HOW TO CHOOSE YOUR BABY’S DOCTOR
If you haven’t already done so, now’s the time to choose a medical care provider for your baby. You can select either a pediatrician who is trained to deal with childhood illnesses, or you may elect to use a family practitioner who is a general physician with post-medical school experience in specialties such as pediatrics, obstetrics, internal medicine, and surgery. A family practitioner is trained to work with your entire family, from infancy through old age, which can provide a welcome sense of familiarity and continuity. He or she will be a good choice if everyone in your family, including your baby, is generally healthy. Should serious problems arise, your practitioner will refer you to specialists according to the situation.
There are a number of places you can turn to, to get recommendations for a good doctor for your baby. Ask your friends with children if they’re happy with the care they get from their doctors. Your own obstetrician or physician may have suggestions, too. Your health insurance policy may mandate the use of only certain physicians who are part of their system of providers.
When you go to meet with a prospective pediatrician or family care practitioner, pay attention to not only your comfort level with the doctor but also the way the receptionist and the rest of the staff act toward you and other parents. Once your baby has been accepted as a patient, you’ll probably discover that you are spending as much time interacting with the staff as you are with the doctor. When deciding about the care provider, it’s important that you think ahead about how that will work over the longer picture of your child’s life and not just while she’s a baby.
Some physicians have very overloaded patient lists. That translates into shorter visits and less time for talking with you and answering your questions. One solution is to try to get your non-urgent baby concerns, such as rashes, feeding problems and teething woes, answered by the doctor’s nursepractitioner, or other professional. If you want to avoid waiting for long periods of time in your doctor’s office, call ahead before you leave home to find out if the doctor is on schedule. Try to schedule your baby’s appointments during the least busy times and hours.
No two health-care providers are the same, so it makes sense to interview several providers before choosing the one who best suits your lifestyle and needs. If you’re breastfeeding, it’s especially important to choose a provider who is totally committed to the importance of breastfeeding, for instance.
When you meet your provider, ask about billing practices and charges, weekend and nighttime coverage, hospital affiliation, and availability for after-hours visits, home visits, or telephone consultations. Find out, too, how he or she typically handles emergencies and how promptly you can expect to have callbacks.
You should feel comfortable with the staff and the general atmosphere of the office. Avoid providers who overschedule patients and require long waits to be seen, and those who make you feel rushed during appointments or who brush off your questions. If you don’t like how you or your baby is being served, discuss the matter directly with your caregiver, or consider finding someone else. Just be sure to remember to have your child’s medical records transferred. It’s important to keep a careful record of your baby’s appointments, illnesses, and immunizations.
Six important questions to ask your baby’s health-care provider
Here is a list of some questions you should have answered by the end of each visit:
1. Is my baby growing normally? At every well-baby exam, your doctor will weigh your baby and measure her length and head size. These measurements are then plotted between dots on a growth chart so that your baby’s growth trends can be followed and compared with the averages for other babies the same age. How petite or large your baby is isn’t as important as a consistent pace of growth.
Breastfed and bottle-fed babies will follow different growth patterns. Typically, breastfed babies grow more rapidly than bottle-fed babies during the first three to four months after birth, but then grow at a slower rate than bottle-fed babies in the months after that—with both groups catching up to each other by their first birthdays. Breastfed babies may have less chance of developing obesity later in life. If you wish, ask to have a copy of your baby’s growth charts or a blank chart that you can fill in yourself with each visit, or download your own from the “CDC Growth Charts: United States” provided by the National Center for Health Statistics (NCHS) and searchable on the Centers for Disease Control’s Web site (www.cdc.gov).
2. When will my baby get immunizations, and what are they for? What reaction(s) can I expect? What are the signs of a serious side effect, and what should I do if that happens? Immunizations start at two months after the birth and are spaced out by two-to six-month intervals. (See Your Baby’s Immunization Schedule on in this chapter.) Being in the know can help you feel more secure about having your baby protected from major, life-threatening illnesses. Mild side effects such as redness, swelling, and a slight temperature may result with certain injections, but serious side effects are extremely rare. Be well-informed, anyway.
3. Does my baby’s diet seem appropriate? Many breastfeeding moms fear that they aren’t making enough milk, and bottle-feeding moms worry that their babies aren’t drinking enough formula (or too much). (You’ll find answers to typical breastfeeding concerns starting on in 3. Your Baby Maintenance Guide.) And when your baby is ready to start solids, you’ll be concerned about how to begin and what to serve. Your well-child exam is a great time to talk about these issues.
4. Should I worry about this? Your baby may have birthmarks, a funny-shaped head, or a heart murmur, all of which are very common and usually not causes for concern. And almost all babies have sleeping and eating problems, spit up, get gas, hiccup, strain with bowel movements, become attached to pacifiers or blankies, and experience brief trembling and times of fussiness for no apparent reason. Now’s the time to raise those concerns, no matter how trivial they may seem. Getting the information and reassurance you need is very important, and that’s one of the biggest roles your doctor can play for you.
5. What’s this vaccination or that test for? Is it really necessary? Can it be postponed until next time? Do I need to schedule a follow-up appointment? Unless there’s a problem, such as a suspected urinary tract infection, anemia, or other serious concern, there are actually very few “routine” tests for babies. Your doctor may recommend a blood test to check iron levels for anemia, cholesterol, or for lead. He or she may suggest taking a urine sample or stool sample to check for lead or parasites or may want to perform a TB test at some point in your baby’s first year. But if this is one of those days when your baby is totally miserable, ask if you can wait until your baby calms down, or if you can bring her back in a day or two. For vaccinations or routine tests, it’s always a good idea to ask what your baby’s being given or what the test is for, and if you need to schedule any follow-up checkups or vaccinations.
6. Is my baby developing as expected? Each time your baby is examined, the doctor will also be making note of developmental milestones that signify that your baby’s brain and body are unfolding on schedule. Does your baby respond to others? Can your baby follow objects with her eyes? How is her head and body control? Hearing that your baby is developing normally from an expert is always reassuring.
If you’re breastfeeding your baby, her appointment may be within the first week of age to ensure that everything’s going smoothly. Formula-fed babies may be seen first at one to two weeks. Your baby will be examined head to toe soon after birth to ensure that all of her body systems, including her vision, hearing, lungs, heart, and abdomen, are functioning normally. Even though your baby just seems to wriggle, your doctor will be able to tell a lot about your baby’s muscle strength and body tone, and your baby’s reflexes and overall responsiveness will be assessed.
Her abdomen will be gently pressed to locate her liver, spleen, and kidneys. Her skin color will be observed to check for jaundice (yellowing), peeling, rashes, birthmarks, bruises and bleeding under the skin, extreme paleness, overall coloring including signs of blueness or grayness, or skin mottling that doesn’t go away.
She will be measured: First her head, followed by the width of her chest and her length, and any molding of your baby’s head from birth will be noted. Her anterior fontanel, the diamond-shaped indentation—called a soft spot—in the front and center of her scalp and the posterior fontanel toward the rear of the top of her skull will be examined to ensure that they don’t bulge or sink in excessively.
Your baby’s heart rate will be counted to see if it is normal or beating irregularly or more rapidly or slowly than normal. Her respiration and chest action will also be observed. Most babies breathe more rapidly than normal during the first 6 to 8 hours after birth. Your baby’s arms and legs will be examined to ensure that they are not too limp, or that her legs and arms are not too flaccid.
Your baby’s hips will be examined and flexed to ensure that she doesn’t have a dislocated hip on one or both sides. Your baby’s eyes will be examined to ensure that there are no signs of infection, that her pupils contract when exposed to light, and that there are no cataracts or other apparent eye problems. Ears will be looked at to see how they are placed in relation to her face, and how your baby responds to noise.
It will be noted if your baby’s nostrils are flared, has structural problems, or your baby’s nose shows signs of bleeding. (Most babies will have a thin, white mucous discharge from their noses, and they will sneeze occasionally.) A baby’s nose may be flattened and bruised, too, from the trip down the birth canal. The baby’s mouth and oral structures will be examined to ensure that she doesn’t have a cleft lip or cleft palate. (These defects are defined in 8. Parent’s Dictionary.)
Your baby’s genitals will be inspected to see if there is any inflammation, or if there are lumps or other signs of problems. She will also be checked to see if there is an inguinal hernia, a bulging in your baby’s abdominal wall in the groin area, which, if present, may need to be surgically repaired at some point. Your son’s testicles will be inspected to ensure that they have descended and that there is no hydrocele, a fluid-filled sac around the testes in the scrotum. If your son was circumcised, the doctor will make sure the area is beginning to heal.
There will be concern if your baby has a large, protruding tongue. All babies drool, but profuse drooling, especially when it’s accompanied by choking or a blue-tinged skin color, will be of concern. Your baby’s cry should be vigorous and loud, and babies with hoarse, high-pitched, weak, or abnormal cries will require closer examination. Your baby’s breathing will be observed to make sure she isn’t struggling to breathe, that her breathing isn’t pausing for longer than 15 seconds at a time, or that her chest rises as her abdomen falls, called “seesaw respirations.”
If your baby got her hepatitis B vaccine in the hospital before she came home, she’s probably safe from needing a shot this time. Other vaccinations are likely to be given at her two-month checkup.
Getting through your baby’s first exam
• Allow time. If your baby’s doctor’s visit is your first “official” outing, be sure to leave yourself lots of time for stocking the diaper bag, getting your baby ready, buckling her into the car seat, finding a place to park, and getting inside.
• Get help and bring a blanket. Having someone to go along with you can be a great help. Baby exams usually mean taking off everything but your baby’s diaper, so keep a blanket handy. You will probably be standing beside your baby while your provider examines her.
• Expect upsets. Your baby may remain calm, but she’s more likely to scream at being undressed, or from the pain if she gets an injection. You may be surprised to find yourself almost as upset as the baby and on the verge of tears yourself.
• Relax first. Rather than trying to race home with an upset baby after your ordeal is over, ask your caregiver if there is a quiet room where you can sit and feed your baby until the two of you are calm again and you feel relaxed enough to latch her into her car.
Weighing and measuring your baby
From the moment your baby is born, your baby’s doctor and other medical staff will be concerned about your baby’s weight, height, and the measurement of her head. Each measurement is duly noted on your baby’s chart. A baby who arrives prematurely will most likely be at the bottom of the size chart, while a baby who arrives late may tip the chart.
During the ’40s and ’50s, in nearly every home where there was a baby, there was also a baby scale—a metal device with a bed for the baby, and a sliding metal weight that was used to gauge the baby’s weight. Most mothers dutifully recorded their baby’s growth every week, if not every day. Unfortunately, the charts had many flaws, including a failure to reflect the different growth patterns of breastfed versus bottle-fed babies. Mothers who bottle feed their babies tend to start solids a lot sooner than moms who breastfeed. Breastfed babies gain weight more slowly after the first 3 to 4 months and then remain leaner than bottlefed babies, who tend to gain more weight after the first 3 months— until both groups catch up to each other by their first birthdays.
“Expect to feel awkward and intimidated when you take your baby to the doctor’s for the first time. Remember: This is not the principal’s office. You’re paying this expert to advise you. Don’t be shy about asking questions, and bring notes so you won’t forget anything. Nothing is too trivial— whether it’s when your baby’s umbilical cord will fall off or how to help cradle cap.”
This obsession with baby weight happened at the pinnacle of the bottle-feeding era. Obsessive nurses (and doctors) demanded careful records of every ounce of formula that a baby took in, and nervous moms tried to stuff as much baby formula into their little ones as they could. Formula was expensive, and you weren’t supposed to keep any leftovers after a feeding, but back then, a fat baby was thought to be synonymous with a healthy baby.
Now we know better. Fat babies aren’t necessarily healthy, and stuffing a baby with formula only makes her more likely to be uncomfortable or to spit up a lot. Now physicians use a more recent (and more accurate) set of charts for measuring baby growth.
Tip
Your baby’s urine stream should be forceful. Stools may vary greatly from one bowel movement to the next, but as long as they are not hard or pellet-like, it’s usually okay. Passing gas is normal and most babies strain and grunt even when passing a soft stool, but that’s not usually a sign that your baby is having trouble or experiencing pain. Don’t try to treat your baby’s constipation or use suppositories without your doctor’s guidance.
Even so, there’s no need to worry about the “percentiles” that your doctor may use to describe where your baby is on a growth chart. Mostly, your doctor wants to see that your baby’s growth is progressing, and not standing still. Some babies hit the extreme highs (the top ninetieth percentile) or lows (the bottom tenth percentile), but again, your baby’s doctor will just want to know that the different norms seem aligned with one another. For example, a baby who’s in the lowest tenth percentile for weight but in the top ninetieth percentile for height may have nutritional problems.
Even though good nutrition is important for babies, a baby’s dimensions are often related to her inheritance and genes. If a mom or dad was extremely tall as a baby, or very petite, this same characteristic may show up again in your child, and a photograph from your own babyhood may look startlingly familiar.
PREMATURE OR LOW-BIRTHWEIGHT BABY
A premature baby is one born before the thirty-seventh week of pregnancy, and a baby is considered low birthweight if she weighs less than 5 pounds at birth.
While new advances arrive constantly to improve the outlook and quality of life for premature and low-birthweight infants, babies who are born preterm are at a very high risk for neurological, breathing, and digestive problems, and death in the first few days of life. Unfortunately, they are also at risk for problems later in their lives in the form of delayed development and learning problems in school. The earlier a baby is born, the more likely she will be to suffer lasting problems.
A small baby can be hard on parents, too. Instead of bringing your baby home as you had expected, she will be in the neonatal intensive care unit (NICU) and will require special attention.
In the NICU:
• Join the team. You’re the most important partner in your baby’s care. Make sure you know the NICU routine and whom to call when you have a question. If you don’t understand medical jargon or any of the procedures or equipment used to help your baby, ask questions until you do understand. Get to know the staff of the NICU: The neonatologists, nurses, and specialists who work there are valuable fonts of knowledge.
• Express your emotions. It’s normal to feel fear, anger, confusion, and uncertainty about becoming attached to the baby. Expect to have good and bad days during this extremely stressful time. Remember that the staff of the NICU is experienced at dealing with both babies and parents, and it’s okay to express your fears and concerns to them.
• Touch the baby. If the baby is too small to be picked up, then gently stroke and touch your baby in her warmer, and talk to her. Studies show that low-birthweight and premature babies do better with human contact. Just remember that the baby will be more sensitive to touch and sound—be gentle and quiet.
• Wear the baby. As soon as the baby can be picked up, keep her as close to you as you can. Studies have shown that preemies grow faster and better when moms practice something called kangaroo care: wearing the (diapered) baby skin-to-skin. The warmth helps regulate the baby’s body temperature, and the cues of your breathing and heartbeat will help your baby learn to breathe and reduce the likelihood of apnea (when the baby briefly stops breathing). Babies in kangaroo care also cry less, which is important: Crying uses a lot of effort.
• Provide human milk, if possible. Research has shown that mothers who deliver premature babies actually produce richer milk that’s higher in calories and protein. The rhythm of breastfeeding also helps the baby conserve valuable energy. If your baby is not mature enough to have a developed sucking reflex, then you’ll need to express breastmilk with an electric pump, or you may need to use a supplemental nutrition system. The hospital should be able to give you all of the necessary supplies and show you how to use the pump. Feeding directly from the breast is best, but naturally, you can’t stay in the NICU 24 hours a day! If your baby is born very early, such as less than 32 weeks, and is small as a result, she may need to be fed through an IV, or via a tube that goes through her mouth or nose and into the stomach (called gavage feeding), because the baby’s suck reflex has not developed yet.
A birth defect, also known as a congenital abnormality or an anomaly, is any health problem or physical abnormality that’s present in a baby at birth. Birth defects can be very mild, when the baby looks and acts like any other baby, or they can be very severe, when a health problem is immediately obvious. About 3 to 4 percent of babies worldwide are born with some kind of birth defect. About 60 percent of birth defects have no known cause. About 20 percent are due to a combination of genetic and environmental factors, about 13.5 percent are caused by a genetic defect, and 4 to 5 percent are caused by a known teratogen (any environmental agent that causes birth defects, such as drinking alcohol, an environmental toxin, or a medication taken during pregnancy).
There are hundreds of recorded birth defects, and, as a result, many organizations to help parents understand and deal with the challenges. A good place to start is with your local chapter of the March of Dimes, a nonprofit devoted to parent education. Contact www.marchofdimes.org for excellent information on birth defects and to find a local chapter.
BIRTHMARKS
Many babies are born with marks on their skin, some of which fade over time, and others that may be permanent or may need to be surgically removed.
Birthmark Guide
| NAME | APPEARANCE | TREATMENT |
| Moles (congenital pigmented nevi) | Light brown or black moles, sometimes with hair. Small ones are common. Larger ones are rarer. | Some moles carry a risk of becoming cancerous. Your baby’s physician may recommend removal. |
| Mongolian spots | Blue or slate gray bruise-like marks, which often appear on the lower back or on the buttocks of dark-skinned babies. They fade over time, but may never completely disappear. | No treatment needed. They usually disappear by the end of the first year, but some may persist into adulthood. |
| Port-wine stain (nevus flammeus) | A large, flat, purplish mark that can occur anywhere on the body. | This permanent mark can be removed with laser treatment. If the mark is on the eyelid, a vision specialist should check the baby’s eyesight. |
| Stork bites (“angel kisses”; “salmon patches”) | Reddish marks and mottling on the forehead, eyelid, or nape of the neck, which darken when the baby cries. They fade as the baby’s skin thickens during the first year. | Usually disappears in the first few months, although some marks may remain. No treat-ment required. |
| Strawberry marks (hemangioma) | A soft, raised, nearly invisible mark that turns bright red usually about four weeks after birth. Some-times the marks grow larger over time, but nearly always they disappear before a child reaches 10 years of age. | Your baby’s doctor can advise you about whether such a mark will disappear on its own or whether you will need to consult a skin specialist to have the mark removed when your child is older. |
Newborn Danger Signs
• Breathing problems. The baby appears to be struggling for breath and/or her ribs pull in as she tries to take a breath. Seek emergency room treatment.
• Fever. Contact your doctor if your baby is less than three months old and has a fever (a temperature of more than 100.4° F) for longer than 8 hours or a febrile seizure—a convulsion that causes the body to twitch and jerk strangely when temperatures rise rapidly. Seek help for a baby at any age with a fever who also seems unusually sluggish and drowsy, who vomits, and who refuses to feed.
• Strange sounds. Persistent groans and weak cries that continue for hours, or a shrill cry unlike any your baby has made before.
• Inconsolable crying. Extreme fussiness day and night may be a sign of baby pain and needs medical attention to rule out physical problems.
• Vomiting. Repeated vomiting (more than 5 times), any green or yellow vomit, or projectile vomiting, when large amounts of milk shoot out of your baby’s mouth and travel 2 or 3 feet or farther during or after two or more feedings.
• Belly button and/or penis problems. Infection signs, such as bleeding, pus, or foul-smelling, yellow-green discharge from around the baby’s umbilical cord or circumcision site.
• Jaundice. A yellow color in your baby’s face, chest, or the white part of her eyes could be harmless, or signal a rarer problem with liver processing. (See in 8. Parent’s Dictionary.)
• Bowel movement changes. Changes in your baby’s stool, such as constipation—which often looks like small, hard pellets, and straining to do a BM—or diarrhea, which can be frequent, mucus-filled, watery bowel movements, or stools with flecks or streaks of blood.
• Feeding problems. Refusing to nurse, frequent choking, fussing during eating, weak or absent sucking, or crying that begins during or shortly after a feed.
• Unusual sluggishness. A baby who is sleeping twice as long as usual, who is difficult to awaken, who seems “out of it,” or who has seizures or who becomes comatose (unable to be awakened).
• Unusual stiffness. A baby whose body stiffens when you try to diaper or feed her, who seems to have a stiff neck or adopts an unusual head position, or who has a bulging soft spot (fontanel) on the top of her skull, even when sitting up.
• Not gaining weight. After the first 10 days, a baby who gains less than half an ounce per day. (See failure to thrive (FTT), on in 8. Parent’s Dictionary.)
Just as in your baby’s first exam, the checkup will probably begin by measuring your baby’s length, weight, and head circumference. The values will be marked on a growth chart that helps to show your baby’s size in comparison with that of other babies the same age and to make sure that your baby is showing steady growth.
The size and softness of the soft spots on your baby’s head will be checked to be sure they’re not sunken or protruding. Your doctor may place your baby on her belly to see if she tries to raise her head, and he will probably remind you to keep your baby on her back for sleep. He may suggest varying your baby’s head position so the back of her head doesn’t flatten from constant pressure.
Your baby’s ears will be checked for signs of fluid or infection using a small, cone-shaped instrument to peer inside the hole of each ear. Your baby’s response to sounds and voices will also be observed. Your baby’s eyes will be examined for blocked tear ducts and discharge and signs of infection, and your doctor may try to get your baby to track a slowly moving, bright object. He or she may use a light to look inside your baby’s eyes.
A fingertip or pacifier may be used to check for a strong suck, and the inside of your baby’s mouth may be examined to ensure that there’s no thrush, an easily treated yeast infection. (See Thrush on in this chapter.) Your baby’s skin will be examined for cradle cap (see Baby-Skin Problem Guide), rashes (see COMMON BABY SKIN PROBLEMS), birthmarks (see Baby’s First Docher belly button will examined to make suretor’s Visit), and other skin conditions; also, it’s healed.
Your baby’s heart and lungs will be listened to with a stethoscope to detect breathing difficulties, abnormal heart rhythms, or unusual heart sounds. Your baby’s abdomen will be pressed to detect tenderness, enlarged organs, or an umbilical hernia (see Asthma (See Respiratory Problems)). Your baby’s legs, hip ligaments, and joints will be checked as well as her overall muscle tone. Your baby’s genitals will be inspected again for any abnormalities, infections, or lumps.
Your baby will be observed to see if she responds to sounds and voices, and you may be asked if your baby has smiled or cooed yet.
Your doctor will probably be prepared to give your baby a series of immunizations on this visit. Colds, low-grade fevers, and minor illnesses are no cause to delay immunizations. Before the shots begin, talk with your doctor about them and ask what reactions to expect, including side effects, and how you should handle them.
Tip
Nursing your baby through an injection is the best painkiller available to help your baby get through an injection. A pacifier may help to distract your baby, too. Hold your baby close and whisper reassuring words to her, and plan to soothe her and feed her afterward, once she calms down.
The list includes diphtheria, tetanus, and acellular pertussis (DTaP); hemophilus influenzae type b (Hib); hepatitis B; polio (IPV), pneumococcal conjugate (PCV7), and rotavirus vaccine (RotaTeq®). In many areas, combination vaccines such as PEDIARIX®— which contains DTaP, hepatitis B, and polio vaccine in a single shot— are available. (See All About Shots on in this chapter.) Note that recent studies have shown that there is an increased risk of fevers associated with the five-dose vaccine, although the fevers are generally harmless.
Your baby’s checkup at month four will seem a lot like earlier visits, and many of the same things will be checked again. Your baby’s physical progress will be monitored, and you’ll be asked questions about how your baby is doing.
Your baby’s length, weight, and head circumference will be measured so her growth line can be assessed and her size compared to baby averages on the chart. By now, your baby will have doubled her birth weight and you can expect about a 1-to 1¼-pound weight gain in the next 3 months.
Now’s the time to raise any questions you may have about your baby’s eating and sleeping, or to talk about colds or teething woes, if your baby has started that process. Your doctor may examine your baby’s gums to see if there are any signs of teething. It may take several months, and possibly not until the latter part of your baby’s first year, until the first tooth breaks through. When it does, your baby may be more irritable than usual, and drool and gnaw more. Fevers and cold-like symptoms can’t be blamed on teething, but a rash on your baby’s chin may develop from the constant wetness of drooling. (Teething is discussed in more detail starting on in 3. Your Baby Maintenance Guide.)
Again, your baby’s fontanels will be examined to ensure they are not deeply sunken or swollen. Your doctor will probably ask again about your baby’s sleeping on her back to protect her from the risk of sudden infant death syndrome (SIDS) and suggest providing some “tummy time” for your baby during waking hours. See 1. Your Baby’s First Half-Year for more about SIDS and for tummy-time suggestions.
“I call my baby’s pediatrician’s office because I believe it’s better to play it safe than to have something become serious. I speak to the nurse anytime something worries me, even if it seems like it’s something small. I rely on their knowledge and experience.”
Your baby’s ears will be checked to ensure there is no fluid or infection, and your baby’s eyes will be examined for redness, blocked tear ducts, or discharge. Eye movements will be tracked using a small flashlight or colorful object, and the inside of your baby’s eyes may be looked at, too.
Your baby’s skin will be examined for signs of cradle cap, diaper rash, and other skin irritations. Your baby’s heart and lungs will be listened to with a stethoscope, and care will be taken to ensure that if your baby’s heart had a murmur, it is starting to resolve.
Your baby’s abdomen and groin will be pressed to feel for any enlargement, tenderness, masses, or a hernia. Legs will be moved to test your baby’s hip joints and how her ankles and feet are growing, and your baby’s diaper area will be examined for bumps and diaper rash or other signs of infection, such as vaginal discharge, or problems with your baby’s testicles.
Your doctor will also test your baby’s muscle tone and strength, and he may want to observe your baby on her tummy to see how well she holds her head and chest up.
FLASH FACT: Baby Development Terms
Your baby’s doctor will be checking your baby’s development with every well-baby visit. The terms that are typically used are: gross motor skills (use of large muscles, such as your baby’s neck strength, and use of her trunk, legs, and arms, such as for crawling and walking); fine motor skills (the use of the hands and fingers for reaching and grasping); social skills (how the baby relates to other people); and speech and language development (babbling, smiling, imitating, and word use). (For detailed information about how babies develop month by month, see 1. Your Baby’s First Half-Year and 2. Your Baby’s Second Half-Year.)
At the end of the exam, your baby will be given a second set of immunizations similar to the ones in month two: diphtheria, tetanus, and acellular pertussis (a combination vaccine called DTaP), haemophilus influenzae type B (Hib), hepatitis B, polio (IPV), pneumococcal conjugate (PCV7), and rotavirus vaccine (RotaTeq®). Again, a combination vaccine such as Pediarix® may be available. (See All About Shots on in this chapter.)
Your baby’s now a half-year old, and her body skills have definitely changed since her first exam! Again, your baby will be weighed and measured to check on her growth and how it compares with the average and with that of previous exams. By this time, your baby will be almost double her birthweight.
Your baby’s fontanels, the soft spots on her skull, will be checked to ensure they are normal. Her head shape will also be noted. If the back of your baby’s head has become flattened from sleeping on her back to prevent SIDS, or if one side is a different shape than the other because of how your baby positions her head during sleep, your doctor may talk about scheduling tummy time when your baby’s awake. Flat spots on the head usually go away when your baby starts to crawl and walk.
Ears and eyes will be checked for signs of infection. By now, your baby’s eyes should coordinate together with no appearance of a wandering eye or crossed eyes. If your baby’s first tooth has emerged, she may have periods of fussiness, redness on her chin from drooling, and a hunger to gnaw on objects, but tooth eruption varies with babies and sometimes follows family patterns. Usually, the two bottom teeth are the first to appear.
Your baby’s skin, diaper area, and genitals will be inspected for rashes, lumps, or other signs of infection. Your baby’s heart and lungs will be listened to with a stethoscope, and if your baby had a heart murmur, it may have resolved itself by now. Your baby’s belly will be pressed to feel her organs, and her hips and legs will be examined to ensure they are growing normally.
By this time, your baby may be able to sit by herself, at least temporarily. The doctor will be looking at your baby’s muscle tone and strength, her head control, and her use of her hands to reach and grasp objects. A baby who is floppy or shows serious developmental lags may be of concern.
Your baby will have another round of shots similar to those she received at months two and four, including diphtheria, tetanus, and acellular pertussis (DTtaP), pneumococcal conjugate (PCV7), and rotavirus vaccine (RotaTeq®). Combination vaccines such as PEDIARIX® may be used, or sometimes DTaP and Hib vaccines are given in a combined shot called DTaP-Hib. A flu shot is recommended each fall for children from six to twenty-three months of age. Depending on the timing, your baby’s doctor may give the flu shot now or suggest that you bring your baby back closer to flu season. (For help with getting through shots, see in this chapter.)
Even though you and your baby are now old pros at medical exams, stranger anxiety and memories of previous shots may cause your baby to protest loudly when she is examined. The best strategy is to hold your baby in your lap for most of the exam so she feels more secure.
As always, your baby’s weight, height, and head size will be measured. The checking of your baby’s eyes, ears, skin, hips, and genitals will follow the same pattern as three months earlier.
Your baby’s health-care provider will be particularly interested in how your baby is developing. By now, your baby can probably sit by herself without help, and many babies have begun to pull up to a standing position, and to try crawling. Most won’t take their first steps until around the first year, and some babies not until months later. What your baby does with her hands, such as how she uses them to pick up objects, will be of interest to the pediatrician.
If she hasn’t done so already, your baby’s health-care provider may also want to talk with you about making sure your house is safe for your little explorer who will soon be getting into cabinets and other places. (For information about accident prevention and babyproofing, go to in this chapter.)
If flu season is nearing, the doctor may suggest a flu shot. It may also be time for your baby to have a blood test for hemoglobin levels to ensure she doesn’t have anemia, and to test for lead if you live in an older home with chipping paint or renovations going on, or in a heavily polluted area.
Your baby may be given shots for hepatitis A, hepatitis B; measles, mumps, and rubella (MMR); haemophilus influenzae type b (Hib); pneumococcal conjugate (PCV7); or chicken pox (varicella) vaccines. Your doctor may also suggest a TB (tuberculosis) test, known as the PPD test. An injection is given under the skin, and you will be asked to watch for swelling or redness over the next three days, which may indicate that your baby has been exposed to TB.
All about shots
Immunizations protect your baby from illnesses that once could have caused lifelong damage or even death. Shots are available to help prevent hepatitis, diphtheria, tetanus, and whooping cough (pertussis), certain influenzas, polio, measles, mumps, rubella, and chicken pox. Immunizations usually start when your child is 2 months old, and most are finished by the time she is 6 years old.
Recommendations about when to have your child vaccinated change from time to time. We suggest printing out a copy of the most current vaccination schedule by searching the keyword “immunization” on the Web sites of the American Academy of Pediatrics (www.aap.org) or the American Academy of Family Physicians (www.familydoctor.org), or you can ask your baby’s doctor for recommendations. Also, on your baby’s first medical exam, ask for literature to help you learn about vaccinations.
Many parents of babies are concerned that vaccines could harm their children or that autism might be related to substances containing mercury in children’s shots. It’s important to note that science has failed to find a solid link between autism and immunizations.
Some babies and children do have more severe reactions to vaccines than others. Certain vaccines are not recommended for children who have certain types of cancer or diseases, or who are taking drugs that lower the body’s ability to resist infection.
If your child has had a serious reaction to the first shot in a series of shots, your family doctor will probably talk with you about the pros and cons of giving her the rest of the shots in the series.
DTaP shots (diphtheria, tetanus, pertussis) can cause illness-like symptoms within 24 hours after being administered. Your baby may be irritable and less energetic than normal, and she may have a mild fever and a red, swollen spot where the shot was given. Ask your doctor how to treat the symptoms.
If your baby has had a serious reaction to the first DTaP shot, or has had a convulsion in the past, your baby’s doctor may recommend postponing additional “boosters.”
Even though some immunizations may cause your baby’s body to briefly react, the illnesses they protect her from are far more dangerous and deadly.
Find a place in your house, such as a kitchen cabinet, where you can store your baby’s immunization records in a zippered plastic bag. They will come in useful later for planning future shots should you move or if your tot is in an accident and you need to know if your baby still has tetanus protection.
Questions to ask about immunizations The first time you meet with your baby’s doctor, try to learn as much as possible about the immunizations your baby is to receive. Being sure about what to expect can be reassuring to you and help you to move forward confidently with your baby’s protection plan. Here are some questions to ask:
• How serious is the illness that this shot will help to prevent?
• How prevalent is the illness?
• How effective is this immunization?
• How long are the effects expected to last?
• Will a booster be needed? How often?
Your Baby’s Immunization Schedule
| NAME OF SHOT | WHAT IT DOES | WHEN IT’S ADMINISTERED | POSSIBLE SIDE EFFECTS |
| HAV (hepatitis A virus) | Helps to prevent hepatitis, a serious liver infection. | Given as a 2-dose regimen at 12 to 15 months. | Fever over 102° F (with injection). Signs of an allergic reaction (contact your pediatrician immediately): difficulty breathing or swallowing; hives; itching; reddening of skin; swelling of eyes, face, or inside of nose. |
| HBV (hepatitis B virus)) | Helps to prevent hepatitis, a serious liver infection. | Within 24 hours after birth or on a 3-or 4-dose schedule. | Fever over 102° F (with injection). Signs of an allergic reaction (contact your pediatrician immediately): difficulty breathing or swallowing; hives; itching (especially on feet or hands); reddening of skin (especially around ears); swelling of eyes, face, or inside of nose. |
| Hib (haemophilus influenza type B) | Protects babies and children from a bacterial illness that can cause a potentially fatal brain infection. (Because of the widespread use of effective vaccines against Hib, very few cases are now diagnosed.) | Given as a series of 1 to 4 shots (depending on the child’s age) start-ing at 2 months and up to 5 years of age. | Fever over 102° F (with injection). Signs of an allergic reaction (contact your pediatrician immediately): difficulty breathing or swallowing; hives; itching (especially on feet or hands); reddening of skin (especially around ears); swelling of eyes, face, or inside of nose. |
| MMR (measles, mumps, and rubella) | Protects babies and children from measles, mumps, and rubella. | Given as 2 shots, the first on or after the first birthday (the recommended range is from 12 to 15 months), the second dose is usually given when the child is 4 to 6 years old. | Fever is the most common side effect, occurring in about 5 to 15 percent of vaccine recipients, and about 5 percent of recipients develop a mild rash 7 to 10 days after the shot. |
| DTaP (diphtheria, tetanus, and pertussis) | All 3 disorders, diphtheria, tetanus, and pertussis, were once very common childhood illnesses and often fatal. But today, vaccinations have all but eliminated them. | A series of 4 doses given at 2, 4, 6, and 15 to 18 months of age. A fifth shot, or booster dose, is recommended at between 4 to 6 years of age, unless the fourth dose was given late (after the fourth birthday). | A rash after the shot is normal. In rare cases, babies are allergic to the vaccine, but no deaths have been reported from allergic reactions. |
| Flu vaccine | Helps to protect babies from the most recent strains of serious viruses. | Usually given at the beginning of flu season A new shot is needed each year to respond to new viruses. Considered safe for babies 6 months and older. | Rarely, flu-like symptoms. (But you can’t catch the flu from the vaccine; it’s made from dead viruses.) |
| PCV7 (pneumococcal conjugate vaccine) | Helps to protect babies and children from bacteria often found in middle-ear infections. These bacteria can also cause more serious illnesses, such as meningitis and bacteremia. | Infants and toddlers under age 2 are given 4 doses of the vaccine; children ages 2 to 5 only need 1 dose. | Bruising at the injection site. About 10 percent of recipients may develop a mild fever. |
| Polio (IPV—inactivated polio virus) | Though rare now, polio can cause muscle pain and paralysis of one or both legs or arms. It may also paralyze the muscles used to breathe and swallow. | Given as 2 shots, the first on or after the first birthday (the recommended range is from 12 to 15 months), the second dose is usually given when the child is 4 to 6 years old. | Fever over 102° F (with injection). Signs of an allergic reaction (contact your pediatrician immediately): difficulty breathing or swallowing; hives; itching; reddening of skin (especially around ears); swelling of eyes, face, or inside of nose. |
| PPD (tuberculin, or tuberculosis skin test) | Helps to determine if your baby has been exposed to tuberculosis (TB). | An injection is given under your baby’s skin on the forearm at 12 months of age or whenever your baby is thought to have been exposed to tuberculosis. | Causes your baby’s immune cells to react with swelling and redness at the site of the injection, signaling that your baby has been exposed. (No reaction means no exposure.) |
| Rotavirus vaccine (RotaTeq ® ) | A vaccine to help protect from a severe virus that can cause fever, vomiting, and diarrhea in babies, and may even lead to death if the baby becomes dehydrated. | A series of 3 doses given at 2, 4, and 6 months of age. | Can cause diarrhea, fever, and vomiting, but not from the virus itself. Should not be given to babies who are ill or who have immunity disorders, such as HIV. |
| Varicella vaccine | This vaccine can help to prevent chicken pox, or lessen the severity of symptoms. May also help to reduce the severity of shingles attacks in adults. | Given twice: at 12 to 15 months and at 4 to 16 years. | Severe side effects are rare. May cause pain, swelling, and redness at the injection site. |
• Should my baby be well (fever free and without other symptoms) to have it?
• Can I nurse the baby while it’s happening?
• Will there be any side effects? What are they? How should they be treated?
• What are the potential risks of this shot, even if they are rare?
• What are the danger signs of more serious side effects?
• Will having close contact with my baby (e.g., nursing) expose me to the illness or cause me to be immunized, too? Will it be safe to nurse the baby after the injection if I’m pregnant?