baby is breastfed, can be a challenge as both baby and parents adjust to feeding patterns.
Although the American Academy of Pediatrics (AAP) recommends a well-child visit at 2 weeks of age, many pediatricians schedule the next check when your baby is 1 month old. Again, at this checkup your baby's doctor will be closely monitoring his growth and checking in with how well feeding is going. Now is a great time to bring up any concerns you may have about your baby's feeding habits or sensitivities. If you are concerned that your baby appears to have sensitivities to your milk or his formula, it's best to get that sorted out earlier rather than later. Also, if your doctor expresses concern over your baby's growth, be firm in speaking up if breastfeeding exclusively is important to you. Although the AAP sets standard growth rates, every child is an individual and you do not have to reach for formula supplementation at first glance. You can also expect some hefty questions about sleep safety and your own stress level, as many newborn deaths are reported from this time from SIDS and Shaken Baby Syndrome.
This visit is the "big" visit where you will have to make some decisions on vaccinating, as it's time for the first batch of vaccines to be administered. If you have concerns about vaccinations or wish to practice a delayed vaccination schedule, be sure to talk to your baby's doctor about that now. The AAP recommends that around this time, all babies receive the combination diphtheria/tetanus/pertussis/HIB/polio (Pentacel) vaccine, the second dose of the hepatitis B vaccine, the pneumococcal (Prevnar), and the rotavirus (RotaTeq – oral) vaccine. Bring back-up for this visit, as it's always hard to watch your baby get vaccinated (if that's what you choose to do!).
Like every other visit, your baby's 4-month-old checkup will include weight (down to a dry diaper, folks!), vital sign assessments, and head circumference measurements to add to her growth chart. With your baby starting to develop a little more, your health care provider will also ask you questions about your baby's development, assessing his muscle and neurological development. If you received all the vaccines at the first checkup, no further vaccines are needed with this visit.
Happy half birthday, baby! All regular assessments continue with this visit, as well as important development checks, like baby's attempts to sit up, smile and communicate more. If you've caught up on all your vaccines, the only poke recommended with this visit is the third (and final) dose of the Hepatitis B vaccine series. Many people start the conversation about solid food for their infant at this visit, although current recommendations from the AAP say that parents can continue exclusive breastfeeding until 7 or 8 months of age and start with fresh, soft table food. No more rice cereal!
The good news for this visit? No vaccines! But just when you think you're done with the pokes for baby, pediatricians are now checking babies' hemoglobin levels at this visit (or possibly at his first year checkup). Typically, this test is a small finger prick or heel prick that collects a blood sample. The doctor's office will send the sample to be analyzed at the lab to screen for blood-related disorders, such as anemia. The hemoglobin test was new to me with my third child this year, but to be honest with you, he didn't even cry when they poked his finger. And I know from personal experience how important this hemoglobin screening is, as one of my close friend's doctors missed her son's severe anemia until he was almost two.
Happy birthday, baby! Can you believe it's been a year already? (Bad news — each year only speeds up from here on out!) Although some offices will take one blood sample to screen for both hemoglobin levels and for dangerous lead levels in the blood, if yours doesn't, your baby may need another blood sample taken for a blood lead level screening. Dangerous levels of lead can build up in a baby's blood, without obvious symptoms at first, especially in older homes or with environmental exposure, so the AAP recommends blood lead level screenings for all babies at this age. Your baby will also need another round of vaccines with this visit, so be sure to schedule his checkup after the birthday party, or you will have one cranky birthday boy! Recommended vaccines are Measles/Mumps/Rubella (MMR), Varicella (Varivax), Pneumococcal (Prevnar), and Hepatitis A.