What are the key components of a well-child visit for a 2-month-old infant?

2-Month Well-Child Visit Template

Growth Assessment and Physical Examination

Plot weight, length, and head circumference on appropriate growth charts, using corrected age for premature infants born before 37 weeks gestation through at least 24 months of life. 1

Head-to-Toe Physical Examination Components:

• Skin: Assess color, perfusion, presence of rashes or lesions 1
• Head: Examine fontanelles for size and tension, assess head shape for abnormalities 1
• Eyes: Perform red reflex testing bilaterally to detect ocular media abnormalities; conduct binocular red reflex (Brückner) test for symmetry; inspect external ocular and periocular structures; assess pupillary responses and fixation/following behavior 1
• Ears: Examine tympanic membranes for appearance and mobility 1
• Nose: Assess nares for patency and any discharge 1
• Mouth: Examine oral cavity including palate integrity and tongue 1
• Cardiovascular: Auscultate heart for rate, rhythm, and presence of murmurs 1
• Respiratory: Auscultate lungs for air entry and abnormal sounds; assess respiratory rate and pattern 1
• Abdomen: Palpate for organomegaly, masses, or tenderness; assess umbilical cord site for complete healing and absence of infection 1
• Genitourinary: Examine external genitalia for abnormalities; assess urinary stream in males and genital appearance in females 1
• Musculoskeletal: Examine hips using Ortolani and Barlow maneuvers for developmental dysplasia 1
• Neurological: Evaluate tone, posture, primitive reflexes (Moro, grasp, rooting), and spontaneous movements; assess for any involuntary movements or coordination impairments 1

Developmental Milestones Assessment

By 2 months, infants should lift head and chest when placed prone, make eye contact, and demonstrate social smiling. 1

Ask parents specific developmental 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?"

For premature infants, subtract the number of weeks born early from chronological age to calculate corrected age for developmental assessment through at least 24 months. 1

Required Screenings

• Review newborn metabolic/hearing screening results if not previously documented 1
• Verify newborn hearing screening completion; if not done or concerns exist, arrange formal brainstem auditory evoked potential response testing 1
• Screen mothers for postpartum depression using a validated tool 2

Immunizations

Administer age-appropriate vaccines per CDC schedule: 1

• DTaP (2nd dose)
• IPV (2nd dose)
• Hib (2nd dose) - Note: Infants born prematurely should be vaccinated at the same chronological age as full-term infants 3
• PCV13 (2nd dose)
• Rotavirus (2nd dose)
• Hepatitis B (2nd dose if not already given)

For infants born to HBsAg-positive mothers, ensure proper hepatitis B vaccine and immune globulin administration was completed at birth. 1

Anticipatory Guidance

Nutrition

• Encourage exclusive breastfeeding through 6 months; cessation before 6 months is associated with childhood obesity 2
• Discuss proper formula preparation if formula-feeding 2
• Avoid introducing solid foods before 6 months as early introduction is associated with childhood obesity 2
• Avoid juice and sugar-sweetened beverages entirely before 1 year of age 2

Sleep Safety

• Emphasize supine positioning for all sleep to reduce SIDS risk 4
• Ensure firm sleep surface without soft bedding, pillows, or toys 4
• Discuss room-sharing without bed-sharing 4

Safety

• Verify proper rear-facing car seat installation; car seats must remain rear-facing until 2 years of age or until height/weight limit is reached 2
• Discuss water heater temperature (<120°F), smoke detectors, and never leaving infant unattended 4
• Address firearm safety if applicable - firearms should be stored unloaded and locked 4

Dental Health

• Begin oral hygiene by wiping gums with soft cloth after feedings 2
• Discuss fluoride supplementation if water supply is not fluoridated 2

Development and Interaction

• Encourage tummy time when awake and supervised to promote motor development 4
• Discuss age-appropriate play and social interaction 1
• Limit screen time - avoid all screens except video chatting before 18 months 2

Tobacco and Substance Exposure

• Screen for tobacco use in home or car; provide cessation resources if needed 4
• Assess for other environmental risks including substance use 4

Social Risk Assessment

Evaluate for social risk factors that may affect infant wellbeing: 4

• Untreated parental substance use
• History of child abuse or neglect
• Parental mental illness (beyond postpartum depression)
• Lack of social support, particularly for single first-time mothers
• Unstable housing
• History of domestic violence
• Barriers to follow-up care (transportation, language, access)

If significant risk factors are identified, coordinate with social services before discharge from visit. 4

Follow-Up Planning

• Schedule 4-month well-child visit 2
• Ensure parents understand how to contact medical home for urgent concerns 4
• Provide written instructions for common infant problems including fever management, feeding concerns, and when to seek immediate care 4