Baby Checkups: What to Expect at the Doctor’s Office

The American Academy of Pediatrics (AAP) suggests that babies begin following a regular schedule of checkups (or well-baby visits) within 24 hours of birth. The check-ups should continue every couple of months as recommended by your doctor. But the first few weeks with a newborn can be filled with uncertainty. Is Baby eating enough? Sleeping enough? What is that red bump on her cheek? With so much to worry about, you’ve hardly had time to ponder what to expect at the doctor’s office.

Before you pack your bulging diaper bag and head for the pediatrician’s office, you might want to write down any questions you’ve been meaning to ask your doctor. “Parents should come to visits armed with any questions or concerns they have about their child,” says Dr. Sharon L. Busey, assistant professor of pediatrics at the Medical College of Wisconsin. “The well-baby visit is a good opportunity to address questions that the parent [may have].” Dr. Busey encourages parents to make questions and concerns known early in the visit so your doctor has enough time to effectively address them.

Before you head for the pediatrician’s office, write down any questions you’ve been meaning to ask your doctor.

If you keep a log of non-urgent questions that pop up in your daily routine, you’ll always have a list ready to bring to the visit. For example, Wendy Podpora, a mother of five in Welches, Ore., was concerned about the “very red stork bite” on her son’s eye. Her doctor assured her it was no problem, and Podpora reports that it did indeed fade with time.

Besides providing a question-and-answer period for parents, the well-baby visit also allows your doctor the opportunity to ask you questions about your baby’s development. “Before examining your child, most doctors will ask specifically about nutrition issues, development and safety concerns,” Dr. Busey says. Some doctors tailor these questions to address areas of particular concern. “If a pediatrician is concerned about the baby’s growth, for example, she may ask more in-depth questions about the type and frequency of feeding, and the baby’s urine output or stool patterns,” Dr. Busey explains.

The doctor’s questions also will touch on which developmental milestones your child has reached. Podpora remembers that her doctor would ask developmentally appropriate questions such as, “Do you notice your baby holding a toy with one hand and then passing it to the other?”

Naomi Sugar, M.D., clinical associate professor in the Department of Pediatrics at the University of Washington, agrees. “We often ask questions about gross motor development: rolling over, sitting, and questions about language and social development, which include smiling, laughing, blowing bubbles, making vowel vocalizations (ooo, ahh) and later babbling (dada, mama),” she says. “There is a wide normal range in development, so your baby isn’t ‘slow’ if she doesn’t do everything the physician asks about.”

Next is the examination itself, which includes measurements of Baby’s length and height, weight and head circumference. Most times, these will be plotted on a growth chart. “This is a way to measure the baby’s recent growth compared to his pattern of growth. There is no correct weight or length or head size, but there are normal patterns of growth which can be tracked, Dr. Sugar says. Your pediatrician may also tell you what percentile your child falls into according to the growth chart. Simply put, if your baby is in the 50th percentile for height, half the children in his age group are taller than your child, while the other half are shorter than he is. Your doctor should give you more information about percentiles and their significance at your visit.

During the physical examination, your pediatrician will listen to your baby’s heart and lungs, look in his ears and at his eyes, possibly check his reflexes, and feel your baby’s body to locate any abnormalities. For example, you may see your doctor lightly pressing your child’s abdomen to feel Baby’s internal organs. The doctor will also examine Baby’s genitals, looking for anything out of the ordinary, and rotate Baby’s legs to rule out problems with his hips.

Another important part of your baby’s routine visit may be the administration of one or more immunizations. “With the immunization schedules we use now, babies usually receive several immunizations at each well baby visit,” Dr. Sugar says. “The combinations have been tested and are safe and effective when used together.” Your doctor may give you information about each vaccine to read before your visit. You can also do research in the library or on the Web to find out more about vaccinations and making informed choices about administering them to your child. The AAP provides a schedule of recommended immunizations, which can be found on its Web site (http://www.aap.org/). Often, a nurse or medical assistant will give your child the immunization(s) after your doctor has completed her visit with you. “The parent’s role is generally to help hold the child still while the vaccines are being given and to console the child afterwards,” Dr. Busey says.

Dr. Sugar suggests that the parent cuddle the baby to calm him down right after the shot. In addition, she says some practitioners will recommend Tylenol.

If your doctor notes something of concern in your baby’s health or behavior during the examination, some type of follow-up is essential, Dr. Busey says. An appropriate follow-up could be a phone call by the doctor or office nurse, a follow-up office visit or referral to a specialist. On the other hand, “If the parent expresses a concern that the doctor does not feel is worrisome from a medical standpoint, the doctor needs to effectively educate and reassure the parent about why it is not worrisome or likely to be harmful to their child,” she says.

In Podpora’s case, she was concerned about her infant daughter’s spitting up after every feeding. “I was concerned that she wouldn’t grow normally, but the pediatrician reassured me that she was growing fine, and that if at any time she stopped growing or lost weight, there was medication to help her.” Never leave the office feeling uncertain or uncomfortable about the answers your doctor has given.

Finally, Dr. Sugar reminds parents not to worry. “Don’t be nervous, this should be fun! Think of a well-baby visit as a time to have a conversation about your baby with someone who has lots of experience with babies.” And for most new parents, that conversation is a welcome one.