What are the recommended assessments and interventions for a well baby at a 2-week visit?

Well Baby 2-Week Visit: Recommended Assessments and Interventions

The 2-week well baby visit should focus on weight assessment, feeding evaluation with direct observation, jaundice screening, maternal postpartum depression screening, and verification that newborn screening results have been reviewed. This visit is critical for identifying conditions that may cause readmission and ensuring proper establishment of care 1, 2.

Physical Examination and Growth Assessment

• Weigh the infant and compare to birth weight, with weight loss >7-10% being concerning and requiring intervention 1, 2
• Measure length and head circumference, plotting on appropriate growth charts 2
• Assess hydration status by examining skin turgor, mucous membranes, fontanelle fullness, and activity level 1, 2
• Evaluate degree of jaundice through visual inspection and obtain serum bilirubin if clinically indicated 1, 2
• Perform a complete head-to-toe physical examination to identify any new problems 1

Common pitfall: Failing to obtain a bilirubin level when jaundice is visually apparent can lead to missed cases of severe hyperbilirubinemia requiring urgent treatment 2.

Feeding Assessment (Critical Component)

• Directly observe breastfeeding technique, assessing adequacy of position, latch, and swallowing 1, 2
• Review feeding frequency and duration—infants should be feeding 8-12 times per 24 hours 1, 2
• For bottle-feeding infants, verify coordination of sucking, swallowing, and breathing 1
• Provide or refer for lactation support if feeding evaluation is not reassuring 1, 2

Common pitfall: Not directly observing breastfeeding when there are concerns about weight loss or feeding adequacy misses the opportunity to identify and correct technique problems 2.

Elimination Patterns

• Obtain historical evidence of adequate stool and urine patterns—infants should have at least 6 wet diapers and 3-4 stools per day by this age 1, 2

Laboratory and Screening Review

• Review results of newborn metabolic screens performed before discharge 1, 2
• Verify that hearing screening was completed 1
• Review maternal laboratory results including syphilis, hepatitis B surface antigen, and HIV status 1
• Perform additional screenings as clinically indicated, particularly serum bilirubin if jaundice is present 1, 2

If metabolic screening was performed before 24 hours of milk feeding, repeat testing must be arranged per local or state policy 1.

Maternal and Family Assessment

• Screen for maternal postpartum depression using a validated screening tool 1, 2, 3
• Assess quality of mother-infant attachment and details of infant behavior 1, 2
• Screen for social risk factors including untreated parental substance use, history of child abuse or neglect, parental mental illness, lack of social support, housing instability, domestic violence history, and barriers to follow-up care 1, 2

Common pitfall: Not screening for maternal postpartum depression misses a critical opportunity for early intervention that affects both maternal and infant outcomes 2.

Anticipatory Guidance and Safety Education

• Reinforce safe sleep practices: back to sleep on firm surface, avoid co-sleeping 1, 2
• Discuss appropriate use of car safety seats—rear-facing until age 2 or until height/weight limit is reached 1, 2, 3
• Review signs of illness, particularly jaundice 1, 2
• Reinforce umbilical cord care, skin care, and temperature assessment 1, 2
• Provide instructions on expected urination and stooling patterns 1, 2

Car safety seats should be used only for travel and not for positioning in the home to reduce risk of positional asphyxia 1.

Establishing Medical Home and Follow-Up

• Verify the plan for ongoing health care maintenance, including method for obtaining emergency services 1, 2
• Ensure parents know how to reach the medical home and have emergency contact information 1, 2
• Schedule the next preventive care visit (typically 2-month well child visit) 2

Immunization Review

• Verify maternal Tdap vaccination status—if not previously vaccinated, mother should receive Tdap immediately postpartum 1
• Encourage other close contacts to receive Tdap if not previously vaccinated 1
• If delivery occurred during flu season and mother was not previously immunized, verify influenza vaccination was given 1

Note: The 2-week visit itself does not include routine infant immunizations, as the first vaccine series begins at 2 months 3, 4.