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Annual Wellness Visits

1 Month Visit

Infants at this young age feed frequently. Their sleep cycle may be erratic. They are totally dependent on adults for care and comfort. Parents may be quite tired because of the high demands of care and the lack of uninterrupted sleep. The first office visit is the opportunity to assess the adjustment of both child and family. At this age, infants will raise their head slightly from prone position, blink in reaction to bright light, focus and follow with their eyes, and respond to sound either by quieting or turning toward the source. Over the next month it is likely that the baby’s schedule will become more regular, and he/she will become more sociable. This is a good age to make or obtain a mobile, since babies begin fixing their vision on moving and bright-colored objects, and a rattle because babies start to grasp and hold onto objects. Parents are encouraged to place their baby in a prone position occasionally while awake.

2 Month Visit

At 2 months old, babies have become responsive to their parents by smiling, cooing, and vocalizing reciprocally at them. Babies have also begun to establish a more regular feeding and sleeping schedule. Babies at this time can be very demanding and require a great deal of attention from their parents. Babies at this age are able to hold their head temporarily erect and can briefly hold a rattle. Babies also track and follow objects visually and respond to sounds. It is around this time that babies will communicate with coos; parents may also notice differentiated crying for differing needs. Infants may also begin to relate differentially to mother, father, siblings, and other caregivers. The responsiveness of the infant to stimuli is important.

4 Month Visit

By 4 months, babies are usually sleeping less, crying less, and smiling more than they had been. They are delighted with their parents, siblings, and other adults when they talk to them. Babies at this age reward attention with smiles, squeals, and laughs. Babies become more curious about their environment and surroundings and eagerly look at anything new or stimulating. They are able to hold their head erect, raise body using arms from prone position, and may support weight on legs. They begin to reach for and grab objects and put their hands together. Babies are also able to follow objects visually to 180˚ and differentiate between individuals. Infants of this age are generally content with all caring adults. Colic typically resolves by this age. The introduction of solid foods can begin at 4 to 6 months of age. Sleeping should be more regular at 4 months of age. Most babies will sleep through the night and take an average of three naps a day. It is normal for your baby to sleep up to 16 hours a day.

9 Month Visit

A big change occurs in babies between 6 and 9 months of age. Now they are usually able to get around on their own, they have developed an efficient way to pick up small objects and get them to their mouths, and they have begun to develop a mind of their own. The normal hesitancy of babies this age to let their parents out of sight may complicate and prolong some daily routines. Infants at 9 months of age become more aware of strangers and are more likely to become upset and less cooperative than before. At this age, many infants begin to interact in a purposeful manner, play with toys, and cry when familiar caregivers leave the room. Babies will start to experience “separation anxiety,” this is when the babies will cry when parents leave their presence. This behavior is normal and does not reflect that they are “spoiled.” Infants at this age are able to sit well, crawl, and may walk while holding onto furniture. They will continue to pick up small objects using their thumb and index finger. They may begin to feed themselves, bang objects together, and can be encouraged to drink from a cup. Babies have become more interested in the trajectory of falling objects. They will respond to their own name, participate in verbal requests such as “wave bye-bye” of “where is mama or dada?” imitate vocalizations, and babble using several syllables. Infants will enjoy social games with familiar adults such as peek-a-boo and patty-cake. Sibling rivalry may intensify at this age when the infant begins to crawl or walk and gain access to the toys and play space of his/her siblings. This is a good age to begin regular daily reading. A regular bedtime routine should be established.

15 Month Visit

This is the golden age for language development. The neurons in the language areas of the brain are rapidly elaborating their branches and making connections. As toddlers become sure of their ability to move around their environment, they also find barriers to their continuing explorations. In order to keep them safe and to maintain order and balance in the family, the parents have to impose rules and limits on toddlers and frustrate some of their excitement. As toddlers acquire more independence physically, they also begin to assert their own will, resulting in their well-known temper tantrums and abundant challenges to their parents’ patience and self-confidence. Babies will be able to feed themselves with fingers or a spoon, scribble with crayons and stack two blocks. At this age, they will begin to say single words (approximately 5-15) and communicate with gestures. Children will typically seek opportunities for autonomy in eating and playing. Independent eating and exploration should be encouraged. Reading books, singing, and talking will stimulate language development in children.

18 Month Visit

Toddlers really develop “a mind of their own” around this age and may be frustrating when they refuse to do what others ask of them or insist adamantly on doing things their way. At this age, the child is experiencing a growth spurt of language. Many children will have a vocabulary of 20-50 words, and speak simple two word sentences. Children who live in a bilingual environment are expected to be about 6 months behind in language milestones. They are astutely listening to the two languages and analyzing the vocabulary and grammar. They might say some words in one language and use the other language for others; for example, the Spanish leche for milk and English for other nouns. Some parents (and day care teachers) might express concern because the child isn’t talking. Then, after the second birthday, the child often starts speaking basic sentences in both languages. At your provider’s office, your toddler’s weight, height, and head circumference is taken, along with a general physical examination. A hemoglobin or hematocrit should be performed for children at risk. Lead levels should be measure at least annually for children at risk for lead exposure. Children by this age should be feeding themselves independently and drinking from a cup. Bedtime routines and regular bedtimes should be encouraged and continued. A regular routine of reading to children at bedtime fosters language development and decreases bedtime problems. Sleep problems may arise such as resistance to falling asleep, nighttime awakening, and night fears. Toddlers may still use self-comforting behaviors (such as thumb sucking or an attachment to a favorite toy, animal, or blanket) as a way of handling stress or tension. Temper tantrums are common during this age. Children are rarely distracted or redirected like before.

2 Year Visit

Children at this age continue to improve their gross motor skills. They are able to run, jump in place, walk up and down stairs, and throw balls overhead. Their energy level is at the highest and they seem to always be on the go. Running becomes much more coordinated and their gait changes from the wide-based toddle gait to a more adult-like, heel-toe gait. At this age, they also typically communicate in short phrases. Toddlers explore the limits of acceptable behavior. It is at this age that parents should watch for signs of the child’s readiness to use a potty for toilet training. Children should continue to have a regular hour for bedtime and predictable bedtime routine. Toddlers are to be sleeping on their own throughout the night. Bedtime book reading continues to promote language development and is an effective part of a quiet bedtime routine. Because children this age are exploring the opportunities for independence and its limits, they can be especially challenging for parents. Parents should continue to encourage the child’s emerging independence and offer choices to the child wherever possible while retaining their authority to make and maintain family rules. Family rules should be established for mealtimes, bedtime, and getting ready in the morning. Toddlers are also able to brush their teeth and dress themselves with help.

3 Year Visit

Three-year-olds may continue to test limits of acceptable behavior or may be showing increasing acceptance of social limits. Their language skills may exceed cognitive understanding, so that their insights may be quite humorous. An active imagination and imaginary friends are common. Children at this age should be eating a well balanced diet and avoiding junk foods. They should be feeding themselves using utensils. By age 3, approximately 90% of children are bowel-trained; 85% of children are dry in the daytime, and 60% to 70% are dry at night. No treatment is necessary for children who are not yet dry at night. Occasional night fears are usual. If feasible and culturally appropriate, parents should be discouraged from sharing their bed with their child. Parents should encourage active play with blocks, simple puzzles, beads and pegs. Passive activities such as watching television should be discouraged. Language development is facilitated by direct conversation. Parents should be prepared to answer questions about where babies come from and the difference between boys and girls. Parents should answer these questions honestly, at a level appropriate to the child’s understanding and within the boundaries of the question. Parents should also use correct terms for the genitalia and to understand that the child’s sexual curiosity and explorations are normal. Children at this age are curious and will continue to ask questions until they feel satisfied with the answer.

10- and 11-Year-Old Visit

Children this age may be in middle childhood or may have entered early adolescence. In early adolescence, children become focused on body image. Their peer group becomes an increasingly important influence on style, attitudes, and values. They may begin risk-taking activities such as smoking cigarettes or drinking alcohol. At this age, the child may be expected to display self-confidence with a sense of mastery and pride in school and extracurricular activities, make friends and participate in group activities, understand and comply with most rules at home and at school, and assume reasonable responsibility for his or her own health, school work, and chores. The age of 10 is a prime year for sports competition. Parents should prepare girls for menarche, and answer any questions the child may have.

12- and 13-Year-Old Visit

Early adolescence typically begins between 10 and 14 years of age. It is characterized by rapid physical growth and sexual development (puberty). It is a time of beginning independence and separation from parents; the child becomes unwilling to participate in some family activities, concentrates on peer relationships, casts off old patterns of behavior, and challenges parental authority. Early adolescents may show a continuation of concrete thinking or may show early signs of the ability to think abstractly. Adolescents in this stage show an increased concern with their developing body and often compare themselves with peers to assess their own normality. Heterosexual and homosexual experimentation are common. Early adolescence may be a particularly trying time for both adolescents and parents.

16- and 17-Year-Old Visit

Most adolescents in this age are in middle adolescence, although some are entering late adolescence. Puberty may be complete, particularly in girls. Preoccupations with the body and with attractiveness decrease after puberty. At the same time, the importance of the peer group may increase. The peer group sets the standards for dress, recreation, behavior, and values. Adolescents experiment with many risk-taking-behaviors. Conflicts with parents over issues of independence are at their highest peak at this time. It is also a time of sexual exploration and experimentation. Recognition of sexual orientation occurs for many individuals in middle adolescence; for gay and lesbian youth such recognition may precipitate severe depression. At this stage the adolescent is frequently idealistic and altruistic. Plans for the future in terms of a career or relationship may still be rudimentary.

18- and 19-Year Old Visit

In late adolescence, emancipation is nearly complete, and there is increased interest in career choice. Social skills become enhanced, and long-term, intimate physical and psychological relationships develop. Body image and gender role definition are nearly completed. Common problems at this age include pressure to engage in sexual relations, somatic complaints, loneliness, discouragement, eating disorders, suicidal thoughts, menstrual disorders, use of alcohol or other drugs, acne, and anxiety.

20- and 21-Year Old Visit

By this age, emancipation is completed for some late adolescents and in process for others. Career choice may be a major concern for some individals. Social skills become enhanced and intimate physical and psychological relationships occur. Body image and gender role definition are generally completed. It is appropriate to plan for the transition to an adult health care professional.

Information on this site is intended for Angel Kids Pediatrics patients only. Always consult your doctor before beginning, modifying, or discontinuing any treatment plan.

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