Well-Child Visits

Overview of Well-Child Visits: What to Expect

Newborns

Congratulations on your new arrival! At Loudoun Pediatric Associates, the physicians and staff welcome you and look forward to caring for your child.

Health

Most newborns sleep 16 to18 hours per day. Infants need to sleep on their backs or sides. Research shows this decreases Sudden Infant Death Syndrome (SIDS) by almost 50 percent. Do not put your baby to sleep on his or her stomach.

Bathe your infant two or three times per week with a mild soap. Bathing more often can dry their skin. Peeling is normal during the first two weeks. Avoid lotions as they sometimes cause reactions on infant skin. Keep the umbilical cord dry.

Hiccups, sneezing and nasal congestion are typical for newborns. Fevers are not. Report any temperature over 100 degrees Fahrenheit to your physician immediately. Temperatures should be taken rectally. Ear thermometers are not accurate in infants under eight to 10 months of age. Limit visitors and avoid crowds to prevent exposure to illnesses during the first two months.

Feeding

Feed your infant with breast milk or iron-fortified formula. Do not give cow’s milk until 12 months of age.

Most newborns breastfeed for 10 to 20 minutes on each breast every two to three hours, or take two to three ounces of formula every two to three hours. Be careful not to overfeed. You may want to try a pacifier if your baby wants to feed more than this.

Babies do not need extra water. Do not give plain or tap water until after six months of age.

Safety

Always use a car seat. Make sure it is installed correctly in your vehicle. Five-point harnesses are the safest. Straps should be snug against your baby’s body when fastened.

Lower your hot water heater to 120 degrees Fahrenheit to prevent accidental burns.

Do not leave your baby unattended with your pets (no matter how good your pet is). Pets are still animals and can act unpredictably.

Development

The majority of a newborn’s time is spent eating and sleeping. Newborns can hear, see, smell, taste and feel. They can focus on objects 8-10 inches away. They respond to gentle voices and touch, especially that of their parents.

2 Months
Health

Continue to put your baby to sleep on his or her back. This is the most crucial time to continue this to prevent SIDS. Many babies are more comfortable on their stomachs and seem to sleep better. This does not matter!  Babies still need to be placed on their backs to sleep.

If you suspect your infant has a fever, take a rectal temperature (ear thermometers are not accurate in infants under 8-10 months). Call for any fever of 100.5 degrees Fahrenheit or more.

Feeding

Continue feeding breast milk or iron-fortified formula. Do not introduce solids until after four months of age. Do not give plain or tap water until after six months of age.

Safety

Do not leave your infant in a bouncy chair or any other device on an elevated surface (counter, table, bed, etc.). Even infants who are not yet mobile are in danger of falling off of high surfaces.

Get in the habit of always buckling your infant into everything—stroller, changing table, swing, bouncy seat, car seat, etc. Even babies who do not move around are in danger of falling out.

Development

Babies can follow you with their eyes and recognize you. They can coo back and forth with you.

Encourage tummy time (lying your baby on their stomach for short periods of time) while your baby is awake.

4 Months
Health

Many infants start to have teething symptoms at this time. These consist of drooling, gnawing on things, and occasional irritability. Despite these symptoms, teeth may still not appear for several months. Most infants feel relief from gnawing on cold objects or teething rings. Teething gels offer temporary relief, but many babies do not like the taste or numbing sensation. Homeopathic teething tablets are helpful for some. You may also try Tylenol.

Feeding

You may start you baby on solid foods sometime between 4-6 months. Start with cereal, and then gradually add fruits and vegetables. Introduce one new food at a time so you can identify the cause of any rashes, vomiting or diarrhea. Do not give plain or tap water until after six months of age.

Safety

Remove all toys, blankets, stuffed animals or any other objects from the crib to prevent choking or suffocation.

Continue to buckle your child into everything possible – stroller, changing table, bouncy seat, etc.

Babies explore with their mouths at this age. Anything they can pick up will likely go right into their mouths. Be careful to keep all small objects (coins, toy pieces, paper clips, nuts, etc.) out of their reach.

Development

Your infant is continuing to explore with all the senses of sight, touch, smell, sound and taste. Provide brightly colored objects, gentle music and conversation.

6 Months
Health

Many infants start to have teething symptoms at this time. These consist of drooling, gnawing on things, and occasional irritability. Despite these symptoms, teeth may still not appear for several months. Most infants feel relief from gnawing on cold objects or teething rings. Teething gels offer temporary relief, but many babies do not like the taste or numbing sensation. Homeopathic teething tablets are helpful for some. You may also try Tylenol.

Many cough and cold medications are not recommended for infants this age. Please ask your physician before you give any over-the-counter medications.

Do not put a bottle of breast milk, formula or juice in the crib with your baby. All of these contain sugar and will cause cavities if they are in contact with the teeth while sleeping. If you must put a bottle in the crib, fill it with water only.

Feeding

You may introduce easily dissolvable foods such as cheerios or teething toast. Continue with two helpings of infant cereal and at least two helpings of jarred baby food per day. Continue with breast milk or formula.

Introduce a sippy cup. Most babies will not drink well from it until they are 9-12 months, but allow yours to experiment with it.

Avoid foods that may cause an allergic reaction if given to your child before 12 months of age. These include eggs, nuts and nut products, milk and dairy products, strawberries, shellfish, wheat and soy.

Avoid foods that may be easily choked on. These include hot dogs, raw apples, raw carrots, grapes, nuts, stringy foods, large chunks, popcorn, raisins and hard candy.

Safety

Remove crib bumpers and mobiles from the crib and lower the crib mattress as your infant will soon be crawling around and pulling up to stand.

Even if your infant has reached 20 pounds, they must remain in a rear-facing car seat until 12 months of age.

our baby will soon be moving around the house. Use gates at stairways and doors. Cover sharp-edged corners on furniture. Do not let cords or tablecloths hang off of furniture. Keep small chokable objects picked up and stored away.

Do not drink hot beverages while holding your child, or leave them on the table or counter edges, where they can spill onto an infant below.

Never leave your infant alone in the bathtub or sink.

Development

Most babies are rolling over and will soon sit up, crawl and pull to stand.

Now is a perfect time to start reading to your baby. Firm board books and books with brightly colored pictures are recommended. A few minutes at a time is best at the beginning.

Babies love to hold and explore simple toys. Make sure these toys have no small parts they could choke on.

9 Months
Health

Do not put a bottle of breast milk, formula or juice in the crib with your baby. All of these contain sugar and will cause cavities if they are in contact with the teeth while sleeping. If you must put a bottle in the crib, fill it with water only.

Feeding

You may introduce small bites of soft, easily chewed foods, such as cooked vegetables, noodles, crackers, fruits or lunchmeats. Some babies are ready for this and some are not. If your baby spits these foods out or starts to gag on them, try again in a week or two.

Avoid foods that may cause an allergic reaction if given to your child before 12 months of age. These include eggs, nuts and nut products, milk and dairy products, strawberries, shellfish, wheat and soy.

Avoid foods that may be easily choked on. These include hot dogs, raw apples, raw carrots, grapes, nuts, stringy foods, large chunks, popcorn, raisins and hard candy.

Continue giving your baby breast milk or iron-fortified formula until 12 months.

Continue letting your baby practice with a sippy cup.

Safety

This is the age where most babies are mobile through crawling, scooting, rolling, cruising or walking. BABY PROOF YOUR HOUSE! Get on your hands and knees and crawl around to see what is at their eye-level.

Keep doors closed. Put locks on cabinets and drawers that contain cleaners, beauty products, sharp objects or breakable objects. Secure furniture so it cannot tip over onto your infant. Use electric outlet covers.

If you haven’t done so already, adjust your hot water heater to 120 degrees. Put locks on your toilets or keep your bathroom doors closed.

Your baby will soon be moving around the house. Use gates at stairways and doors. Cover sharp-edged corners on furniture. Do not let cords or tablecloths hang off of furniture. Keep small chokable objects picked up.

Do not drink hot beverages while holding your child, or leave them on the table or counter edges, where they can spill onto an infant below.

Remove crib bumpers and mobiles from the crib and lower the crib mattress as your infant will soon be crawling around and pulling up to stand.

Even if your infant has reached 20 pounds, he or she must remain in a rear-facing car seat until 12 months of age.

Never leave your infant alone in the bathtub or sink.

Development

Babies at this age are learning to crawl, scoot, roll, cruise or walk. They are starting to learn social games, such as pat-a-cake, peek-a-boo and bye-bye. They enjoy exploring toys, hearing music and looking at picture books.

May prefer eating with their hands rather than being fed. This allows them to discover the texture, smell and consistency of food. It’s natural for them to be messy and drop food-spread newspapers under the high chair or just plan on cleaning the floor afterwards.

Common words are ma-ma, da-da, hi, no, ba-ba, or something similar.

Infants at this age are starting to show a range of emotions, including frustration and anger. This is normal and is their only way to express themselves since they cannot talk yet. If your infant is upset or having a tantrum, try to remedy the problem or distract them with a toy or other object. They are too young to comprehend discipline at this age.

12 Months
Health

Do not put a bottle of breast milk, formula or juice in the crib with your baby. All of these contain sugar and will cause cavities if they are in contact with the teeth while sleeping. If you must put a bottle in the crib, fill it with water only.

If your child has teeth, start brushing them using a soft child-size toothbrush and children’s fluoride containing toothpaste. Use only a pea-sized amount of toothpaste. All children resist this at some point (some very strongly) but it is important to establish the habit twice a day.

Your child should be weaned from the pacifier between 12-15 months. Most children will resist this, but pacifiers can interfere with dental development and speech at this critical age. Pacifiers also cause a pooling of saliva around the teeth that can encourage cavities. Find another “comfort object” your child can use, such as with a doll or stuffed animal.

Shoes are meant only to protect the feet at this point. Expensive shoes will not help your child walk earlier, improve their arch (children are naturally flat-footed) or make them stable.

Many children have one or both feet that point in or point out when they walk. This is normal at this age. Mild bowing of the lower legs is also normal. All of these conditions generally improve with time, and special devices to “correct” them are unnecessary and not used anymore.

Feeding

You may now start giving whole milk to your child. Do not give 2%, 1% or nonfat skim milk. Children need the fat content of whole milk to nurture continuing brain development.

Your child should transition from a bottle to a sippy cup between 12 and 15 months. You can encourage this by only putting water in the bottle and putting milk and juice in the sippy cup.

Most children are picky eaters at some point. Some days they will eat well and other days they will not. Continue to offer a nutritious, well balanced diet. You can supplement with liquid vitamin drops (such as Poly-vi-sol or Gerber Vitamin Drops) once a day.

Safety

Children at this age are walking or will be within the next few months. BABY PROOF YOUR HOUSE.

Get on your hands and knees and crawl around to see what is at their eye-level. Keep doors closed. Put locks on cabinets and drawers that contain cleaners, beauty products, sharp objects or breakable objects.

Secure furniture so it cannot tip over onto your infant. Use electric outlet covers. Adjust your hot water heater to 120 degrees. Put locks on your toilets or keep your bathroom doors closed.

Your baby will soon be moving around the house. Use gates at stairways and doors. Cover sharp-edged corners on furniture. Do not let cords or tablecloths hang off of furniture. Keep small chokable objects picked up.

Do not drink hot beverages while holding your child, or leave them on the table or counter edges, where they can spill onto an infant below.

Remove crib bumpers and mobiles from the crib and lower the crib mattress as your infant will soon be crawling around and pulling up to stand.

Even if your infant has reached 20 pounds, they must remain in a rear-facing car seat until 12 months of age.

Never leave your infant alone in the bathtub or sink.

Your child may ride in a forward facing car seat if they are over 20 pounds. They still must ride in the back seat.

Development

At this age your child will enjoy pushing and pulling toys and climbing stairs.

Your baby can follow simple commands and expand his or her vocabulary, but he or she may not say “real” words until 15-18 months. Your baby should understand most or all of what you say. Spend time naming objects and describing things. Start to name body parts.

Your baby learns a great deal from books. Board books are great for this age.

Will enjoy stacking objects and putting things into containers as well as dumping them out.

Show a range of emotions. If they are frustrated or upset, showing them how to fix the problem or distracting them are still the most effective responses.

15-18 Months
Health

If your child has teeth, start brushing them using a soft child-size toothbrush and children’s fluoride containing toothpaste. Use only a pea-sized amount of toothpaste. All children resist this at some point (some very strongly) but it is important to establish the habit twice a day.

Your child should be weaned from the pacifier between 12-15 months. Most children will resist this, but pacifiers can interfere with dental development and speech at this critical age. Pacifiers also cause a pooling of saliva around the teeth that may encourage cavities. Find another “comfort object” your child can use, such as with a doll or stuffed animal.

Shoes are meant only to protect the feet at this point. Expensive shoes will not help your child walk earlier, improve their arch (children are naturally flat-footed) or make them ore stable.

Feeding

It is now time to replace your child’s bottle with a sippy cup.

Most children are picky eaters at some point. Some days they will eat well and other days they will not. Continue to offer a nutritious, well balanced diet. You can supplement with liquid vitamin drops (such as Poly-vi-sol or Gerber Vitamin Drops) once a day.

Safety

Children at this age are walking or will be within the next few months. BABY PROOF YOUR HOUSE!

Get on your hands and knees and crawl around to see what is at their eye-level. Keep doors closed. Put locks on cabinets and drawers that contain cleaners, beauty products, sharp objects or breakable objects.

Secure furniture so it cannot tip over onto your infant. Use electric outlet covers. If you haven’t done so already, adjust your hot water heater to 120 degrees. Put locks on your toilets or keep your bathroom doors closed.

Your baby will soon be moving around the house. Use gates at stairways and doors. Cover sharp-edged corners on furniture. Do not let cords or tablecloths hang off of furniture. Keep small chokable objects picked up

Do not drink hot beverages while holding your child, or leave them on the table or counter edges, where they can spill onto an infant below.
Remove crib bumpers and mobiles from the crib and lower the crib mattress as your infant will soon be crawling around and pulling up to stand.

Never leave your infant alone in the bathtub or sink.

Your child may ride in a forward facing car seat if they are over 20 pounds. They still must ride in the back seat.

Development

At this age, your child will become more independent in expressing likes and dislikes.

Will want to do more things for themselves.

Will start building a vocabulary. Talk with him/her often and avoid baby talk. Repeat his/her words and phrases if you can.

They will respond more to positive reinforcement than negative consequences.

Can help with simple tasks, such as putting away a few toys or throwing garbage away.

Continue to learn from being read to.

They enjoy simple songs and nursery rhymes.

Can start exploring playground equipment under your careful supervision.

24 Months
Health

Your child needs to ride in a car seat until he/she weighs 40 pounds.

Continue to help your child brush his/her teeth with children’s fluoride toothpaste. If your child’s teeth appear healthy, their first dental visit should be around age three. That is usually when they can cooperate well during the visit. If their teeth do not appear healthy, go now.

Continue to supervise your child in the bathtub. Bubble baths may cause genital discomfort, especially in girls.

Feeding

You may now give your child chewable vitamin supplements. Some brands recommend giving only ½ of a chewable vitamin to 2 year olds. Be sure to read the directions.

Most children continue to be picky eaters. Be sure to offer well-balanced nutritional meals that include at least one food you know your child will eat.

Your child should not be using a pacifier or bottle anymore.

You should consistently encourage use of a fork, spoon and napkin during meals.

Safety

Children remain curious and unaware of danger at this age. Continue to watch them carefully in all situations, especially around swimming pools.

Development

At this age, your child may begin to toilet train

Will start repeating words, phrases and actions they are exposed to. Limit the amount of violence and harsh language they see and hear.

They will play well along side of other children not necessarily with them. They are just beginning to understand the concept of sharing.

They continue to learn from reading and books. They begin to learn counting, shapes and colors.