Well-baby exam: What to expect during routine checkups

Most infants have their first well-baby exam within the first few days to 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 during a well-baby exam.

Your baby's measurements

A well-baby exam usually begins 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 to check out. 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. The doctor may also recommend giving your baby more tummy time while he or she is awake.
• 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 formal hearing evaluation isn't usually needed at a well-baby exam.
• Eyes. The doctor may look for blocked tear ducts and eye discharge. He or she may also look inside your baby's eyes with an instrument called an ophthalmoscope. As your baby gets older, the doctor may use a bright object or flashlight to catch your baby's attention and then track your baby's eye movements.
• 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. Cases that are more severe may need treatment.
• 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. Most heart murmurs are innocent, yet sometimes consultation with a specialist is recommended.
• 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 heal on their own by the toddler years.
• 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).

Your baby's development

Your baby's motor skills and development are important, too. Depending on your baby's age, be prepared to answer certain questions. For example:

• 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?

Your baby's 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. Your baby may experience mild side effects from the vaccines, such as redness, pain or swelling at the injection site. Ask the doctor what to expect.

Unless your baby has special needs or concerns, lab tests aren't needed at most well-baby exams.

Time to talk

During the appointment, your baby's doctor 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 your baby? If you're breast-feeding, are you having any trouble? How active is your baby? How is your baby's temperament? How many diapers does your baby wet and soil in a day? In addition, your baby's doctor may ask questions about your family's home life and medical history.

The doctor may discuss safety issues, such as placing your baby to sleep on his or her back and using a rear-facing infant car seat. As your baby becomes more mobile, the doctor may give you tips for 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 questions, too. Ask away! Nothing is too trivial when it comes to caring for your baby. Also, remember your own health. If you're feeling depressed, stressed out or rundown, describe what's happening. Your baby's doctor is there to help you, too.

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 peace of mind.

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