2 Month Well Child Care - University of Arizona



2 Month Well Child Care

AAP Board Content Specifications:

• Evaluate the motor developmental progress/status of an infant at 2 months of age, including recognition of abnormalities

• Evaluate the cognitive and behavioral developmental progress/status of an infant 2 months of age, including recognition of abnormalities

• Immunizations:

o Recognize adverse reactions to various vaccine constituents and manage appropriately

o Know the indications, safety, and schedule for the pneumococcal vaccine, hepatitis B, pertussis, polio, rotavirus, hib

AAP priorities to assess for this visit:

• Parental well-being, parental roles, family support, sibling relationships

• Infant behavior, developmental changes, physical activity

• Infant-Family synchrony (parent-infant separation, child care)

• Nutritional adequacy

• Safety

Questions:

1) What are some questions to ask the parents at this visit? What interactions should you observe?

2) What are some developmental milestones a two-month old should have achieved?

3) What is an appropriate diet? What further recommendations should you give at this appointment?

4) What parts of the physical exam are important?

5) What vaccinations do you give at this age?

6) What safety topics should be addressed at this visit?

7) What anticipatory guidance is important at this age?

1) Parent-Child Interaction:

Parental Questions?

o How are things going?

o Maternal post-partum checkup? Depression?

o What kind of support system do they have?

Parent-Child Interaction

o How responsive are the parents and the infant to each other

o Do parents appear comfortable with infant and responsive to infant’s distress, comforting, and feeding cues?

o Parental roles- Do parents support each other or show signs of disagreement?

o Do parents seem anxious, depressed, fatigued, or overwhelmed?

2) Developmental milestones: What to expect for this visit & in the upcoming months

|Age |Gross Motor |Fine Motor |Communicative |Social |

|2 m/o |*Push to prone, holds |*Hands unfisted 1/2 |*Indicates boredom |*Social smile |

|  | up chest while prone |time |(cries/fusses) |*Attempts to look |

|  |*Able to hold up head |*Tracks past midline |*Coos |at parents |

|  | |*Diminishing newborn |*Clearer behaviors |*Consoles/comforts |

|  | |reflexes |to indicate needs |self |

|3 m/o |*Partial head lag |*Bats at objects |*Regards small |*Echoes speaker |

|  |when pulled from |*Sustained palmar |objects |*Babbles |

|  |sitting |grasp | |  |

3) Diet:

• At 2 months breastfed infants need about 8-12 feeding in 24 hours.

• Bottle fed infants take about 21-32 oz in 24 hrs (usually 4-6 oz every 3-5 hrs).

• Babies only need breast milk or iron-fortified formula in the first 4-6 months of life. Parents should not start solid foods until 4-6 months, when infant is developmentally ready.

• The only supplement is Vitamin D for exclusively BF babies (D-visol/Trivisol/Polyvisol) or babies taking under 1L of formula.

• Avoid honey & cow’s milk

o Botulinum spores in honey put an infant under 1 year old at risk for infantile botulism.

o Cow’s milk has been shown to increase intestinal blood loss by 30% in infants ................
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