What does a 2-month well baby visit include?

2-Month Well Baby Visit Components

A 2-month well baby visit includes a comprehensive physical examination, growth assessment, developmental surveillance, administration of multiple vaccines (DTaP, Hib, PCV, IPV, Rotavirus, and second dose of Hepatitis B), and anticipatory guidance covering feeding, safety, and developmental milestones. 1, 2, 3

Physical Examination and Growth Assessment

• Perform a complete head-to-toe physical examination including vital signs assessment with heart rate (100-190 beats per minute awake, as low as 70 while sleeping quietly), respiratory rate (below 60 per minute), and axillary temperature (36.5°C to 37.4°C). 4

• Measure and plot growth parameters including weight, length, and head circumference on appropriate growth charts to assess trends over time. 2, 3

• Examine for developmental dysplasia of the hip (DDH) through physical examination at every well-baby visit, particularly checking for limited hip abduction, asymmetric buttock creases, and leg length discrepancy. 4

Immunizations

The 2-month visit is vaccine-intensive, requiring multiple simultaneous injections:

• DTaP (Diphtheria, Tetanus, acellular Pertussis) - first dose 1
• Hib (Haemophilus influenzae type b) - first dose 1
• PCV (Pneumococcal conjugate vaccine) - first dose 1
• IPV (Inactivated Poliovirus) - first dose 1
• Rotavirus vaccine - first dose 1
• Hepatitis B vaccine - second dose 1

Special vaccination considerations:

• For infants born to HBsAg-positive mothers, ensure proper follow-up of the hepatitis B series that began at birth with both HepB vaccine and HBIG. 4, 1
• For preterm infants weighing less than 2,000 grams at birth, the birth dose of HepB should not be counted in the series; these infants require a total of 4 doses. 4, 1
• Combination vaccines can reduce the number of injections and should be used when any components are indicated and others are not contraindicated. 4

Developmental Surveillance and Screening

• Conduct developmental surveillance at this visit, assessing age-appropriate milestones including social responsiveness, visual tracking, and early motor skills. 2

• Screen the birthing person for perinatal mood disorders including postpartum depression, which should be performed through the infant's first 6 months of life. 4, 3

Feeding Assessment

• Review feeding patterns and technique with particular attention to breastfeeding success, including observation of position, latch, and swallowing if breastfeeding. 4

• Document that the infant has completed at least 2 successful feedings and can coordinate sucking, swallowing, and breathing while feeding. 4

• Assess urination and stooling patterns to ensure adequate hydration and nutrition. 4

• Discuss vitamin D supplementation (if breastfeeding) and future introduction of solid foods (not before 6 months). 2, 3

Anticipatory Guidance

Safety counseling should cover:

• Car seat safety - infant should remain in rear-facing car seat until 2 years of age or until height/weight limit is reached. 2

• Safe sleep practices - supine positioning for sleeping, avoidance of co-sleeping, and safe sleep environment. 4, 3

• Recognition of illness signs particularly jaundice, fever, respiratory distress, and feeding difficulties. 4

Additional guidance topics:

• Umbilical cord care and skin care 4
• Temperature assessment and thermometer use 4
• Water safety 3
• Avoidance of infant walkers 3

Screening and Laboratory Tests

• Review results of newborn metabolic screening performed at birth, and arrange repeat testing if initial screening was done before 24 hours of milk feeding. 4

• Review newborn hearing screening results 4

• Screen families for social determinants of health and offer community resources for identified needs. 3

Medical Home Establishment

• Verify the plan for ongoing health care maintenance including methods for obtaining emergency services, preventive care schedule, and future immunizations. 4

• Schedule the 4-month well-child visit before the family leaves. 2

Common Pitfalls to Avoid

• Do not delay immunizations due to minor illnesses like upper respiratory infections without fever - these are not contraindications to vaccination. 4

• Do not count the birth dose of Hepatitis B in low-birth-weight infants (<2,000 grams) as part of the vaccine series. 4, 1

• Do not dismiss parental vaccine concerns - address vaccine hesitancy with empathetic discussion of risks versus benefits, emphasizing that serious vaccine side effects are far less common than risks from vaccine-preventable diseases. 3, 5

• Do not overlook maternal mental health screening - postpartum depression screening is a critical component of infant well-child visits through 6 months. 4, 3