Recommended Assessments and Vaccinations for a 2-Month Well Visit
At the 2-month well visit, infants should receive DTaP, Hib, PCV, IPV, Rotavirus, and the second dose of Hepatitis B vaccines as part of the standard immunization schedule to protect against serious infectious diseases. 1
Physical Assessment Components
- Complete physical examination including head-to-toe assessment with special attention to growth parameters (weight, length, head circumference) plotted on standard growth charts 2, 3
- Assessment of developmental milestones appropriate for age 3
- Evaluation of feeding patterns, stooling, and sleeping habits 2
- Screening for any congenital abnormalities that may have been missed at birth 2
Recommended Vaccinations
Standard Vaccinations at 2 Months
- Hepatitis B (HepB): Second dose in the series (first dose given at birth) 1, 4
- Diphtheria, Tetanus, and acellular Pertussis (DTaP): First dose 1
- Haemophilus influenzae type b (Hib): First dose 1, 5
- Pneumococcal conjugate vaccine (PCV): First dose 1
- Inactivated Poliovirus (IPV): First dose 1
- Rotavirus (Rota): First dose 1
Special Considerations
- For infants born to HBsAg-positive mothers, ensure proper follow-up of the hepatitis B vaccination series that began at birth with both HepB vaccine and HBIG (Hepatitis B Immune Globulin) 1
- For preterm infants weighing <2,000 grams, the birth dose of HepB should not be counted in the series; they will need a total of 4 doses 1
- If using PRP-OMP (PedvaxHIB) for Hib vaccination, note that this requires only 2 primary doses (at 2 and 4 months) rather than 3 doses with other Hib vaccines 1, 5
Additional Screenings and Assessments
- Screening for maternal postpartum depression is recommended at this visit 2, 3
- Assessment of social determinants of health and family needs for community resources 2
- Evaluation of infant nutrition, including breastfeeding support or formula feeding guidance 2, 3
- Screening for any signs of child abuse or neglect 2
Anticipatory Guidance
- Safety: Discuss proper use of rear-facing car seats, water safety, and avoiding infant walkers 2, 3
- Sleep: Counsel on safe sleep practices and normal sleep patterns 2
- Nutrition: Discuss exclusive breastfeeding until 6 months or proper formula feeding techniques 2, 3
- Development: Provide information about expected developmental milestones by the next visit 3
- Oral Health: Discuss early oral hygiene practices even before tooth eruption 3
Addressing Vaccine Hesitancy
- If parents express concerns about vaccinations, provide evidence-based information about vaccine safety and efficacy 6, 7
- Explain that the risk of serious adverse effects from vaccines is much lower than the risk of complications from the diseases they prevent 7
- Acknowledge parental concerns while emphasizing the importance of following the recommended immunization schedule 7
Common Pitfalls to Avoid
- Failing to document growth parameters accurately: Always plot measurements on standardized growth charts to identify any concerning trends 2
- Missing the opportunity to screen for maternal depression: This screening is critical during the first 6 months of an infant's life 3
- Not addressing parental questions about vaccines: Take time to discuss concerns and provide educational materials 7
- Overlooking social determinants of health: These factors can significantly impact infant health outcomes 2
- Delaying vaccinations without medical indication: This can leave infants vulnerable to preventable diseases during a critical period 6