What are the essential components to assess during a 1-month well-child examination?

From the Guidelines

At a 1-month well-child examination, it is essential to assess the child's overall health, growth, and development, including vision screening, through a comprehensive physical examination, with special attention to the neurologic examination and evaluation of vision and hearing, as recommended by the most recent study 1. The assessment should include:

• A complete physical examination, with special attention to the neurologic examination and evaluation of vision and hearing
• Careful assessments of head circumference, weight, and length/height with interpretation of percentiles according to Centers for Disease Control and Prevention or World Health Organization growth curves
• Vision screening, including red reflex testing, external inspection of ocular and periocular structures, pupillary examination, and assessment of fixation and following behavior, as outlined in the study 1
• Discussion of the baby's developmental progress, such as beginning to focus on faces and respond to sounds
• Inquiries about the baby's environment, including safety measures at home and exposure to tobacco smoke
• Assessment of the parents' well-being, particularly maternal postpartum recovery, mood changes, and family adjustment to the new baby The 1-month visit is also an opportunity to discuss upcoming vaccinations, safe sleep practices, and strategies for soothing a fussy infant, as well as to establish a baseline for monitoring the baby's progress in subsequent visits, as suggested by the study 1. It is not necessary to discuss virtual violence at this age, as recommended by the study 1, since the child is only 1 month old and not yet exposed to media. The most recent and highest quality study 1 provides the best guidance for the essential components to assess during a 1-month well-child examination, and its recommendations should be prioritized.

From the Research

Essential Components of a 1-Month Well-Child Examination

The following components are essential to assess during a 1-month well-child examination:

• A complete history, including:
  • Birth history
  • Prior screenings
  • Diet
  • Sleep
  • Dental care
  • Medical, surgical, family, and social histories 2
• A head-to-toe examination, including a review of growth 2
• Immunizations should be reviewed and updated as appropriate 2
• Screening for postpartum depression in mothers of infants up to six months of age is recommended 2
• Developmental surveillance, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months 2
• Assessment of the child's environment, including:
  • Car seat safety (rear-facing until two years of age or until the height or weight limit for the seat is reached) 2
  • Fluoride use and dental health 2
  • Screen time and media use (avoiding screen time in children younger than 18 months, except for video chatting) 2
• Identification of potential health risks, including:
  • Childhood obesity (associated with cessation of breastfeeding before six months and transition to solid foods before six months) 2
  • Malnutrition, immunization status, level of development, and screening for 4 Ds (Defects at birth, Deficiencies, Diseases, and Developmental Delay including Disability) 3

Additional Considerations

• The approach to physical examination should consider age and developmental level 3
• The examination should be performed in a comfortable and pleasant environment, with playful behavior to yield maximum information from the examination 3
• The assessment should involve identification of hearing and visual assessment, and detection of child abuse 3
• Anticipatory guidance and parent education should be provided through age-appropriate counseling 4, 5, 6