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Caring for the Growing Needs of Our Community.

Wellness Exams

From Birth through Young Adulthood

One of the events we look most forward to at Live Well Pediatrics is the well child visit. Not only is it a great time to talk about any concerns you may have, it also allows us the chance to get to know your child more thoroughly. During the visit, we encourage you to ask any and all questions you have about your child’s growth, nutrition, development, behavior and general all around health.

Listed below is a recommended schedule of well child visits. We follow the American Academy of Pediatrics for both well child visits and immunization schedules. Starting with a newborn exam and then followed by exams at ages two months, four months, six months, nine months, 12 months, 15 months and 18 months, your child will then be seen annually from age two through age six. This schedule could be altered if your child suffers from a chronic condition such as asthma or if he/she is in need of more closely monitored medical attention. We schedule visits each four months with children who are on medication for A.D.D., A.D.H.D or other mood-related conditions.

To learn more about what each well child visit entails, please click on the following link for the specific visit you are interested in learning more about.

Well Child Exam Schedule

Congratulations on the birth of your child! What a wonderful journey you are embarking on! While it is amazingly rewarding, it can be very confusing and stressful too. We are here to help you navigate that stress and answer questions you have about your newborn. Obviously your schedule will become a bit unpredictable, so the golden rule as a new parent is to take care of yourself as well as your baby. If you haven’t already heard this advice, please take it to heart… Sleep when your baby sleeps, eat healthy and nutritious meals and ask for help whenever you can. Both you and your baby have been through an intense physical journey, so take time getting your footing and getting used to all the changes.

Your Baby and Feeding: If you have chosen to breastfeed, your child will probably be expecting to be fed every two to three hours or up to 10 times in a 24-hour period. Your child will generally dictate how much he wants to be fed in that time. Don’t forget to switch breasts halfway through each feeding to avoid engorgement and discomfort for you. If you have chosen to formula feed, carefully mix the formula according to the directions. While each child is different, most babies consume about two to three ounces every three to four hours. If at any time with either breast or bottle-feeding you feel your child is showing discomfort or crying excessively after feedings, call us to discuss. We may need to make changes to either your diet or your formula choice to ease the baby’s discomfort.

Your Baby and Bowel Movements: Expect your child to have a bowel movement after each feeding so keep a good supply of diapers handy! As he gets older, he will have fewer stools. The odor will vary too, depending on the diet you are following or the formula you will be supplying. The color of the stools will vary and this is normal. Red stools are cause for concern, so please call us if that occurs. As long as your baby’s stools are soft, do not worry if he strains and cries with a movement. However, if the stool results in small, hard pellets, your baby may be constipated and we can help you manage that issue. Five to seven wet diapers per day is a norm but it could be as many as 10 per day.

Your Baby’s Motor Skills: At the beginning, babies take in their surroundings and notice bright colors, but they actually will prefer black and white at this stage. If your child’s eyes cross at times do not be alarmed. He is learning to focus and at this early stage, he can focus on objects 8-12 inches away. For that reason, hold your baby in front of you and talk to him closely. He will not be able to hold his head up very long but that will change quickly.

Your Baby’s Communication Skills: As you will find out quickly, crying is the primary mode of communication for your newborn. At first it may seem like all cries sound the same but as time goes on, you will learn to interpret whether your baby is crying due to hunger, pain, dirty diaper, too hot, too cold or just plain bored. Again, if your baby seems to be showing signs of excessive crying, he may be exhibiting what is known as colic symptoms. While it is a brief condition that usually diminishes around three months, we can help you manage the condition.

Your Baby and Safety: Keep these guidelines at the top of your mind.

  • Put your baby to sleep on his back in a crib with a firm mattress. Do not put the baby in the crib with soft toys or blankets. A good suggestion is to dress your baby warmly in a onesie for bedtime.
  • In the car, always use a rear-facing car seat and place in the back seat of the car.
  • Never shake your baby. While you may be exhausted and frustrated at times, make sure your baby is in a safe place, well fed with a clean diaper and then take a break for a minute by leaving the room. This is a common feeling but make sure your child is not unattended. If you feel unable to control the frustration or anger, call someone for help.
  • Do not allow your baby to be near smoke. Second-hand smoke has been proven to be dangerous and can lead to childhood illnesses such as asthma, colds, ear infections and sudden infant death syndrome.
  • Make sure when you wash your baby that the water is not too hot.
  • While it is uncommon for a newborn to have a fever, check your baby’s temperature rectally if he feels warm and call us immediately if the temperature reads 100.4 degrees or higher.

Your Baby At Play: At this age, your baby is enthralled by you in every way. Talk to him, cuddle him and hold him as much as possible. You won’t spoil your child by holding him or responding to each cry he makes. Building a strong attachment is a crucial foundation for your baby’s healthy development. Play some soft music or sing to him. Place an unbreakable mirror in the crib so he can keep himself entertained. Soft and brightly colored toys and mobiles and toys that make sounds are excellent choices.

Your next visit is at two months of age. Until then, enjoy getting to know your baby and take good care of yourself!

At one month of age your baby is still taking in the wonders around him and getting used to this new and amazing world. If your baby was born prematurely, please keep in mind these milestones may be advanced for your child at this point so do not be alarmed. Measure your child’s milestones against the original due date.

Your Baby’s Growth: If you notice that your baby loses a bit of weight during the first two weeks of his life, don’t sound the alarm…it is perfectly normal. Babies drop fluid weight, and by the one-month mark will start gaining between a half-ounce and an ounce each and every day.

Your Baby’s Feeding: At one month old, breastfed babies are eating every two to three hours (8-12x/day) while bottle fed babies will eat 6-8x/day. Some parents may try to put the baby on a feeding schedule while others feed on demand. You will know when your child is hungry by his crying, fussing and rooting at you (turning his head toward the breast.) If your baby has SIX to TEN wet diapers per day, you will know that he is getting plenty to eat.

Your Baby’s Sleep: After the journey of delivery your baby has a lot of sleep to catch up. Most babies will sleep 15-16 hours each day. You can help your child to develop a sleep routine by limiting activity to the daytime and keeping things dark, quiet and basically boring at night. They need to be taught the difference between night and day.

Your Baby’s Communication: At one-month old, your baby basically has one mode of communication…crying. Most babies cry up to three hours per day. You will quickly start to learn the meaning of your child’s cry. While the “feed me” cry sounds one way, the “my diaper’s wet” cry may sound another. If you feel your baby has excessive problems being consoled, he may be experiencing colic. Please call your doctor to discuss this matter further before it becomes overly frustrating to you.

Your Baby’s Safety:

  • Put your baby to sleep on his back in a crib with a firm mattress. Do not put the baby in the crib with soft toys or blankets. Instead, dress your baby warmly in a onesie for bedtime.
  • In the car, always use a rear-facing car seat and place the seat in the back seat of the car.
  • Never shake your baby. While you may be exhausted and frustrated at times, make sure your baby is in a safe place, well fed with a clean diaper and then take a break for a minute by leaving the room. This is a common feeling but make sure your child is not unattended. If you feel unable to control the frustration or anger, call someone for help.
  • Do not allow your baby to be near smoke. Second-hand smoke also has been proven to be very dangerous and can lead to childhood illnesses such as asthma, colds, ear infections and sudden infant death syndrome.
  • Make sure when you wash your baby the water is not too hot. Always check the water temperature with your elbow.
  • While it is uncommon for a newborn to have a fever, check your baby’s temperature rectally if he feels warm and call us immediately if the temperature reads 100.4 degrees or higher.

Tips For Your Newborn:

  • Babies can recognize your voice. They heard it the entire time they were in the womb so talk, talk, talk to him and it will comfort him.
  • Move your baby’s legs in a bicycle motion. It will strengthen his leg muscles and prepare him for the walking and crawling that will happen very soon.
  • Touch and massage your baby. He cannot have enough contact with you and it shows him love and comfort.

Most of all enjoy this wonderful experience and the wonder of getting to know your baby. Call us with any questions you may have and we will see you at your two-month checkup.

You have probably discovered how many amazing changes your child has experienced in a very short time. Hopefully, a schedule has formed for you and your baby has regulated his sleep and wake cycles a bit more and is alert for a much longer time. Take this opportunity to talk, laugh, sing and hold him!

Your Baby’s Nutrition: Breast milk and formula are meeting all of your baby’s nutritional needs at this time. You may be discovering that the frequency of the feedings is stretching to every three or four hours during the day and hopefully longer at night. The amount of formula your baby drinks can vary widely at this stage but the average is four to five ounces up to seven times per day.

Your Baby’s Stools: Bowel movements become less frequent at this stage and some breast-fed babies have only one stool per week. If the stool is soft, your baby is not constipated so there is no cause for alarm.

Your Baby and Sleep: Another area that can vary widely from baby to baby is sleep. If you are very lucky, your baby may have short naps during the day and sleep for seven to nine hours per night. However, do not get upset if the average is more like three to four hours per night.

Your Baby’s Immunizations: Your baby will receive immunizations at this visit. If your child experiences a fever and fussiness, that is normal. Go ahead and administer acetaminophen (Tylenol) for the first 24 hours. Please ask your doctor about the appropriate dosage for your child.

Your Baby’s Motor Skills: Your baby is becoming stronger and more focused. He can now hold up his head for a longer time and follow objects and faces with his eyes. He also will reach and be able to hold things for a short amount of time. He becomes amazed by his own hands and can start to raise his chest from the floor when lying on his tummy.

Your Baby’s Communication: No, it’s not just gas. That’s right, your baby is starting to smile at you and will start to coo and laugh and respond to you by squealing. It’s a wondrous time for you and your baby as he starts to awaken to the stimulus around him.

Safety and Your Baby: Babies at this stage are getting more mobile, so never leave them on a bed, couch, table or countertop. They are getting ready to roll over so don’t leave them unattended. They also may be starting to put things into their mouths, so be cautious about toys that may have loose or sharp parts. Keep your hands washed to avoid passing germs that can cause them illness.

Your Baby’s Socialization: Your baby very much enjoys being around you and the rest of the family, so make sure he is included. Talk to him about everything. Sing to him and play with him. Most of all enjoy him and we will see you at your four-month visit!

Your four-month old continues to change dramatically each and every day. You will start to notice a true personality peeking out as your baby develops and grows. Life is becoming more “normal” now because schedules have been set. You may notice that your child’s weight has now doubled since birth. If you have concerns about his growth, always feel free to call your doctor and discuss.

Your Baby’s Feeding: Many babies will continue to be breastfed, some exclusively. Others will have formula and the amount that is fed will be determined by your child’s personal growth. If your baby breastfeeds 8-10 times per day or you are giving him more than 32 ounces of formula, your little tyke is ready for solids to supplement his diet. We recommend starting with cereals, such as rice, oatmeal or barley. Talk to your doctor about the proper way to introduce solids. You don’t want to throw too much variety at them at first as that could lead to allergies. A slow introduction food by food will be your best method.

Your Baby’s Bowel Movements: With the introduction of those solids, the bowel movements your child has will change. Color and consistency will be altered due to the solids. If you find that your child’s stools are hard and pellet-like, he may be constipated. This is common because some cereals can be constipating. Discuss with your doctor about how to manage that constipation.

Your Baby’s Sleep: By now I hope you are enjoying a full night’s sleep! Between the nighttime sleep and two naps that are recommended per day, your baby is likely sleeping up to 16 hours per day. Enjoy! Make sure you put your baby to sleep awake. It will save you problems in the future because he will learn to comfort himself to fall asleep. Do not put the baby to bed with a bottle. It can lead to ear infections. Add a soft toy to the crib at sleep time for comfort.

Your Baby’s Motor Skills: Your baby can now hold his head up and turn his head in all directions. When lying on his back, he can lift his head forward and grab his feet. He also can roll from side to side and grasp toys without looking first at his hands. Sitting up is vastly more entertaining to baby than lying down, so support his little body and let him take it all in.

Your Baby’s Socialization: It is said that imitation is the sincerest form of flattery. Babies at this age will be a little copycat of everything you do! They love to coo, grin and squeal with joy at just about everything. They will know their name and they may even develop a bit of stranger anxiety, so introduce new faces to them carefully.

Safety For Your Child:

  • Keep using a rear-facing car seat.
  • Never the leave the baby unattended or on top of anything. Your baby is very mobile right now and in a flash could roll off or into anything around.
  • Keep any and all dangerous objects out of reach. Everything he sees and touches will go into his mouth.
  • Keep baby away from smokers…direct and second hand.
  • Be mindful of baths. Never turn away from your child while in the bath.

This is a time of great discovery for your baby. Keep holding him often, kissing, talking, singing and reading to him. He wants to be with you all his waking hours and is a little sponge taking in everything around him. Enjoy… the journey keeps getting more exciting and we will see you at your six-month visit.

At six months, your child is the definition of personality. You are most likely starting to see quite a little person emerging and you are able to get a more clear picture of his likes, dislikes and everything in between. Babies at six months love to coo, laugh, squeal and follow every detail that goes on around them. In terms of growth, the weight gain your baby experiences will slow to about a pound per month.

Your Baby’s Feeding: You are probably already into the solid foods at this point. If not, go ahead and start with the cereals (rice, oatmeal). If he has been trying solid foods, you can begin Stage 2 foods. Introduce only one at a time and feed it to him for several days before moving to a new food. Keep your eyes open for any allergic reactions… vomiting, rashes, diarrhea. You can also start giving him soft foods such as banana, Cheerios and grated cheese. Steer clear of citrus fruits until around eight months. And no peanut butter or honey until 12 months. Offer your child a cup with 100% juice inside and get him used to drinking from it. If your child has never had a bottle, do not be alarmed if he resists at first. Keep trying.

Your Baby’s Sleep: Sound sleep continues at this age. Usually your child will sleep six to eight hours on average a night. He also will take two to three naps during the day. If your child wakes, don’t rush to comfort him. Let him learn how to do it on his own. If you are having problems with sleep, talk to your doctor to develop sleep strategies.

Your Baby’s Motor Skills: Batten down the hatches because baby is starting to become much more mobile. He should be able to roll from tummy to back. He will be able to sit up for long periods of time. He may even be able to bear weight on his legs when you hold him upright. Some will start creeping and some may even begin to crawl.

Your Baby’s Communication: Squealing, cooing and laughing are still the main ways of communicating. Some babies will start to verbalize with syllables such as “da, ba and ma.” They also will react to everything around them…happy, mad and sad sounds will affect them. They may be developing a stranger anxiety so be cautious when introducing new people.

Your Baby’s Safety:

  • Get yourself baby gates. Once he begins to crawl, he will be everywhere.
  • Make sure small objects are out of reach. He will put anything he can into his mouth. That can include anything from dog food to poop!
  • Keep the number for poison control handy…1-800-222-1222. More information is available at safe kids: http://www.safekids.org/safetytips/field_risks/poison?gclid=CK3eypeRnLwCFVQV7AodcjkAnQ
  • Baby proof electrical outlets and make sure cords of any kind are out of reach. Secure cabinets and put cleaning supplies and medicines safely out of reach.
  • It may be time to move your baby to the big tub for baths. If so, make sure you never leave him unattended at any time.

Your baby is a complete joy at this age. Talk to him, read to him and sing. Push toys and pull toys are great for your baby. Allow him fun in the tub. Peek a Boo is a big hit now too! He is stimulated by everything around him. Enjoy and we will see you at your nine-month visit.

Your baby continues to make great strides as he develops his personality. You may notice your child wavers back and forth between demanding independence and frustration when he can’t master something quickly. This is quite common considering he is learning to feed himself, crawl, walk and talk. You may see a glimmer of temper as you move through these next few months.

Your Baby’s Sleep: By now, your baby is most likely a good sleeper. He is taking a couple of naps per day and clocking about 10½ hours of consistent sleep per night.

Your Baby’s Feeding: Keep introducing new foods into your baby’s diet. At this point, you can give him soft finger foods such as Cheerios, ripe bananas and well-cooked pasta. You may also introduce small amounts of protein into the diet. Pureed cooked meats, poultry and fish are good choices. Also well-cooked mashed beans such as green, black or pinto beans.

Your Baby’s Motor Skills: Big changes are happening on this front. Sitting, standing, cruising, crawling and even some walking may be occurring. Don’t compare your child to the baby next door. Each child develops at a different pace. Your baby can climb onto things at this stage but he may not be able to get down! It is also at this point you may notice your baby’s preference for using the right or left hand. Watch as he looks in the mirror and realizes he is separate from the image staring back at him.

Your Baby’s Communication: Your baby is communicating with you more verbally and can also understand what is being said. He can understand simple one word commands and even understand the meaning of “No,” though he doesn’t like to hear it! Your baby can respond to his name and will babble constantly. He also will begin to use words like “Dada” and “Mama.”

Your Child’s Safety:

  • Your baby is shaky on his feet and that may lead to falls. Keep a close eye and close gates and doors so you can “contain” your baby in a safe area.
  • Only allow your child to eat while seated to minimize the risk for choking.
  • Keep medicines and cleaning supplies out of reach and latch all doors and cabinets.
  • Keep electrical cords out of reach.
  • Move the baby to the big tub and never leave him unattended.
  • Lower the crib to the lowest setting.
  • Don’t expose your baby to tobacco smoke.

While the growing independence your child is exhibiting may lead to some frustration for you, take the time to marvel at the milestones your baby is hitting right now. Put on the music and let your baby dance and sing for you. Hide objects under cups and play Peek a Boo and Patty Cake.

Get the camera ready; this may be the debut of your little walker. While some children may not reach the walking milestone until 16 months or so, many babies are ready to start. Keep an eye on them because they will be unsteady on their feet and can take off like a rocket without much control!

Feeding Baby: Your child is ready to start using a spoon. While it won’t be a neat experience, it will delight him as he continues to gain independence and improve his hand to eye coordination. You may possibly still be breastfeeding or giving him formula. You can supplement this with more finger foods and soft choices. Cut up fruit or mash it, puree meats, cut up soft foods such as small bites of fresh bread. Give him macaroni and cheese and eggs. Your baby is swallowing much more easily now and may even be getting some teeth coming in. Many foods that were prohibited before can now be introduced such as fish, egg whites, citrus fruits, and honey.

Your Baby’s Sleep: Don’t be alarmed if your baby starts to resist naps. There are just too many new things out there for him to miss. Make sure you allow your child to wind down before putting him to bed and follow a structured bedtime routine.

Your Baby’s Motor Skills: Your baby now has an attention span of up to five minutes. His pincer grasp is quite developed so he can now pick up even tinier objects from everywhere. Your baby will love to push, throw and knock down anything in his path and if you give them access to your Tupperware cabinet, you will have yourself one very happy child.

Your Baby’s Social Skills: Your baby is starting to form recognizable words so keep talking to him. He loves nothing more than to be the center of attention. When playing with other children, your baby will not necessarily play “with” them but “next” to them. Your child is the master copycat right now and will imitate those who are most important in his life. You may notice him pretending to talk on a phone or brushing his hair. You also may be seeing the emergence of some temper tantrums. Very normal at this stage since he experiences frustration over not being able to master things quickly or being told no when he wants to do something. Don’t be alarmed if you find your baby undressed frequently. This is a great source of entertainment for one-year-olds.

Safety and Your Baby:

  • Your baby loves the water but be cautious and never leave him unattended.
  • Make sure you have gates up and locks on the cabinets and doors.
  • Keep any and all small objects, cleaning supplies and medicines out of baby’s reach.
  • Don’t let your baby near direct or second-hand smoke.
  • Be mindful when leaving your baby with new caretakers or meeting new people. Separation anxiety is quite common.
  • Brush your baby’s teeth twice a day. Always use a fluoride free toothpaste at this stage; babies can not rinse and spit.

Enjoy the newfound skills your baby has developed. He/she may wear you out but it will be a joyful fatigue as you watch your baby grow into toddler hood.

Many pediatricians consider the 15th month as a major “milestone” marker. More than 90 percent of babies now walk and independence has taken hold of your toddler. At this point, many children have gone from walking to sprinting. They are happy as can be doing anything they can to help you in everyday chores and activities.

Feeding Your Toddler: At this point, your child should be off the bottle and drinking from a cup. If that has not happened, wean your child off the bottle slowly over the course of one to two weeks. Don’t be alarmed if your child’s appetite decreases. This is typical because growth has slowed. All foods are allowed with the exception of those that can create a choking hazard ( ie.- raw vegetables, popcorn and peanuts, whole grapes, large chunks of hot dog).

Your Toddler’s Sleep: Your toddler should have a well-established nighttime routine by this time that allows him to wind down and relax a bit before a full night’s sleep. Many toddlers will drop from two to one naps per day at this age.

Your Toddler’s Thinking and Learning Skills: Growth in these areas is huge. Your toddler is an explorer, examiner and imitator. Make his surroundings safe for the exploration. Give him plenty of soft or plastic toys to play with, let him help you wash, mop or fold. He learns through trial and error at this point and looks to you, the parent, to help him solve some problems. He/she can understand simple commands, but that does not assure that the command will be followed! She/he should have about a 5 word vocabulary and be able to point to 1-2 body parts. Overall the pace of development is beginning to accelerate.

What Your Toddler Will Love to Do: Toddlers at this age love to dance and sing, so turn up the tunes and let him go. Give him paper and crayons so your little Picasso can explore his art skills and talk to him constantly. Point to an object while telling him its name and fill up buckets with toys so he can empty and fill it endlessly. If your nerves can stand it, give him pots and pans for endless fun. Your child will likely start to climb stairs with assistance so never let him try it alone and always use gates to close off areas you are not able to supervise.

Safety and Your Toddler: With all of the exploring and experimenting going on, there are many ways your toddler can find trouble. Keep these safety tips in mind:

  • Watch your water-loving toddler around any type of water i.e., baths and toilets.
  • Never leave your child alone in a car.
  • Turn down the water heater to 120 degrees F.
  • Keep hold of your child in traffic or crowded areas.
  • Buy unbreakable toys with no sharp edges or small parts.
  • Keep plastic bags and balloons safely out of reach.
  • Cut food into small pieces to avoid choking.

There will likely be another round of immunizations at this age. If your child runs a small fever or has discomfort, give him acetaminophen based on the dosage suggested by your doctor.

Children 18 months of age can be a lesson in patience for a parent. At times it seems as though your child is well on his way to independence but in the next moment is clinging and crying and holding onto you for dear life. He is beginning to understand limits but will not always obey them.

Your Child’s Sleep: Don’t be too concerned if your child’s sleep patterns turn upside down right now. Your child may awaken in the night but do not reward him by allowing him to call the shots and either get up and play or come in and sleep in your bed with you. Be firm and lay him back down, tuck him in and give him a favorite stuffed animal or blanket to hold. If your child continues to fuss and cry, leave the room and allow him time to try to soothe himself. And be consistent!

Your Child’s Feeding: Your child should not only be totally off a bottle at this point but also be able to handily hold and drink from a cup. Use whole milk until the age of two. Some foods should be avoided at this age due to choking hazards. Grapes and hot dogs should be cut up very carefully. Nuts and raw vegetables are too much for your child right now to properly chew so steer clear. Popcorn can be a problem, too. Your child should be eating three balanced meals per day and two or three healthy snacks.

Your Child and Potty Training: It may be time to get the potty training rolling. Some signs that your child is ready to train may be if he awakes from a nap dry, begins to use words or gestures to let you know he has a dirty diaper or if you can start to see a pattern emerge where he appears to grunt or strain after a meal. Get a potty chair and allow your child to become familiar with it. Don’t put too much pressure on him though. Give him encouragement but allow him to set the pace. The hard core training will not begin until about the age of 2 years.

Your Child’s Social Skills: Your little toddler’s vocabulary may be up to 20 words now. Make sure you stress manners and set a good example. He is watching and able to understand now. You may also notice your child is starting to show interest in making new friends. While he may appear pushy and even a little rude, that is okay. He is just starting the process of building those social skills so expose him to as many group settings as possible to encourage that healthy growth.

Your Child’s Motor Skills: Your child is likely walking up a storm now and possibly climbing stairs with your help. He also loves pedaling a big wheel or tricycle and scribbling with crayons and markers. He loves songs and books and sand and water play. He loves to pretend and you may find him imitating everything you do all day long.

Safety and Your Child:

  • With so much constant movement, make sure you have gates up and at the stairs.
  • Put up barriers against any open windows.
  • Never leave your child unattended anywhere. He is a quick mover and avid explorer and can easily wander off.
  • Your child should be in a car safety seat in the backseat, never in the front until at least age 10.
  • Watch your child around any water.
  • Keep the poison control number handy. 1-800-222-1222
  • Keep any firearms locked up and the ammunition stored in a separate area.
  • Do not expose your child to any smoke, matches, lighters, etc.

While your child may test your patience at this age, it is all due to his journey towards independence. Be consistent and firm. If you have questions about anything, do not hesitate to call us.

It may seem like the past two years have sped by, and you are right. Your child has grown and matured at an amazing rate. At two years old, he is making connections to the world around him and developing new relationships. It’s a time some call “the terrible twos” but it really is a time for him to stand up for himself as an individual.

Your Child and Eating: Don’t get too concerned if your independent little eater gives you problems with meals. Sometimes you feel that he may not be getting enough to eat, but over the course of a week the two-year-old’s diet balances itself out and he will get all the nutrients he needs. At this time, you can move to 2% milk but keep the intake to no more than 24 ounces in a day. Shoot for a daily diet of two servings of protein, four servings of fruits and vegetables and four servings of breads and cereals. A good gauge of portion size is one serving is equal to one tablespoon for each year of age. If you have questions about anything related to diet, please call us and we can help you form a balanced and healthy eating plan.

Your Child and the Potty: Potty training may be getting closer for your two-year-old. If your child wakes dry after a nap, can start to alert you to dirty diapers and begins to strain after meals, you may be ready to start the process. First begin by getting a potty seat and making your child comfortable with it. Let your child see you and other family members using the bathroom and explain the process of going potty as you go along. Teach your child the words for bodily functions and reward him for any success he may have through praise and encouragement. Make this a learning experience and not a battle.

Your Child’s Sleep: Your busy two-year-old does not like to miss anything going on around him so he may fuss at bedtime. Be firm and consistent and stick to your routine. A child this age will still need a nap of one hour per day and 12-13 hours of sleep per night.

Your Child’s Motor Skills: Coordination takes a huge leap in this second year. Your child is walking and running and climbing quite efficiently. He may be riding a bike and can stand on one foot. He is learning and insisting on dressing himself so if he leaves the house with two different socks, don’t discourage him. He is learning to draw more clearly and the use of a preferred hand is quite obvious.

Your Child’s Communication: Your two-year-old is now expressing his emotions through words and not just tantrums. He will most likely be able to talk in simple three- or four-word sentences. He can start to name things and be descriptive of objects. Your child is starting to understand rules so help him by clearly and simply spelling out what you expect of him.

Safety and Your Child:

  • Never leave your child unattended. A two-year-old is a natural explorer and is not able to understand what may be dangerous to him.
  • Continue to put your child in his car seat and explain why it is important to be securely fastened in.
  • Keep the poison control number close by. 1-800-222-1222
  • Keep all medicines and cleaning supplies well out of reach and explain to your child why they are dangerous.
  • Keep all firearms tightly locked up and ammunition stored separately.
  • Avoid any cigarette smoking near your child and keep matches and lighters well away from his reach.

Your child may give you a run for your money in the patience department right now but the process of becoming more independent has some bumps along the way. Start giving your child responsibility around the house and he can become a great helper. Be firm and consistent in your discipline and allow your child a lot of playtime with other children. At this age, he will play side by side and not directly interact but will learn to form healthy relationships.

Congratulations! You have survived the “terrible twos!” Some of you may now be moving into the years many call the “magic years.” On one hand, it seems your child magically now seems to listen to you while on the other hand his imagination is running magically wild! Don’t be alarmed if your little one starts to have fears of darkness, monsters and all things imaginary. For others of you that had easy two year olds, no it is not your imagination that the terrible two’s were delayed until age 3; some children do have a tougher time of it at age 3….seems as if they did not have the chance to read the textbook stating that the difficult time was at age two. Do not dispair, this will pass in about a year.

Your Child’s Diet: Your child should now be eating what the rest of the family does. Introduce a wide variety of foods but don’t fret if it seems your child only wants to eat one thing day in and day out. Offer three meals per day with one or two nutritious snacks. Limit your milk and dairy offerings to no more than 24 ounces per day. Place an emphasis on the family dinner and begin to stress table manners.

Potty Training: Your child should be close to being potty trained. Some children may still have issues overnight. Use a pull up or nighttime diaper to help in this area.

Your Child’s Sleep: Some children may have knocked out the daytime nap altogether at this point; others will nap until almost 5 years of age . Generally, he/she will average about 11-13 hours at night. If your child is having night fears, make sure the bedtime routine is strictly adhered to and allow a nightlight if necessary.

Your Child’s Motor Skills: Running, jumping and climbing are the most loved activities of a three-year- old. He is also now walking up and down stairs quite well, one foot per step, and can bend without falling. Others skills that are emerging include: dressing and undressing, using age appropriate scissors, turning rotating handles, throwing and catching a ball, drawing, finger painting, and copying squares and circles.

Your Child’s Cognitive and Social Skills: Your child now has a vocabulary of up to 1,000 words! Other feats include imitating friends and parents, pretending and fantasizing, sorting by shape and color, showing affection to family and friends, understanding the concept of same and different, remembering parts of stories, understanding the concept of time i.e., night and morning, counting and understanding the concept of counting and showing a wider range of emotions. He also may be having fewer tantrums when dropped off at daycare, preschool or a play date.

Safety and your child:

  • Make sure your child is in a forward-facing car seat with harness straps.
  • Strap your child into his high chair.
  • If using handed down equipment, make sure it has not been recalled.
  • Keep toys with parts smaller than 1¼ inch in diameter out of reach.
  • Begin teaching stranger awareness.
  • Teach pedestrian and playground safety.
  • Always use sunscreen.
  • Teach your child wariness of other people’s pets. Do not allow him to just walk up and reach for a dog or cat that is unfamiliar.

Parenting at this age can be a true lesson in patience. Be firm and consistent with rules. Timeouts are appropriate for this age. Remove him from action for one minute for each year of age. Keep TV watching limited to no more than two hours per day. Keep reading to your child and let him use that wonderful imagination to think up stories to entertain the whole family!

Your four-year-old continues to use his imagination and develop social skills. Many of his milestones mirror the three-year-old child. In terms of sleeping, be firm with a nighttime routine and be sensitive to any night fears. Do not let him get in the habit of sleeping with you if he has fears. Tuck him back in bed and stress his safety and allow him to fall asleep on his own. The diet of a four-year-old should mirror your own…three balanced meals and one or two nutritious snacks per day.
Physical and Motor: The typical four-year-old:

  • Shows improved balance.
  • Hops on one foot without losing balance.
  • Throws a ball overhand with coordination.
  • Can cut out a picture using scissors.
  • Can draw a simple person
  • May still wet the bed (normal).
  • Runs, jumps and climbs with ease.
  • Dresses and undresses himself.
  • Walks up and down stairs alternating feet without assistance.
  • Can pedal a tricycle

Cognitive and Social: The typical four-year-old :

  • Has a vocabulary of more than 1,000 words.
  • Easily puts together sentences of four or five words.
  • Can use the past tense.
  • Can count to ten and identify colors.
  • Will constantly question things.
  • May have language that is a bit unrecognizable.
  • Learns and sings simple songs.
  • Tries to be very independent
  • Talks about personal family matters to others.
  • Commonly has imaginary playmates.
  • Has an increased understanding of time.
  • Is able to tell the difference between two objects based on things like size and weight.
  • Lacks moral concepts of right and wrong.
  • Rebels if too much is expected of him or her.
  • Throws fewer and fewer tantrums.
  • Shows affections for family and friends.

Play:

  • Encourage and provide space for physical activity.
  • Show the child how to participate in and follow the rules of sporting activities.
  • Encourage play and sharing with other children.
  • Encourage creative play.
  • Teach children to do small chores, such as setting the table.
  • Read together.
  • Limit television watching to two hours a day of quality programs.
  • Expose the child to different stimuli by visiting local areas of interest.

Safety:

  • Teach your child his name, parent’s names, address and phone numbers including area codes. Also teach emergency numbers i.e., 911.
  • Make sure your child is in a forward-facing car seat with harness straps.
  • Strap your child into his high chair.
  • If using handed down equipment, make sure it has not been recalled
  • Keep toys with parts smaller than 1¼ inch in diameter out of reach.
  • Begin teaching stranger awareness.
  • Teach pedestrian and playground safety.
  • Always use sunscreen.
  • Teach your child wariness of other people’s pets. Do not allow him to just walk up and reach for a dog or cat that is unfamiliar.
  • Always use a helmet when riding a bike.

Get ready for school because soon your child will enter kindergarten! Some call these years the “golden age” but they are filled with new and sometimes difficult transitions. The examples that are set at this age will in many ways help determine how they react and perform in school settings. At five years of age, your child is now able to stop and think before acting impulsively in a situation. There may be a more serious air about your child now as he ponders and asks questions. Some of these questions may seem quite adult i.e., why do you and Daddy close your bedroom door at night? Be matter of fact in your answers and tailor them to what a five-year-old can and should understand.

Feeding and Your Five-Year-Old: Your child should now be eating what the family eats. Limit meals to three balanced meals and no more than two healthy snacks per day.

Your Child and Elimination: At this age, some children may have some issues with nighttime wetting but should be totally potty self-sufficient during the day. He will be entering school soon and it will be essential that he is completely potty trained. If you are having any issues in this area, please call us and we can help you work through them.

Sleep and Your Child: Your child’s fears may be decreasing at night and should be sleeping a good 10-12 hours per night. Continue with a bedtime routine. As you reach entry into school, make laying out clothes and preparing backpacks part of this routine.

Motor Skills: At this age, your child is dressing himself and brushing his teeth. He is able to stand on one foot for 10 seconds or longer. He loves to climb, run, hop and ride bikes. He can draw recognizable pictures and use utensils at the table, though the knife may still give problems. He is able to print some letters and numbers.

Communication and Social Skills: Talking is the favorite pastime of the five-year-old and he can now create simple stories to tell. He wants to please and be like his friends. He has a vocabulary of more than 2,000 words. He knows the difference between make believe and real and is aware now of gender. In one moment he may be very demanding but in the next, very cooperative. He is more likely at five to agree with the rules.

Safety:

  • Make sure your child knows your phone number (with area code), address and parent’s names.
  • Teach your child about stranger awareness.
  • Discuss pedestrian, school bus and playground safety.
  • Always use a helmet when riding a bicycle.
  • Keep all firearms locked up with ammunition stored separately.
  • Teach your child safety around animals.
  • Monitor the amount of time and content of your child’s TV viewing. No more than two hours per day.
  • Continue to use a car seat.

With so many new experiences on the horizon, continue to be firm and consistent with rules. Praise your child for good behavior and nip the bad behavior in the bud immediately. Continue stressing reading and talk to your child about all his new experiences. Stress the family dinner table each night and expose your child to as many new and different experiences as you can.

Despite the fact that once a child is 6 years of age he/she no longer requires vaccinations at every well child exam, the annual exam is still extremely important. We provide surveillance on many fronts at these visits. For example, we monitor the child’s weight and height every year. This allows us to manage an upswing in weight before it becomes obesity. It allows us to detect conditions such as Celiac Disease, Crohn’s Disease, and Growth Hormone Deficiency by utilizing the information derived from the child’s growth trends. In addition, we check urine samples yearly. Through these screens we have picked up conditions such as Diabetes as well as conditions of the kidneys in our patients before the child has gotten to the point where he/she has become ill. Yearly blood pressure measurements have enabled us to direct our patients ( usually in the teenage age group) to the Cardiologist when necessary. Through the physical exam we can catch everything from hernias that need repairing, to cardiac abnormalities, to enlarged thyroids in kids with early thyroid disease, to early scoliosis which is remedied much more effectively by bracing in the early stages. We can detect abnormalities of pubertal development whether it is delayed or premature. Furthermore, when indicated by family history, we can do phlebotomy in the office to screen for early cholesterol conditions, anemia, and even some genetic disorders. We can counsel families that are dealing with a huge list of possible issues in their children; anything from bedwetting to academic issues, from constipation to nutritional challenges, from sleep disorders to chronic allergies. When a child comes in for a checkup we check on every aspect of that child’s life.

When the child enters the teen years these checkups take on another level of importance. Young people today encounter a myriad of challenges on a social/emotional level. They are dealing with situations that force them to make choices that impact their health on a significant level. Every teen in our communities, whether we want to believe it or not, will be faced with the challenge of abstaining from the use of tobacco, alcohol, illegal street drugs/prescription drugs, as well as the difficult question of whether he/ she will abstain from early sexual relations (or if active, how to protect against disease and teen pregnancy). We address all of these issues at our teen visits, and if needed, help the teen to sort through the difficult choices he/she is facing. We can support them, encourage communication with the parent, and educate them in order to help them make good decisions. However, we can not do this if we only see the child once every 2 to 3 years. Continuity of care year after year is crucial to enable a doctor to form a relationship with a young person that will enable that teen to be honest and seek help when needed. In today’s world of cutting middle school sports, state laws that no longer require yearly school physicals, and insurance companies that do not always pay for yearly physicals, these annual checkups are getting lost in the shuffle, and it is to the detriment of the child.

What we are saying is that although the initial series of shots and booster shots for Kindergarten may end at 5, the need for yearly health surveillance never ends. If you are not sure when your child’s last physical occurred, or if your child’s birthday is approaching, please call to arrange for a yearly physical.