Well Child Visit Schedule

Congratulations! Your baby is finally here. Newborns are wonderful but exhausting! Having friends or family around to provide extra help and support can be very helpful. Make sure all visitors are not ill and wash their hands well. Your baby's first visit to our office takes place during his or her first week of life, usually 2-3 days after you are discharged from the hospital. We do a lot at this visit, including:

• Check your baby's weight/growth/head circumference.
• Monitor for signs of jaundice.
• Check to see how your baby is feeding.
• Circumcision if desired.
• Answer questions about your new baby.

Immunizations: HepB#1 (if not given in hospital)
Tests/Screens/Assessments: Follow up on Newborn Metabolic Screen done in hospital.

Families are usually settling in some by this visit. Feeding, sleeping and bowel habits are sometimes a concern. At this visit we will track your baby's growth and development and answer any questions. Your baby may be starting to smile now and that helps a lot!

Tests/Assessments: Second Newborn Metabolic Screening

Many babies seem more fussy or colicky at this age. Be patient. Colicky babies eventually outgrow their crying phase. Keeping your baby safe is the most important thing you can do. Even if you feel frustrated, handle your baby gently and reach out for help to friends, relatives or your pediatrician if the crying is getting to be too much. If you need a break and no one is available to help you, place your baby on his/her back gently in a safe space such as a crib or bassinet and take a few minutes to calm down.

We do a lot at this visit, including:

• Measure your baby's weight, length and head size and record on a growth curve.
• Provide your baby's first set of immunizations. Immunizations are safe, effective, and keep your child and our community healthy. During this visit, you will be able to discuss any questions you may have about immunizations.
• Assess your baby’s developmental milestones.

Immunizations: Pediarix #1 (DTap#1, HepB#1, IPV #1), HIB#1, PCV#1, Rotavirus#1
Tests/Screens/Assessments: Developmental Milestone Assessment

Your baby is becoming more active and verbal. Be careful not to leave your baby unattended, especially on a bed, couch, or counter. They move faster than you think! Babies need only breast milk or iron-fortified formula for the first 4-6 months of life. We will talk at this appointment about the appropriate time to introduce solid foods and what foods to introduce first.

At this visit we will:

• Measure your baby's weight, length and head size and record on a growth curve.
• Provide your baby's immunizations.
• Discuss when to start feeding your baby solid foods.
• Assess your baby’s developmental milestones.

Immunizations: Pediarix#2 (DTap#2, IPV#2, HepB#2), PCV#2, Rotavirus#2
Tests/Screens/Assessments: Developmental Milestone Assessment

Your baby will begin to move more and will be able to sit up independently for short periods. Now is the time to start baby-proofing your house if you haven't already done so. You should move the mattress in your baby's crib down to the lowest level.

At this visit we will:

• Measure your baby's weight, length and head size and record on a growth curve.
• Provide your baby's immunizations.
• Discuss the introduction of fluoridated water to encourage the development of strong and healthy teeth. If you have city or rural water, your water is fluoridated. If you have well water, you should have your water tested for fluoride before offering it to your baby.

Immunizations: Pediarix #3 (DTaP#3, IPV#3, HepB#3), HIB#3, PCV#3, Rotavirus#3, Influenza vaccine (during flu season with booster 30 days later)
Tests/Screens/Assessments: Developmental Milestone Assessment

Your baby may be starting to crawl, pulling to a stand, and cruising on furniture. Babies will want to touch everything; this is how they learn. This is a messy time! Have fun and be patient.

At this visit we will:

• Measure your baby's weight, length and head size and record on a growth curve.
• Discuss your baby's upcoming dental care. Your baby should see a dentist once the first teeth erupt. You should be brushing your child's teeth with an infant toothbrush and water or infant toothpaste twice a day.
• Discuss nutrition and safety.

Immunizations: Influenza vaccine (during flu season), catch up on any missing immunizations
Tests/Screens/Assessments: Developmental Milestone Assessment, Complete Blood Count and Lead Surveillance

At this age, your baby can transition from breast milk or formula to cow's milk; however, it is healthy to continue breast milk if that is what you prefer for your baby. Most babies need 3 meals, 2-3 snacks per day, and no more than 16-20 ounces of whole cow's milk per day. Your baby will be able to eat many of the foods you eat, but be careful to avoid small, hard foods that can cause choking. It is time to wean your child from the bottle and offer all liquids in a sippy cup or straw cup. It is much easier to wean your child now than if you wait until they are older - avoid cavities and additional tears and make the change now!

Your baby will be outgrowing the infant carrier car seat. Continue to have your baby in a rear facing car seat until age 2.

At this visit we will:

• Measure your baby's weight, length and head size and record on a growth curve.
• Provide your baby's immunizations.
• Discuss dental health and recommend starting to use a smaller than rice sided smear of fluoride toothpaste. See a pediatric dentist anytime now.
• Screen your baby’s vision with our ocular photoscreen device.

Immunizations: MMR#1, Varicella#1, Influenza Vaccine (during flu season)
Tests/Screens/Assessments: Developmental Milestone Assessment, Vision Screen

Your child may be able to climb and run, so be sure to safety proof your home. Poison control is available 24 hours a day: 1-800-222-1222 - keep this number handy in your cell phone and on your refrigerator.

At this visit we will:

• Measure your baby's weight, length and head size and record on a growth curve.
• Provide your baby's immunizations.

Immunizations: Influenza vaccine (during flu season)
Tests/Screens/Assessments: HIB #4, Pneumococcal #4, Hepatitis A #1, Influenza vaccine (during flu season)
Helpful Info: Developmental Milestone Assessment

At 18 months, your child understands much more than he or she can say in words. Use words to describe your child's feelings and gestures. Read and sing to your child often. When reading, use simple words to talk about the pictures.

At this visit we will:

• Measure your child's weight, length and head size and record on a growth curve.
• Provide your child’s  immunizations.

Immunizations: DTaP#4, Influenza vaccine (during flu season)
Tests/Screens/Assessments: Developmental Milestone Assessment, M-CHAT autism screen

At this age, your 2-year-old may go from trying to be independent to clinging to you; this is normal. Toddlers should play and develop their imagination rather than enjoying screentime with tablets and television. Even having television playing in the background interrupts healthy toddler play.

At this visit we will:

• Measure your child's weight and length and record on a growth curve.
• Screen your child’s vision.
• Discuss dental health and ensure a dental visit is performed if not already done.
• Discuss toilet training and time out.

Immunizations: Hepatitis A #2, Influenza vaccine (during flu season)
Tests/Screens/Assessments: Developmental Milestone Assessment, M-CHAT autism screen, complete blood count, and lead level

Your baby is not really a baby anymore. They are firmly in the toddler years. One moment they seem so big and the next still very small. This is the "do-it-myself time."

At this visit we will:

• Measure your child's weight and length and chart on a growth curve.
• Most of our patients do not have immunizations due at this visit.
• Discuss dental health  (if they have not yet seen a dentist, they should!)
• Discuss healthy meals/snacks, avoid food pouches and no or little juice

Immunizations: Influenza vaccine (during flu season)
Tests/Screens/Assessments: Developmental Milestone Assessment

Your child will likely be moving into a world of make believe that they create with their imagination. They will also be developing more refined language skills and fine motor and gross motor skills. Read books, sing songs and play rhyming games with your child daily.

At this visit we will:

• Measure your child's weight, height, blood pressure, and body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit.  Your child may need immunizations if they are behind on their shots or during flu season.
• Discuss dental health.
• Discuss behaviors that commonly occur at this age.

Immunizations:  Flu vaccine (during flu season)
Tests/Screens/Assessments: Developmental Milestone Assessment, complete blood count and lead level, vision screen, hearing screen

Four-year-olds often like to sing, dance and act. They like to tell "tall tales" and makeup stories.  Enjoy these fun moments with your little one!  Parents should continue to help with brushing teeth even though your child will want to do it all by themselves.

At this visit we will:

• Measure your child's weight, height, blood pressure and body mass index and record on a growth curve.
• Provide your child's immunizations.
• Discuss dental health.

Immunizations: Kinrix (Dtap and Polio), MMR #2, and Varicella #2. Influenza vaccine (during flu season)
Tests/Screens/Assessments: Developmental Milestone Assessment, complete blood count, lead level, vision screen, and hearing screen.

At this visit we will:

• Measure your child's weight, height, blood pressure and body mass index and record on a growth curve.
• Review your child's speech and development.
• Discuss exercise and nutrition.
• Discuss dental health.

Immunizations: Influenza vaccine (during flu season), catch up on any missing immunizations
Tests/Screens/Assessments: vision screen, hearing screen, complete blood count at least every 2 years

Your child may be transitioning to middle school at this age. He or she may be participating in more group activities. Expand your conversations about healthy living practices to include tobacco, drug and alcohol avoidance.

At this visit we will:

• Measure your child's weight. Height, blood pressure and body mass index and record on a growth curve.
• Provide your child's immunizations.
• Review your child's school performance and development.
• Discuss exercise and nutrition.
• Discuss puberty changes to expect or that may be starting to occur.

Immunizations: Meningitis A #1, TdaP #1, HPV #1. (HPV # 2 due 6 months later) Influenza vaccine (during flu season)
Tests/Screens/Assessments: vision screen, hearing screen, complete blood count, cholesterol and lipid levels (completed once between 9-11 years)

Your child will be in middle school and high school at this age. Continue your conversations about healthy living practices to include tobacco, drug and alcohol avoidance. Your child should be able to assume more responsibility for personal hygiene and chores.

During the teen years, we allow your teen to have at least a portion of the visit with the parent out of the room.

At this visit we will:

• Measure your child's weight, height, blood pressure and body mass index and record on a growth curve.
• Review your child's school performance and development.
• Complete sports physical forms and discuss sports safety (if your child is participating in sports).
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
• Discuss puberty changes to expect or that may be starting to occur.
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.).
• Reinforce healthy choices and risk behavior avoidance.

Immunizations: Meningitis A #2 and Meningitis B # 1 (Due at 16 year visit) Meningitis B #2 due at 16 ½ years. HPV if not already completed, Influenza vaccine (during flu season)
Tests/Screens/Assessments: Adolescent Depression Screening (PHQ), vision screen, hearing screen, Lipid Profile (once between 17-21 yrs of age), HIV testing and Urine Chlamydia/GC Screen if warranted.