What are the recommended assessments, screenings, and counseling points for a healthy term newborn at a 2‑week well‑child visit?

2-Week Well-Baby Visit: Essential Components

The 2-week well-baby visit should prioritize weight assessment with comparison to birth weight, direct observation of feeding technique, jaundice evaluation with bilirubin measurement if indicated, maternal postpartum depression screening, and verification of newborn screening results. 1

Growth and Physical Assessment

Weight evaluation is the single most critical measurement at this visit. Compare current weight to birth weight; weight loss exceeding 7-10% is concerning and requires immediate intervention 1. Measure length and head circumference, plotting all parameters on appropriate growth charts 1.

Hydration and Jaundice Evaluation

• Assess hydration status by examining skin turgor, mucous membranes, fontanelle fullness, and activity level 1
• Visually inspect for jaundice and obtain serum bilirubin if clinically indicated 1
• Major risk factors for significant jaundice include: jaundice in first 24 hours of life, blood group incompatibility, gestational age 35-36 weeks, previous sibling requiring phototherapy, exclusive breastfeeding with poor intake, and East Asian race 2

Complete Physical Examination

Perform a head-to-toe examination including vital signs, assessment of umbilical cord healing, skin condition, and genital health 2. Document adequate stool and urine patterns 2.

Feeding Assessment and Support

Direct observation of feeding is mandatory—do not rely solely on parental report, as this can miss feeding difficulties. 2, 1

For Breastfeeding Infants

• Directly observe breastfeeding technique, assessing position, latch, and swallowing 1
• Verify feeding frequency of 8-12 times per 24 hours 1
• Provide or refer for lactation support if feeding evaluation is not reassuring 1
• Avoid routine supplementation with water or dextrose water for non-dehydrated breastfed infants 2

For Bottle-Fed Infants

• Verify coordination of sucking, swallowing, and breathing 1

Laboratory and Screening Verification

• Review results of newborn metabolic screens performed before discharge 1
• Verify hearing screening completion 1
• Review maternal laboratory results including syphilis, hepatitis B surface antigen, and HIV status 1
• Verify newborn blood type and direct Coombs test results if clinically indicated 2
• Confirm pulse oximetry screening for congenital heart disease was completed 2
• If initial metabolic screening was performed before 24 hours of milk feeding, arrange repeat testing 2

Maternal and Psychosocial Assessment

Screen for maternal postpartum depression using a validated screening tool—this is a required component of the 2-week visit. 1

Family Risk Assessment

• Assess quality of mother-infant attachment and infant behavior 1
• 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

Safety Education and Anticipatory Guidance

Safe Sleep Practices

• Reinforce back-to-sleep positioning on firm surface 1
• Avoid co-sleeping 1
• Provide guidance on proper skin-to-skin care with monitoring to prevent sudden unexpected postnatal collapse 2

Car Safety

• Discuss appropriate use of car safety seats—rear-facing until age 2 or until height/weight limit is reached 1

Illness Recognition

• Review signs of illness, particularly jaundice 1
• Educate on temperature assessment and thermometer use 2
• Provide information on expected urination and stooling patterns 2

Maternal Vaccination

• Assess maternal Tdap vaccination status and administer if not previously received 2

Medical Home and Follow-Up Planning

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

Common Pitfalls to Avoid

Do not skip direct observation of feeding. Many feeding difficulties are missed when clinicians rely only on parental report 2. Do not dismiss parental concerns about growth based solely on percentiles. Parents may discount growth chart findings when interpreted as negative, favoring other comparisons 3. Ensure you explain what percentiles mean in understandable terms, as mothers frequently misunderstand their significance 3.