From the Guidelines
At a 1-month well child visit, you should perform a comprehensive assessment of the infant's growth, development, and overall health, including measuring and documenting weight, length, and head circumference, and conducting a complete physical examination, as recommended by the American Academy of Pediatrics 1. This assessment is crucial as it establishes baseline health parameters and identifies any early concerns requiring intervention during this period of rapid development. Begin by measuring and documenting weight, length, and head circumference, plotting these on growth charts to ensure appropriate growth patterns. Conduct a complete physical examination including assessment of fontanelles, reflexes, hip stability for dysplasia, eye tracking, and general appearance. Review feeding patterns, discussing breast milk or formula intake (typically 2-3 ounces every 2-3 hours at this age), and address any feeding concerns or questions about weight gain. Assess developmental milestones appropriate for this age, such as briefly lifting the head when prone, following objects to midline, and responding to sounds. Discuss normal sleep patterns and safe sleep practices (back to sleep, firm mattress, no loose bedding). Review safety topics including car seat use, avoiding secondhand smoke, and preventing falls. Address any parental concerns about crying, colic, or skin care. This visit typically does not include vaccinations unless the hepatitis B vaccine was missed at birth. Document all findings and parental education in the medical record. Additionally, consider inquiring about media use, as the American Academy of Pediatrics recommends that pediatricians ask at least 2 media-related questions at each well-child visit, including how much entertainment media per day the child is watching and whether there is a TV set or Internet access in the child's bedroom 1. However, at 1 month, this may not be directly applicable, but it sets the stage for future discussions on media use and its potential impact on the child's health and development. It is also essential to monitor growth and developmental milestones at each well-child visit, consistent with current well-child care guidelines, and provide parents with information on monitoring development so that concerns are recognized and appropriate interventions are initiated in a timely manner 1.
From the Research
1-Month Well-Child Visit
At a 1-month well-child visit, the following activities should be performed:
- A complete history should be taken, including information about birth history, prior screenings, diet, sleep, dental care, and medical, surgical, family, and social histories 2
- A head-to-toe examination should be performed, including a review of growth 2
- Immunizations should be reviewed and updated as appropriate 2
- Screening for postpartum depression in mothers of infants up to six months of age is recommended 2
- Developmental surveillance should be performed, although formal developmental screening is not recommended at this age 2
- Parents' or caregivers' questions should be answered and age-appropriate guidance should be provided 2
Safety and Prevention
- Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached 2
- Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health 2
- There is no specific recommendation for vision screening at this age, but a one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia 2
- Screen time should be avoided, with the exception of video chatting, in children younger than 18 months 2
Immunizations
- Hepatitis B vaccine is an important part of the immunization schedule, and its efficacy and safety have been well established 3, 4, 5
- The hepatitis B vaccine has been shown to be effective in preventing hepatitis B virus infection and its complications, including chronic liver disease and hepatocellular carcinoma 3, 4, 5