Categories: Feature Story
      Date: Aug  4, 2007
     Title: Exam Time

Well-baby visit sets a standard for health

By Gina Roberts-Grey

The cornerstone in the foundation of your baby's health is the well-child visit. This regular checkup gives you a chance to discuss your child's physical, emotional, social and developmental health with her physician.



The cornerstone in the foundation of your baby's health is the well-child visit. This regular checkup gives you a chance to discuss your child's physical, emotional, social and developmental health with her physician.

Whether you are a new parent or the parent of many, well-baby visits serve as the bridge between you and your baby's doctor. They provide a forum to discuss your child's growth and development, as well as age-specific issues related to safety, behavior, nutrition, potty training and recommended immunizations. Well-baby checkups 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 (AAP) recommends well-baby checkups at 2 to 4 days of age and then at 2, 4, 6, 9 and 12 months of age. In early childhood, middle childhood and adolescence, the AAP schedule calls for checkups at 15 months, 18 months, each year from ages 2 to 6 and every other year after that.

Twenty-month-old Blake had seen his pediatrician 14 times since he was born. At birth, Blake weighed almost eight pounds, placing him in the 75th percentile for weight, and he measured 21 inches in length, ranking him in the 54th percentile.

Early in his life, Blake's mother, Amy, began to sense something might be wrong. Blake seemed different from her first child. A cold or occasional fever would be expected, but Blake's frequent fevers often lingered for days. Nearly every trip to the doctor yielded a new prescription for Blake and a diagnosis of "fever of unknown origin" (FUO) or the suggestion that teething or an ear infection could be the cause. Despite numerous trips to the pediatrician's office, at age 6 months Blake was behind on his immunizations and his well-baby visits.

Weighing the Benefits

One important element of well-baby visits is assessing a child's physical development and his development trends. At these visits a parent might learn that 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 it is still rapid. 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 percent to 20 percent of their adult weight and four times as heavy as at birth. Each of these numbers is an average or standard typically further broken down by gender.

To understand your child's numbers, you also need to understand percentiles. 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," says Daniel Levy, M.D., spokesman for the American Academy of Pediatrics. "However, parents should not fixate on the percentages." A baby who's in the 95th percentile for height and weight isn't necessarily healthier than a baby who's in the fifth 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.

"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," said Kathryn C. Dewey, Ph.D., at the annual meeting of the American Academy of Pediatrics.

Pediatricians unaware of the differences tend to assume that breast-fed babies lagging their age-group peers on the growth charts are inadequately nourished. As a result, too many mothers are advised to begin supplementing with formula earlier than necessary, said Dewey, associate director of the Program in International Nutrition and professor of nutrition at the University of California, Davis.

Current growth charts for children 2 to 18 years old were based on a nationally representative sample, but charts for children under 2 were based on a study that, Dewey said, "has been since shown to have several limitations."

What's the Difference?

Chrissy Helfer, a licensed practical nurse in Syracuse, says, "Well-child checkups are different than visiting the doctor for an earache or upper respiratory infection." While both types of visit include listening to a child's breathing, taking his or her blood pressure 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 the growth and development of a child," says Helfer.

In addition to monitoring height and weight, well-baby exams can help keep your children healthy and assist in preventing illness and disabilities. "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," says Helfer. "A drop in a child's percentile ranking alerts parents and professionals that something might be wrong."

In Blake's situation, 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 one doctor visit every six weeks, he had not been seen for a well-baby checkup in eight months.

Amy decided she wanted specialists to take a closer look at Blake. Collecting his health records, Amy took Blake to the hospital. As the doctors reviewed Blake's medical records, they made a startling discovery. "Within two hours, a team of doctors said that Blake's head circumference was below the norm," says Amy. "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."

Health-care professionals probably would have noticed Blake's under-average growth after a series of well-baby examinations. Even though Blake was not able to receive the recommended immunizations, his mother believes that results of well-baby check-ups would have prompted further testing to determine the cause of his chronic illnesses. "We would have at least noticed that his head was not growing at the same rate as the rest of his body," she says.

The Physical

Parents should mention any concerns they have or areas they want the doctor or nurse practitioner to check out more specifically. Well-baby visits include assessing your baby's: