Newborn Checkup Schedule
Healthy newborns should be examined at 3-5 days (72-120 hours) after hospital discharge, followed by visits at 1,2,4,6,9, and 12 months of age. 1, 2, 3
First Week Visit (3-5 Days Post-Discharge)
The timing of this critical first visit depends on when the infant was discharged from the hospital 1:
- Discharged before 24 hours: Visit at 72 hours after discharge 1
- Discharged between 24-47.9 hours: Visit at 96 hours after discharge 1
- Discharged between 48-72 hours: Visit at 120 hours after discharge 1
Essential Components of the First Week Visit
Weight and hydration assessment are mandatory 1:
- Measure actual weight and calculate percentage change from birth weight 1
- Assess hydration through physical examination and feeding patterns 1
- For breastfed infants, directly observe breastfeeding position, latch quality, and swallowing effectiveness 1
- Document stool and urine output frequency and characteristics 1
Jaundice evaluation is critical because severe hyperbilirubinemia peaks during the first week 1:
- Measure total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) if any doubt exists about jaundice severity 1
- Do not rely on visual inspection alone, particularly in darkly pigmented infants 1
Complete physical examination should assess 1:
- General appearance and vital signs 1
- Umbilical cord for signs of infection, bleeding, or delayed separation 1
- Skin and genitalia 1
Laboratory and screening review 1:
- Review newborn metabolic screening results 1
- Confirm hearing screening completion 1
- Verify all state-mandated screenings 1
High-Risk Infants Requiring Earlier or More Frequent Follow-Up
Schedule earlier visits for infants with 1:
- Gestational age 35-38 weeks 1
- Jaundice in the first 24 hours of life 1
- Blood group incompatibility or hemolytic disease 1
- Exclusive breastfeeding with intake concerns 1
- Cephalohematoma or significant bruising 1
- Previous sibling who received phototherapy 1
- East Asian ethnicity 1
- Discharge before 48 hours of age 1
Standard Well-Child Visit Schedule
After the first week, follow the American Academy of Pediatrics periodicity schedule 2, 3:
Core Components at Each Visit
Developmental surveillance and screening 3:
- Developmental surveillance at every visit 3
- Formal developmental screening at 9,18, and 30 months 3
- Autism-specific screening at 18 and 24 months 3
Physical examination and growth monitoring 3:
- Complete head-to-toe examination 3
- Review and plot growth parameters 3
- Vision screening once between 3-5 years of age 3
Immunizations 3:
- Review and update according to CDC schedule 3
Maternal mental health screening 3:
- Screen for postpartum depression in mothers of infants up to 6 months of age 3
Special Circumstances
Prolonged Jaundice (Beyond 3 Weeks)
All newborns with jaundice persisting beyond 3 weeks require 4:
- Measurement of total and direct/conjugated bilirubin to identify cholestasis 4
- Verification of newborn screening results for thyroid and galactosemia 4
- Blood typing and Coombs test if not previously done 4
- Follow-up until complete resolution 4
NICU Infants
Newborn screening timing differs for NICU infants 5:
- Screen on day of birth prior to interventions 5
- Repeat screening at 1 and/or 2 weeks of life 5
- Additional screening as needed due to potential interference from aminoglycosides, blood transfusions, or heparinized solutions 5
Common Pitfalls to Avoid
Do not delay the first visit beyond the recommended timeframe - early visits are associated with a 15% reduction in readmission rates 6. However, only 15% of families actually complete visits within the recommended 72-hour window for early-discharge infants, representing a significant gap in care 6.
Do not rely on visual assessment alone for jaundice - this is particularly unreliable in darkly pigmented infants and can miss severe hyperbilirubinemia 1.
Do not discharge infants before 24 hours without ensuring appropriate follow-up - these infants require the earliest follow-up at 72 hours and have higher risk profiles 1.