Well-baby exam: What to expect during routine checkups

Well-baby exams are an important way to monitor your baby's growth and development. Regular checkups also provide an opportunity to develop a relationship with your baby's doctor.

Your baby's doctor will likely recommend the first well-baby exam within three to five days after birth, or shortly after you're discharged from the hospital — and additional well-baby exams every two to four months for the first year. Here's what's on the agenda during these exams.

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 more 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 are safe to touch and give your baby's brain plenty of room to grow. The doctor will check the shape of your baby's head as well.
• Ears. The doctor will check for fluid or infection in your baby's ears with an instrument called an otoscope. He or she might observe your baby's response to various sounds, including your voice.
• Eyes. The doctor might look for blocked tear ducts and eye discharge. He or she might also look inside your baby's eyes with an instrument called an ophthalmoscope. As your baby gets older, the doctor might 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 might reveal signs of oral thrush, a common — and easily treated — yeast infection. As your baby gets older, the doctor might ask whether you've noticed more drooling or chewing than usual. These are often the first signs of teething.
• Skin. Various skin conditions might be identified during the exam, including birthmarks and rashes.
• 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 often 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.
• Hips and legs. The doctor might move your baby's legs to check for dislocation or other problems with the hip joints.
• Genitalia. The doctor will likely inspect your baby's genitalia for tenderness, lumps or other signs of infection. He or she might also check for an inguinal hernia, which results from a weakness in the abdominal wall. For girls, the doctor might ask about vaginal discharge. For boys, the doctor will make sure both testes have descended into the scrotum.

Your baby's 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 reach for objects or put them 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 vaccines

Your baby will need various vaccines at well-baby visits.

During each injection, swaddle your baby or hold him or her 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.

You might also talk with the doctor ahead of time about numbing creams for your baby's skin or other ways to decrease the pain of injections.

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 likely ask how things are going. Be ready to describe a typical day with your baby. For example:

• 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 many diapers does your baby wet and soil in a day?
• How active is your baby?
• Are you including tummy time in your baby's activities?
• How is your baby's temperament?

In addition, your baby's doctor might ask questions about your family's home life and medical history.

The doctor might also 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 might give you tips for childproofing 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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