Well Child Care (“Physicals”)
First Year• 3‐5 Days• 2‐4 Weeks• 2 Months• 4 Months• 6 Months• 9 Months• 12 Months
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After The First Year• 15 Months• 18 Months• 24 Months• 2.5 Years• Annually for age 3+
Newborn Weight
• Infants are made to lose weight, 7‐10% in the first few days.
• Your pediatrician will let you know when and if you need to supplement with formula.
• Follow up from hospital is typically in 2‐5 days.
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What Happens At Each Visit?Physical Exam
Growth & Nutrition
Behavior & Development
Safety
General Health & Immunizations
Growth
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Length• 0‐6mo: ½‐1 inch per month• 1st birthday: 1½ times birth length
Weight• 0‐6mo: 1.5‐2 pounds per
month• 1st birthday: triple birth
weight
Nutrition
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• Newborns feed 8‐12 times per day (every 2‐3 hours)
• Don’t worry too much about a schedule at this point!
Breastmilk
• Breast is best• Benefits
– For baby: • Decrease SIDS risk• Optimize development• Bonding
–Maternal emotional and physical benefits– Economical, readily available
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StoolsFirst few days:
• Frequent stools• Usually black, sticky meconium that transitions to brown/yellow looser
stool
Breastfed infants:• First couple months, typically stool with each feed
• Loose, yellow in color with small solid particles• Beyond 2m, may decrease in frequency
Formula‐fed infants:• Typically stool more often than breastfed infants• Stools may be darker and thicker in consistency
Black
Diapering: The Basics
• Keep Your Baby Dry!– Change diapers frequently– Disposable vs. cloth diapers
• Use Fragrance‐Free Products
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Diaper Rash
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• Frequent diaper changes• Avoid diaper wipes• Pat skin dry • Apply diaper rash cream
Diaper Rash: When to Consult Your Pediatrician
• Moderate/severe rash• Has blisters or pus‐filled sores• Persistent or worsening despite good care
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Sleep
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Do NOT attempt“Sleep Training” or “Crying It Out”
until at least 4 months old
Baby’s Age Total Sleep per day
DaytimeSleep
Nighttime Sleep
0‐2 months 14‐17 hr 2‐3hincrements
2‐3h increments
2‐4 months 14‐17 hr Napsgradually shorten
3‐5h
4‐6 months 12‐15 hr 3 naps 6‐10h
6‐12 months 12‐15 hr 2‐3 naps 6‐10h
Normal Newborn Breathing
• Babies breath fast—40‐60 breaths per min.• Periodic breathing• Noisy breathing• Coughing and sneezing are normal in newborn period
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When Should I Call My Doctor
• If babies temperature is above 100.4• If you are concerned with excessive cough or wheeze.
• They are retracting• Your baby has signs of cold or illness• You are worried.
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Emergencies‐Hospital or 911
• If your baby stops breathing• If the baby pauses for more than 15 seconds• Your baby is limp or difficult to arouse• If they are blue or dusky‐especially around the face and the lips.
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Umbilical Cord Care
• Keep the area clean and dry• No need for alcohol• The cord typically takes 1‐2 weeks to fall off, slight bleeding is possible.
• Do not tape or place any other object on the umbilical cord!
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Signs of Umbilical Cord Infection
• Skin around the umbilicus appears red, swollen or increased warmth
• Bleeding is persistent or more than a teaspoon• Continues to leak one week after cord falls off, you see pus or a foul odor persists.
• If any of the above occur, then call your doctor right away.
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Umbilical Hernias
• Swelling or bulging at the site of the belly button
• Very Common• Gets larger and harder when baby cries or strains, then goes down
• 80% go away by 3‐4 years of age.• If red, painful, or doesn’t go down, see your
doctor or go to the ER.
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Tummy Time
• Prevents flattening of the head‐brachycephaly• Increases strength for other milestones such a rolling sitting and crawling
• Helps master head control• May help with gas pain• Start as soon as the umbilical cord falls off.• Initially 3‐5 min 2‐3 times per day, working up
to 20‐30 min by 3‐4 months old.
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Burps, Hiccups and Spit Ups
• Burping‐Burp when switching breasts or every 2‐3 oz of formula for the first 6 months of life.
• Hiccups‐very normal to have them multiple times per day. Frequent burping may help prevent them.
• Spitting up‐normal after almost every feeding. Vomiting once per day is normal. If arching back, uncomfortable with spit up then contact
your doctor.
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Colic
• Lengthy episodes of crying and fussiness• Starts 4‐6 weeks old, peaks around 3‐4 months, then subsides
• Rule of 3s:– 3 hours of crying– At least 3 days a week– 3 weeks to 3 months old
Car Safety
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How to select a car seat• Child’s age• Child’s weight • Expiration date• History: no car accident
Baby Blues vs. Postpartum Depression
• First 2‐3 days there is a feeling of euphoria.• Then with hormone changes, lack of sleep other feelings may emerge. Mood swings, crying, anxiety and difficulty sleeping. This will often last 2 weeks.
• If symptoms continue, call your OB, talk to your pediatrician and please do not be afraid to fill out our screening forms. We are here to help you. There are many resources for you.
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Cocooning
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Young infants are more susceptible to certain infectious diseases.
Get the recommended adult vaccines:• Tdap• Flu
Vaccines are safe.Vaccines are effective.
If you have questions or concerns regarding childhood vaccines, please discuss with your pediatrician.
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Vaccinations
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Instead of perfection, have
laughter.
Enjoy the moment
Ask for help, it really is ok.
It’s ok not to enjoy every
moment
Plans can change….try to go
with the flow
Be easy on yourself
Try not to micromanage,
dads, grandparents.If unsure…..
Call your Pediatrician.
We are here for you!