What is included in a comprehensive development check at a 2-month exam?

Comprehensive Development Check at 2-Month Exam

A comprehensive development check at a 2-month exam should include assessment of gross motor skills (particularly head and chest lifting in prone position), physical growth measurements, neurological examination, vision and hearing screening, and parent education about expected developmental milestones.

Physical Growth Assessment

• Measure and plot complete vital signs including height, weight, and head circumference on standard growth curves (WHO or CDC) 1, 2
• Assess overall body habitus looking for appropriate growth patterns 3
• Compare measurements to previous values to establish growth trajectory 4

Developmental Assessment

Gross Motor Skills

• Assess ability to lift head and chest while in prone position (expected at 2 months) 1
• Observe spontaneous motor function, posture, and symmetry of movement 1
• Note any asymmetry in movement or tone which may indicate neuromotor concerns 1

Fine Motor Skills

• While specific fine motor milestones are not typically expected at 2 months, observe hand movement and whether hands are unfisted 1
• Note any tremors or unusual movements 1

Neurological Examination

• Perform cranial nerve examination including eye movements, pupillary reactivity, and facial expressions 1
• Assess muscle tone, strength, and deep tendon reflexes 1
• Observe quality and quantity of body posture and movement 1
• Note any use of extremities against gravity 1

Vision and Hearing Screening

• Check for red reflexes (should be detectable and symmetric) 1
• Assess response to visual stimuli 1
• Evaluate response to auditory stimuli 1

Parent Interview

Key Questions About Motor Development

• Ask parents: "Is there anything your child is not doing that you think he or she should be able to do?" 1
• Ask parents: "Is there anything your child is doing that you are concerned about?" 1
• Ask parents: "Is there anything your child used to be able to do that he or she can no longer do?" 1
• Ask parents: "Is there anything other children your child's age can do that are difficult for your child?" 1

Risk Factor Assessment

• Review prenatal, perinatal, and interval history 1, 5
• Assess for risk factors that might impact development 1
• For premature infants (less than 36 weeks gestation), consider correcting for prematurity 1

Parent Education

• Provide anticipatory guidance about expected developmental milestones for the next visit 1
• Discuss the importance of tummy time for motor development 1
• Explain the next expected milestones (by 4 months: rolling over prone to supine, supporting on elbows and wrists in prone, hands unfisted, playing with fingers in midline, grasping objects) 1

Screening Tools

• Consider using standardized developmental screening tools such as Ages and Stages Questionnaire (ASQ-III) if there are any concerns 1
• Document findings to establish baseline for future developmental surveillance 1

Common Pitfalls to Avoid

• Failing to correct for prematurity when assessing development in infants born before 36 weeks gestation 1
• Not allowing for normal variations in development while still identifying concerning patterns 6
• Overlooking subtle signs of neuromotor concerns such as asymmetry in movement or tone 1
• Focusing only on current skills without establishing a developmental trajectory 3
• Conducting the examination when the infant is tired or stressed, which may not yield accurate results 1