Well child checks: Monitoring your child’s health and development

Dr. Sara L Watkin
Specialist Pediatrician & Neonatologist
Integra Healthcare Ltd., Grand Pavilion

The normal growth and development of infants and children, coupled to timely and effective intervention where necessary, is the primary goal of parents and pediatricians alike. The American Academy of Pediatrics recommends that all children have regular well-child checks with their doctor, in support of this goal. These visits provide the opportunity to address many vital components of achieving that goal, including:

  • Confirming that your child is growing and developing normally, through formal assessments by your pediatrician
  • Giving you an opportunity to discuss any concerns that you have
  • Allowing your child’s doctor to advise you on what to expect or watch out for in the next period of life, both normally and with respect to any adverse signs or symptoms that may emerge

These appointments are offered by all the private pediatricians on-island. They ensure that if your child is not developing as they should, additional support can be put in place early, for example, physiotherapy, occupational therapy or speech and language therapy, the early provision of which can have a significant impact on your child’s success in school.

If your child is not growing as he or she should, it is important that this is investigated further, especially to differentiate between simply being short versus a range of more serious conditions.

Your doctor learns a tremendous amount about your child at each of these checks. What’s more, research shows that failing to adhere reliably to the schedule is linked to increased emergency admissions and late diagnosis of conditions that warrant early treatment. All in all, they are a vital part of ensuring happy, healthy, thriving children.

THE SCHEDULE

In the first two years, visits are frequent, matched to a child’s own rapid rate of development. As time progresses, visits become annual.

Routine well-child checks follow the following schedule:

  • 4 to 7 days
  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 18 months
  • 2 years
  • Annually thereafter until age 21

WHAT IS CHECKED?

Many different things are specifically assessed at each visit and the checks are designed to build up a sequential picture over time. Additionally, at each visit, your pediatrician learns a great deal from observing and examining your child. It’s difficult to list all of what’s done at each individual visit, but we have provided a flavor below by highlighting certain aspects at each stage.

4 to 7 days

  • Your doctor will be checking your baby has not lost too much weight which can be a sign of a poor milk supply or other problems.
  • The doctor will look for jaundice which may need treatment with special light therapy to prevent harm to your baby.
  • There is a big focus on ensuring your baby has successfully transitioned from their cozy intrauterine home to the big wide world.

2 months

  • Your doctor is now particularly interested in your child’s very early development and whether they are reaching their first milestones.
  • Direct observations are made, for example early assessment of vision, to ensure vital intervention is provided as early as possible is necessary.

4 months

  • There will be lots to discuss at this visit, including teething, moving to solid food at six months and, of course, lots of development.
  • There are some very specific things to assess, such as the presence or absence of strabismus ( an eye turning in or out).

6 months

  • At this point, your doctor will be checking that your child is not anemic.
  • They will discuss feeding solids and preventing food allergies, teeth cleaning and more.
  • Safety is an additional focus at this point, important in preventing or addressing a range of common accidents.

9 months

  • This is a very important time for your doctor to observe your child’s developmental progress and a time when many more signals can be found through assessment.
  • Your doctor may discuss sleep training, if your child still wakes in the night, as well as other emerging behaviors.

12 months

  • This is an important time to review your child’s nutrition and examine growth, as your child enters a new phase of physical development.

18 months

  • By this time, behavioral and physical changes allow your doctor to perform a screening test for autism, which, if picked up, allows some particularly important interventions to be provided at the earliest possible point.

24 months

  • At this check your doctor may well repeat the autism screen, as a follow on from the 18-month check.
  • Your doctor will be carefully observing and assessing your child’s speech and interactions with them, as well as their growth.
  • Your doctor will be able to provide advice on potty training, temper tantrums and the “terrible twos.”

Annually thereafter

  • In annual checks, your child’s doctor is assessing both growth and behavioral development, including social development.
  • From age four onwards, checks will be made to ensure your child’s spine is growing straight and that their blood pressure is normal.
  • Each visit contains specific checks, unique to that point in life, as well as allowing continued, sequential follow up of earlier assessments.

If you would like to know more about any single visit, please contact your pediatrician, who should be happy to discuss the visit and what they will be assessing.

To see the HSA’s childhood immunization schedule click here.