Medical Care

When your child is sick or injured, it’s natural to panic and head straight for the emergency room (ER), because you know that you can get care, regardless of the time, day, or severity of your child’s injury.

In some cases, it is a true medical emergency and the ER is the most appropriate place to get care.

In other cases, the illness or injury can be handled at an urgent care clinic, or treatment can wait until your child’s doctor can see you.

When the ER is the right place to go, it’s important to know what to expect once you get there. Having this information ahead of time can help make the experience a little less stressful.

Finding the Right ER at the Right Time

In certain situations, you should dial 911 to get an ambulance instead of taking your child to the ER yourself. Call 911 if:

• Your child is having trouble breathing and is turning blue.
• There has been a car accident and your child is unconscious or seriously injured.
• Your child is having a seizure that lasts 3-5 minutes, is having difficulty breathing, or is turning blue.
• Your child loses consciousness or is not responsive.
• Your child might have a neck or spine injury.
• Your child has a head injury with a loss of consciousness, persistent vomiting, or is not responding normally.
• Your child has significant uncontrolled bleeding.
• Your child has a possible poisoning and is not responding normally or is having difficulty breathing. In any possible poisoning, call the Poison Control Center (1-800-222-1222) for expert advice and they may direct you to the ER.

Planning Ahead

Talk with your doctor about what to do — and which ER to go to — before you’re in a situation where you might need to visit one. The doctor may direct you to an ER that’s close to you or one in a hospital where he or she regularly sees patients.

Should your child go to an ER at a children’s hospital? Because they’re dedicated to caring for kids, children’s hospitals probably have the most pediatric staff, specialists, and facilities. So if it’s an emergency and a children’s hospital is conveniently located, consider going there.

Otherwise, the community hospital nearest you will provide the medical care needed. If for any reason the hospital isn’t equipped to treat your child’s specific condition, the doctors there will arrange a transfer to a facility that is.

Preparing to Go to the ER

When you go to the ER (also called the emergency department, or ED), it’s important to have a good handle on your child’s symptoms. It’s also important to know your child’s medical history — allergies, past illnesses, injuries, surgeries, immunization history, or chronic conditions.

Even if you know the medical history by heart, consider writing it down so it’s handy during the chaos of an emergency. And keeping a written record readily available at home will let anyone caring for your child — such as a babysitter or grandparent — provide it should your child be taken to the ER.

To prepare a medical history, include:

• medications your child is taking
• allergies
• history of previous hospitalizations
• any previous surgeries
• illnesses
• relevant family history
• immunization history

You also might be asked when your child last had anything to eat or drink. You should know the name and number of your child’s primary care provider. And it’s good to know the name and number of the pharmacy where you usually get your prescriptions filled.

If you go to the ER because your child has ingested a particular medication or household product, bring the container of whatever was ingested. That will help the doctors understand what kind of treatment is needed. If your child swallowed an object, bring an example of that object, if possible.

At any ER, except in the most serious emergencies, be prepared to wait. If you have time before you go to the emergency room, consider bringing something to do while you wait, such as a book, magazines, or bills to pay. You also may want to bring pen and paper to write down any questions you have for the doctor. If your child is not too ill, bring things for him or her to do as well, such as crayons, books, toys, and comforting objects, like stuffed animals.

If you think there’s a chance that your child might have to be admitted to the hospital, you may want to grab a change of clothes and toothbrushes for you and your child.

Most ERs have some translation services or someone who can help translate. If you do not speak English fluently, consider bringing along a family member or friend who can help you translate.

What to Expect at the ER

There’s no way to predict how long you’ll have to wait to be seen at the ER. If your child has a severe medical problem, be assured that the doctors will provide whatever attention is needed right away.

Because doctors attend to the most severe injuries and illnesses first, there’s a good chance that if you are there with a minor injury, you’ll have to wait longer. Even if the waiting room is empty, you still may have to wait if the exam rooms are filled or many doctors and nurses are attending to a particularly serious case.

If your child’s condition becomes worse while you are waiting to see a doctor, tell the medical staff.

Before offering any food or drink to your child, make sure to ask the medical staff if it is OK. In some situations, your doctor would prefer your child has nothing to eat or drink.

While you wait, there’s a chance that you — and your child — may see some very sick and injured people come into the ER. The sights and sounds of those who are seriously hurt or sick can be frightening. So assure your child that the ER is the best place for the hurt people to be and that this is where the doctors can help them feel better. You might even give an example of a time when someone you know was injured and, as scary as it was at the time, all was fine after the doctor’s care.

Soon after arriving at the ER, your child probably will be seen by a nurse, who will ask about symptoms, check vital signs, and make a quick assessment. This evaluation, also called triage, will prioritize your child’s medical needs based on the severity of his or her condition.

You’ll also go through a registration process where you’ll be asked to sign consent for treatment forms. And if you have health insurance, be sure to have your member card with you.

When you’re in the ER, try to write down important information that you hear. It’s scary and stressful when your child is in the ER, so it can be hard to remember details you may need later, such as:

• the names of the doctors
• what they say about the illness or injury
• any medications or treatment they give your child
• any directions for follow-up or care at home

If your child is being discharged, make sure you understand the home care instructions and ask questions if you don’t.

A specialist might not be on-site if you go to the ER on the weekend or at night, but if the problem requires it, one will be called in. If surgery is needed, a surgeon will be contacted.

Some hospitals even have child life specialists. They can help children cope with the stress of being in the ER, help prepare them for procedures, and provide them with non-pharmacological pain management techniques even at very young ages.

In many cases, the doctor who treats your child in the ER will contact your primary care doctor afterward. If your child is admitted to the hospital, the emergency room doctor will let your doctor know.

Some ERs provide written or computer-generated documentation of the visit and others dictate and fax the report to the primary care doctor. Carry a copy of the papers you receive when your child is discharged to share with your doctor.

If your daughter is a newborn or under 5 months old, try a method called the “5 S’s” immediately after she gets a vaccine. These are:

1. swaddling immediately after the shot. You also can swaddle (wrapping a baby tightly in a blanket like a “burrito”) before the shot, but leave your baby’s legs exposed for the vaccination.
2. placing her on her side or stomach
3. making shushing sounds in her ear
4. swinging her in your arms or an infant swing
5. giving her the opportunity to suck (whether through breastfeeding, a bottle, or a pacifier)

Research has shown that doing at least 4 of the 5 S’s greatly reduces the amount of time infants cry after getting a shot. If you’re OK with breastfeeding your daughter at the doctor’s office (to fulfill the sucking recommendation), this alone can be an effective method of distracting your baby and calming her down. You might even be able to do it while your child gets the vaccine.

In some situations, a sugar water solution may be available. Dipping a pacifier into this solution, then giving it to a fussy baby may help soothe the child.

Before and after the shot is given, try applying gentle pressure and rubbing the skin around the injection site. This massage may prevent the area from feeling so painful.

For an older baby or a toddler, swaddling or shushing might not work. Try letting your child sit on your lap during the shot and distract her with a toy, book, or song. Try not to look upset or concerned. Children can pick up on a parent’s anxiety, and it can make them anxious as well.

If your child has pain at the site where the shot was given or develops a fever and feels sick, speak to your child’s doctor about giving medicine such as acetaminophen or ibuprofen to relieve symptoms.

Also, don’t forget to praise your child afterward. A little positive reinforcement can make the next trip to the doctor easier. When possible, try to do something fun after the appointment. A trip to the park or playground can make the overall immunization experience less stressful.

This schedule of recommended immunizations may vary depending upon where you live, your child’s health, the type of vaccine, and the vaccines available.

Some of the vaccines may be given as part of a combination vaccine so that a child gets fewer shots. Talk with your doctor about which vaccines your kids should receive.

Birth

• HepB: Hepatitis B vaccine; ideally, the first dose is given at birth, but kids not previously immunized can get it at any age.

1–2 months

• HepB: Second dose should be administered 1 to 2 months after the first dose.

2 months

• DTaP: Diphtheria, tetanus, and acellular pertussis vaccine
• Hib: Haemophilus influenzae type b vaccine
• IPV: Inactivated poliovirus vaccine
• PCV: Pneumococcal conjugate vaccine
• RV: Rotavirus vaccine

4 months

• DTaP
• Hib
• IPV
• PCV
• RV

6 months

• DTaP
• Hib: This third dose may be needed, depending on the brand of vaccine used in previous Hib immunizations.
• PCV
• RV: This third dose may be needed, depending on the brand of vaccine used in previous RV immunizations.

6 months and annually

• Influenza (Flu): The flu vaccine is recommended every year for children 6 months and older:
  • Kids younger than 9 who get the flu vaccine for the first time (or who have only had one dose before July 2016) will get it in two separate doses at least a month apart.
  • Those younger than 9 who have had at least two doses of flu vaccine previously (in the same or different seasons) will only need one dose.
  • Kids older than 9 only need one dose.
• The vaccine is given by injection with a needle (the flu shot). The nasal spray form that was available in the past is not currently recommended because it was not found to be effective enough in recent years.

6–18 months

• HepB
• IPV

12–15 months

• Hib
• MMR: Measles, mumps, and rubella (German measles) vaccine
• PCV
• Chickenpox (varicella)

12–23 months

• HepA: Hepatitis A vaccine; given as two shots at least 6 months apart

15–18 months

• DTaP

4–6 years

• DTaP
• MMR
• IPV
• Varicella

11–12 years

• HPV: Human papillomavirus vaccine, given in two shots over a 6- to 12-month period. It can be given as early as age 9. For teens and young adults ages 15–26, it is given in three shots over 6 months. It’s recommended for both girls and boys to prevent genital warts and certain types of cancer.
• Tdap: Tetanus, diphtheria, and pertussis booster. Also recommended during each pregnancy a woman has.
• Meningococcal conjugate vaccine: And a booster dose is recommended at age 16.

16–18 years

• Meningococcal B vaccine (MenB): The MenB vaccine may be given to kids and teens in two or three doses, depending on the brand. Unlike the meningococcal conjugate vaccine, which is recommended, the MenB vaccine is given at the discretion of the doctor.

Special circumstances

• HepA is also recommended for kids 2 years and older and adults who are at high risk for the disease. This includes people who live in, travel to, or adopt children from locations with high rates of hepatitis A; people with clotting disorders; and people with chronic liver disease. The vaccine also can be given to anyone who desires immunity to the disease, and is useful for staff at childcare facilities or schools where they may be at risk of exposure.
• The MMR vaccine can be given to babies as young as 6 months old if they will be traveling internationally. These children should still be given the recommended routine doses at 12–15 months and 4–6 years of age.
• The flu vaccine is especially important for kids who are at risk for health problems from the flu. High-risk groups include, but aren’t limited to, kids younger than 5 years old and those with chronic medical conditions, such as asthma, heart problems, sickle cell disease, diabetes, or HIV.
• The meningococcal vaccines can be given to kids as young as 6 weeks old (depending on the type of vaccine) who are at risk of getting a meningococcal infection, such as meningitis. This includes children with certain immune disorders. Kids who live in (or will be traveling to) countries where meningitis is common, or where there is an outbreak, should also receive a vaccine.
• Pneumococcal vaccines also can be given to older kids (age 2 and up) who have conditions that affect their immune systems, such as asplenia or HIV infection, or other conditions, like a cochlear implant, chronic heart disease or chronic lung disease.

Even healthy kids get hurt or sick sometimes. In some cases, you will know that you need to head straight to the emergency room (ER) at the nearest hospital. In other cases, it’s harder to determine whether an injury or illness needs the attention of a medical professional or can be treated at home.

Different problems require different levels of care. When your child needs some sort of medical help, you have many options:

• Handle the problem at home. Many minor injuries and illnesses, including some cuts, certain types of rashes, coughs, colds, scrapes, and bruises, can be handled with home care and over-the-counter (OTC) treatments.
• Call your doctor. If you’re unsure of the level of medical care your child needs, your doctor — or a nurse who works in the office — can help you decide what steps to take and how.
• Visit an urgent care center. An urgent care center can be a good option for non-emergencies at night and on weekends when your doctor may not be in the office. At these centers, you can usually get things like X-rays, stitches, and care for minor injuries that aren’t life threatening yet require medical attention on the same day.
• Visit a hospital emergency room. An ER — also called an emergency department (ED) — can handle a wide variety of serious problems, such as severe bleeding, head trauma, seizures, meningitis, breathing difficulties, dehydration, and serious bacterial infections.
• Call 911 for an ambulance. Some situations are so serious that you need the help of trained medical personnel on the way to the hospital. These might include if your child: has been in a car accident, has a head or neck injury, has ingested too much medication and is now hard to rouse, or is not breathing or is turning blue. In these cases, dial 911 for an ambulance.

As a parent, it can be hard to make these judgment calls. You don’t want to rush to the ER if it isn’t really an emergency and can wait until a doctor’s appointment. On the other hand, you don’t want to hesitate to get medical attention if your child needs treatment right away. As your kids grow, you’ll learn to trust yourself to decide when it’s an emergency.

Remember that in cases when you know the problem is minor, it’s best to contact your child’s doctor, go to an urgent care center, or handle it at home. ERs can be crowded and it can take a long time for minor problems to be treated.

Should I Go to the ER?

Here are some reasons to go to the ER :

• if your child has difficulty breathing or shortness of breath
• if your child has had a change in mental status, such as suddenly becoming unusually sleepy or difficult to wake, disoriented, or confused
• if your child has a cut in the skin that is bleeding and won’t stop
• if your child has a stiff neck along with a fever
• if your child has a rapid heartbeat that doesn’t slow down
• if your child accidentally ingests a poisonous substance or too much medication
• if your child has had more than minor head trauma

Other situations may seem alarming, but don’t require a trip to the ER. The list below includes some of the symptoms that may require calling your doctor:

• high fever
• ear pain
• pain in the abdomen
• headache that doesn’t go away
• rash
• mild wheezing
• persistent cough

When in doubt, call your doctor. Even if the doctor isn’t available, the office nurse can talk with you and determine whether you should go to the ER. On weekends and at night, doctors have answering services that allow them to get in touch with you if you leave a message.

Urgent Care Centers

Sometimes an injury or an illness isn’t life threatening but needs medical attention on the same day. If that’s the case, and your doctor doesn’t have office hours at the time, consider going to an urgent care center.

Urgent care centers usually allow you to walk in without an appointment, just as you would in an ER. But they’re equipped and staffed to treat minor, non-critical issues. Patients usually will be seen by a doctor and also might be able to get X-rays or blood drawn.

Most of these clinics offer extended hours on evenings and on weekends for patients to receive treatment when the family doctor is not available. Some are open 24 hours a day every day. In addition to accepting walk-in patients, some allow you to call ahead to be seen.

Some cases where you might take your child to an urgent care center include:

• cuts
• minor injuries
• vomiting or diarrhea
• ear pain
• sore throat
• infected bug bites
• mild allergic reactions
• suspected sprain or broken bone
• minor animal bites

The doctors who work at freestanding urgent care centers often are ER doctors or family physicians who focus on treating adult and pediatric diseases. Some centers are also staffed by nurse practitioners and physician assistants. The ERs in many children’s hospitals have special sections similar to an urgent care center for treatment of minor injuries and illnesses.

Find out about the urgent care centers near you — before a situation comes up where you need to go to one. Ask your doctor about local facilities. In general, you should find a clinic that meets the state licensing requirements and is staffed by doctors who are board certified in their specialties, such as pediatrics, family medicine, or emergency medicine. It’s also a good idea to find out if the center accepts your insurance plan.

Talk with your doctor before your child gets sick about how to handle emergencies and ask about the doctor’s policy on addressing medical needs outside of office hours. Having that information ahead of time will mean one less thing to worry about when your child is sick!

The toddler months continue to bring the medical challenges of colds, scrapes and bruises, and other minor emergencies. You’ll also find yourself dealing with an emerging personality and increasing conflicts.

Your doctor will see your child four times for routine well visits during this period, at 12, 15, 18, and 24 months. If your toddler has missed any immunizations, or if a problem has been detected that needs special attention, additional visits may be scheduled.

What to Expect During the Office Visit

The well-child checkups during your child’s second year are similar to those before, but discussions with your doctor about behavior and habits may become more detailed as your toddler gets older.

Your toddler’s checkup will include:

• Measurement of your child’s length, weight, and head circumference. Growth will be plotted on the growth chart, and you’ll be advised of your toddler’s progress.
• A physical exam.
• A review of your toddler’s development through both observation and your progress report. Is your tot starting to walk? Scribbling? Following simple instructions? Saying a few words? Combining two words by age 2? The doctor may ask you these questions and others like them.
• The doctor may go over safety questions such as: Have you childproofed your home? (You’ll need to review your babyproofing efforts now that your toddler can stand and reach.) Is your tot in an appropriate safety seat while riding in the car?
• A discussion of your child’s eating habits. Is he or she eating a variety of foods? Finger feeding or using a spoon? Using a cup? Being weaned from the breast or bottle? Most doctors advise a switch from bottle to cup between 12 and 18 months.
• Advice on what to expect in the coming months.
• Some immunizations.

If they haven’t already, kids this age might undergo a tuberculin skin test, especially those at risk for tuberculosis. You’ll be given instructions on how to monitor the test and report results to the doctor’s office. Your doctor may recommend a blood test to check for anemia and lead poisoning.

Address any questions or concerns you have, and write down any specific instructions the doctor gives you regarding special care. Keep updating your child’s permanent medical record, listing information on growth and any problems or illnesses.

Immunizations Your Child Will Receive

A child who did not have them at the 12-month visit will get these vaccines at 15 months:

• the third or fourth Hib vaccine, depending on the manufacturer
• measles, mumps, and rubella (MMR) vaccine
• chickenpox (varicella) vaccine
• the fourth pneumococcal conjugate vaccines (PCV, PPSV)
• fourth diphtheria, tetanus, and pertussis (DTaP) vaccine

At the 18-month visit, if not already been given, children should get:

• fourth DTaP vaccine
• third hepatitis B vaccine (HBV), which can be given starting at 6 months
• third inactivated poliovirus vaccine (IPV), which can be given starting at 6 months

Your child may also get a flu shot, which is recommended every year before flu season for children older than 6 months. If your child is at high risk for developing meningococcal disease, a serious infection that can lead to bacterial meningitis, your doctor may offer the meningococcal vaccine as well.

Discuss possible vaccine reactions with your doctor and get advice on when to call with problems.

Developmental Progress

At the 18-month visit, toddlers undergo a screening test to help identify developmental delays and autism.

There is a wide range of normal when it comes to reaching developmental milestones. But by 18 months, most toddlers:

• walk on their own
• speak at least 15 words

By age 2, toddlers should be able to:

• put two words together to form a sentence
• follow simple directions
• imitate actions
• push and pull a toy

Talk to your doctor if you have concerns about your child’s development.

When to Call the Doctor

By now you have probably called your doctor’s office many times with questions and concerns about your child’s health. Don’t hesitate to notify the doctor if you think that something is wrong — you know your child best.

And always call the doctor if your child has a fever, is acting sick, has serious problems sleeping, is refusing all food or drink, is vomiting, or has diarrhea.

During these early months, you might have many questions about your baby’s health. Most doctors have phone hours when parents can call with routine questions. Don’t hesitate to call with your concerns, no matter how minor they might seem.

Of course, if you think your baby could have an illness, don’t wait for phone hours — call your doctor immediately. As in the newborn period, illness at this age needs immediate attention.

How often you see the doctor in the first 2 months will depend on your baby’s health, but most infants are seen at 1 month and again at 2 months for routine care.

Babies are checked for growth, development, and feeding, among other things. These regular checkups also let your doctor follow up on any concerns from earlier checkups and are a chance for you to ask questions.

What Happens at the Office Visit

During these early months, your doctor will check your baby’s progress and growth. Common parts of a checkup include:

• weight, length, and head circumference measurements that are plotted on your baby’s growth chart
• a physical exam with special attention to any previous problems
• assessing development (for example, head control, cooing, and smiling)
• questions about how you’re doing with your baby
• advice about feeding and other aspects of nutrition
• what to expect during the coming months, including a discussion about safety precautions
• immunizations during some visits

Bring up any questions you have, and write down the answers or specific instructions the doctor gives you. At home, update your baby’s medical record, tracking growth and any problems or illnesses.

Vaccines

At 1–2 months old, your baby should receive the second dose of the hepatitis B vaccine (HBV).

At 2 months, your baby will get other immunizations:

• DTaP (diphtheria, tetanus, acellular pertussis) vaccine
• Hib (Haemophilus influenzae type b) vaccine
• IPV (polio vaccine)
• PCV (pneumococcal) vaccines
• RV (rotavirus vaccine)
• possibly HBV (hepatitis B vaccine), if not previously given

Babies at high risk for meningococcal disease, which can lead to bacterial meningitis and other serious conditions, may get the meningococcal vaccine. (Otherwise, the meningococcal vaccine is routinely given at 11–12 years old.)

Vaccines protect against serious childhood illnesses. Vaccines, like any other medicine, may cause reactions (usually mild), such as fever or irritability. Be sure to discuss side effects with your doctor and get guidelines for when to call the office.

When to Call the Doctor

Some common medical problems at this age may need a doctor’s attention, including:

• diarrhea and vomiting, which could be caused by an infection and put your infant at risk for dehydration
• ear infections; a baby with an ear infection may become irritable, and could have a fever
• rashes, which are common in infants. Some may not seem to bother your baby, but skin conditions like eczema can result in dry, itchy skin. Your doctor can recommend lotions, creams, and soaps to try.
• upper respiratory tract infections (including the common cold), which affect infants just like the rest of us. Babies can’t blow their own noses, so you may need to help clear mucus with a rubber bulb aspirator. Don’t give your baby any medicines without checking first with your doctor. Call the doctor’s office right away if your baby has trouble breathing, refuses to eat, has a rectal temperature above 100.4°F (38°C), or is excessively cranky or sleepy.

Again, don’t hesitate to contact the doctor’s office about any health or behavior concerns.

By meeting yearly with your teen, the doctor can keep track of changes in physical, mental, and social development and offer advice about avoiding unhealthy behaviors, such as smoking and drinking.

The doctor also can help your teen understand the importance of choosing a healthy lifestyle that includes good nutrition, proper exercise, and safety measures.

The more that teens understand about their physical growth and sexual development, the more they will recognize the importance of active involvement in their own health care.

What to Expect at the Doctor’s Office

Teens should visit their doctors annually. Those with a chronic medical condition or certain clinical signs or symptoms might need more frequent visits.

Medical care should include screenings for high blood pressure, obesity, eating disorders, depression, and if indicated, hyperlipidemia (an excess of cholesterol and/or other fats in the blood). Older teens may be screened for alcohol, drugs, and sexually transmitted diseases (STDs). A tuberculin (PPD) test may be done if a teen is at risk for tuberculosis.

Vision and hearing will be checked. Teens are also checked for scoliosis (curvature of the spine).

Immunizations

By age 13, teens should have already had these immunizations:

• chickenpox (varicella) vaccine (if they have not had chickenpox)
• measles, mumps, and rubella (MMR) vaccine
• hepatitis B vaccine (HBV) series
• hepatitis A vaccine (HAV) series
• meningococcal vaccine
• human papillomavirus vaccine (HPV)
• diphtheria, tetanus, and acellular pertussis booster (Tdap)

Doctors recommend a Tdap booster at 11–12 years of age, with a tetanus and diphtheria booster (Td) every 10 years after that. The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had it before, or when it was last given. The flu vaccine, given before flu season each year, also is recommended.

As teens go through puberty, issues of sexual health will be addressed. Young women may be referred to a gynecologist for a first visit. Young men will be checked for hernias and testicular cancer and taught how to do a testicular self-exam.

Teens should be asked about behaviors or emotional problems that may indicate depression or the risk of suicide. The doctor also should provide counseling about risky behaviors and other issues, including:

• sexual activities that may result in unintended pregnancy and STDs
• use of alcohol and other substances, including anabolic steroids
• use of tobacco products, including cigarettes and smokeless tobacco
• drinking and driving
• the importance of bicycle helmets, seatbelts, and protective sports gear
• how to resolve conflicts without violence, including how to avoid the use of weapons
• learning problems or difficulties at school
• importance of regular physical activity

Common Medical Problems

Sports injuries and other problems, such as knee pain and headaches, are common concerns. Your teen’s doctor should evaluate any pain that is severe or long-lasting.

Issues involving puberty and sexual development are typical concerns for teens. Doctors can be a valuable resource by answering questions and giving guidance during this period of physical and emotional changes. Teens should be reassured that anything they discuss with their doctor will be kept confidential, unless their health or the health of others could possibly be in danger.

If You Have Concerns

Parents or other caregivers should receive health guidance from their teen’s doctor during these routine checkups. The doctor will share information about normal development, including signs and symptoms of illness or emotional distress and ways to watch for and manage potentially harmful behaviors.

If you think that your teen has a physical disorder, a psychological problem, or a problem with drugs or alcohol, contact the doctor.

Well-Child Visits

Regular well-child exams are an important part of keeping kids healthy and up to date on immunizations against many serious childhood diseases.

Checkups also are a chance for you and the doctor to talk about developmental and safety issues, and for you to get answers to any questions about your child’s overall health.

What to Expect at the Doctor’s Office

At a typical well-child visit, your child will be weighed and measured and these results will be plotted on growth charts for weight, height, and body mass index (BMI). Using these charts, doctors can see how kids are growing compared with other kids the same age and gender. The doctor will take a family and medical history and do a physical exam.

Your child may be screened for anemia, lead poisoning, tuberculosis, high cholesterol, or other conditions. The doctor also will ask about your child’s eating habits.

The doctor will make sure all immunizations are up to date. At this age, most kids should have had these recommended vaccines:

• four doses of diphtheria, tetanus, and pertussis (DTaP) vaccine
• three doses of inactivated poliovirus vaccine (IPV)
• three or four doses of Haemophilus influenzae type B (Hib) vaccine
• one dose of measles, mumps, and rubella (MMR) vaccine
• three doses of hepatitis B vaccine (HBV)
• one dose of chickenpox (varicella) vaccine
• two or three doses of rotavirus vaccine (RV)
• four doses of pneumococcal conjugate vaccines (PCV, PPSV)
• one or two doses of hepatitis A vaccine (HAV)

Your child should also get the flu vaccine every year, ideally before flu season begins. Other vaccines might be needed if the doctor determines that your child is at risk for conditions like meningococcal or pneumococcal disease.

Developmental Progress

The doctor will check your child’s developmental progress, asking about behavior and specific developmental milestones. Doctors also give a screening test to help identify developmental delays and autism at the 24- or 30-month visit.

Child safety is another topic discussed at well-child visits. The doctor will talk about the importance of using car seats, closely watching kids around swimming pools, preventing poisoning, not smoking around kids, and using sunscreen. In homes with guns, weapons and ammunition should be stored separately and kept locked at all times.

When to Call the Doctor

Some symptoms can be signs of an infection, chronic medical condition, or other medical problem. Call your doctor if your child has any of these:

• changes in weight or eating habits
• changes in behavior or sleep patterns
• a failure to grow in height as expected
• a fever and also looks sick
• long-lasting or frequent vomiting or diarrhea
• severe or long-lasting irritability or tiredness
• signs of a skin infection or a long-lasting rash
• long-lasting cough, wheezing, shortness of breath, or other breathing problems
• localized pain, such as pain caused by an ear infection

Common Medical Problems

Young children have an average of 6 to 8 colds a year, and also may have several bouts of diarrhea and vomiting, as well as ear infections.

Sleep problems and behavior or discipline concerns are very common at this age and can be frustrating for parents. Your doctor can offer guidance to help you manage these issues too.

The Well-Child Visit

Regular well-child exams are an important part of keeping kids healthy and up to date on immunizations against many serious childhood diseases.

Checkups also are a chance for you and the doctor to talk about developmental and safety issues, and for you to get answers to any questions about your child’s overall health.

What to Expect at the Doctor’s Office

At yearly exams, your child will be weighed and measured, and these results will be plotted on growth charts for weight, height, and body mass index (BMI). Using these charts, doctors can see how kids are growing compared with other kids the same age and gender. The doctor will take a medical and family history and do a physical exam.

During checkups, your child’s blood pressure, vision, and hearing will be checked. Your child may be screened for anemia, lead poisoning, tuberculosis, or high cholesterol.

Immunizations given might include:

• fifth diphtheria, tetanus, and pertussis (DTaP) vaccine
• second measles, mumps, and rubella (MMR) vaccine
• fourth inactivated poliovirus vaccine (IPV)
• second chickenpox (varicella) vaccine

The flu vaccine, given before flu season each year, also is recommended. Other vaccines might be needed if the doctor determines that your child is at risk for conditions like meningococcal or pneumococcal disease.

The doctor will check for crossed eyes and any vision and hearing problems, and also check the teeth for tooth decay, abnormal tooth development, malocclusion (abnormal bite), dental injuries, or other problems. In addition to the doctor’s dental evaluation, your child should be making regular visits to the dentist.

The doctor also will check on behavioral and social development, asking questions to see if your child’s everyday behavior is age appropriate, how well your child does in social situations, and how well he or she communicates.

Developmental Milestones

Developmental milestones for 4-year-olds include being able to:

• help with household tasks
• play cooperatively with other kids
• understand the concept of gender
• identify colors

Developmental milestones for 5-year-olds include being able to:

• dress independently and tie shoes
• know their address and phone number
• draw a person with head, body, arms, and legs
• print some letters

Child safety is another topic discussed at well-child visits. The doctor will talk about the importance of using car seats, closely watching kids around swimming pools, preventing poisoning, not smoking around kids, and using sunscreen. In homes with guns, weapons and ammunition should be stored separately and kept locked at all times.

When to Call the Doctor

Some symptoms can be signs of an infection, chronic medical condition (such as asthma), or other medical problem. Call your doctor if your child has any of these:

• changes in weight or eating habits
• changes in behavior or sleep patterns
• a failure to grow in height as expected
• a fever and looks sick
• lasting vomiting or diarrhea
• trouble keeping liquids down
• signs of a skin infection or long-lasting rash
• a lasting cough, wheezing, or other breathing problems
• localized pain, such as from an ear infection

Common Medical Problems

Problems often found in this age group include bedwetting and sleep disturbances, such as nightmares. Kids also might have growing pains in their calves at night.

Your doctor can offer guidance to help you manage these issues.

Babies really begin to show their personality during these months. So you might find yourself talking to your baby’s doctor less about sleeping and eating and more about physical and social development.

Most likely your baby will now be seen at 4 months and at 6 months, but your doctor may schedule extra visits to check on any problems found earlier.

Colds and ear infections can become more common at this age, especially in winter. Once babies can reach out and grab objects and start having contact with more people, they can be at increased risk for contagious illnesses, especially if they’re in childcare or have older siblings.

What to Expect at the Office Visit

Well-baby checkups vary from doctor to doctor, but usually will include:

• Measurement of your baby’s length, weight, and head circumference. Growth will be plotted on a growth chart, and you’ll be advised of the progress.
• A physical exam.
• A review of your baby’s development through both observation and your progress report. Can your baby hold up his or her head? Is your tot rolling over? Sitting with or without support? Can he or she transfer an object from hand to hand? Respond to own name? Has your baby started to babble? Your doctor may ask you these questions and more.
• You may be asked how you are doing with your baby and how the rest of the family is doing. Your doctor may go over safety questions with you: Have you babyproofed your home? Is your little one in an appropriate safety seat while in the car?
• A discussion of your baby’s eating habits, including the likelihood that solid foods will be introduced soon.
• Advice on what to expect in the coming months.
• Your baby will receive immunizations during some visits.

Bring to the doctor any questions or concerns you may have at this time. Make sure to write down any specific instructions you receive regarding special baby care. Keep updating your child’s medical record, listing information on growth and any problems or illnesses.

Immunizations Your Baby Will Receive

Immunizations usually given at the 4-month visit:

• second diphtheria, tetanus, acellular pertussis (DTaP) vaccine
• second Haemophilus influenzae type b (Hib) vaccine
• second polio vaccine (IPV)
• second pneumococcal conjugate (PCV) vaccine
• second rotavirus (RV) vaccine

At the 6-month visit, your baby also may get (depending on the brand of vaccine given, and whether your child has had earlier doses):

• the third DTaP vaccine
• the third polio vaccine (IPV)
• the third hepatitis B vaccine
• the third Hib vaccine
• the third PCV vaccine
• the third rotavirus (RV) vaccine
• a flu shot

Babies at high risk of developing a meningococcal disease, which can lead to bacterial meningitis and other serious conditions, may receive an additional vaccine. (Otherwise, kids usually get the meningococcal vaccine at 11–12 years old.)

When to Call the Doctor

Colds and other illnesses are a part of growing up. Your baby is beginning to explore and probably is being exposed to other kids. While it’s hard to see your baby fight a stuffy nose or suffer with an ear infection, rest assured that most kids grow out of the frequent-illness stage as they build their immunity.

Meanwhile, these safeguards can help keep your baby well:

• Breastfeeding your baby will provide antibodies and enzymes that help protect against illness.
• Try to keep your baby away from kids you know are sick, especially those with infectious diseases such as the flu.
• Family members who are sick should not share food or drink with the baby, and they should wash their hands well before handling the baby and your tot’s toys.
• Stay up to date with your baby’s vaccines. Stick to the immunization schedule recommended by your doctor.

Call your doctor if your baby has a fever, is acting sick, refuses to eat, suddenly has trouble sleeping, has diarrhea, or is vomiting.