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

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Introduction0:00–0:33

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.

History & Physical0:33–1:57

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.

First visit after newborn discharge1:57–3:31

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!

1 Month3:31–4:31

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.Next up is the 2 month visit!

2 Months4:31–5:55

Start by asking about family well-being, and screen for caregiver depression. Then, it’s time for the baby's first round of shots!
Standard two month vaccines include hepatitis B; rotavirus; diphtheria, tetanus, and acellular pertussis, or DTaP; Haemophilus influenzae type B; pneumococcal conjugate; and inactivated poliovirus.
While it may seem like a lot of shots at once, you can reassure families that it’s safe to give these vaccines together!Here’s a clinical pearl!
Because some vaccines have different formulations that come with their own recommended dosing schedule, you should always check which vaccine and formulation you are giving, to determine the appropriate vaccine intervals for each regimen.
As far as developmental milestones go, a 2-month-old is able to recognize their caregivers, and will smile and coo. Again, discuss nutrition with breast milk or iron-fortified formula, and continue to recommend vitamin D supplementation.
In addition, counsel about oral health, and encourage caregivers to gently wipe their baby’s gums and tongue after each feeding.
Finish the visit with reminders about safe sleep, car safety, and fall prevention.Now, for the 4 month visit! Start by screening the caregiver for depression.

4 Months5:55–6:58

Then it’s time for another round of shots, including rotavirus, DTaP, Haemophilus influenzae type B, pneumococcal conjugate, and inactivated poliovirus.
At this age, new developmental milestones include rolling and laughing. When discussing nutrition, bottle-fed infants should continue with iron-fortified formula, while infants who are exclusively breastfed should start iron supplementation.
Also continue recommending supplementation with vitamin D. Now, because many infants start teething at this age, caregivers should start cleaning their baby’s teeth with a soft cloth or toothbrush and a tiny bit of fluoridated toothpaste twice daily.
Additionally, caregivers should be advised not to put their baby to bed with a bottle, since this habit can lead to dental caries.
Finish the visit with reminders about safe sleep, car safety, and fall prevention.Let’s move on to the 6 month visit. Start by screening the caregiver for depression; and then, give the 6 month vaccines, including hepatitis B, DTaP, pneumococcal conjugate, and inactivated poliovirus.

6 Months6:58–8:27

Additionally, at this age infants can receive their first doses of the influenza and COVID-19 vaccines. When it comes to developmental milestones, a 6-month-old can babble, and they smile at their own reflection in a mirror.
Their main nutrition source is still breast milk or iron-fortified formula, along with vitamin D supplementation; but at this age, caregivers can start introducing mashed or pureed solid foods.
For oral health, encourage caregivers to continue cleaning their baby’s teeth with a soft cloth or toothbrush and a tiny bit of fluoridated toothpaste twice daily.
Additionally, they should be advised not to put their baby to bed with a bottle, since this habit can lead to dental caries.
You should also perform an oral exam, and apply a fluoride varnish to the teeth, which strengthens tooth enamel and helps prevent cavities.
Finally, end the visit by discussing car safety and tips for childproofing the home, such as storing cleaning supplies in locked cabinets and keeping small objects and plastic bags away from their baby.
You can also share strategies for sun protection, including the use of sunscreen.Now let’s switch gears and talk about the 9 month visit.

9 Months8:27–9:29

This is the time to perform developmental screening with a validated tool. New milestones to look for at this age include crawling, pulling to stand, and separation anxiety.
By 9 months, most infants are primarily eating solid food, but breastfeeding should be encouraged, if desired, with the addition of an iron supplement.
If the infant is still receiving iron-fortified infant formula, you can discuss strategies for weaning. All infants in this age group should continue to receive vitamin D supplementation.
Next, promote oral health by continuing to encourage tooth brushing twice daily with fluoridated toothpaste, performing an oral exam, and applying fluoride varnish.
Finish the visit with reminders about car safety, childproofing the home, and sun protection, as well as firearm safety, by advising caregivers with firearms to store them unloaded and locked separately from ammunition.Finally, let’s talk about the 12 month visit.

12 Months9:29–10:55

At this age, all children should be screened for anemia with a hemoglobin and hematocrit, as well as a lead level. The 12 month vaccines include Haemophilus influenzae type B; pneumococcal conjugate; measles, mumps, and rubella, or MMR; varicella; and hepatitis A.
At this age, children have achieved new developmental milestones, and are now taking their first steps and saying their first words!
When discussing nutrition, encourage caregivers to offer healthy foods and snacks, especially vegetables and lean proteins.
You should also recommend whole milk as a source of calcium and water for hydration, but juice intake should be limited, due to its high sugar content.
The 12 month visit is also the time to ensure the infant has had their first visit to a dentist. Meanwhile, continue to encourage twice daily tooth brushing with fluoridated toothpaste, perform an oral exam, and if they have not been to a dentist yet, you can apply a fluoride varnish.
Finally, finish the visit with safety advice, including car safety, childproofing the home, sun protection, and firearm safety.
Also be sure to discuss water safety, since young children can drown in water that is just a few inches deep; so emphasize the need for close supervision around water.
Alright, as a quick recap… Well-child visits promote the health and well-being of children, from birth through adolescence.

Review10:55–11:22

Each visit in the first year of life starts with a comprehensive history and physical exam, followed by age-appropriate screenings and immunizations.
Visits also include a developmental assessment; counseling on nutrition and oral health; and anticipatory guidance on safety topics.
Well-child visit (newborn and infant): Video | Osmosis