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Well-baby exams

Well-baby exams begin shortly after birth. Well, actually they begin in the hospital before you take the baby home, but we're not counting that.

Even with a normal, healthy baby, well-baby exams are important to measure growth and development milestones to make certain your baby is staying healthy. Make sure you have a pediatrician you trust and who will take the time to talk to you about your baby's growth and progress.

Measurements

Most well-baby checkups begin with measurements of your baby's length, weight and head circumference. You'll need to undress your baby, so keep a blanket handy.

Your pediatrician will have a growth chart and mark the baby's height, weight and head circumference measurements against a "normal" growth curve for age. Some babies will be "off the chart," or way above the growth curve for their age. Premature infants will fall below the growth curve, but there is an adjustment for "gestational age." If your baby is 4 weeks premature, they are considered "newborn" at one month. Some preemies catch up quickly; others take longer, usually depending on the amount of prematurity. If your baby is losing on the growth curve, your pediatrician may become concerned about failure-to-thrive or other factors, such as adequate feeding and sleep habits. Don't be fixated on the growth chart, however; a baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the 5th percentile. What's most important is steady growth from one visit to the next.

Physical examination

Your pediatrician will perform a head-to-toe physical examination of your baby at every visit. Some of the things they will look at:

  • Head: Soft spots (fontanels) are areas on your baby's head that give your baby's brain room to grow. They typically disappear some time between 12 and 18 months of age, when the skull bones fuse together. The doctor will also check the shape of your baby's head. If there are flattened areas, you may be advised to place the baby in different positions. Don't worry - not everyone has a perfectly rounded skull!
  • Ears. Ear infections are common in infants and toddlers and can cause hearing loss if not treated. Your doctor will check the baby's external auditory canal and then examine the tympanic membrane (eardrum) with an instrument to make sure it's pink and pearly and not bulging. Bulging and discoloration of the eardrum is an early sign of ear infection. (Watch for crying and tugging at the ears for early signs of ear infection. Ask me how I know this!) There should be no discharge from the ear, which is a sign of severe infection. The pediatrician will also check your baby's response to sounds, to make sure hearing is good. Hearing tests typically aren't necessary for well-baby exams.
  • Eyes. Plugged tear ducts are a common problem in newborns. This can frequently be resolved by massage the duct area, which is very simple and painless; your pediatrician will show you how to do this if there are signs of tear duct plugging. If that doesn't resolve the problem, the procedure to clear the tear duct is very simple. Your doctor will also check the baby's eyes with an instrument to see inside the eye and test pupil response to light. As your baby gets older, the doctor will also check to make sure the baby tracks objects with his/her eyes without turning the head.
  • Mouth. Thrush is a yeast infection very common in newborns. Your doctor will examine the baby's mouth for signs of thrush, which is easily treated. As your baby grows and develops, the exam will also look for teeth breaking through the gums on schedule.
  • Skin. In the first few weeks after birth, the doctor will examine the umbilicus to make sure it is clean and that the residual cord is healthy and in the process of falling off. Make sure you keep it clean with a swab soaked in alcohol - the more you clean it, the faster it will fall off. Your doctor will look for unusual skin conditions, such as birth marks, rashes and jaundice (a yellowish discoloration of the skin and eyes). Jaundice is common in newborns and frequently disappears on its own; if it doesn't, light therapy may be recommended to clear it up. Make sure when you bathe your baby that you lift all the folds of skin and clean thoroughly, as rashes and sores may occur if dirt is trapped and irritates the baby's tender skin.
  • Heart and lungs. Your pediatrician will listen to the baby's heart to make sure there are no abnormalities in the beat. Murmurs are not always a cause for concern but you may be referred to a specialist if your pediatrician is concerned. The pediatrician will listen to make sure lung sounds are healthy and normal.
  • Abdomen. When your pediatrician palpates the baby's abdomen, he or she is feeling for enlarged organs or excessive gas or signs of tenderness. Some babies also have umbilical hernias; these are also common and typically resolve by 1 or 2 years of age.
  • Genitalia. Your doctor will examine the genitalia to make sure they are clean and normal, without signs of discharge, lumps or tenderness. In boys, the testes will be examined to make sure they are normally descended.

Development milestones will be covered in another article.

Make sure you ask if you have any questions. Pediatricians generally schedule a generous block of time for well-baby exams, especially for first-time parents. It's important for both the parents and the baby to have confidence that what you're doing is what's best for your baby

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