Medical Care & Your Baby

Part of parenting is being in charge of your child’s medical care. Usually, it’s no big deal. You take your child to the same doctor every time for routine checkups and sick visits, and that’s about all you need to do.

But what if your child has to see many doctors or spend a lot of time in hospitals? What if your child needs multiple tests and procedures?

When your child has a serious injury or medical condition, things can get complicated — and costly — very quickly. You need an approach to medical care that is focused on your child in a way that will ensure the right type of care, delivered as quickly as possible by people who communicate with each other regularly — all at a price you can afford.

You need what’s called a “medical home” for your child.

What Does the Term “Medical Home” Mean?

A medical home isn’t a place like a hospital or doctor’s office. In fact, it’s not a place at all. It’s more like a way of keeping everything about someone’s medical self — his or her medical history, dealings with insurance companies, treatment schedule, referrals to specialists — in one place. These records can be kept at doctor’s offices, clinics, or hospitals and stored in files on a computer or within an electronic medical record (EMR), or in paper folders.

When kids have a medical home, it’s easier for doctors, nurses, and other health care providers to look up their medical information quickly and find what’s needed. This helps everyone stay on the same page and work together to coordinate care so that are no overlaps, gaps, or mistakes.

In all cases, the medical home should be led by a primary care provider (PCP) who knows your kids best.

What This Means for a Child’s Care

The goal of a medical home is to make sure kids get all the care they need and always have access to medical care, whether that means a routine checkup or a trip to the ER.

A medical home means that you’ll establish a relationship with a primary care doctor who you and your child trust and who can work together with you to keep your child’s care and records organized and up to date.

Your PCP should:

• share clear and unbiased information with you about your child’s health and the options available to you when it comes to medical care
• help coordinate efforts between schools, childcare centers, and other agencies to ensure that any of your child’s special needs are met
• keep a thorough, easily accessible, and organized record that has all your child’s medical information while preserving his or her rights to privacy
• refer you to trusted specialists or surgeons, if necessary, and work with them to establish a plan for your child’s health care
• organize and assist you with any transitions or changes in your child’s care, including the transition to adult care
• work with you and your insurance provider to ensure that your child’s care is properly covered and paid for with no gaps in coverage as your child grows

What Should I Do?

To start, make sure that your child has health insurance that allows him or her to see a doctor for regular checkups. Then, make sure your child gets to all scheduled appointments on time, and talk to your doctor about everything related to your child’s health. Listen to what your doctor has to say, educate yourself on any conditions your child has, and ask the doctor about any concerns or questions that come up.

When your child needs a vaccine (like a flu shot), go to your doctor’s office for it first, not a drugstore or health fair. If you do take your child elsewhere for a shot, make sure to bring any related medical information with you, and remember to tell your doctor about it so he or she can update your child’s record.

If your child has symptoms of an illness or injury, always call the doctor’s office and schedule an appointment. Only use emergency departments and other urgent care centers when there’s a real emergency, or if your doctor’s office is closed and the on-call nurse or doctor tell you to seek urgent care.

Most of all, though, find a PCP you and your child like and stick with him or her. For lots of kids, the doctor can be someone they only see once a year. But for others, their doctor can be a big part of their lives.

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 any concerns, and offer advice about how your baby is:

Feeding. Infants should be fed when they seem hungry. At this age, breastfed babies will eat about eight to twelve times in a 24-hour period. Formula-fed infants consume about 24 ounces a day. Burp your baby midway through feedings and at the end.

Peeing and pooping. Infants should have several wet diapers a day. The number of poopy diapers varies, but most breastfed babies will have three or more. Around 6 weeks of age, breastfed babies may go several days without a bowel movement. Formula-fed babies have at least one bowel movement a day. Tell your doctor if you have any concerns about your infant’s bowel movements.

Sleeping. Infants this age sleep about 16 hours a day, including 4 or 5 daytime naps. Breastfed babies may still wake often to eat at night, while bottle-fed infants may sleep for longer stretches.

Developing. By 1 month of age, babies should:

• focus and follow objects (especially faces)
• respond to sound by quieting down, blinking, turning the head, startling, or crying
• still hold arms and legs in a flexed position, but start to extend legs more frequently
• move arms and legs equally
• lift the head briefly when on the stomach
• have strong newborn reflexes:
  • 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 and then curls them in when startled

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, examining the belly, and checking the hips.

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 2 months:

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 breast or nipple and closing the mouth. Between 6 and 8 weeks, your baby may be hungrier due to a growth spurt.
2. Don’t introduce solids or juice, and don’t put cereal in your baby’s bottle unless directed by your doctor.
3. Continue to burp your baby midway through and at the end of feedings.
4. If you breastfeed:
   • You may now begin pumping and storing breast milk for future use.
   • If breastfeeding is well established, it’s OK to introduce a bottle or pacifier.
   • If you plan on going back to work, introduce the bottle in the next few weeks to get your baby used to bottle-feeding.
   • Continue to take a prenatal vitamin or multivitamin daily.
   • Ask your doctor about vitamin D drops for the baby.
5. 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. Hold your baby and be attentive to his or her needs. You can’t spoil a newborn.
3. 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.
4. 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 at around 3 weeks, peaks around 6 weeks, and improves by 3 months.
5. Use fragrance-free soaps and lotions.
6. Call your doctor if your baby has a fever or is acting sick. Don’t give medication to an infant younger than 2 months old without consulting a doctor first.
7. It’s common for new moms to feel tired and overwhelmed at times, but if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.
8. 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. To reduce the risk of sudden infant death syndrome (SIDS):
   • 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.
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 backseat.
4. Keep all cords, wires, and toys with loops or strings away from your baby.
5. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
6. Never shake your baby — it can cause bleeding in the brain and even death.
7. 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 toddler’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 child is:

Eating. By 12 months, toddlers are ready to switch from formula to cow’s milk. Children may be breastfed beyond 1 year of age, if desired. Your child may be moving away from baby foods and may be more interested in table foods. Offer a variety of soft table foods and avoid choking hazards.

Pooping. As you introduce more foods and whole milk, the appearance and frequency of your child’s poopy diapers may change. Let your doctor know if your child has diarrhea, is constipated, or has poop that’s hard to pass.

Sleeping. One-year-olds need about 12 to 14 hours of sleep a day, including one or two daytime naps.

Developing. By 1 year, it’s common for many children to:

• say “mama” and “dada” (specific to parents), plus one or two other words
• follow a one-step command (such as “Please bring me the ball.”)
• point at objects
• stand alone
• walk with one hand held and possibly even walk alone
• precisely pick up object with thumb and forefinger
• feed self with hands
• enjoy peek-a-boo, pat-a-cake, and other social games

3. Perform a physical exam with your child undressed while you are present.

4. 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.

5. Order tests. Your doctor may check for lead exposure, anemia, or tuberculosis if your child is at risk.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 15 months:

Feeding

1. Give your child whole milk (not low-fat or skim milk) until 2 years of age.
2. Limit your child’s intake of cow’s milk to about 16–24 ounces (480–720 ml) a day. Transition from a bottle to a cup. If you’re nursing, begin offering pumped breast milk in a cup.
3. Serve juice in a cup and limit it to no more than 4 ounces (120 ml) a day.
4. Serve iron-fortified cereal and increase iron-rich foods (such as sweet potatoes, strawberries, and beans) in your child’s diet.
5. Encourage self-feeding.
6. Have your child remain seated when drinking and eating.
7. Serve three meals and two or three nutritious snacks a day. Don’t be alarmed if your child seems to eat less than before. Growth slows during the second year and appetites tend to decrease. Talk to your doctor if you’re concerned.
8. Avoid foods that can cause choking, such as whole grapes, raisins, popcorn, pretzels, nuts, hot dogs, sausages, chunks of meat, hard cheese, raw veggies, or hard fruits.
9. Avoid drinks or foods that are high in sugar.

Learning

1. Babies learn best by interacting with people. Make time to talk, read, and play with your child every day.
2. 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.
3. Have a safe play area and allow plenty of time for exploring.

Routine Care & Safety

1. Brush your child’s teeth without toothpaste twice a day. Schedule a dentist visit soon after the first tooth appears or by 1 year of age.
2. Continue to keep your baby in a rear-facing car seat in the back seat until age 2, or whenever your child reaches the weight or height limit set by the car-seat manufacturer.
3. Avoid sun exposure by keeping your baby covered and in the shade when possible. You may use sunscreen (SPF 30) if shade and clothing are not protecting your baby from direct sun exposure.
4. Be vigilant about childproofing:
   • Install safety gates and tie up drapes, blinds, and cords.
   • Keep locked up/out of reach: choking hazards; medicines; toxic substances; items that are hot, sharp, or breakable.
5. Keep emergency numbers, including poison control, near the phone.
6. To prevent drowning, close bathroom doors, keep toilet seats down, and always supervise your child around water (including baths).
7. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
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 doctor and/or nurse will probably:

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

2. Administer screening (test) that helps with the early identification of developmental delays or autism.

3. Ask questions, address concerns, and provide guidance about how your toddler is:

Eating. Feed your toddler three meals and two or three scheduled nutritious snacks a day. Growth slows in the second year so don’t be surprised if your child’s appetite decreases. Your child can drink from a cup and use a spoon but probably prefers to finger-feed.

Peeing and pooping. You may notice your child’s diapers are dryer for longer periods, but most children do better with toilet training when they’re a little bit older, usually between 2 and 3 years. Let your doctor know if your child has diarrhea, is constipated, or has poop that’s hard to pass.

Sleeping. There’s a wide range of normal, but generally toddlers need about 12 to 14 hours of sleep a day, including one or two daytime naps. By 18 months, most toddlers have given up their morning nap.

Developing. By 18 months, it’s common for many toddlers to:

• say 10–20 words
• point to some body parts
• run
• walk up stairs with hand held
• throw a ball
• take off some clothes
• scribble with a crayon
• engage in pretend play

4. Perform a physical exam with your child undressed while you are present. This will include an eye exam, tooth exam, listening to the heart and lungs, and paying attention to your toddler’s motor skills and behavior.

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 test for lead exposure, anemia, or tuberculosis if your child is at risk.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 2 years:

Feeding

1. Give your child whole milk (not low-fat or skim milk) until 2 years of age.
2. Serve milk and juice in a cup and limit juice to no more than 4 ounces (120 ml) a day.
3. Food “jags” are common during the toddler years. Even if your child seems to get stuck on one food, continue serving a variety of foods. Let your child decide what to eat and when he or she has had enough.

Learning

1. Toddlers learn best by interacting with people and exploring their environment. Make time to talk, read, and play with your child every day.
2. 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.
3. Have a safe play area and allow plenty of time for exploring and active play.

Routine Care & Safety

1. Watch for signs that your toddler is ready to start potty training, including showing interest in the toilet, staying dry for longer periods, and pulling pants up and down.
2. Set up a potty chair and let your child come in the bathroom with you.
3. Brush your child’s teeth without toothpaste twice a day. If you haven’t already, schedule a dental appointment.
4. Toddlers look for independence and will test limits. Be sure to establish reasonable and consistent rules.
5. Tantrums are common at this age, and tend to be worse when kids are tired or hungry. Try to head off tantrums before they happen — distract your child or remove him or her from frustrating situations.
6. Don’t spank your child. Children don’t make the connection between spanking and the behavior you are trying to correct. If necessary, use a brief time-out to discipline your toddler.
7. Keep your baby in a rear-facing car seat in the back seat until he or she is 2 years old or reaches the highest weight or height limit allowed by the car-seat manufacturer.
8. 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.
9. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
10. Make sure your home is safe for your curious toddler:
    • Keep out of reach: choking hazards; cords; hot, sharp, and breakable items; and toxic substances (lock away medicine and household chemicals).
    • Keep the local poison control number near the phone.
    • Use safety gates and watch your toddler closely when on stairs.
    • To prevent drowning, close bathroom doors, keep toilet seats down, and always supervise your child around water (including baths).
    • Be sure the crib mattress is in the lowest position.
    • 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, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address concerns, and provide guidance about how your toddler is:

Eating. By 15 months, most toddlers are eating a greater variety of foods and are better able to handle textures. Offer your toddler three meals and two or three scheduled nutritious snacks a day. Growth slows down in the second year of life so don’t be surprised if your child’s appetite has decreased. Your child can drink from a cup and may be able to use a spoon but probably prefers to finger-feed.

Pooping. As you introduce new foods and whole milk, the appearance and frequency of your child’s poopy diapers may change from day to day. Let your doctor know if your child has diarrhea, is constipated, or has poop that’s hard to pass.

Sleeping. There’s a wide range of normal, but generally toddlers need about 12 to 14 hours of sleep a day, including one or two daytime naps.

Developing. By 15 months, it’s common for many toddlers to:

• say three to five words
• understand and follow simple commands
• point to one body part
• walk alone
• make marks with a crayon
• imitate activities, such as housework
• take off an article of clothing (usually shoes or socks)

3. Perform a physical exam with your child undressed while you are present. This will include an eye exam, tooth exam, listening to the heart and lungs, and paying attention to your toddler’s motor skills and behavior.

4. 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.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 18 months:

Feeding

1. Give your child whole milk (not low-fat or skim milk) until 2 years of age.
2. Limit your child’s intake of cow’s milk to about 16–24 ounces (480–720 ml) a day.
3. Serve iron-fortified cereal and increase iron-rich foods in your child’s diet, including meat, poultry, well-cooked leafy greens, beans (white, black, and kidney), and tofu.
4. Serve a variety of foods, but let your child decide what to eat and when he or she has had enough.
5. Transition from the bottle to a cup. If you’re nursing, avoid the bottle habit — only offer milk in a cup.
6. Serve juice in a cup and limit it to no more than 4 ounces (120 ml) a day.
7. Avoid drinks or foods that are high in sugar.
8. Avoid foods that may cause choking, such as hot dogs, grapes, raw carrots, or hard candy.

Learning

1. Infants learn best by interacting with people. Make time to talk, read, and play with your child every day.
2. 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.
3. Have a safe play area and allow plenty of time for exploring.

Routine Care & Safety

1. Brush your child’s teeth without toothpaste twice a day. Schedule a dental visit if you have not done so already.
2. Tantrums are common at this age, and tend to be worse when children are tired or hungry. Try to head off tantrums before they happen — distract your child or remove him or her from frustrating situations.
3. Don’t spank your child. Children don’t make the connection between spanking and the behavior you are trying to correct. If necessary, use a brief time-out to discipline your toddler.
4. Continue to keep your baby in a rear-facing car seat in the back seat until age 2, or whenever your child reaches the weight or height limit set by the car-seat manufacturer.
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 two hours.
6. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
7. Make sure your home is safe for your curious toddler:
   • Keep out of reach: choking hazards; cords; hot, sharp, and breakable items; and toxic substances (lock away medicine and household chemicals).
   • Keep the local poison control number near the phone.
   • Use safety gates and watch your toddler closely when on stairs.
   • To prevent drowning, close bathroom doors, keep toilet seats down, and always supervise your child around water (including baths).
   • Be sure the crib mattress is in the lowest position.
   • 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 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. Your baby might be going longer between feedings now. Feeding should still be on demand (when your baby is hungry), but you may notice a predictable schedule developing. Keep in mind that your baby may have periods when he or she wants to eat more. Most babies this age will breastfeed about eight times in a 24-hour period or drink about 26–28 ounces (780–840 ml) of formula a day.

Peeing and pooping. Babies should have several wet diapers a day and tend to have fewer poopy diapers. Breastfed babies’ stools should be soft and may be slightly runny. Formula-fed babies’ stools tend to be a little firmer, but should not be hard.

Sleeping. Your baby will probably begin to stay awake for longer periods and be more alert during the day, sleeping more at night. Waking up at night to feed is normal.

Developing. By 2 months, it’s common for many babies to:

• focus and track faces and objects from one side to the other
• be alert to sounds
• recognize parents’ faces and voices
• gurgle and coo (say “ooh” and “ah”)
• smile in response to being talked to, played with, or smiled at
• lift their head up while lying on their belly
• grasp a rattle placed within the hand

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 4 months:

Feeding

1. Do not introduce solids, including infant cereal, or juice. Breast milk or formula is still all your baby needs.
2. Pay attention to signs that your baby is hungry or full.
3. If you breastfeed:
   • If possible, breastfeed exclusively (no formula, other fluids, or solids) for 4–6 months. If desired, pumped breast milk may be given in a bottle.
   • If you plan to go back to work soon, introduce the bottle now to get your baby used to bottle-feeding.
   • Ask your doctor about vitamin D drops for your baby.
4. If formula-feeding, give iron-fortified formula.
5. If your baby takes a bottle of breast milk or formula:
   • Do not prop your baby’s bottle.
   • Do not put your baby to bed with a bottle.

Routine Care & Safety

1. To help prevent sudden infant death syndrome (SIDS), place your baby to sleep on his or her back on a firm mattress in a crib or bassinet without any crib bumpers, blankets, pillows, or plush toys.
2. Limit the amount of time your baby spends in an infant seat, bouncer, or swing.
3. Give your baby plenty of “tummy time” when awake. Always supervise your baby and be ready to help if he or she gets tired or frustrated in this position.
4. Don’t use a walker. They’re dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it.
5. Soon, your baby will be reaching, grasping, and moving things to his or her mouth, so keep small objects and harmful substances out of reach. Keep your baby away from cords, wires, and toys with loops or strings.
6. While your baby is awake, don’t leave your little one unattended, especially on high surfaces or in the bath.
7. It’s normal for infants to have fussy periods, but for some, crying can be excessive, lasting several hours a day. Infant colic peaks at about 6 weeks and improves by 3 months.
8. Never shake your baby — it can cause bleeding in the brain and even death.
9. Always put your baby in a rear-facing car seat in the back seat.
10. Don’t smoke or let anyone else smoke around your baby.
11. 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.
12. 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.

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, height, and head circumference and plot the measurements on the growth charts. Your doctor will also calculate and plot your child’s body mass index (BMI).

2. Administer a screening (test) that helps with the early identification of autism.

3. Ask questions, address concerns, and provide guidance about how your toddler is:

Eating. Don’t be surprised if your toddler skips meals occasionally or loves something one day and won’t touch it the next. Schedule three meals and two or three nutritious snacks a day. You’re in charge of the menu, but let your child be in charge of how much of it he or she eats.

Peeing and pooping. Most children are ready to begin potty training between 2 and 3 years. You may have noticed signs your child is ready to start potty training, including:

• showing interest in the toilet (watching a parent or sibling in the bathroom, sitting on potty chair)
• staying dry for longer periods
• pulling pants down and up with assistance
• connecting feeling of having to go with peeing and pooping
• communicating that diaper is wet or dirty

Sleeping. Generally 2-year-olds need about 13 hours of sleep a day, including one nap.

Developing. By 2 years, it’s common for many children to:

• say more than 50 words
• put two words together to form a sentence (“I go!”)
• be understood at least half the time
• follow a two-step command
• run well
• kick a ball
• walk down stairs
• make lines and circular scribbles
• play alongside other children

4. Perform a physical exam with your child undressed while you are present. This will include an eye exam, tooth exam, listening to the heart and lungs, and paying attention to your toddler’s motor skills, use of language, and behavior.

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 lead exposure, 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 30 months:

Feeding

1. Food “jags” are common during the toddler years. Even if your child seems to get stuck on one food, continue to offer a variety of nutritious choices. Limit sugary drinks and unhealthy snacks.
2. Switch to low-fat or nonfat milk and other low-fat and nonfat dairy products.
3. Limit juice to no more than 4–6 ounces (120–180 ml) a day.

Learning

1. Toddlers learn by interacting with parents, caregivers, and their environment. Limit time in front of a TV or other screens, including computers and smartphones, to no more than one to two hours a day of quality children’s programming.
2. Have a safe play area and allow plenty of time for exploring and active play.
3. Read to your child every day.

Routine Care & Safety

1. Children may start brushing their teeth with a small amount of fluoride toothpaste (no more than the size of a pea). Let your child brush his or her teeth with your guidance. Go over any areas that may have been missed. If you haven’t already, schedule a dentist visit.
2. Look for the signs that your child is ready to start potty training. If he or she doesn’t show interest, it’s OK to wait a few months before trying again. A child who uses the potty and is accident-free during the day may still need a diaper at night.
3. Tantrums are common at this age, and tend to be worse when children are tired or hungry. Try to head off tantrums before they happen — distract your child or remove him or her from frustrating situations.
4. Toddlers look for independence and will test limits. Be sure to establish reasonable and consistent rules. Reinforce positive behaviors.
5. Don’t spank your child. Children don’t make the connection between spanking and the behavior you are trying to correct. If necessary, use a brief time-out to discipline your toddler.
6. Most kids are ready to move from a crib to a regular bed with safety rails between 2 and 3 years.
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. To prevent the risk of drowning, do not leave your child alone in the bathtub or in a pool, no matter how shallow the water.
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 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 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.