Well-child visit (newborn and infant): Clinical sciences

Well-child visits promote the health and well-being of children from birth through adolescence. In the first year of life, each well-child visit starts with a comprehensive history and physical exam, followed by age-specific interventions and recommendations.

Your goal at each well-infant visit is to provide age-appropriate screenings and immunizations; assess development; counsel on nutrition and oral health as indicated; and provide anticipatory guidance.

When a newborn or infant presents for a well-child visit, your first step is to obtain a comprehensive history and physical examination. Be sure to review birth history, including gestational age, birth weight, and any pregnancy, delivery, or postpartum complications. You should also take an interval history, noting any health changes that may have occurred since the last office visit.

Then, remember to ask caregivers if they have any concerns, as they are often the first to notice when something isn’t quite right. Finally, be sure to ask about social determinants of health, like tobacco exposure, intimate partner violence, or food insecurity; as well as protective factors such as social support and a positive caregiver-infant relationship.

Next, perform a physical exam, starting with an assessment of the infant’s general appearance. Then, perform a full body exam, paying close attention to fontanels, head shape, and muscle tone; and look for symmetric movement of all extremities. Also, don’t forget to check the red reflex, to assess for congenital cataract or tumor. Finally, review the patient’s growth chart, and track the infant’s length, weight, weight-for-length, and head circumference, over time.

Now, your next steps are determined by assessing your patient’s age. Let’s start with the first well-child visit, which occurs during the first week of life, often within 48 to 72 hours after discharge from the hospital. First, check the results of the bilirubin screening, and follow-up as needed. Then assess their development by checking newborn reflexes.

Now, here’s a clinical pearl to keep in mind! A healthy newborn exhibits several distinct reflexes in response to various stimuli. For example, in the rooting reflex, the baby turns their head and opens their mouth when their cheek is stroked. In the sucking reflex, the baby begins sucking when the roof of their mouth is touched.

Finally, the moro reflex occurs when the infant is startled; for example, with sudden noise or unexpected movement. In response, the infant throws their head back, cries, and then draws the extremities inwards. These newborn reflexes normally disappear as the infant ages.

Next, you should discuss the family’s plans for feeding their baby with breast milk or iron-fortified formula; and recommend vitamin D supplementation. Anticipatory guidance for newborn safety includes illness prevention, such as frequent handwashing; safe sleep practices, like putting their baby to sleep on their backs and sleeping in a crib without loose or soft bedding; and car safety, where the infant is placed in a rear-facing car seat in the backseat.

Now, let’s move on to the 1 month old visit! First, be sure to review the results of the hearing and newborn metabolic screens, and follow-up as needed. You should also screen for caregiver depression. From a developmental standpoint, a 1-month-old should be alert and responsive; they enjoy looking at faces, and they recognize familiar voices.

This is also a good time to start “tummy time” while the infant is awake, as this builds muscle strength in the neck, shoulders, and arms; and also promotes motor development. For nutrition, discuss how much and how often the baby is taking breast milk or iron-fortified formula, and continue vitamin D supplementation.

Safety recommendations for a 1-month-old includes several topics, such as safe sleep, car safety, and preventing falls by instructing caregivers to never leave their baby alone on high places, like changing tables.