Well Child Care

Congratulations! Your baby is finally here. Newborns are wonderful, but  exhausting! Having friends or family around to provide extra help and support can be very helpful. Make sure all visitors wash their hands well. Your baby’s first visit to our office takes place during his or her first week of life, usually 2-3 days after you are discharged from the hospital. This is not a well visit, but otherwise considered a newborn office visit.  We do a lot at this visit, including:

• Check your baby’s weight.
• Monitor for signs of jaundice.
• Check to see how your baby is feeding.
• Provide a referral for breastfeeding consultation with a local Lactation Consultants (if needed).
• Answer questions about your new baby.

Immunizations: HepB#1 (if not given in hospital)
Tests/Screens/Assessments: None
Helpful Info: Caring for Your Newborn Bright Futures Parent Info

The 7-10 Day Visit is a time for us to re-assess how your baby is doing with feeding, sleeping, elimination, and general comfort.  This is not a well visit, but otherwise considered a newborn office visit.  Babies usually lose weight right after birth, and we like them to have re-gained their birth weight by 10 days.  Please remember that it is important to always put your baby to sleep on his or her back in a flat, firm and separate sleep space to reduce the risk of SIDS. As always, we are here to answer questions and offer anticipatory guidance.

Friends and family may offer help. Please honor them and take them up on their offer because they will soon stop asking.  They can just sit in the room with the baby while you take a long shower, eat a good meal, or take a walk on your own.  If you don't feel they can help with direct care of the baby, then let them do some of the following for YOU:  cut your grass, rake your leaves, shovel your snow, pickup some groceries, address your thank you notes, or fold your laundry. 

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Remind you to give your baby a daily supplement of 400 IU of vitamin D drops if you are breastfeeding.

Immunizations: None
Tests/Screens/Assessments: None
Helpful Info: Vitamin D for Babies, Back to Sleep Bright Futures Parent Info

Families are usually settling in some by this visit. Feeding, sleeping and bowel habits are sometimes a concern. At this visit we will track your baby's growth and development and answer any questions. Your baby may be  starting to spontaneously smile now and should be obviously responding to bright lights and loud sounds.  As you are likely to be traveling more frequently with your newborn, it's a good idea to make sure all of your vehicles have securely installed infant car safety seat base.

Immunizations: HepB#2
Tests/Screens/Assessments: Post Partum Depression Assessment
Helpful Info: Back to Sleep, Tummy to Play
Please Complete Before Your Visit: Post Partum Depression Assessment, add child to your insurance policy Bright Futures Parent Info

Many babies seem more fussy or colicky at this age. Be patient. Colicky babies eventually outgrow their crying phase. Keeping your baby safe is the most important thing you can do. Even if you feel frustrated, handle your baby gently and reach out for help to friends, relatives, or your pediatrician if the crying is getting to be too much. If you need a break and noone is available to help you, place your baby on his/her back gently in a safe space such as a crib or bassinet and take a 4-5 minutes out of hearing range of your baby to calm down.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s first set of immunizations. Immunizations are safe, effective, and keep your child and our community healthy. During this visit, you will be able to discuss any questions you may have about immunizations.
• Screen for post-partum depression.

Immunizations: Pentacel #1 (DTaP/HIB/IPV), PCV13 #1, Rotavirus#1
Tests/Screens/Assessments: Post Partum Depression Assessment
Helpful Info: Colic, Crying and Your Baby: How to Calm a Fussy or Colicky Baby, Acetaminophen dosing chart
Please Complete Before Yor Visit: Post Partum Depression Assessment, 2 mo ASQ (Ages and Stages Questionnaire)  Bright Futures Parent Info

Your baby is becoming more active and verbal. Be careful not to leave your baby unattended, especially on a bed, couch, or counter. They move faster than you think! Babies need only breast milk or iron fortified formula for the  first 4-6 months of life. We will talk at this appointment about the appropriate time to introduce solid foods and what foods to introduce first.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss when to start feeding your baby solid foods
• Screen for post-partum depression.

Immunizations: Pentacel #2 (DTaP/HIB/IPV), PCV13 #2, Rotavirus #2
Tests/Screens/Assessments: Post Partum Depression Assessment
Helpful Info: Your Child's Development
Please Complete Before Yor Visit: Post Partum Depression Assessment  Bright Futures Parent Info

Your baby will begin to move more and will be able to sit up independently for short periods of time. Now is the time to start baby-proofing your house if you haven't already done so. You should move the mattress in your baby's  crib down to the lowest level.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss the introduction of fluoridated water to encourage the development of strong and healthy teeth. If you have city or rural water, your water is fluoridated. If you have well water, you should have your water tested for fluoride before offering it to your baby.
• Screen for post-partum depression.

Immunizations: Pentacel #3 (DTaP/HIB/IPV), PCV13 #3, Rotavirus #3
Tests/Screens/Assessments: Post Partum Depression Assessment, TB Surveillance, Lead Surveillance, Oral Health Surveillance
Helpful Info:  MD Poison Center (888-222-1222), Starting Solid Foods, AAP Video on Starting Solids, Suggested Feeding Schedule, Your Child's Development, •Instructions for Introduction of Peanut Products to Infants
Please Complete Before Yor Visit:  Ages and Stages, Post Partum Depression Assessment Bright Futures Parent Info

Your baby may be starting to crawl, pulling to a stand, and cruising on furniture. Babies will want to touch everything; this is how they learn. This is  a messy time! Have fun and be patient.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Discuss your baby's upcoming dental care. Your baby should see a dentist at 1 year of age. You should be brushing your child's teeth with an infant toothbrush and a tiny smear of fluoride toothpaste. We will provide you with a list of dentists and encourage you to schedule your baby's first appointment.

Immunizations: Hep B #3
Tests/Screens/Assessments: Ages and Stages Questionnaire, Oral Health Surveillance
Helpful Info: Caring for Your Child's Teeth, Your Child's Development, Suggested Feeding Schedule, MD Poison Center (888-222-1222)
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

At this age, your baby can transition from breast milk or formula to cow’s milk, however it is healthy to continue breast milk if that is what you prefer for your baby. Most babies need 3 meals, 2-3 snacks per day, and no more than 16-20 ounces of whole cow's milk per day. Your baby will be able to eat many of the foods you eat, but be careful to avoid small, hard foods that can cause choking. It is time to wean your child from the bottle and offer all liquids in a sippy cup. It is much easier to wean your child now than if you wait until they are older - avoid cavities and additional tears and make the change now!

Your baby will be outgrowing the infant carrier car seat. Continue to have your baby in a rear facing  seat as long as possible up to the maximum height or weight allowed by the care seat manufacturer.

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss dental health 
• Screen your baby for amblyopia (lazy eye) with our ocular photoscreen device.

Immunizations:  MMR #1, Varicella #1 (Chicken Pox), PCV 13 #4, HepA#1
Tests/Screens/Assessments: TB Surveillance, Lead Testing, Anemia Testing, Oral Health Surveillance, Vision Photoscreen
Helpful Info: Playing Is How Toddlers Learn, Your Child's Development, Suggested Feeding Schedule, MD Poison Center (888-222-1222)
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

Your child may be able to climb and run, so be sure to safety proof your home. Poison control is available 24 hours a day: 1-800-222-1222 - keep this number handy in your cell phone and on your refrigerator.  

At this visit we will:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.

Immunizations:  Pentacel #4 (DTaP/HiB/IPV)
Tests/Screens/Assessments: Anemia Surveillance
Helpful Info: Choking Prevention and First Aid for Infants and Children, 
MD Poison Center (888-222-1222)
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

At 18 months, your child understands much more than he or she can say in words. Use words to describe your child’s feelings and gestures. Read and sing to your child often. When reading, use simple words to talk about the  pictures.

At this visit we will:

• Measure your child’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Review your child’s development with you using the M-CHAT developmental questionnaire (autism screening tool) and the Ages and Stages Questionairre.
• Discuss dental health.
• Discuss temper tantrums.

Immunizations: Hep A #2
Tests/Screens/Assessments: Ages and Stages Questionnaire, MCHAT Questionnaire, TB Surveillance, Anemia Surveillance, Lead Surveillance, Oral Health Surveillance
Helpful Info: Weaning from the Pacifier, Is Your Toddler Communicating With You?, MD Poison Center (888-222-1222)
Please Complete Before Your Visit: Ages and Stages Questionnaire, MCHAT Questionnaire Bright Futures Parent Info

At this age, your 2 year old may go from trying to be independent to clinging to you; this is normal. It is better for toddlers to play than to watch TV. Even having television playing in the background interrupts healthy toddler play - background music is a better choice.

At this visit we will:

• Measure your child’s weight, length, head size and Body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit. Your child may need immunizations if they are behind on their shots.
• Review your child’s development with you using the MCHAT (Autism screening tool) questionnaire.
• Screen your baby for amblyopia (lazy eye) with our ocular photoscreen device.
• Discuss dental health
• Discuss toilet training and time out.

Immunizations: Flu vaccine during flu season
Tests/Screens/Assessments: MCHAT Questionnaire, TB Surveillance, Anemia Surveillance, Lead Surveillance, Dyslipidemia Surveillance, Lead Test, Vision Photoscreen
Helpful Info: Playground Safety, Toilet Training, Suggested Feeding Schedule
Please Complete Before Your Visit: Ages and Stages Questionnaire, MCHAT Questionnaire Bright Futures Parent Info

Your baby is not really a baby anymore. They are firmly in the toddler years.  One moment they seem so big and the next still very small. This is the "do-it-myself time."  But they still need parents to be there when things don't turn out as expected. Toddlers will look to parents to give them the freedom to try and the room to fail.  There are so many activities your toddler will love at this age including reading, coloring, singing, dancing, puzzles, and imaginary play. 

At this visit we will:

• Measure your child’s weight, length, head size and Body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit. Your child may need immunizations if they are behind on their shots.
• Assess your child's development and consider repeating an Autism Screen if necessary.
• Screen your baby for amblyopia (lazy eye) with our ocular photoscreen device.
• Discuss dental health
• Help prepare parents for sleeping, eating, and tantruming issues associated with this age.

Immunizations: Flu vaccine during flu season
Tests/Screens/Assessments: Ages & Stages Developmental Screening, Anemia Surveillance, Oral Health Surveillance,
Helpful Info: Temper Tantrums: A Normal Part of Growing Up
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

Your child will likely be moving into a world of make believe that they create with their imagination. Toys for dress up and make believe are important at  this age. Read books, sing songs and play rhyming games with your child each day.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit. Your child may need immunizations if they are behind on their shots or duirng flu season.
• Discuss dental health.

Immunizations: Flu vaccine during flu season
Tests/Screens/Assessments: TB Surveillance, Lead Surveillance, Oral Health Surveillance, Vision Testing, 
Helpful Info: Toilet Training, Temper Tantrums
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

Four year olds often like to sing, dance and act. They like to tell "tall tales" and make up stories. Enjoy these fun moments with your little one! Parents  should continue to help with brushing teeth even though your child will want to do it all by themselves.

At this visit we will:

• Measure your child’s weight and height and body mass index and record on a growth curve.
• Provide your child's immunizations.
• Discuss dental health.

Immunizations: MMR#2, Var#2 DTaP#5, IPV#4
Tests/Screens/Assessments: TB Surveillance, Anemia Surveillance, Lead Surveillance, Dyslipidemia Surveillance, Oral Health Surveillance, Vision Testing, Hearing Testing
Helpful Info: Encourage Your Child to Be Physically Active, Suggested Feeding Schedule
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

At this age, your child needs more independence. However, you need to set clear limits. A regular bedtime and consistent bedtime routine are important. Be a great role model. Show an interest in what they are learning. 

At this visit we will:

• Measure your child’s weight and height and body mass index and record on a growth curve Review your child’s speech and development
• Discuss exercise and nutrition
• Vision and Hearing Screens
• Discuss kindergarten readiness
• Discuss dental health

Immunizations: Administer any final booster doses not done a the 4 year visit.
Tests/Screens/Assessments: TB Surveillance, Anemia Surveillance, Lead Surveillance, Oral Health Surveillance, Vision Testing, Hearing Testing, 
Helpful Info: Bedtime Hassles
Please Complete Before Your Visit: Ages and Stages Questionnaire Bright Futures Parent Info

Encourage good learning by helping your child organize a distraction-free time to do homework and ensuring eleven hours of sleep each night. Teach your child what to do if there is a fire and   have practice fire drills. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

At this visit we will:

• Measure your child’s weight and height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Discuss exercise and nutrition
• Review safety issues

Immunizations: None
Tests/Screens/Assessments: TB Surveillance, Anemia Surveillance, Lead Surveillance, Dyslipidemia Surveillance (Lipid profile testing for those with risk factors), Oral Health Surveillance, 
Helpful Info: Helping Children Help Themselves Bright Futures Parent Info

Continue to encourage good nutrition and exercise for your child. This is the time he or she is building good health habits for a lifetime! There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Discuss exercise and nutrition
• Review safety issues

Immunizations: None
Tests/Screens/Assessments: Vision Surveillance, Hearing Surveillance, TB Surveillance, Anemia Surveillance
Helpful Info: Growing Up Healthy: Fat, Cholesterol, and More Bright Futures Parent Info Patient Handout

Ensure that your child ALWAYS wears a helmet when bicycling, skateboarding, scooter riding and skating. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Discuss exercise and nutrition
• Review safety issues

Immunizations: None
Tests/Screens/Assessments: TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance.
Helpful Info: About Bicycle Helmets, Bedwetting Bright Futures Parent Info Patient Handout

Your child be is becoming more responsible and will be able to take on more tasks such as taking care of his/her own room. He or she may also start reading independently for pleasure.  

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Discuss exercise and nutrition
• Review safety issues

Immunizations:  None
Tests/Screens/Assessments: Vision Surveillance, Hearing Surveillance, TB Surveillance, Anemia Surveillance, Lipid Profile testing (completed once between 9-11 years)
Helpful Info: Chores, Age-Appropriate Bright Futures Parent Info Patient Handout

Your ten year old still requires adult supervision when you are away. Watching TV with your child allows you to discuss any controversial topics that may come up.  

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Discuss exercise and nutrition
• Discuss puberty changes to expect or that may be starting to occur

Immunizations: None
Tests/Screens/Assessments: TB Surveillance, Anemia Surveillance, Lipid Profile (completed once between 9-11 years)
Helpful Info: Puberty: Ready or Not, Expect Some Big Changes Bright Futures Parent Info Patient Handout

Your child may be transitioning to middle school at this age. He or she may be participating in more group activities. Expand your conversations about healthy living practices to include tobacco, drug and alcohol avoidance.  

At this visit we will:

• Measure your child’s weight. height and body mass index and record on a growth curve
• Provide your child’s immunizations
• We will screen your child's vision and hearing
• Screen your child for anemia and dysipidemia per AAP recommendations Review your child’s school performance and development Discuss exercise and nutrition
• Discuss puberty changes to expect or that may be starting to occur

Immunizations:  Tdap #1, MCV#1, HPV#1 
Tests/Screens/Assessments: Vision Surveillance, Hearing Surveillance, TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance, Lipid Profile (completed once between 9-11 years)
Helpful Info: Substance Abuse Prevention Bright Futures Parent Info Patient Handout

Your child will be in middle school at this age. Continue your conversations about healthy living practices to include tobacco, drug and alcohol avoidance. Your child should be able to assume more responsibility for   personal hygiene and chores. There are no scheduled immunizations at  this visit unless your child is behind and needs to catch up on immunizations.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Complete sports physical forms and discuss sport safety (if your child is participating in sports)
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet
• Discuss puberty changes to expect or that may be starting to occur

Immunizations: HPV (if not already done)
Tests/Screens/Assessments: Hearing Surveillance, TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance 
Helpful Info: Substance Abuse Prevention, Establishing Chores and Routines Bright Futures Parent Info Patient Handout

Even though friends are becoming more important at this age, having a caring adult to provide a listening ear and from which to obtain accurate health information is equally important. Foster open communication with your child. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of the visit with the parent out of the room.

At this visit we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Review your child’s school performance and development
• Complete sports physical forms and discuss sport safety (if your child is participating in sports)
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet
• Discuss puberty changes to expect or that may be starting to occur

Immunizations: None
Tests/Screens/Assessments: Vision Surveillance, Hearing Surveillance, TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance, Adolescent Screening (Depression, Anxiety, STI Substance Use, High Risk Exposures)
Helpful Info: Helping Your Child Cope With Conflict, Talking With Your Teen About Sex, Adolescent Screening Bright Futures Parent Info Patient Handout

Your child may be showing an increasing interest in extracurricular activities. Have conversations about risk taking behaviors, driving, alcohol, drug use, family rules and expectations. Discuss media and internet safety. Make certain that they have an adult they can  confide in if they are unable to communicate with you. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of the visit with the parent out of the room.

At these visits we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Complete sports physical forms and discuss sport safety (if your child is participating in sports)
• Review your child’s school performance and development
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet

Immunizations: None
Tests/Screens/Assessments: Vision Surveillance, Hearing Surveillance, TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance, Adolescent Screening (Depression, Anxiety, STI Substance Use, High Risk Exposures) 
Helpful Info: Talking With Your Teen
Please Complete Before Your Visit: Adolescent Screening Bright Futures 14 Year Parent Info 14 Year Patient Handout Bright Futures 15 Year Parent Info 15 Year Patient Handout

Congratulations! Your child is becoming a young adult! It is exciting to see the wonderful person your child is becoming. Possible conflict can arise at this time as your teen assesses your family values versus those of culture and peers.

During these teen years, we provide the opportunity for your young adult to have most of the visit with the parent out of the room.  We will always engage parents to ask about any concerns or changes and to communicate our findings at the end of the visit.

At these visits we will:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Provide your child's immunizations
• Complete sports physical forms and discuss sport safety (if your child is participating in sports)
• Review your child’s school performance
• Reinforce healthy choices and risk behavior avoidance Perform any recommended yearly screening tests (depending on family history, sexual activity etc.)
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet

Immunizations: MCV#2, Men B (optional)
Tests/Screens/Assessments: Vision Surveillance, Hearing Surveilllance, TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance, Adolescent Screening (Depression, Anxiety, STI Substance Use, High Risk Exposures) , Urine Chlamydia Screen (females), Hemoglobin Test (females)
Helpful Info: Safe Driving…A Parent's Responsibility, Dating Violence
Please Complete Before Your Visit:  Adolescent Screening Bright Futures 16 Year Parent Info 16 Year Patient Handout Bright Futures 17 Year Parent Info 17 Year Patient Handout

Your are now transitioning to adult life!  You may still look to your parents for support and guidance, but you are legally on your own when it comes to decision making.

During these visits,  you will typically visit the office on your own.  Though parents, if present, will be out of the room for the entire visit, they will still provide valuable input regarding updated family history and can assist you with symptom reporting.

At these visits we will:

• Discuss transitions to life after high school—whether that be work, travel, military, vocational school, or college
• Discuss importance of responsible decision making and recognizing healthy -vs- unhealthy relationships
• Complete college physical forms and any required college screening labs/tests
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.)
• Reinforce healthy choices and risk behavior avoidance

Immunizations: Men B (optional)
Tests/Screens/Assessments: Hearing Surveilllance, TB Surveillance, Anemia Surveillance, Dyslipidemia Surveillance, Adolescent Screening (Depression, Anxiety, STI Substance Use, High Risk Exposures) , Vision Testing, Cholesterol Panel, Metabolic Panel, Complete Blood Count
Helpful Info:  Info for Patients 18 yrs and Older-(PDF) 18 Year and Older Patient Handout