What are the guidelines for a two-month well-child examination?

From the Guidelines

A two-month well child exam is a crucial healthcare visit that should include a thorough physical examination, particularly focusing on the assessment of developmental dysplasia of the hip (DDH), as recommended by the American Academy of Pediatrics 1. During this visit, the pediatrician will monitor the baby's growth by measuring weight, length, and head circumference. A complete physical examination will be performed to assess development, including a hip examination to screen for DDH. The hip examination is a critical component of the well-baby visit, as early detection of DDH is essential for effective treatment and prevention of long-term complications 1. The examination for DDH at this age includes the Ortolani and Barlow tests, which are designed to detect instability between the femoral head and acetabulum, indicating ligamentous or capsular laxity 1. Key points to be discussed during the visit include:

• Feeding patterns and nutritional advice
• Sleep habits and safety precautions
• Developmental milestones, such as smiling, following objects with the eyes, and making cooing sounds
• Any parental concerns about care, behavior, or development The visit also provides an opportunity for the pediatrician to educate parents on how to identify potential signs of DDH, such as asymmetric skin folds or limited hip abduction, and to emphasize the importance of follow-up visits to monitor the baby's development and detect any potential issues early on 1. The American Academy of Pediatrics recommends selective screening for DDH, focusing on children with risk factors, such as female gender, breech positioning in utero, and a positive family history 1.

From the Research

Two Month Well Child Exam

• The two month well child exam is a crucial check-up for infants, where healthcare providers assess the child's overall health, growth, and development 2.
• During this visit, the healthcare provider will review the child's 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, and immunizations should be reviewed and updated as appropriate 2.

Immunizations

• At two months of age, infants typically receive a combination of vaccines, including diphtheria, tetanus, and acellular pertussis (DTaP), hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b (Hib) 3, 4.
• The DTaP-IPV-HB-PRP-T vaccine has been shown to be safe and effective in infants, with high seroprotection rates for diphtheria, tetanus, and poliovirus, and geometric mean concentrations for pertussis 3, 4.
• Coadministration of the DTaP-HepB-IPV vaccine with PCV-7 and Hib has been found to be safe and well tolerated, with no significant differences in adverse events compared to separate administration of the vaccines 4, 5.

Safety and Adverse Events

• The safety of the DTaP-HepB-IPV vaccine coadministered with PCV-7 and Hib has been evaluated in several studies, with findings indicating that the combination vaccine is well tolerated and safe 4, 5.
• However, one study found that administration of the combination vaccine was associated with higher rates of irritability, fever, and some local symptoms compared to separate vaccines 4.
• Another study found that the incidence of any fever (> or =100.4 degrees F) was significantly higher in the Combination Vaccine Group, but the rate of fever >103.1 degrees F was < or =1.4% in both groups after any of the doses 5.