Infant Checkups

with Darcy Fechner, M.D., Pediatrician, Columbia St. Mary’s

Posted: Jan. 1, 2004

Regular visits to the doctor are part of the routine of a healthy pregnancy – monthly checkups which become more frequent close to your due date. Once your baby is born, those visits will be replaced by another set of regular appointments – with your new baby’s pediatrician.

“In the first year of life, they have more frequent visits than at any other time during their childhood,” said Dr. Darcy Fechner, a pediatrician at Columbia St. Mary’s Germantown Clinic, of her young patients.

Darcy Fechner, M.D., Pediatrician, Columbia St. Mary's "Parents should ask questions, even if they seem like silly questions. If they're concerned in any way and for any reason, they should be able to ask their pediatrician, if only to be reassured and to clear up any concerns."

Checkup schedule
Parents should take their new baby to his or her first pediatric appointment within a few days of leaving the hospital. Called into the doctor’s office by his or her name, this is often the first time parents hear their child’s name called by an adult outside the family.

From that point, the baby will be seen at age 2-4 weeks. Regularly scheduled checkups occur at two months, four months, six months, nine months, and one year of age. During your child’s second year, there’s a 15-month checkup, an 18-month checkup, and the two-year exam. After that, unless there’s a medical problem, your trips to the doctor will be once a year.

At the initial visit, Dr. Fechner schedules enough time to ensure that parents, particularly first-timers, have enough time to ask and get answers to questions. For parents who have older children, she still likes to provide extra time in the early stages of her newest patients’ lives, because each child is different, generating different questions and concerns.

“I talk about what’s normal, because being new parents, they usually have not spent a lot of time taking care of a child and don’t know what’s normal,” she said. “The other thing I make sure I cover in most visits is giving parents some anticipatory guidance as to what to expect with nutrition, sleep, behavior issues, discipline and safety.”

Dr. Fechner said parents should feel comfortable addressing any and all concerns about child-rearing and baby care with their pediatrician.

Charting growth
One of the reasons for the frequent visits during the first year is to make sure concerns are kept to a minimum, and that the baby is developing normally.

Beginning at two months, babies are started on their vaccinations. At each visit, the baby’s height, weight and head circumference are plotted on a growth curve, giving parents – and the doctor – the ability to track the baby’s growth rate. A full physical exam, with the doctor checking everything from the baby’s heartbeat to looking in his or her ears and inquiring about developmental milestones, is also conducted.

The growth chart is a key part of monitoring overall health.

“We like to see children staying on their own curve,” she said. “It’s more reassuring to have a child in the fifth percentile who is tracking consistently than to see a child who was tracking in the 75th percentile drop to the fifth.”

If one measurement is behind the others, she said, that could also indicate a need for further investigation. If all three (height, weight and head circumference) are small, it could indicate a genetic problem, growth problem, neurological problem – or even no problem at all, particularly if there are petite people in the child’s gene pool.

The growth chart is a key part of monitoring overall health.

Dr. Fechner also tracks motor, speech and social development.

“There’s a wide range of normal,” she said. “You want to see a progression of development – a big red flag would be any regression. I’m less concerned about a big, chunky breastfed baby who is happy, growing and developing, but isn’t able to roll over yet than I am about a baby who was able to sit up on his own and then couldn’t.”

Vaccinations
During the first two years of life, there is also a full schedule of recommended immunizations. While most parents are relieved to know that their children are inoculated against polio, whooping cough and some bacterial causes of meningitis – diseases that devastated earlier generations – some parents are initially wary about their baby’s first shots.

“The most common side effects are fevers within the first few days, and local swelling, redness or irritation,” Dr. Fechner said. “But these are safe to the point where we’re recommending them strongly because the benefits of giving them far outweigh the risks of not doing so.”

A lot of vaccines that used to be given in single doses are now combined, which means fewer needle pokes for young patients.

At two months, four months, six months, 15 months and just before entering kindergarten, children get a DTaP shot, which inoculates against diphtheria, tetanus and pertussis (whooping cough).

The polio vaccine, which is a killed virus, is given as an injection at two, four and six months and again before a child enters kindergarten.

At two, four and six months, children are vaccinated against Hib (Haemophilius Influenza B), against Hepatitis B and against pneumococcal bacteria, which causes pneumonia, meningitis and is responsible for many ear infections.

A lot of vaccines that used to be given in single doses are now combined, which means fewer needle pokes for young patients.

Depending on the pediatrician, children are initially vaccinated against measles, mumps and rubella (MMR) in a single shot given between one year and 15 months of age, with another shot given before kindergarten. Also, at one year, children are now vaccinated against chicken pox.

Currently, doctors are suggesting that children between the ages of six months and 23 months receive a flu shot. Dr. Fechner said this will probably be changed to an official recommendation by next year. The recommended status, she said, means that the Committee on Infectious Diseases considers this age at high risk of getting influenza, and also, health insurance will cover the vaccine.

Suggested Books:

Caring for Your Baby and Young Child Birth to Age Five, American Academy of Pediatrics (AAP)
Caring for Your School-Age Child Ages 5 to 12, AAP
Caring for Your Adolescent Ages 12 to 21, AAP
Guide to Your Child’s Symptoms Birth through Adolescence, AAP
Instructions for Pediatric Patients, Barton Schmitt, MD
The Happiest Baby on the Block, Harvey Karp, MD
The Womanly Art of Breastfeeding, Gotsch
Toilet Training in Less Than a Day, Nathan Arzin
The Magic Years, Selma Frailberg
How to Get Your Kid to Eat . . . But Not Too Much, Ellyn Satter
Raising Your Spirited Child, Mary Sheedy Kurcinka
How to Talk So Kids Will Listen and Listen So Kids Will Talk, Faber and Mazlish

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