What is the typical schedule for well child checks and what assessments are performed during these visits?

Well-Child Check Schedule

The American Academy of Pediatrics recommends well-child visits at 1-2 weeks, then at 2,4,6,9,12,15,18,24, and 30 months during infancy and early childhood, followed by annual visits thereafter. 1

Visit Schedule by Age

Infancy (First Year)

• 1-2 weeks of age: Initial newborn visit after hospital discharge 1
• 2,4, and 6 months: Monthly visits during rapid growth period 1
• 9 and 12 months: Visits spaced at 3-month intervals 1

Toddler Years (1-3 Years)

• 15,18,24, and 30 months: Visits continue at regular intervals 1, 2
• Note: If the 30-month visit is not feasible due to reimbursement or scheduling issues, screening can be performed at 24 months 2

Preschool and Beyond

• Annual visits starting at 3 years of age through adolescence 3
• Some practitioners individualize frequency based on family needs after school entry 4

Core Components at Each Visit

History Assessment

• Birth history and prior screenings 3
• Diet, sleep patterns, and dental care 3
• Medical, surgical, family, and social histories 3
• Reproductive life planning for adolescent females at every visit 1

Physical Examination

• Complete head-to-toe examination at every visit 3
• Growth assessment including height, weight, and head circumference (when age-appropriate) 3
• Testicular examination for quality and position at each visit in males 1
• Hip examination for developmental dysplasia, particularly in infancy 1
• Neurologic examination with emphasis on muscle tone assessment 1

Developmental Surveillance and Screening

Developmental surveillance should occur at every well-child visit, with formal standardized screening at specific intervals 1, 2:

• 9 months: First formal developmental screening 1, 2
• 18 months: Developmental screening plus autism-specific screening 1, 2
• 24 months: Autism-specific screening 1
• 30 months: Developmental screening 1, 2
• 48 months: Final early childhood developmental screening 1

Sensory Screening

Vision:

• One-time screening between 3-5 years of age to detect amblyopia 3
• Age 8 and beyond: Continue vision screening using age-appropriate methods (HOTV chart, Lea symbols, or tumbling E) 5

Hearing:

• Newborn hearing screening before hospital discharge 1
• Ongoing surveillance at each visit consistent with AAP periodicity schedule 1
• Audiological assessment by 24-30 months for all infants with risk indicators for hearing loss 1

Behavioral and Mental Health Screening

• Maternal postpartum depression screening for mothers of infants up to 6 months of age 3, 1
• Behavioral assessment for attention, learning, and emotional concerns in school-age children 5
• Social interactions, bullying prevention, and mental health concerns (depression/anxiety) in school-age children 5

Laboratory and Risk Assessment

• Dyslipidemia risk assessment including family history of early cardiovascular disease, recommended for school-age children 5
• Cryptorchidism monitoring: Refer by 6 months corrected age if testes remain undescended 1
• Serum creatine kinase for children with decreased muscle tone 1
• Brain MRI for children with increased muscle tone 1

Immunizations

• Review and update immunizations according to current CDC schedule at each visit 3

Anticipatory Guidance Topics

Nutrition

• Breastfeeding support: Continue exclusively for 6 months 3
• Solid food introduction: Not before 6 months of age 3
• Juice avoidance: No juice before 1 year; limited quantities after 1 year 3
• Weaning to cup: By 12 months of age 3
• Healthy eating habits and appropriate portion sizes for school-age children 5

Safety

• Car seat positioning: Rear-facing until 2 years or until height/weight limit reached 3
• Booster seat use and proper seat belt use for school-age children 5
• Helmet use for biking and sports 5
• Water safety and drowning prevention 5
• Firearm safety when applicable 5

Screen Time

• Avoid screen time (except video chatting) before 18 months 3
• Limit to 1 hour daily for children 2-5 years 3
• Reasonable limits on recreational screen time for school-age children 5

Physical Activity

• 60 minutes of physical activity daily for school-age children 5

Dental Health

• Fluoride supplementation as appropriate 3
• Limiting juice consumption 3
• Regular dental care discussion 3

Special Populations

Premature Infants

• Correct for gestational age when assessing development and scheduling interventions 1
• Higher prevalence of cryptorchidism (15-30% vs 1-3% in term infants) 1
• Spontaneous testicular descent unlikely after 6 months corrected age 1

Children with Special Health Care Needs

• Longer visit duration (36% longer than typical visits) 6
• Address chronic conditions alongside routine health supervision 6
• Initiate chronic-condition management when developmental disorders identified 2

High-Risk Infants

• More frequent audiological assessments for infants who received ECMO or have CMV infection 1
• Middle-ear status assessment at all visits; refer for otologic evaluation if effusion persists ≥3 months 1

Common Pitfalls to Avoid

• Conducting only sports physicals rather than comprehensive well-child assessments 5
• Failing to ask open-ended questions about parent/child concerns at visit start (occurs in only 39% of visits) 6
• Missing motor delays: Use validated screening tools rather than clinical judgment alone 1
• Delaying referrals: Pursue diagnostic evaluations while concurrently referring to early intervention programs 1
• Overlooking vision screening which can significantly affect learning and development 5
• Missing acquired cryptorchidism: Document testicular position at every visit, as ascent can occur after initial descent 1
• Inadequate anticipatory guidance: Studies show fewer than half of recommended age-specific topics are addressed 6