Well-child care for newborns and infants (birth to 12 months) allows clinicians to identify any abnormalities in growth and development, administer vaccinations, and provide anticipatory guidance. History should focus on feeding, stooling, and sleeping. Trends in infant growth over time should be observed. Infants require a comprehensive physical examination to assess for normal development. Caregivers should be counseled on vaccination practices and their importance for disease prevention with adherence to standard schedules. Vaccine hesitancy should be addressed. Clinicians should review or perform routine newborn screenings for critical congenital heart disease, genetic conditions, hearing, hyperbilirubinemia, and neonatal opioid withdrawal syndrome. The birthing person should be screened for perinatal mood disorders through the infant’s first 6 months of life. Families should be screened for social determinants of health and offered community resources to help with identified areas of need. Caregivers should be educated on infant nutrition, including breastfeeding and introduction of solid foods. Many infants may benefit from vitamin D and iron supplementation. Safety should be discussed with caregivers, including rear-facing car seats, water safety, and avoiding infant walkers. Caregivers should be counseled on normal infant sleep patterns and safe sleep.
Case 1. JR is a 6-month-old infant brought to your office by his parents. They are concerned that he is not sitting by himself like his older sister did at this age. On review of his records, you see that his last visit was 4 months ago, and he is behind on recommended vaccinations.
Well-Child Visit Goals
Well-child visits (at ages 2, 4, 6, and 9 months) for newborns and infants (birth through 12 months) focus on evaluating growth and development, identifying any abnormalities, addressing parental concerns, administering vaccines, and providing anticipatory guidance.1,2
HISTORY
The well-child history should review the birth history, including gestational age.1 Feeding history; frequency of voiding; and the color, consistency, and frequency of stooling should be assessed. Sleep location and quantity should be ascertained.
PHYSICAL EXAMINATION
Infants should undergo a complete physical examination. Fontanelles should be palpated for flatness and the skull palpated for deformities.2 Skin and sclera should be assessed for jaundice.3 Ocular red reflexes should be elicited.4 Cardiac examination should include auscultation for murmurs and palpation of femoral pulses.2 Abdominal examination should focus on identifying organomegaly and masses.
Hips should be evaluated for developmental dysplasia. The Ortolani and Barlow maneuvers are appropriate for infants younger than 3 months, whereas asymmetric abduction, Galeazzi sign, examination of thigh folds, and leg length are used for assessing unilateral developmental hip dysplasia in infants older than 3 months.5 Cranial nerves can be examined by observing eye movements, pupillary response during red reflex monitoring, and facial muscle and tongue movements during periods of smiling and crying.
Muscle bulk should be palpated to detect atrophy.6 Extremity tone should be evaluated through scarf sign and popliteal angle. Physicians should observe for symmetry. Strength can be assessed through movement observations, when the infant is picked up and by evaluating body posturing during sitting or walking. Primitive reflexes should be assessed. Skin should be observed for rashes, which can be benign or associated with systemic disease.7
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