What are the key components of a 2-month well checkup for an infant?

2-Month Well-Child Checkup

The 2-month well-child visit should include comprehensive physical examination with growth assessment, developmental milestone evaluation, age-appropriate immunizations, and anticipatory guidance for caregivers. 1

Growth Assessment and Vital Signs

Measure and plot weight, length, and head circumference on appropriate growth charts to track growth trajectory and identify deviations from expected patterns. 1, 2 For premature infants, correct all growth measurements for gestational age by subtracting the number of weeks born early from chronological age—this correction should continue through at least 24 months for developmental assessments and through 36 months for growth in extremely and very preterm infants. 1

Physical Examination Components

Head and Neurological

• Examine fontanelles for size and tension, assess head shape for abnormalities such as craniosynostosis. 1
• Evaluate tone, posture, primitive reflexes, and spontaneous movements to identify neurological concerns. 1
• Assess for any involuntary movements or coordination impairments. 1

Eyes

• Perform red reflex testing bilaterally (Brückner test) to detect abnormalities of the ocular media such as cataracts or retinoblastoma and assess symmetry. 1
• Conduct external inspection of ocular and periocular structures. 1
• Perform pupillary examination and assess fixation and following behavior. 1

Ears, Nose, Throat

• Examine tympanic membranes. 1
• Assess nares for patency and any discharge. 1
• Examine oral cavity, including palate and tongue. 1

Cardiovascular and Respiratory

• Auscultate heart for rate, rhythm, and presence of murmurs that may indicate congenital heart disease. 1
• Auscultate lungs for air entry and any abnormal sounds. 1
• Assess respiratory rate and pattern. 1

Abdomen and Umbilicus

• Palpate for organomegaly, masses, or tenderness. 1
• Assess umbilical cord site for complete healing and absence of infection. 1

Genitourinary

• Examine external genitalia for any abnormalities. 1
• Assess urinary stream in males and genital appearance in females. 1

Musculoskeletal

• Examine hips for signs of developmental dysplasia using appropriate maneuvers. 1

Skin

• Assess skin color, perfusion, and presence of any rashes or lesions. 1

Developmental Assessment

By 2 months, infants should lift head and chest when placed prone. 1 Social interaction should include making eye contact and demonstrating social smiling. 1

Ask parents specific developmental screening questions: 1

• "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?"

Note that poor eye contact after 8 weeks warrants further assessment. 1

Hearing Assessment

Review results of newborn hearing screening if not done previously. 1 If not completed or if there are concerns, a formal assessment of hearing (brainstem auditory evoked potential response) should be performed. 1

Required Screenings

Review metabolic/newborn screening results if not previously reviewed. 1 Assess for risk factors that might warrant additional screening. 1

Immunizations

Administer age-appropriate immunizations according to the CDC recommended schedule. 1 For infants born to HBsAg-positive mothers, ensure proper administration of hepatitis B vaccine and hepatitis B immune globulin. 1

Anticipatory Guidance

Discuss basic infant care including bathing, skin care, and temperature measurement. 1 Ensure caregivers understand developmental expectations for the next period. 1

Common Pitfalls to Avoid

• Do not skip corrected age calculations for premature infants—using chronological age alone can lead to unnecessary referrals or missed delays. 1
• Do not rely on visual assessment alone for developmental concerns—use structured questions and objective observations. 1
• For premature infants born <32 weeks or <45 weeks postconceptional age, maintain heightened surveillance as they are higher-risk for Brief Resolved Unexplained Events (BRUE) and other complications. 1