What should be included in a 2-month-old well-child check?

Components of a 2-Month-Old Well-Child Visit

A comprehensive 2-month well-child visit should include a complete history, physical examination, developmental assessment, immunizations, anticipatory guidance, and appropriate screenings to ensure optimal health outcomes and early identification of potential concerns.

History and Physical Examination

• Complete medical history including birth history, prior screenings, diet, sleep patterns, and medical, surgical, family, and social histories 1
• Head-to-toe physical examination with review of growth parameters (height, weight, head circumference) 1
• Assessment of vital signs including temperature, heart rate, respiratory rate, and blood pressure 1
• Evaluation of fontanelles, skin, eyes, ears, nose, mouth, heart, lungs, abdomen, genitalia, extremities, and neurological status 1

Vision and Hearing Assessment

• Red reflex testing to detect abnormalities of the ocular media 2
• External inspection of ocular and periocular structures 2
• Pupillary examination and assessment of fixation and following behavior 2
• Parental observations regarding the quality of the child's vision and eye alignment (poor eye contact after 8 weeks warrants further assessment) 2
• Assessment of response to sounds and auditory stimuli 1

Developmental Assessment

• Motor development assessment: By 2 months, infants should be able to lift head and chest when in prone position 2
• Assessment of social interaction, including eye contact and social smiling 2
• Developmental surveillance should be performed at every visit as recommended by the American Academy of Pediatrics 2

Immunizations

• Review and update immunizations according to the recommended schedule 1
• At 2 months, typically administer:
  • DTaP (diphtheria, tetanus, acellular pertussis) 3
  • IPV (inactivated poliovirus) 3
  • Hib (Haemophilus influenzae type b) 3
  • PCV (pneumococcal conjugate vaccine) 4
  • RV (rotavirus) 4
  • Hepatitis B (if not given at birth or 1 month) 5

Screenings

• Screening for maternal postpartum depression is recommended for mothers of infants up to six months of age 1
• Metabolic/newborn screening results should be reviewed if not done previously 2
• Assessment for risk factors that might warrant additional screening (family history of eye problems, genetic conditions) 2

Anticipatory Guidance

• Feeding guidance: Support for breastfeeding or formula feeding, introduction of solid foods (recommended after 6 months) 1
• Sleep positioning and safety: Back to sleep, safe sleep environment 1
• Car seat safety: Rear-facing until at least 2 years of age 1
• Prevention of illness: Hand washing, avoiding sick contacts 1
• Family adjustment to the infant 1
• Childproofing the home environment 1

Common Pitfalls and Caveats

• Failure to screen for maternal postpartum depression can lead to missed opportunities for intervention 1
• Incomplete immunizations at this critical age can leave infants vulnerable to preventable diseases 4
• Missing subtle developmental delays or vision/hearing issues that may be present even in apparently well-developing infants 2
• Not providing adequate anticipatory guidance about upcoming developmental milestones and safety concerns 1
• Overlooking family dynamics and support systems that may affect infant care 1

Follow-up Planning

• Schedule next well-child visit at 4 months of age 1
• Provide guidance on when to seek medical attention between visits 1
• Ensure parents understand vaccine schedule and importance of timely follow-up 4

Remember that the 2-month visit is a critical opportunity to establish a strong relationship with the family, address parental concerns, and ensure the infant is developing appropriately and receiving necessary preventive care 1, 6.