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What Doctors Look for at Well-Baby Visits

Baby lying on back chewing on rubber ducky

"He's in the 90th percentile!" my sister-in-law ecstatically told me over the phone after she had gotten home from my nephew's one-month well-baby checkup. For new parents, there is no better way to pat yourself on the back for a job well done than to hear your pediatrician say, "He's right on target! Keep up the good work!" Growth charts, developmental milestones, and immunizations, oh yes! This is what baby books are made of. What follows is a guide to what you can expect at your baby's checkups.

Growth

The first thing your doctor will check at the well visit is growth. Specifically, he will measure your baby's weight, length, and head size. Next, he will give these measurements a percentile on an age- and gender-specific growth chart. So, for instance, if your infant is in the 60th percentile for length, only 40 percent of babies his age are taller than he is. Keep in mind that anything between the 5th and 95th percentile is considered normal, and sometimes even measurements that fall outside these ranges can be normal, depending on your family traits and whether your baby was born a little early.

It's more important that your child continues to grow from visit to visit than it is which percentile he's in. I always tell parents not to get too "attached" to certain percentiles, either, as they are likely to change a lot over the first 18 months of your child's life. Babies grow most rapidly during the first 6 to 9 months, and then just around the time they start to become mobile with crawling and scooting, their growth slows slightly.

Did You Know? Most babies double their birth weight by 6 months and triple it by 1 year of age. In terms of length, most babies grow between 7 and 10 inches during the first year, and that rate slows down during the second year of life, when they only gain an average of 4 to 5 inches.

Development

The next big part of a well-baby visit is assessing your child's development. At each checkup, your doctor will ask questions about basic milestones, such as smiling, rolling over, and pulling up to make sure your child is on target with normal development. If she is truly behind schedule, it's important that you tell your pediatrician. Developmental delay in one or more areas can be indicative of an underlying neurologic or muscular condition. Many times, however, it's just a case of baby's taking her sweet old time. Your pediatrician will also check some of these milestones by having your baby "perform" tasks on the exam table, such as dangling a toy or shiny object in front of her face at 4 months to see if she reaches for it.

During each visit, your pediatrician will perform a physical exam. Although your baby's schedule of checkups may vary depending on his doctor, this is when they usually happen:

  • 1 to 2 weeks
  • 1, 2, 4, 6, 9, and 12 months
  • 15 and/or 18 months
  • 2 years
  • Yearly thereafter

Generally, here's what you can expect:

  • Head: We inspect the newborn's head to check for any residual swelling following the delivery. From then on, we check the shape of his head, paying particular attention to the soft spots, as well as making sure that his head isn't misshapen from sleeping on his back to prevent SIDS.
  • Eyes: We use our ophthalmoscope -- an instrument with a magnifying lens and a light -- to make sure baby's pupils, cornea, and vision are normal, and that the eyes are aligned.
  • Ears, nose, and throat: We check for any eardrum abnormalities, such as redness or fluid, any irregular narrowing of the nostrils, and the appearance of structures, such as gums, teeth, and tonsils.
  • Neck: Baby's immune system is growing rapidly, so pediatricians check the lymph nodes to make sure they're not unusually swollen, which may indicate an underlying infection. We also look for abnormal swellings, such as rare congenital cysts.
  • Chest: We listen to the heart for any murmurs and to the lungs for any wheezing or congestion noises.
  • Tummy: We feel for any masses or swollen organs. Although they're rare, the most common cause of a mass is a swollen kidney.
  • Groin: We feel both sides of the groin for equal and regular pulses, indicating that the major blood vessels are properly working.
  • Genitals: We check boys and girls to see that they have normal external genital structures. In boys, we feel the scrotum to make sure both testicles are inside, and we inspect the foreskin or circumcised penis.
  • Hips: We will push and pull your baby's legs up and out toward his tummy, checking for any congenital hip dislocations. They occur in 1.5 per 1,000 births and are 8 times more common in girls than boys. Undiagnosed hip dislocations can cause permanent deformities of the hip joint, which can lead to unequal leg lengths, difficulty crawling and walking, and chronic pain.
  • Back: We feel to make sure the spine is straight and that there are no deep dimples, which can signify an abnormal spinal cord. This can occur with a certain form of spina bifida and when the spinal cord isn't properly attached to the back, known as a tethered cord. In these cases, babies will usually also have decreased movement in their legs, but sometimes, if the defect is mild, the back's external appearance may be the only indication of the malformation early on.
  • Skin: We'll inspect the scalp for cradle cap and the face and chest for baby acne. We also look for other conditions, such as diaper rashes and eczema, which most often appears as dry, red patches on the cheeks or in the creases of the arms and legs. For some babies, eczema is triggered by a food allergy. If this is the case, your pediatrician will suggest dietary changes.
  • Nervous system: We'll pull your baby's arms up toward us and then let them go to check for a startle reflex. His arms should extend outward quickly. A normal reflex shows us that the child's brain is developing normally. We will also move your baby's arms and legs around individually to check his muscle tone.

Yum, Yum!

Good eating habits start early, so another part of these visits is discussing what your baby is currently noshing on. Your doctor will talk to you about whether your child is consuming enough food and will instruct you when to make big changes, such as adding baby cereal, table foods, and whole milk. This is also a time to bring up any concerns about your child's eating habits, such as if she's not getting the hang of eating off a spoon.

Sleepy Time

The number one problem voiced by parents in my practice is poor sleep patterns, so it's probably a main concern for you too. At the checkup, we'll likely ask you specific questions about your baby's sleep habits, because what constitutes a problem for one mother may be perfectly fine for another. An example of this is the issue of co-sleeping.

Although the American Academy of Pediatrics recommends against bed sharing, based on the possible risk of suffocation, many parents choose to have their baby sleep in bed with them and don't view it as a problem, while others do so only because they can't get their baby to go to sleep any other way. Whatever the reason, I urge parents to be open and honest about their sleeping arrangement.

If you fall into the first group, say something like, "Emma does sleep with us in our bed, but we don't see it as a problem." This lets me know that you're not looking for a "fix" to co-sleeping, and I'm happy to move on to the next subject at hand after reviewing the safety issues of bed sharing.

If, on the other hand, you fall into the second group of parents who are in need of another solution to avoid co-sleeping, then most pediatricians are happy to offer several suggestions.

Shots!

The last (but not least) parts of these well-baby visits are the immunizations. They are usually done at the end of the visit, and, depending on age, your baby may be getting anywhere from one to four shots at a time. Combination vaccines can minimize the number of actual injections your baby will need, but some are associated with a slightly higher rate of side effects, such as fever. Ask your pediatrician if she offers these vaccines, and ask her to discuss their pros and cons.

You'll come away from these well-baby visits with a wealth of information about baby-care issues. Remember that checkups are also a time to celebrate milestones, so grab that baby book and record how your child is growing.

Sara DuMond, MD, is a pediatrician in Mooresville, North Carolina, and the mother of two children.

Originally published in American Baby magazine, August 2006.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.