The Smart Parenting Well-Baby Checkup Guide

A soon as your little one enters the world, his growth and development are your utmost concern. Each month, new changes take place in his body. Well-baby checkups are important in helping you keep track of your child’s development. Through these checkups, you and your child’s pediatrician become partners in making sure your baby grows healthy.

Florianne Feliza Valdes, M.D., ambulatory pediatrician from The Medical City in Pasig, explains what well-baby checkups are all about.  “These are what we call health supervision visits. Parents should bring their children to the doctor for regular health supervisions visits—even if they are not sick.”

When parents bring their newborn to the pediatrician for the first time, the doctor usually sets a schedule for the child to be brought back again. A well-baby checkup usually begins immediately after birth. About a week or two later, another well-baby checkup is scheduled. “Then monthly thereafter until the first year of life,” says Dr. Valdes, “Usually at the same time as the immunization schedule.” As your child turns a year old, well-baby checkups are scheduled every three months until his second birthday. Other pedia visits must be scheduled at least once or twice a year, at any time between ages four to six years old, 11 to 12 years old, and 14 to 16 years old. Dr. Valdes suggests scheduling these checkups in time with the child’s birthday or his annual scheduled flu vaccine shot.

Mark Reysio-Cruz, M.D., a developmental and behavioral pediatrician at Capitol Medical Center in Quezon City, says, “The reason for these early consults is to make sure your child is growing and developing properly and [that he] has no serious problems.” The well-baby checkup is an essential part of ensuring your child receives the best care possible. It is important that you take each and every doctor’s visit seriously, and use this time wisely. “These are opportunities for the parents to ask their pediatrician medical concerns and general child care issues,” adds Dr. Reysio-Cruz. Consider the well-baby checkup as a time for you and your child’s doctor to come up with a plan on how best to care for your child.

 

[previous|page|next]

What goes on
A complete physical checkup or an immunization shot is not enough, says Dr. Valdes. There are five basic areas explored in a well-baby checkup:  

Vital signs. These include the child’s temperature, respiratory rate, heart rate, blood pressure, and pain scale. To find out the child’s pain response, “Look if there’s pain based on the smiley faces [of the child]. ‘Pag happy child, walang pain,” points out Dr. Valdes.


Anthropometric measures
At every visit, the child’s length and weight are measured. Until age three years, his head circumference will also be regularly measured. These are all plotted and analyzed using the standard growth chart. “This is the best way to decide whether your child is growing well and how he compares with other children his age on the growth curves,” says

Dr. Reysio-Cruz. In some instances or when the child turns two years old, his body mass index is computed to assess if the child is in a satisfactory nutritional condition.


Head-to-toe physical examination
According to Dr. Reysio-Cruz, in the complete physical examination, the following are checked by the pediatrician:
•    Head—The soft spots should be open and flat. The spot at the back should be closed by three months of age while the spot at the front should be closed by 18 months of age.
•    Neck—The doctor feels the baby’s neck to check for lymph nodes, masses, or tumors.
•    Ears—Does your child respond to sounds and voices? The doctor places an otoscope inside each ear to see whether there is any fluid or infection in the ear.
•    Eyes—The doctor flashes a light on both eyes to track eye movements and uses an ophthalmoscope to look inside the eyes. The doctor also checks for cataracts.
•    Mouth—The mouth is checked for clefts, signs of infection, and later, for tooth development.
•    Skin—The skin is examined to check for rashes, birthmarks, lumps, or bumps.
•    Heart and Lungs—A stetho-scope is used to listen to heart and lung sounds at the front and back of the chest.
•    Abdomen—Bowel sounds are checked using a stethoscope as the doctor gently presses the abdomen with his hand to check for any masses, tenderness, or enlarged organs.
•    Arms and legs—These are observed for dislocations. At the same time, the doctor feels them for muscle tone.
•    Genitalia—The pediatrician checks the child’s genitalia for masses, tenderness, or signs of infection. Boys are checked to make sure both testes have descended and are located in the scrotum.

As the child is lain on the examination table for the complete physical examination, the pediatrician must explain to his parents or caregiver what is being done, as well as discuss the findings.

 

[previous|page|next]

History-taking
“If it is the child’s first pedia visit, his birth history, feeding history, and immunization history are noted,” says Dr. Valdes. The child’s past health history, past hospitalizations, family history, and personal social history are also accounted for. “These are all important because everything that happens to the baby and his family paints a picture of the kind of environment the child is growing into,” says Dr. Valdes. By asking about the child’s living arrangements, family dynamics— and even inquiring about who cares for the child every day and who is financially responsible for him, the pediatrician gets a clearer understanding of how the child is being cared for.


Anticipatory guidance and counseling
After your child is examined and the pediatrician has inquired about your child’s history, the doctor sits down with you to discuss how to best care for your child. During this time, you can voice out your concerns and ask questions on child care.  Developmental and behavioral screening and surveillance are carried out by your child’s pediatrician, giving you a chance to ask about your child’s social, fine and gross motor, speech, and language skills and development. You should also discuss nutritional counseling, dental health, child safety, and injury prevention.


Time spent wisely
A well-baby checkup usually takes at least 15 minutes to 30 minutes to almost an hour. Use this time to ask your child’s pediatrician all your questions about raising your baby. “Parents are responsible for the management of the health of their child,” stresses Dr. Valdes. “They should be brave enough to ask their doctor any question. No question is too silly,” she encourages.

“For example, ‘Doc, okay po ba ang development ng anak ko? Tama po ba sa edad niya?  Di pa kasi siya nagsasalita.’” She points out that this helps your child’s pediatrician because “[by mentioning this, the] doctor should have alarm bells ringing in his mind na dapat tignan na niya, or i-refer na niya [to a specialist]. The concerns of parents that are verbalized have bearing.”

Dr. Reysio-Cruz stresses, “When in doubt, ask.” He also advises that both parents be present during a well-baby checkup to ensure that each of the child’s primary caregivers are aware and up-to-date on the health of their baby.

It is important to find a pediatrician who, not only treats you and your child well, but is someone you can trust and talk to, says Dr. Valdes, “Because it’s going to be a long, continuous relationship. Open communication is important between the pediatrician and the guardian or parent.”

 

[previous|page|next]

Ask away!
At a loss and tongue-tied at your child’s well-baby checkup? Start with some of these questions:

1. Is my baby's weight and length within the expected range for his age?
2. At what age should my baby start crawling/talking/walking/responding to stimuli already?
3. Is my baby getting enough nutrients? Am I feeding my baby well enough?
4. What immunizations should my baby have, and what are the schedules for these? How much would each shot cost?
5. Do you accept medical insurance? May we use them to cover the medical expenses such as immunization costs?


What Your Pedia Needs From You
Your child’s pediatrician helps you care for your child. Help him out by following these pieces of advice:

“Make sure your baby is in a good mood. If you’re bringing a toddler, make sure he’s had a nap or has been fed.”—Dr. Mark Reysio-Cruz, developmental and behavioral pediatrician at Capitol Medical Center, Quezon City

“I expect the parents to speak up if they have difficulty meeting the expectations from them. They should be honest enough if they cannot meet the requirements for the health of their child. For example, if I tell them to come back on a certain date for the next immunization of their child, they should tell me, ‘Doc, I can’t afford it yet.’

Then we can reschedule kasi we can go around it.”—Dr. Florianne Feliza Valdes, ambulatory pediatrician at The Medical City, Pasig City

“As much as possible, be present during the checkup, not just the yaya. First-hand information is always reliable.”—Sharon Rose Hidalgo-Palanas, M.D., Diplomate, Philippine Pediatric Society, private practice in Ipil, Zamboanga Sibugay



Photo by David Salafia via flickr creative commons