Components of a 2-Month Well-Child Examination
A comprehensive 2-month well-child examination should include assessment of growth parameters, developmental milestones, physical examination, preventive care, and anticipatory guidance to ensure optimal health and development of the infant. 1
Growth Assessment
- Measurement and plotting of weight, length, and head circumference on appropriate growth charts 1
- Assessment of growth trajectory compared to previous measurements 1
- Evaluation of feeding patterns and nutrition intake 1
Developmental Assessment
- Assessment of ability to lift head and chest when placed in prone position 1
- Evaluation of social interaction, including eye contact and social smiling 1
- Assessment of fixation and following behavior with eyes 1
- Specific questions to parents about developmental concerns, such as:
- "Is there anything your child is not doing that you think he or she should be able to do?"
- "Is there anything your child is doing that you are concerned about?"
- "Is there anything your child used to be able to do that he or she can no longer do?" 1
Physical Examination Components
General Assessment
- Evaluation of overall appearance, activity level, and interaction with caregivers 1
- Assessment of skin color, perfusion, and presence of any rashes or lesions 2
Head, Eyes, Ears, Nose, and Throat
- Examination of fontanelles, shape of head, and presence of any abnormalities 2
- Red reflex testing to detect abnormalities of the ocular media 2
- Binocular red reflex (Brückner) test to assess for symmetry of the red reflexes 2
- External inspection of ocular and periocular structures 2
- Pupillary examination and assessment of fixation and following behavior 2
- Examination of tympanic membranes 2
- Assessment of nares for patency and any discharge 2
- Examination of oral cavity, including palate and tongue 2
Cardiopulmonary
- Auscultation of heart for rate, rhythm, and presence of murmurs 2
- Auscultation of lungs for air entry and any abnormal sounds 2
- Assessment of respiratory rate and pattern 2
Abdomen
- Palpation for organomegaly, masses, or tenderness 2
- Assessment of umbilical cord site for healing and absence of infection 2
Genitourinary
- Examination of external genitalia for any abnormalities 2
- Assessment of urinary stream in males and genital appearance in females 2
Musculoskeletal
- Evaluation of tone, posture, primitive reflexes, and spontaneous movements 1
- Assessment for any involuntary movements or coordination impairments 1
- Examination of hips for signs of developmental dysplasia 2
Neurological
- Assessment of primitive reflexes appropriate for age 1
- Evaluation of muscle tone and symmetry of movements 1
Screening
- Review of newborn metabolic screening results if not previously reviewed 1
- Review of newborn hearing screening results if not previously completed 1
- Assessment for risk factors that might warrant additional screening 1
Preventive Care
- Administration of age-appropriate immunizations according to the recommended schedule 2
- For infants born to HBsAg-positive mothers, ensure proper administration of hepatitis B vaccine and hepatitis B immune globulin 2
Anticipatory Guidance
- Discussion of basic infant care including bathing, skin care, and temperature measurement 1
- Guidance on safe sleep practices (back to sleep, firm mattress, no soft bedding) 3
- Information about normal developmental expectations for the next period 1
- Discussion of car seat safety (rear-facing position) 3
- Guidance on feeding practices and introduction of solid foods (typically not recommended until around 6 months) 3
Special Considerations
- For premature infants, developmental assessments should be corrected for gestational age 1
- Assessment for Brief Resolved Unexplained Events (BRUE) risk factors in infants with concerning history 2
- Screening for postpartum depression in mothers 3
By systematically addressing all these components during the 2-month well-child examination, healthcare providers can effectively monitor infant growth and development, identify potential concerns early, and provide appropriate guidance to parents or caregivers.