What are the recommendations for a 2-month well-child visit (Well Child Visit)?

From the Guidelines

A 2-month well-child visit should include routine vaccinations, such as DTaP, IPV, Hib, and PCV, as well as a physical examination to assess development and address any parental concerns. The pediatrician will measure the baby's weight, length, and head circumference to ensure proper growth, and perform a complete physical examination to check development 1. They will assess developmental milestones such as smiling, following objects with eyes, lifting the head during tummy time, and making cooing sounds. The doctor will discuss feeding patterns, sleep habits, and safety measures like proper car seat use and safe sleep practices.

• Key components of the visit include:
  • Routine vaccinations, such as DTaP, IPV, Hib, and PCV
  • Physical examination to assess development
  • Measurement of weight, length, and head circumference
  • Assessment of developmental milestones
  • Discussion of feeding patterns, sleep habits, and safety measures
• The visit also provides an opportunity to address any parental concerns about crying, colic, or other issues, and to establish a strong relationship with the child's healthcare provider 1.
• It is essential to note that the American Academy of Pediatrics (AAP) recommends periodic developmental screening using a standardized test, as well as continuous developmental surveillance throughout childhood 1.

From the FDA Drug Label

All children should receive four doses of IPV at ages 2,4,6 to 18 months, and 4 to 6 years. Infants 2 to 14 months of age should receive a 0.5 mL dose of vaccine ideally beginning at 2 months of age followed by a 0.5 mL dose 2 months later (or as soon as possible thereafter).

The recommendations for a 2-month well-child visit include:

• Administering the first dose of IPV (Inactivated Poliovirus Vaccine) at 2 months of age.
• Administering the first dose of Haemophilus b vaccine at 2 months of age, with a second dose to follow 2 months later. 2 3

From the Research

Recommendations for a 2-month Well-Child Visit

The following are recommendations for a 2-month well-child visit:

• A complete history should be taken, including information about birth history, prior screenings, diet, sleep, dental care, and medical, surgical, family, and social histories 4.
• A head-to-toe examination should be performed, including a review of growth 4.
• Immunizations should be reviewed and updated as appropriate 4, 5.
• Screening for postpartum depression in mothers of infants up to six months of age is recommended 4.
• Developmental surveillance should be performed at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months 4.
• Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached 4.
• Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health 4.
• The American Academy of Pediatrics recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months 4.

Immunization Schedule

• The combination DTaP-IPV/Hib vaccine is recommended to be administered at 2,4,6, and 15-18 months of age 5.
• The safety of DTaP-IPV/Hib vaccine has been assessed in a study, which found no unexpected safety risks 5.

Timing of Initial Well-Child Visit

• The first well-child visit should occur within 48 hours of discharge for newborns with a well-baby nursery length of stay of ≤48 hours, and within 3 to 5 days for those with a length of stay of >48 hours 6.
• Early visits have been associated with a 15% reduction in the rate of readmissions 6.

Preventive Pediatric Health Care

• The American Academy of Pediatrics has approved the 2017 Recommendations for Preventive Pediatric Health Care, which represents a consensus of AAP and the Bright Futures Periodicity Schedule Workgroup 7.
• These recommendations are designed for the care of children who are receiving competent parenting, have no manifestations of any important health problems, and are growing and developing in a satisfactory fashion 7.