Checking Up on Baby
Well-child visits are a cornerstone in the foundation of your child’s health. These checkups are specific times when you can discuss your children’s physical, emotional, social and developmental health with their primary health care practitioner. Regardless of whether you are a new parent or the parent of many, well-baby visits are part of a support system for parents as well as a significant element in a child’s early life.
The American Academy of Pediatrics recommends the first well-baby check within the three to five days of birth and within the first 48 to 72 hours after discharge. Additional well-baby checks are recommended at 1, 2, 4, 6 and 9 months. In early and middle childhood and adolescence, the schedule calls for well-child visits at 12, 15, 18, 24 and 30 months and annually from ages 3 to 21.
Amy Ramsey believes her son, Blake, would have benefited from specific well-baby visits. At 20 months, Blake had seen his pediatrician 14 times. At birth, he weighed almost 8 pounds, placing him in the 75th percentile for weight, and measured 21 inches in length, ranking him in the 54th percentile.
As the first weeks and months of infancy passed, Ramsey, sensed something might be wrong. Blake seemed different from her first child. Although she expected a cold or occasional fever often typical of childhood, Blake’s chronic weekly fevers often lingered for days. Despite having made numerous trips to the pediatrician’s office, at 6 months, Blake was already behind on his immunizations and his well-baby visits.
Weighing the differences
Well-child checkups are different than visiting the doctor for an earache or upper respiratory infection. While both usually include listening to a child’s breathing, taking a blood pressure reading and using an otoscope to look into the ear canal, visiting the doctor for an illness focuses more specifically on the symptoms that prompted the visit. Well-child visits delve into growth and development.
One important element of well-baby visits is assessing a child’s physical development and individual development trends. Infants typically double their birth weight by the fourth month and triple it by the end of the first year. Physical growth slows in the second year, but by 24 months, most children weigh almost 30 pounds and measure between 32 and 36 inches. This means that typical 2-year-olds are half of their adult height but 15 to 20 percent of their adult weight and four times as heavy as at birth. Each of these numbers is a norm, an average or standard for a particular population that is then further broken down by gender.
An average child is at the 50th percentile, a number that would represent the midpoint between 1 and 99, with 49 percent of the children above it and 49 percent below it. “
The measurements are plotted on a growth chart. You'll see how your baby's size compares with that of other babies the same age. However, parents should not fixate on the percentages,” says Daniel Levy, a pediatrician in Maryland. A baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the 5th percentile. What's most important is steady growth from one visit to the next.
Not all growth charts are created equal
In April 2006, the World Health Organization introduced new pediatric growth charts to better reflect the growth of breast-fed babies. “And for good reasons,” said Kathryn C. Dewey, Ph.D., at an annual meeting of the American Academy of Pediatrics.
“Breast-fed babies tend to weigh less in their first year than formula-fed babies, with the most marked differences seen between ages 3 and 9 months. Pediatricians who are unaware of the differences tend to assume that breast-fed babies lagging behind the growth charts are inadequately nourished. As a result, too many mothers are advised to begin supplementing earlier than necessary,” says Dewey, director of the Program in International and Community Nutrition and professor of nutrition at the University of California.
Tracking a child’s individual growth
Pediatricians pay special attention to children whose growth is far from the average, but the critical factor for height and weight is not the absolute number but the rank. A drop in a child’s percentile ranking alerts parents and professional that something might be wrong.
In Blake’s situation, missing well-baby visits played a key role in his life. Because he was following multiple courses of antibiotic therapies and consistently running fevers, Blake was unable to receive routine vaccinations. Although he averaged visiting the doctor nearly once every six weeks, he had not been seen for a well-baby checkup in eight months.
Ramsey decided she wanted specialists to take a closer look at Blake. Collecting his health records, she took him to Ochsner Hospital in New Orleans. As the doctors reviewed Blake’s medical records, they quickly made one startling discovery. “Within two hours, a team of doctors said that Blake’s head circumference was below the norm,” Ramsey says. “Now I wish that we would have scheduled well-baby visits. I should have insisted that he be weighed and have his length and head circumference measured at each visit.”
Even though there’s no cure for micro-cephaly, Blake’s disgnosis, Ramsey says she wishes she had known her son had it sooner. “We could have been better-prepared for the diagnosis and begun treatment. And routine well-baby visits may have caught this earlier and given us that time.”
Gina Roberts-Grey is a freelance writer who frequently writes about family and parenting issues.