Well-baby exams: What to expect
17 12 07 - 00:00
Most babies have their first checkup within the first few weeks after birth. Even when things are going well, frequent checkups during the first year are an important way to monitor your baby's growth and development. Here's what's on the agenda.
Measurements
Most well-baby checkups begin with measurements of your baby's length, weight and head circumference. You'll need to undress your baby, so keep a blanket handy.
The measurements will be plotted on a growth chart. You'll see how your baby's size compares with that of other babies the same age — but don't fixate on the percentages. A baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the 5th percentile. What's most important is steady growth from one visit to the next.
Most babies have their first checkup within the first few weeks after birth. Even when things are going well, frequent checkups during the first year are an important way to monitor your baby's growth and development. Here's what's on the agenda.
Measurements
Most well-baby checkups begin with measurements of your baby's length, weight and head circumference. You'll need to undress your baby, so keep a blanket handy.
The measurements will be plotted on a growth chart. You'll see how your baby's size compares with that of other babies the same age — but don't fixate on the percentages. A baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the 5th percentile. What's most important is steady growth from one visit to the next.
Head-to-toe physical exam
Expect a thorough physical exam during the checkup. Mention any concerns you have or areas you want the doctor or nurse practitioner to check out more specifically. Here are the basics.
Head. The doctor will check the soft spots (fontanels) on your baby's head. These gaps between the skull bones give your baby's brain plenty of room to grow. They're safe to touch and typically disappear within 12 to 18 months, when the skull bones fuse together. The doctor will check the shape of your baby's head as well. If flat spots are a concern, continue to place your baby on his or her back to sleep — but alternate the direction your baby's head faces.
Ears. The doctor will check for fluid or infection in your baby's ears with an instrument called an otoscope. He or she may observe your baby's response to various sounds, including your voice. Unless there's cause for concern, a hearing evaluation isn't usually needed.
Eyes. The doctor may look for blocked tear ducts and eye discharge. Using a bright object or flashlight to catch your baby's attention, he or she may track your baby's eye movements and check for crossing of the eyes. The doctor may look inside your baby's eyes with an instrument called an ophthalmoscope.
Mouth. A look inside your baby's mouth may reveal signs of oral thrush, a common — and easily treated — yeast infection. As your baby gets older, the doctor may ask whether you've noticed more drooling or chewing than usual. These are often the first signs of teething.
Skin. Various skin conditions may be identified during the exam, including birthmarks, rashes and jaundice — a yellowish discoloration of the skin and eyes. Mild jaundice that develops soon after birth often disappears on its own within a week or two. More severe cases may need light therapy or other treatments.
Heart and lungs. The doctor will listen to your baby's heart and lungs with a stethoscope to detect any abnormal heart sounds or rhythms or breathing difficulties. Heart murmurs are common in infants and are rarely a concern.
Abdomen. By gently pressing your baby's abdomen, the doctor can detect tenderness, enlarged organs or an umbilical hernia, which occurs when a bit of intestine or fatty tissue near the navel breaks through the muscular wall of the abdomen. Most umbilical hernias resolve on their own by age 2.
Hips and legs. Your baby's legs may be moved to check for dislocation or other problems with the hip joints.
Genitalia. The doctor will inspect your baby's genitalia for tenderness, lumps or other signs of infection. He or she will also check for an inguinal hernia, which results from a weakness in the abdominal wall. For girls, the doctor may ask about vaginal discharge. For boys, the doctor will make sure both testes have descended into the scrotum and there is no fluid-filled sac around the testes (hydrocele).
General development
Your baby's motor skills and development are important, too. Depending on your baby's age, be prepared to answer questions like these:
How well does your baby control his or her head?
Does your baby imitate your facial expressions and sounds?
Does your baby put objects into his or her mouth?
Does your baby attempt to roll over?
Can your baby sit with support?
Does your baby pull up into a standing position?
Does your baby use individual fingers to pick up small objects?
Time to talk
During the appointment, the doctor or nurse practitioner will ask how things are going. Be ready to describe a typical day with your baby. How many hours does your baby sleep during the day? At night? How often do you feed the baby? If you're breast-feeding, are you having any trouble? How active is the baby? How is the baby's temperament? How many diapers does your baby go through a day?
The doctor or nurse practitioner will discuss safety issues, such as placing your baby to sleep on his or her back, using a rear-facing infant car seat and baby-proofing your home. Although breast milk or formula will be the main part of your baby's diet throughout the first year, you'll also talk about when to introduce solid foods.
Undoubtedly, you'll have many questions of your own as well. Ask away! Nothing is too trivial when it comes to caring for your baby. And remember your own health. If you're feeling depressed, stressed out or run-down, describe what's happening. Your baby's doctor is there to help you, too.
Immunizations
Your baby will need various immunizations at well-baby visits. During each injection, hold your baby close. Softly sing a familiar song or whisper reassuring words. Offer a pacifier, blanket or other comfort object. Your presence and calm reassurance can help your baby feel secure.
Lab tests
Lab tests aren't needed at most well-baby exams. If lead poisoning is a possibility, a blood test may be done to measure the amount of lead in your baby's blood. If your baby lives with anyone who's at risk of tuberculosis, a tuberculosis skin test may be recommended.
Heading home
Make sure you know when to schedule your baby's next appointment — and how to reach the doctor in the meantime. Ask if the doctor's office or clinic offers a 24-hour nurse information service. Knowing help is available when you need it can offer precious peace of mind.