The 1-, 2-, and 4-Month Well Child Visits

Chapter 18 The 1-, 2-, and 4-Month Well Child Visits



Dennis Z. Kuo, MD, MHS




Speaking Intelligently


Early infancy is a time of rapid growth and change as the infant develops increasing awareness of the environment and motor skills begin to emerge. Key elements of these visits include eliciting parental concerns, monitoring growth percentiles, developmental surveillance, administering immunizations, and providing individualized anticipatory guidance. Many infants transition to a group day care setting when the mother resumes employment outside the home. Parents have usually become comfortable caring for their baby. It is important to acknowledge this and provide reassurance that the infant is growing and developing as expected.



Medical Knowledge and Patient Care


In early infancy the excitement of a new baby settles down into a routine. Parents become attuned to responding to their child’s needs and wants, and the child begins to smile, coo, and laugh. Many parents simply want to know “Is my child healthy and normal?” Almost all infants you will see are, in fact, healthy, normal, and growing well. Time should be devoted to reassurance and giving parents a vote of confidence in their parenting skills.


image Nutrition. The child grows quickly at this age. Typical weight gain is 20 to 30 g/day. Length typically increases 3.5 cm/month and head circumference 2 cm/month. The child should be fed with either breast milk or iron-fortified formula. If the mother is breastfeeding, the milk supply and the feeding routine are generally well established at this age. Encourage the breastfeeding mother to exclusively breastfeed through 6 months of age. Solid foods such as iron-fortified baby cereals can be introduced to formula-fed infants at 4 to 6 months of age. Starting solids earlier is discouraged because oral motor skills are not adequately developed, nutrition may be adversely affected, and there may be an increased incidence of allergies. Solids are introduced to allow the baby to try new textures and flavors, but breast milk or formula remains the principal source of nutrition until 6 months of age.

image Development. As the infant grows, he/she acquires new motor, language, and social skills in a predictable sequence. These skills, called developmental milestones, are important for assessing the developmental trajectory. At the 1-month visit, the child may be smiling and holding his/her head up briefly. At 2 months, the child will be smiling socially, visually tracking across the midline, and holding his/her head up steadily. By the 4-month visit, the child will be cooing, starting to babble and laugh, reaching for an object, pushing up on his/her arms, and visually tracking around the room.

image Teaching parents to recognize a sick child. Although infants may get common colds, they are also susceptible to more serious invasive illnesses such as bacteremia or urinary tract infections. Teach parents how to recognize a sick child. Under 3 months of age, a child who feels warm, is fussy, or is feeding poorly should have a rectal temperature taken. If the temperature is above 100.4° F, the family should call the physician immediately so the infant can be evaluated for infection. Over the age of 3 months, the family should call for fussiness, labored breathing, poor feeding, or high fever.

image Immunizations. Immunizations are important to protect against childhood diseases. The 2-month-old can receive up to eight vaccines: diphtheria, tetanus, pertussis, Haemophilus influenzae type b, pneumococcus, hepatitis B, polio, and rotavirus. Several vaccines are combined to reduce the number of shots. Parents should be counseled about the benefits and risks of each vaccine, but discuss that the risk of each vaccine is exceedingly low compared with the actual disease.

image Common questions at the young infant checkup include:
• Is my baby eating enough? Too much? Infants usually self-regulate how much to feed. Hunger cues (rooting, sucking on a hand, then finally crying) and satiety cues (sleepy, not interested in feeding) are important to recognize. A consistent growth curve reassures parents. It is difficult to overfeed an infant at this age, but counsel parents that crying infants may simply want to be held and not fed.
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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on The 1-, 2-, and 4-Month Well Child Visits

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