Well Child Visits 

Congratulations! Your baby is finally here. Newborns are wonderful, but exhausting! The 2 Week Visit is a time to talk about how your family is acclimating to the newest addition. Feeding, bowel habits and sleeping are common topics. Babies usually lose weight right after birth. By 2 weeks of age, your baby will likely have regained his or her birth weight. Please remember that it is important to always put your baby to sleep on his or her back in a flat, firm and separate sleep space to reduce the risk of SIDS. As always, we are here to answer questions and offer anticipatory guidance.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Remind you to give your baby a daily supplement of 400 IU of vitamin D drops if you are breastfeeding.
• Monitor for signs of jaundice.
• Check to see how your baby is feeding.
• Answer questions about your new baby.
• Obtain second Newborn Metabolic Screen

Tests/Screens/Assessments: Newborn Metabolic Screen 
Helpful Info: Caring for Your Newborn Bright Futures Parent Info

Families are usually settling in some by this visit. Feeding, sleeping and bowel habits are sometimes a concern. At this visit we will track your baby's growth and development and answer any questions. Your baby may be starting to smile now and that helps a lot!

Immunizations: HepB#2

Helpful Info: Back to Sleep, Tummy to Play

Bright Futures Parent Info

Many babies seem more fussy or colicky at this age. Be patient. Colicky babies eventually outgrow their crying phase. Keeping your baby safe is the most important thing you can do. Even if you feel frustrated, handle your baby gently and reach out for help to friends, relatives or your pediatrician if the crying is getting to be too much. If you need a break and no one is available to help you, place your baby on his/her back gently in a safe space such as a crib or bassinet and take a few minutes to calm down.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s first set of immunizations. Immunizations are safe, effective, and keep your child and our community healthy. During this visit, you will be able to discuss any questions you may have about immunizations.
• Screen for post-partum depression.

Note that DTap#1, HIB#1 and IPV#1 listed below are given as a single combination vaccine.

Immunizations: DTap#1, HIB#1, PCV#1, IPV#1, Rotavirus#1
Helpful Info: Colic, Crying and Your Baby: How to Calm a Fussy or Colicky Baby Bright Futures Parent Info

Your baby is becoming more active and verbal. Be careful not to leave your baby unattended, especially on a bed, couch, or counter. They move faster than you think! Babies need only breast milk or iron fortified formula for the first 4-6 months of life. We will talk at this appointment about the appropriate time to introduce solid foods and what foods to introduce first.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss when to start feeding your baby solid foods

Note that DTap#2, HIB#2 and IPV#2 listed below are given as a single combination vaccine.

Immunizations: DTap#2, HIB#2, PCV#2, IPV#2, Rotavirus#2
Helpful Info: Starting Solid Foods Bright Futures Parent Info

Your baby will begin to move more and will be able to sit up independently for short periods of time. Now is the time to start baby-proofing your house if you haven't already done so. You should move the mattress in your baby's crib down to the lowest level.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss the introduction of fluoridated water to encourage the development of strong and healthy teeth. If you have city or rural water, your water is fluoridated. If you have well water, you should have your water tested for fluoride before offering it to your baby.

Note that DTap#3, HIB#3 and IPV#3 listed below are given as a single combination vaccine.

Immunizations: DTaP#3, HIB#3, IPV#3, PCV#3, Rotavirus#3, Influenza vaccine (during flu season)
Helpful Info: Starting Solid Foods Bright Futures Parent Info

Your baby may be starting to crawl, pulling to a stand, and cruising on furniture. Babies will want to touch everything; this is how they learn. This is a messy time! Have fun and be patient.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Discuss your baby's upcoming dental care.

Immunizations: HepB#3
Tests/Screens/Assessments: Pediavision Screen
Helpful Info: Caring for Your Child's Teeth Bright Futures Parent Info

At this age, your baby can transition from breast milk or formula to cow’s milk, however it is healthy to continue breast milk if that is what you prefer for your baby. Most babies need 3 meals, 2-3 snacks per day, and no more than 16-20 ounces of whole cow's milk per day. Your baby will be able to eat many of the foods you eat, but be careful to avoid small, hard foods that can cause choking. It is time to wean your child from the bottle and offer all liquids in a sippy cup. It is much easier to wean your child now than if you wait until they are older - avoid cavities and additional tears and make the change now!

Your baby will be outgrowing the infant carrier car seat. Continue to have your baby in a rear facing car seat until age 2 or later if they are still fitting comfortably rear facing.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss dental health. Your baby should see a dentist after 1 year of age. You should be brushing your child's teeth with an infant toothbrush and a tiny smear of fluoride toothpaste. We will provide you with a list of dentists and encourage you to schedule your baby's first appointment.
• Screen your baby for lead exposure and anemia

Immunizations: HepA#1, PCV#4
Tests/Screens/Assessments: TB Surveillance, Lead Surveillance, Complete Blood Count
Helpful Info: Playing Is How Toddlers Learn Bright Futures Parent Info

Your child may be able to climb and run, so be sure to safety proof your home. Poison control is available 24 hours a day: 1-800-222-1222 - keep this number handy in your cell phone and on your refrigerator.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.

Immunizations: MMR#1, Var#1
Helpful Info: Choking Prevention and First Aid for Infants and Children Bright Futures Parent Info

At 18 months, your child understands much more than he or she can say in words. Use words to describe your child’s feelings and gestures. Read and sing to your child often. When reading, use simple words to talk about the pictures.

At this visit we will:

• Measure your child’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Review your child’s development with you using the M-CHAT developmental questionnaire (autism screening tool) and the Ages and Stages Questionairre.
• Discuss temper tantrums.

Note that DTap#4, HIB#4 and IPV#4 listed below are given as a single combination vaccine.

Immunizations: DTaP#4, IPV#4, Hib#4
Tests/Screens/Assessments: MCHAT Questionnaire
Helpful Info: Is Your Toddler Communicating With You? Bright Futures Parent Info

At this age, your 2 year old may go from trying to be independent to clinging to you; this is normal. It is better for toddlers to play than to watch TV. Even having television playing in the background interrupts healthy toddler play - background music is a better choice.

At this visit we will:

• Measure your child’s weight, length, head size and Body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit.  Your child may need immunizations if they are behind on their shots.
• Review your child’s development with you using the MCHAT (Autism screening tool) questionnaire.
• Test for lead exposure with a finger prick in the office.
• Screen your baby for amblyopia (lazy eye) with our ocular photoscreen device.
• Discuss dental health and apply fluoride varnish to your child's teeth.
• Discuss toilet training and time out.

Immunizations: HepA#2, Flu vaccine (during flu season)
Tests/Screens/Assessments: Lead Surveillance, Lead Test
Helpful Info: Playground Safety Bright Futures Parent Info

Your child will likely be moving into a world of make believe that they create with their imagination. Toys for dress up and make believe are important at this age. Read books, sing songs and play rhyming games with your child each day.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit.  Your child may need immunizations if they are behind on their shots or duirng flu season.
• Discuss dental health 

Immunizations:  Flu vaccine (during flu season)
Helpful Info: Toilet Training Bright Futures Parent Info

Four year olds often like to sing, dance and act. They like to tell "tall tales" and make up stories.  Enjoy these fun moments with your little one!  Parents should continue to help with brushing teeth even though your child will want to do it all by themselves.

At this visit we will:

• Measure your child’s weight and height and body mass index and record on a growth curve.
• Provide your child's immunizations.
• Discuss dental health

Note that DTap#5 and IPV#5 listed below are given as a single combination vaccine.

Immunizations: DTaP#5, IPV#5
Helpful Info: Encourage Your Child to Be Physically Active Bright Futures Parent Info

At this age, your child needs more independence. However, you need to set clear limits. A regular bedtime and consistent bedtime routine are important. Be a great role model. Show an interest in what they are learning.

At this visit we will:

• Measure your child’s weight and height and body mass index and record on a growth curve.
• Review your child’s speech and development.
• Discuss exercise and nutrition.
• Discuss kindergarten readiness.
• Discuss dental health 

Immunizations:MMR#2, Var#2,
Tests/Screens/Assessments: Anemia Surveillance with Complete Blood Count, Vision Testing, Hearing Testing
Helpful Info: Bedtime - The Four B's Bright Futures Parent Info

Encourage good learning by helping your child organize a distraction-free time to do homework and ensuring eleven hours of sleep each night. Teach your child what to do if there is a fire and have practice fire drills. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

At this visit we will:

• Measure your child’s weight and height and body mass index  and record on a growth curve.
• Screen your child's hearing and vision as needed.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Review safety issues.

Immunizations: None
Helpful Info: Helping Children Help Themselves Bright Futures Parent Info

Continue to encourage good nutrition and exercise for your child. This is the time he or she is building good health habits for a lifetime! There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

At this visit we will:

• Measure your child’s weight, height and body mass index  and record on a growth curve.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Review safety issues.

Immunizations: None
Helpful Info: Growing Up Healthy: Fat, Cholesterol, and More Bright Futures Parent Info Bright Futures Patient Info

Your child be is becoming more responsible and will be able to take on more tasks such as taking care of his/her own room. He or she may also start reading independently for pleasure.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Review safety issues.

Immunizations: None scheduled
Helpful Info: Chores, Age-Appropriate Bright Futures Parent Info Bright Futures Patient Info

Your child may be transitioning to middle school at this age. He or she may be participating in more group activities. Expand your conversations about healthy living practices to include tobacco, drug and alcohol avoidance.

At this visit we will:

• Measure your child’s weight. height and body mass index and record on a growth curve.
• Provide your child’s immunizations.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Discuss puberty changes to expect or that may be starting to occur.

Immunizations: Tdap#1, MCV#1, HPV#1
Helpful Info: Substance Abuse Prevention Bright Futures Parent Info Bright Futures Patient Info

Even though friends are becoming more important at this age, having a caring adult to provide a listening ear and from which to obtain accurate health information is equally important. Foster open communication with your child. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of the visit with the parent out of the room.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Review your child’s school performance and development.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
• Discuss puberty changes to expect or that may be starting to occur.

Immunizations: None, HPV#2 if series not completed prior to this date
Helpful Info:  Teens, Behavior Bright Futures Parent Info Bright Futures Patient Info

Your child may be showing an increasing interest in extracurricular activities. Have conversations about risk taking behaviors, driving, alcohol, drug use, family rules and expectations. Discuss media and internet safety. Make certain that they have an adult they can confide in if they are unable to communicate with you. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of the visit with the parent out of the room.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Review your child’s school performance and development.
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.

Immunizations: None
Helpful Info: Teens, Behavior Bright Futures Parent Info Bright Futures Patient Info

Your child may be adjusting to the transition to high school. Development of family relationships continues to be important, but it is also normal for teens to place more and more emphasis on their peer relationships. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of the visit with the parent out of the room.

At this visit we will:

• Measure your child’s weight and length and record on a growth curve.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Review your child’s school performance.
• Reinforce healthy choices and risk behavior avoidance.
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.).
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.

Immunizations: HPV series if not previously completed
Helpful Info: Teens, Behavior Bright Futures Parent Info Bright Futures Patient Info

Your child is getting closer to finishing high school and entering the adult world. Making mistakes are a normal part of growing up. Continue to provide emotional support and guidance for them during this time. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of the visit with the parent out of the room.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Review your child’s school performance.
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.).
• Reinforce healthy choices and risk behavior avoidance.
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.

Immunizations: MCV#2, Men B (0ptional)
Helpful Info: Teens, Behavior Bright Futures Parent Info Bright Futures Patient Info

Your child is now transitioning to adult life! They will still look to you for support and guidance but will be more on their own when it comes to decision making. 
At this age we recommend transitioning to adult healthcare. You may wish to contact your insurance for a list of covered physicians in your area. We have enjoyed being a part of your family! 
Bright Futures Parent Info Bright Futures Patient Info