Checkups

What to Expect During This Visit

The doctor and/or nurse will probably:

1. Check your son’s/daughter’s weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your son’s/daughter’s blood pressure and vision using standard testing equipment.

3. Ask questions, address concerns, and offer advice about how your son or daughter is:

Eating. Young adults should be eating three meals a day that include a colorful array of vegetables, whole grains, and at least three servings of dairy products that provide 1,300 milligrams of calcium per day. Include enough lean meats, poultry, and seafood in the diet to reach 15 milligrams of iron per day for young women and 11 milligrams for guys. One serving of beef has 2–3 milligrams of iron. Opt for water over juice or sports drinks.

Sleeping. Young adults generally need about 8 hours of sleep per night. Inadequate sleep can lead to decreased alertness and poor performance.

Physical activity. Young adults should aim for 60 minutes of physical activity per day.

Growth and development. By 21, it’s common for many young adults to:

• have completed their physical development
• value individual relationships over peer groups
• become more independent from parents
• think abstractly to solve problems
• have long-term plans for the future

4. Perform a physical exam. In a young woman, perform a pelvic exam if she is sexually active and has excessive discharge or pelvic pain. In guys, examine the testicles for masses and varicocele (swollen veins).

5. Update immunizations. Immunizations can protect people from serious illnesses, so it’s important that people receive them on time. Your son or daughter should talk to the doctor about what to expect.

6. Order tests. Your doctor may assess whether your son or daughter is at risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind:

School

1. Talk to your son or daughter about college or work plans.
2. Encourage him or her to continue to pursue areas of interest, including art, music, exercise, and community service.
3. Encourage taking personal responsibility for school and work. Praise accomplishments and provide support in areas where he or she is struggling.

Self

1. Encourage your son or daughter to learn strategies for coping with stress, such as exercising or meditation. Encourage him or her to continue to come to you with worries, and to also lean on friends and other family members.
2. Talk about sex and the importance of contraceptive and condom use.
3. Discuss the dangers of smoking, alcohol, and drugs, inhalants, and other means to get high. Praise your son or daughter for abstaining from these activities.
4. Look for signs of depression, which can include irritability, depressed mood, loss of interest in activities, poor academic performance, and talk of suicide.
5. If this hasn’t happened yet, your son or daughter should prepare to switch to an adult doctor. People generally begin seeing an adult doctor at age 18, but some wait until after college.
6. Young women should schedule a gynecologist visit. This first visit will not include a pelvic exam, unless women are sexually active or having problems.

Safety

1. Young adults should always wear a seatbelt while in a vehicle.
2. Discuss the dangers of texting and other cell phone use while driving.
3. Talk about the dangers of drinking and driving and tell your son or daughter to never get in a car with someone who has been drinking or using drugs. Instead, your son or daughter should call you (or another responsible adult) for help.
4. Prevent gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child’s blood pressure and vision, if your child is able to cooperate.

3. Ask questions, address concerns, and offer guidance about how your child is:

Eating. Growth is slow and steady during the preschool years. Offer three meals and two nutritious snacks a day. Even if your child is a picky eater, keep offering a variety of healthy foods.

Peeing and pooping. Your preschooler may be potty trained or using the potty during the day. Even so, it is common for kids this age to have an occasional accident during the day and still need a diaper at night. If your child has not yet shown the signs of being ready to potty train, tell your doctor. Also let the doctor know if your child is constipated, has diarrhea, seems to be “holding it,” or was potty trained but is now having problems.

Sleeping. Preschoolers generally sleep about 11–12 hours a day. Most children this age still take a nap during the day.

Developing. By 3 years, it’s common for many kids to:

• string three or more words together to form short sentences
• be understood most of the time when they speak
• pedal a tricycle
• walk up stairs alternating feet
• copy a circle
• dress and undress with a little help
• play make-believe
• take turns while playing

4. Perform a physical exam with your child undressed while you are present. This will include an eye exam, teeth exam, listening to the heart and lungs, and paying attention to speech and language development.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 4 years:

Feeding

1. Preschoolers should get 2 cups (480 ml) of low-fat or nonfat milk (or equivalent low-fat dairy products) daily.
2. Limit juice to no more than 4–6 ounces (120–180 ml) a day.
3. Limit foods and drinks that are high in sugar and fat.
4. Make time to eat together as a family most nights of the week.

Routine Care

1. If your child gives up the afternoon nap, be sure to allow for some quiet “winding down” time during the day. You may also need to adjust bedtime to ensure your child gets enough sleep.
2. Nightmares and night awakenings are common at this age. Establish a consistent bedtime routine to help your child fall asleep at night. Avoid scary or upsetting images or stories, especially before bed.
3. If you’ve enrolled your child in preschool, visit the classroom together a few times before school starts. If your child is not in preschool, look for opportunities to interact and play with other kids.
4. Limit screen time (spent on TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 to 2 hours a day of quality children’s programming.
5. Read to your child every day.
6. Establish reasonable and consistent rules and reinforce positive behaviors.
7. Do not spank your child. Use time-outs instead.
8. Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule a dental visit to have your child’s teeth examined and cleaned.

Safety

1. Have a safe play area and allow plenty of time for exploring, make-believe, and active play.
2. Make sure playground equipment is well maintained and age-appropriate for your child. Surfaces should be soft to absorb falls (sand, rubber mats, or a deep layer of wood or rubber chips).
3. Always supervise your child around water and when playing near streets.
4. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
5. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
6. Make sure your child always wears a helmet when riding a tricycle or bicycle.
7. Use a forward-facing car seat with a harness in the back seat until your child reaches the highest weight or height limit allowed by the car-seat manufacturer.
8. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your baby’s doctor and/or nurse will probably:

1. Check your baby’s weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address any concerns, and offer advice about how your baby is:

Feeding. Newborns should be fed when they seem hungry. Breastfed infants eat about every 1 to 3 hours, and formula-fed infants eat about every 2 to 4 hours. Your doctor or nurse may observe breastfeeding and help with technique. Burp your baby midway through a feeding and again at the end.

Peeing and pooping. Newborns should have several wet diapers a day. The number of poopy diapers varies, but most newborns have 3 or 4 soft bowel movements a day. Tell your doctor if you have any concerns about your newborn’s bowel movements.

Sleeping. A newborn may sleep 18 hours a day or more, waking up often (day and night) to breastfeed or take a bottle. Breastfed babies usually wake to eat every 1 to 3 hours, while formula-fed babies may sleep longer, waking every 2 to 4 hours to eat (formula takes longer to digest so babies feel fuller longer). Newborns should not sleep more than 4 hours between feedings until they have good weight gain, usually within the first few weeks. After that, it’s OK if a baby sleeps for longer stretches.

Developing. In the first month, babies should:

• focus and follow objects (especially faces)
• respond to sound — they may quiet down, blink, turn head, startle, or cry
• hold arms and legs in a flexed position
• move arms and legs equally
• lift head briefly when on stomach (babies should only be placed on the stomach while awake and under supervision)
• have strong newborn reflexes, such as:
  • rooting and sucking: turns toward, then sucks breast/bottle nipple
  • grasp: tightly grabs hold of a finger placed within the palm
  • fencer’s pose: straightens arm when head is turned to that side and bends opposite arm
  • Moro (startle response): throws out arms and legs, then curls them in when startled

3. Perform a physical exam with your baby undressed while you are present. This exam will include an eye exam, listening to your baby’s heart and feeling pulses, inspecting the umbilical cord, and checking the hips.

4. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it’s important that your baby receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 1 month:

Feeding

1. Continue to feed your baby on demand (when he or she is hungry). Pay attention to signs that your baby is full, such as turning away from the nipple or bottle and closing the mouth.
2. Don’t introduce solids or juice, and don’t put cereal in your baby’s bottle unless directed by your doctor.
3. If you breastfeed:
   • Help your baby latch on correctly: mouth opened wide, tongue down, with as much areola in the mouth as possible.
   • Continue to take a prenatal vitamin or multivitamin daily.
   • Ask your doctor about vitamin D drops for your baby.
   • Don’t use a bottle or pacifier until nursing is well established (usually about 1 month).
4. If you formula-feed:
   • Give your baby iron-fortified formula.
   • Follow the formula package’s instructions when making and storing bottles.
   • Don’t prop bottles or put your baby to bed with a bottle.
   • Talk to your doctor before switching formulas.

Routine Care

1. Wash your hands before handling the baby and avoid people who may be sick.
2. Keep the diaper below the umbilical cord so the stump can dry. The umbilical cord usually falls off in 10–14 days.
3. For circumcised boys, put petroleum jelly on the penis or diaper’s front.
4. Give sponge baths until the umbilical cord falls off and a boy’s circumcision heals. Make sure the water isn’t too hot — test it with your wrist first.
5. Use fragrance-free soaps and lotions.
6. Hold your baby and be attentive to his or her needs. You can’t spoil a newborn.
7. Give your baby supervised “tummy time” when awake. Always supervise your baby and be ready to help if he or she gets tired or frustrated in this position.
8. It’s normal for infants to have fussy periods, but for some, crying can be excessive, lasting several hours a day. If a baby develops colic, it usually starts in an otherwise well baby around 3 weeks of age.
9. Call your baby’s doctor if your infant has a fever or is acting sick, isn’t eating, isn’t peeing, or isn’t pooping. Don’t give medication to an infant younger than 2 months old without consulting a doctor first.
10. It’s common for new moms to feel sad, moody, or anxious after the birth. Call your doctor if feelings are intense or last more than a week or two.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):
   • Breastfeed your baby.
   • Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.
   • Avoid overheating by keeping the room temperature comfortable.
   • Don’t overbundle your baby.
   • Consider putting your baby to sleep sucking on a pacifier. If you’re breastfeeding, wait until breastfeeding is established before introducing the pacifier.
2. Don’t smoke or let anyone else smoke around your baby.
3. Always put your baby in a rear-facing car seat in the back seat.
4. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
5. Never shake your baby — it can cause bleeding in the brain and even death.
6. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don’t offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby’s weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address concerns, and offer advice about how your baby is:

Feeding. Breast milk or formula is all a baby needs for the first 4–6 months. Iron-fortified cereal or puréed meats can be introduced between 4 and 6 months of age. Talk with your doctor before starting any solids.

Peeing and pooping. Babies this age should have several wet diapers a day and regular bowel movements. Some may poop every day; others may poop every few days. This is normal as long as stools are soft. Let your doctor know if they become hard, dry, or difficult to pass.

Sleeping. At this age, babies sleep about 14 hours a day, with two or three daytime naps. Most babies “sleep through the night” with a stretch of 5 or 6 hours of sleep. Some infants, particularly those who are breastfed, may still wake at night. But most no longer need a middle-of-the-night feeding.

Developing. By 4 months, it’s common for many babies to:

• smile, laugh, and squeal
• “coo” in response to your “coos”
• bring hands together in front of chest
• reach for and grasp objects
• bring toys to the mouth
• have good head control when sitting
• hold up head and chest, supporting themselves on arms, while on tummy
• possibly roll from front to back

There’s a wide range of normal and children develop at different rates. Talk to your doctor if you’re concerned about your child’s development.

3. Perform a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby’s heart and feeling pulses, checking hips, and paying attention to your baby’s movements.

4. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it’s important that your baby receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 6 months:

Feeding

1. Breast milk or formula is still all your baby needs.
2. If your doctor recommends introducing solids:
   • Share your family history of any food allergies.
   • Start with a small amount of iron-fortified single-grain cereal mixed with breast milk or formula. You can also start with a pureed meat, another iron-rich food.
   • Use an infant spoon — do not put cereal in your baby’s bottle.
   • If your baby is pushing a lot out with the tongue, he or she may not be ready for solids yet. Wait a week or so before trying again.
   • Wait until your baby successfully eats cereal from the spoon before trying other solids. Introduce one new food at a time and wait several days to a week to watch for a possible allergic reaction before introducing another.
3. Pay attention to signs that your baby is hungry or full.
4. Do not give juice until after 6 months.
5. Do not prop bottles or put your baby to bed with a bottle.

Routine Care/Safety

1. Many babies begin teething when they’re around 4 months old. To help ease pain or discomfort, offer a clean wet washcloth or a teether. Talk to your doctor about giving acetaminophen for pain.
2. Babies begin rolling over at around 4–6 months. Keep placing your baby to sleep on his or her back on a firm mattress in a crib without any crib bumpers, blankets, pillows, or plush toys. But it’s OK if your little one rolls over while sleeping.
3. Remove mobiles when your baby starts to push to his or her hands and knees or when your baby turns 5 months old, whichever comes first.
4. Continue to give your baby plenty of supervised “tummy time” when awake. Create a childproof play space for him or her to explore.
5. Limit the amount of time your baby spends in an infant seat, bouncer, or swing.
6. Don’t use a walker. They’re dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it.
7. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
8. Keep small objects and harmful substances out of reach.
9. Always put your baby in a rear-facing car seat in the back seat.
10. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don’t offer enough protection.
11. TV viewing (or other screen time, including computers) can interfere with the brain development of young children. Therefore, TV is not recommended for those under 2 years old.
12. If you haven’t already, start childproofing your home. Get down on your hands and knees to look for potential dangers. Keep choking hazards, toxic substances (medicines, cleaning supplies, etc.), and hot or sharp items out of reach.
13. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on the growth charts.

2. Check your child’s blood pressure, vision, and hearing using standard testing equipment.

3. Ask questions, address concerns, and offer advice about how your child is:

Eating. Schedule three meals and two nutritious snacks a day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don’t force them to eat them.

Peeing and pooping. By 4 years old, most kids are using the toilet. But many preschoolers who are potty trained during the day are not able to stay dry all night. It’s also common for busy preschoolers to have an occasional daytime accident. Look for signs of “holding it” and encourage regular potty breaks. Talk to your doctor if your child is not yet potty trained or was previously trained and is now having problems.

Sleeping. Preschoolers sleep about 11–12 hours a day. Many 4-year-olds have given up their afternoon nap, but be sure to schedule some quiet time during the day.

Developing. By 4 years, it’s common for many children to:

• be completely understood by strangers
• know their first and last name and gender
• relate events or tell a story
• follow three-step commands
• hop on one foot
• walk up stairs, alternating feet
• catch a bounced ball most of the time
• identify some colors and numbers
• enjoy playing with other children

4. Perform a physical exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking to your child to assess speech and language development.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child’s next routine visit at 5 years:

Eating

1. Make time to eat together as a family most nights of the week.
2. Serve a variety of foods, including lean meats, fruits, vegetables, and whole grains.
3. Preschoolers should get 2 cups (480 ml) of low-fat milk (or equivalent low-fat dairy products) daily.
4. Limit foods and drinks high in sugar and fat.
5. Limit juice to no more than 6 ounces (180 ml) a day.

Routine Care

1. Let your child be active every day while under adult supervision.
2. Limit screen time (spent on TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 to 2 hours a day of quality children’s programming.
3. If your child doesn’t go to preschool, look for opportunities for playing and interacting with other kids.
4. To help prepare your child for kindergarten:
   • Keep consistent daily routines and times for meals, snacks, playing, reading, cleaning up, waking up, and going to bed.
   • Practice counting numbers and singing the ABCs, along with other songs and rhymes.
   • Read to your child every day.
   • Encourage drawing, coloring, and recognizing and writing letters.
   • Allow your child to take responsibility for self-care, including going to the bathroom, washing hands, brushing teeth, and getting dressed. Offer reminders and help when needed.
   • Teach your child his or her address and phone number.
5. Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule regular dental checkups as recommended by your child’s dentist.

Safety

1. Supervise your child around water and when playing near streets. Consider enrolling your child in a swimming class.
2. Make sure playground equipment is well maintained and age-appropriate. Surfaces should be soft to absorb falls (sand, rubber mats, or a deep layer of wood or rubber chips).
3. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
4. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
5. Make sure your child always wears a helmet when riding a tricycle or bicycle.
6. When your child has reached the highest weight or height limit allowed by the car-seat manufacturer, switch to a belt-positioning booster seat until your child is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
7. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child’s blood pressure, vision, and hearing using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your child’s:

Eating. Schedule three meals and one or two nutritious snacks a day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don’t force them to eat them.

Bathroom habits. By now, your child should be able to go to the bathroom alone. Constipation may become a problem because some children are embarrassed to use the bathroom at school. Remind your child to take regular potty breaks and not to “hold it.” Talk to your doctor if you have concerns about your child’s bathroom habits.

Sleeping. Kids this age generally sleep about 10–11 hours each night. Most 5-year-olds no longer nap during the day. To help your child get enough sleep, you might need to set an earlier bedtime.

Development. By 5 years, it’s common for many children to:

• know their address and phone number
• tell stories using full sentences
• recognize and print some letters
• draw a person with head, body, arms, and legs
• skip
• walk down stairs, alternating feet
• count their fingers
• dress by themselves

4. Perform a physical exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking with your child to assess language skills.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, lead, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 6 years:

Eating

1. Serve your child a well-balanced diet that includes lean protein, whole grains, fruits, vegetables, and low-fat dairy products. Kids this age should get 2 cups (480 ml) of low-fat milk (or equivalent low-fat dairy products) daily.
2. Limit juice to no more than 6 ounces (180 ml) a day.
3. Limit foods and drinks that are high in sugar and fat.
4. Make time to eat together as a family most nights of the week.

Routine Care

1. Allow plenty of time for physical activity and free play every day.
2. Limit screen time (spent on TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 to 2 hours a day of quality children’s programming.
3. Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule regular dental checkups as recommended by your child’s dentist.
4. To help prepare your child for kindergarten:
   • Practice counting and singing the ABCs.
   • Encourage drawing, coloring, and recognizing and writing letters.
   • Keep consistent daily routines and times for meals, snacks, playing, reading, cleaning up, waking up, and going to bed.
   • Allow your child to take responsibility for self-care, including going to the bathroom, washing hands, brushing teeth, and getting dressed. Offer reminders and help when needed.
   • Teach your child his or her address and phone number.
   • Read to your child every day.

Safety

1. Teach your child the skills needed to cross the street independently (looking both ways, listening for traffic), but continue to help your child cross the street until age 10 or older.
2. Make sure your child always wears a helmet when riding a bicycle (even one with training wheels). Do not allow your child to ride in the street.
3. Make sure playground surfaces are soft enough to absorb the shock of falls.
4. Always supervise your child around water, and consider enrolling your child in a swimming class.
5. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
6. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
7. Keep your child in a belt-positioning booster seat until he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
8. Teach your child what to do in case of an emergency, including how to dial 911.
9. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.
10. Discuss appropriate touch. Explain that certain parts of the body are private and no one should see or touch them. Tell your child to come to you if he or she feels uncomfortable about this, is ever asked to look at or touch someone else’s private areas, or is asked to keep a secret.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby’s weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address concerns, and offer advice about how your baby is:

Feeding. If you haven’t already, it’s time to introduce solids, starting with iron-fortified single-grain cereal or puréed meat. Let your doctor know if your baby has had any reactions to a new food (bloating or gas, vomiting or diarrhea, fussiness, rash). Breast milk and formula still provide most of your infant’s nutrition.

Peeing and pooping. You may notice a change in your baby’s poopy diapers once you introduce solids. The color and consistency may vary depending on what your baby eats. Let your doctor know if stools become hard, dry, or difficult to pass or if your baby has diarrhea.

Sleeping. At 6 months, infants average about 14 hours of sleep per day, including two or three daytime naps. Most babies this age usually “sleep through the night” for a stretch of at least 6 hours.

Developing. By 6 months, it’s common for many babies to:

• blow raspberries
• say “ba,” “da,” and “ga” and start to babble (“babababa”)
• reach for and grasp objects
• use a raking grasp (using the fingers to rake and pick up objects)
• pass an object from one hand to the other
• roll over both ways (back to front, front to back)
• sit with support

There’s a wide range of normal, and children develop at different rates. Talk to your doctor if you’re concerned about your child’s development.

3. Perform a physical exam with your baby undressed while you are present. This includes an eye exam, listening to your baby’s heart and feeling pulses, checking hips, and paying attention to your baby’s movements.

4. Update immunizations. Immunizations can protect babies from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 9 months:

Feeding

1. If you are breastfeeding, continue for 12 months or for as long as is mutually beneficial. Breastfed babies weaned before 12 months should be given iron-fortified formula. Wait until 12 months to switch from formula to cow’s milk.
2. Start giving your baby solid foods:
   • If there’s a history of food allergies in your family, talk to your doctor before introducing foods.
   • Begin with a small amount of iron-fortified single-grain cereal mixed with breast milk or formula. You can also offer pureed meat, another iron-rich food.
   • Use an infant spoon — do not put cereal in your baby’s bottle.
   • Wait until your baby successfully eats cereal or meat from the spoon before trying other single-ingredient new foods (pureed or soft fruits, vegetables, or other meats).
   • Introduce one new food at a time and wait a few days to a week to watch for any allergic reactions before introducing another.
3. When introducing finger foods, usually around 9 months, choose small pieces of soft foods, and avoid those that can cause choking (such as whole grapes, raw veggies, raisins, popcorn, hot dogs, hard cheese, or chunks of meat).
4. Pay attention to signs your baby is hungry or full.
5. If you give your baby juice, limit it to 2–4 ounces (60–120 ml) a day. Always give juice in a cup, which is safe to introduce at 6 months.
6. Talk to your doctor about giving your baby fluoride supplements.
7. Do not put your baby to bed with a bottle.

Routine Care

1. Babies’ first teeth often appear around 6 months. To ease teething discomfort, rub your baby’s gums with a clean finger. Or offer a teething toy or a clean, wet washcloth, which can be frozen for 30 minutes first.
2. Wipe your baby’s gums with a wet washcloth to clear away bacteria. Once teeth come in, use a soft infant toothbrush with a tiny bit of toothpaste (about the size of a grain of rice) to clean your baby’s teeth.
3. Between 6 and 9 months, babies who previously slept through the night may start waking up. Allow some time for your baby to settle back down. If fussiness continues, offer reassurance that you’re there, but try not to pick up, play with, or feed your baby.
4. Read to your baby every day.
5. Create a childproof space for your baby to move around, play, and explore.
6. TV viewing (or other screen time, including computers) can interfere with the brain development of young children. Therefore, TV is not recommended for those under 2 years old.

Safety

1. Place your baby to sleep on the back, but it’s OK if he or she rolls over.
2. Don’t use a walker. They’re dangerous and can cause serious injuries. Walkers do not encourage walking and may actually hinder it.
3. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
4. Brush any baby teeth without toothpaste twice a day. Schedule a dentist visit soon after the first tooth appears or by 1 year of age.
5. Keep small objects and harmful substances out of reach.
6. Always put your baby in a rear-facing car seat in the back seat.
7. Avoid sun exposure by keeping your baby covered and in the shade when possible. You may use sunscreen (SPF 30) if shade and clothing don’t offer enough protection.
8. Childproof your home. Get down on your hands and knees to look for potential dangers. Keep doors closed and put up gates, especially on stairways.
9. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child’s blood pressure, vision, and hearing using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your child’s:

Eating. Schedule three meals and one or two nutritious snacks a day. Serve your child a well-balanced diet that includes lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 2 cups (473 ml) of low-fat milk daily (or equivalent low-fat dairy products). Limit foods and drinks that are high in sugar and fat, and offer no more than 6 ounces (180 ml) of juice per day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don’t force them to eat them.

Bathroom habits. Bladder and bowel control should be mastered by this age. Bedwetting is a problem that is more common in boys and deep sleepers. In most cases it ends on its own, but talk to your pediatrician if it continues past the 7th birthday.

Sleeping. Kids this age generally need about 10–11 hours of sleep per night. Lack of sleep can cause behavior problems and make it difficult to pay attention at school. Set a bedtime that allows for adequate sleep and establish a relaxing bedtime routine.

Physical activity. Children this age should get at least 60 minutes of physical activity per day. Limit screen time, including TV, DVDs, video games, smartphones, tablets, and computers, to no more than 2 hours per day of quality children’s programming.

Development. By 6 years, it’s common for many kids to:

• tandem walk (walk heel-to-toe)
• tie their shoes
• start reading, spelling, and performing simple addition and subtraction
• write their first and last name and short sentences
• begin to know the difference between fantasy and reality

4. Perform a physical exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking with your child to assess language skills.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, lead, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 7 years:

1. Praise your child’s accomplishments and provide support in areas where he or she is struggling.
2. Reinforce rules and set appropriate limits. At this age, it’s normal for children to test the boundaries of established rules. Decide which rules can be eased and which must remain in place.
3. Teach your child the skills needed to cross the street independently (looking both ways, listening for traffic), but continue to help your child cross the street until age 10 or older.
4. Make sure your child always wears a helmet when riding a bike (even one with training wheels). Do not allow your child to ride in the street.
5. Make sure playground surfaces are soft enough to absorb the shock of falls.
6. Always supervise your child around water, and consider enrolling your child in a swimming class.
7. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
8. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
9. Keep your child in a belt-positioning booster seat until he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
10. Teach your child what to do in case of an emergency, including how to dial 911.
11. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.
12. Discuss appropriate touch. Explain that certain parts of the body are private and no one should see or touch them. Tell your child to come to you if he or she feels uncomfortable about this, is ever asked to look at or touch someone else’s private areas, or is asked to keep a secret.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child’s blood pressure using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your child’s:

Eating. Schedule three meals and one or two nutritious snacks a day. Serve your child a well-balanced diet that includes lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 2 cups (480 ml) of low-fat milk daily (or equivalent low-fat dairy products). Limit foods and drinks that are high in sugar and fat, and offer no more than 8 ounces (240 ml) of juice per day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don’t force them to eat them.

Bathroom habits. Bladder and bowel control should be mastered by this age. Bedwetting is a problem that is more common in boys and deep sleepers. In most cases it ends on its own, but talk to your pediatrician if it continues to be a problem.

Sleeping. Kids this age generally need about 10–11 hours of sleep per night. Lack of sleep can cause behavior problems and make it difficult to pay attention at school. Set a bedtime that allows for adequate sleep and establish a relaxing bedtime routine.

Physical activity. Children this age should get at least 60 minutes of physical activity per day. Limit screen time, including TV, DVDs, video games, smartphones, tablets, and computers, to no more than 2 hours per day of quality children’s programming.

Growth and development. By 7 years, it’s common for many kids to:

• show more independence from parents and family members
• have a group of friends, usually of the same gender
• look up to role models, such as professional athletes, actors, or superheroes
• know the difference between right and wrong
• enjoy reading
• have longer attention spans
• problem solve in a more organized and logical way
• tell time and know the days of the week and the months of the year
• ride a bicycle independently

4. Perform a physical exam. This will include listening to the heart and lungs, examining teeth for cavities, and checking your child’s hips, knees, and ankles. Because some children start to show signs of puberty as early as age 7, your pediatrician will check pubertal development. A parent or caregiver should be present during this exam.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 8 years:

School

1. Encourage your child to participate in a variety of activities, including music, arts and crafts, sports, after-school clubs, and other activities of interest.
2. Praise accomplishments and provide support in areas where your child is struggling.
3. Poor school performance could be a sign of a learning disability or of being bullied. Get to the heart of the problem now so your child can receive the help needed to succeed.

Self

1. Explain to your child that his or her body will change as he or she gets older and that this is normal. Teach the proper names for sexual body parts and explain their functions. Let your child know that it’s never OK for an adult to ask a child to keep a secret. No one should look at or touch your child’s private parts, or ask him or her to look at or touch theirs.
2. Make sure your child brushes his or her teeth twice daily, flosses once a day, and sees a dentist once every 6 months.
3. Establish reasonable consequences for breaking the rules. Spanking or other corporal punishment should not be used.
4. Give your child a sense of responsibility by letting him or her participate in simple chores, like making the bed and setting the table.

Safety

1. Your child should continue to ride in the back seat of the car and use a belt-positioning booster seat until he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
2. Make sure your child wears a helmet while riding a bike, skateboard, or scooter, and that he or she only rides in the daytime.
3. Teach your child the skills needed to cross the street independently (looking both ways, listening for cars), but continue to help your child cross the street until age 10.
4. Teach your child what to do in case of an emergency, including when to dial 911.
5. Teach your child to swim, but do not let him or her go swimming unless an adult is watching.
6. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
7. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease. Explain to your child why he or she should never try tobacco products.
8. Monitor your child’s Internet usage. Keep the family computer in a place where you can watch what your child is doing. Install safety filters and check the browser history to see what websites your child has visited.
9. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child’s weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child’s blood pressure using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your child’s:

Eating. Schedule three meals and one or two nutritious snacks a day. Serve your child a well-balanced diet that includes lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 2 cups (480 ml) of low-fat milk daily (or equivalent low-fat dairy products). Limit foods and drinks that are high in sugar and fat, and offer no more than 8 ounces (240 ml) of juice per day.

Bathroom habits. Bladder and bowel control should be mastered by this age. Bedwetting is a problem that is more common in boys and deep sleepers. In most cases it ends on its own, but talk to your pediatrician if it continues to be a problem.

Sleeping. Kids this age generally need about 10–11 hours of sleep per night. Lack of sleep can make it difficult to pay attention at school. Set a bedtime that allows for adequate sleep and encourage your child to follow a relaxing bedtime routine.

Physical activity. Children this age should get at least 60 minutes of physical activity per day. Limit screen time, including TV, DVDs, video games, smartphones, tablets, and computers, to no more than 2 hours per day of quality children’s programming.

Growth and development. By 8 years, it’s common for many kids to:

• show more independence from parents and family members
• have a group of friends, usually of the same gender
• look up to role models, such as professional athletes, actors, or superheroes
• know the difference between right and wrong
• enjoy reading
• solve simple math problems
• have longer attention spans and cooperate more
• problem solve in a more organized and logical way
• tell time and know the days of the week and the months of the year
• ride a bicycle independently

4. Perform a physical exam. This will include listening to the heart and lungs, examining teeth for cavities, and checking your child’s hips, knees, and ankles. Because some children start to show signs of puberty as early as age 7, your pediatrician will check pubertal development. A parent or caregiver should be present during this exam.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it’s important that your child receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child’s risk for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 9 years:

School

1. Encourage your child to participate in a variety of activities, including music, arts and crafts, sports, after-school clubs, and other activities of interest.
2. Praise accomplishments and provide support in areas where your child is struggling.
3. Poor school performance could be a sign of a learning disability or of being bullied. Get to the heart of the problem now so your child can receive the help needed to succeed.

Self

1. Explain to your child that his or her body will change as he or she gets older and that this is normal. Teach the proper names for sexual body parts and explain their functions. Let your child know that it’s never OK for an adult to ask a child to keep a secret. No one should look at or touch your child’s private parts, or ask him or her to look at or touch theirs.
2. Make sure your child brushes his or her teeth twice daily, flosses once a day, and sees a dentist once every 6 months.
3. Establish reasonable consequences for breaking the rules. Spanking or other corporal punishment should not be used.
4. Give your child a sense of responsibility by letting him or her participate in simple chores, like making the bed and setting the table.

Safety

1. Your child should continue to ride in the back seat of the car and use a belt-positioning booster seat until he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
2. Make sure your child wears a helmet while riding a bike, skateboard, or scooter, and that he or she only rides in the daytime.
3. Teach your child the skills needed to cross the street independently (looking both ways, listening for cars), but continue to help your child cross the street until age 10.
4. Teach your child what to do in case of an emergency, including when to dial 911.
5. Teach your child to swim, but do not let him or her go swimming unless an adult is watching.
6. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside to play and reapply about every 2 hours.
7. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease. Explain to your child why he or she should never try tobacco products.
8. Monitor your child’s Internet usage. Keep the family computer in a place where you can watch what your child is doing. Install safety filters and check the browser history to see what websites your child has visited.
9. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.