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Well Child Information

There is nothing more joyful to us as loving parents than that moment when we hold our precious little baby, or babies, in our arms after birth. We should acknowledge them as gifts from God and count ourselves blessed to have them.

Behold, children are a heritage from the Lord, the fruit of the womb is a reward.

Psalm 127:3 NJKV

As we watch them grow and share many memorable moments and events together through life, we come to see the wonders of God unfold before our very eyes.

As their earthly parents, we are but care-takers and only for a season. While we are at it, it is our responsibility to give it our best shot.

You may track your child’s development at every stage as they grow throughout their young and eventful life.

1. Call your pediatrician right away or make an appointment and bring your newborn baby that is less than three months old to the clinic if your baby has any of the following:

2. Your baby feels warm, you think the baby might have a fever, and you take the temperature and your baby has a temperature of 100.4oF (38oC) or higher, or if your baby feels cold to touch, you take the temperature and it is less than 98oF (36.6oC) when taken under the arm. The range of normal body temperature is 97oF – 100oF (36.1oC – 37.8oC).

3. Your baby is vomiting and it is forceful (projectile), especially if there is a large amount after each feeding session, or if vomiting persists for more than 24 hours.

4. Your baby is refusing to feed for more than one or two feedings.

5. Your baby seems to be sleeping a lot, especially if difficult to awaken, is weak or floppy and or if not feeding well.

6. When your baby is fed, changed, properly swaddled in appropriate clothing and comforted but is crying constantly.

7. There is redness around the umbilical cord or it has a foul odor or any kind of discharge or drainage. Your baby has an eye discharge, swelling or redness around the eyes.

8. Your baby has frequent, watery, foul smelling stools (diarrhea), especially if the stools contain blood. There is bleeding from around the umbilical area, the circumcision site or any other sites.

9. Your baby has a seizure or convulsion.

10. You notice a color change; ‐ either the skin becomes pale or blue or your baby becomes blue around the eyes or mouth.

11. If your baby looks yellow or has jaundice. Jaundice is a yellow discoloration of the skin which usually starts on the face and spreads downwards towards the body and feet. The eyes may also look yellow.

12. Your baby has trouble breathing, breathes fast (more than 60 times a minute), or makes a grunting noise when breathing. If you notice nose flaring with breathing or chest retractions.

13. If your baby has not had the usual number of wet diapers in 24 hours. As a guide during the first week of life, babies should make at least the number of wet diapers corresponding to their age in days. For instance a 4day old baby should be making at least 4 wet diapers in 24 hours. After the first week your baby should be making about 6 to 8 wet diapers per day, or sometimes with each feeding.

14. If you notice white patches on the roof of the mouth, the tongue or the inside of the cheeks that you are not able to rub off. This is thrush and may prevent your baby from feeding well.

APPOINTMENTS The American Academy of Pediatrics recommends that newborns should receive checkups once a month in the first two months. They will likely need immunizations at 2 months of age. Please note that this is not an exclusive list of problems that newborn babies may develop. If you have any concerns, feel free to contact us at PrimeCare Pediatrics (770)‐251‐5253.
DEVELOPMENT
Your baby is becoming more aware of his surroundings and while he is still changing and growing every day, he often will begin to have certain patterns of sleeping and waking. These patterns, including some fussy or colicky periods, are part of normal, healthy, neurologic development. Your baby is continuously learning as he can see, hear, smell, taste and touch.

NUTRITION
Breast milk and infant formulas are the only recommended sources of calories for the first four to six months. Mothers who breastfeed should continue taking prenatal vitamins. Bottle-fed babies usually take 24-28 ounces every 24 hours at one month of age. Babies who wet their diapers every 4-6 hours are very likely receiving adequate amounts of fluid.

SAFETY
We are concerned about your child’s safety just as you are. Always use the car seat every time your child travels in a vehicle. Your baby should remain rear-facing in their car seat until he is 20 pounds and 12 months old. The back seat is preferred for all children under age 12 years. Do not secure a pacifier around a baby's neck with a string. Always be attentive to your baby to avoid falls and injuries. Avoid cooking or drinking hot liquids with your baby in your arms. Passive smoke is dangerous to the baby's health now and as they grow. Never leave your baby unsupervised while bathing him.

GENERAL WELL-BEING
Rashes in the first weeks of life are relatively common. Rashes in a healthy-appearing baby are generally of minimal consequence. If your baby's rash remains more than a few days, or your baby appears sick, he should be seen by your pediatric health care provider. Colic, inconsolable crying without identifiable cause may develop. A calm environment and other measures, such as the monotonous noise of a vacuum or clothes dryer, may help your baby to relax. If your baby has a fever over 100.3, particularly in the first 8 weeks after birth, he needs to be examined by a pediatric healthcare provider. Congestion (stuffy nose) is a common problem for many infants. Often this is alleviated by using a cool mist humidifier in the child’s room. Saline nose drops can be purchased over the counter to help this situation as well.

NEXT APPOINTMENT
Schedule an appointment for your child’s 2 month physical. Your baby will be due additional immunizations at that visit.

DEVELOPMENT
Verbal communication is important for language development and emotional well being, so be sure to talk to your baby often. You will notice that your baby is beginning to lift her head with more control. The ability for your baby to move with control begins with the head and extends down the rest of the body. Later your baby will push up with her arms, and then refine the use of her hands. Waking and sleeping patterns are still changing some. Work with your baby as she grows and develops.

NUTRITION
Mothers who breastfeed should continue taking prenatal vitamins. Bottle-fed babies usually take 28 to 30 ounces per 24 hours at 2 months old. Breast milk or infant formula is the only recommended source of calories until four to six months of age. Refrain from feeding eggs, wheat, cow milk, or citrus fruits until nine months of age.

SAFETY
We are concerned about your child’s safety just as you are. Please be reminded to always use the car seat every time your child travels in a vehicle. Your baby should remain rear-facing in their car seat until 20 pounds and 12 months of age. The back seat is preferred for all children under age 13 years. Do not secure a pacifier around a baby's neck with a string. Always be attentive to your baby to avoid falls and injuries. Avoid cooking or drinking hot liquids with your baby in your arms. Passive smoke is dangerous to the baby's health now and as they grow. Never leave your baby unattended while being bathed.

GENERAL WELL-BEING
Baby's immunity from mother is beginning to decrease. Your baby is now becoming susceptible to illnesses: coughs, colds, diarrhea, runny noses, etc. Your baby will build immunity with each exposure to illness. Stuffy noses can sometimes be helped with saline solution that can be purchased other the counter. Sometimes a cool mist humidifier will also help. If your child is running a fever over 100, she may need to be examined by your pediatric health care provider. The appropriate dose of acetaminophen (Tylenol) is 5-7 milligrams per pound every 4 hours as needed for relief. Colic, inconsolable crying without identifiable cause may still be present. A calm environment may help you and your baby to relax.

NEXT APPOINTMENT
Schedule an appointment for your child’s 4 month physical. Your baby will be due to receive additional immunizations at that visit.
DEVELOPMENT
Your baby may be holding his head steady when upright and is probably beginning to push up onto his forearms when lying on his stomach. He may begin to roll from front to back, and will begin bringing objects to his mouth. Talk to your baby. He will continue to make more and more varied babbling noises and may begin to imitate sounds. This is an important part of language development. Some 4-month old babies will be sleeping through the night. If your baby does wake up in the middle of the night, give him time to get back to sleep on his own. If he does not stop crying within 20 minutes, check on him and verbally try to calm him. Try not to get into a waking routine but help him learn to put himself back to sleep. Avoid letting the baby go to sleep with a bottle in his mouth -- this will cause tooth decay. Some children get their first tooth around 6 months of age and many will chew on firm objects and drool a lot for a few months before any teeth actually come in.

NUTRITION
If you desire, your baby may begin to take solid foods now. Start with cereal, then vegetables, and fruits, in that order- some children may view fruits as a dessert. Adding one solid food at a time at intervals of several days is recommended. The amount of solid food per day varies among individual babies. Your baby still needs breast milk or formula to ensure a healthy diet. It is not recommended to give your baby eggs, citrus fruits or strawberries until 9 months of age to help prevent food allergies later. You may want to prepare your own nutritious baby food. Food processors will help you prepare food for placement in ice cube trays. After the food is frozen, place it in a sealable bag in the freezer. Carefully warm the amount you desire to use for each feeding, testing to make sure it is not too hot before giving it to the baby. Commercial baby foods are also convenient. If your drinking water is not fluoridated, you may need to add a fluoride supplement at the age of six months. Please discuss this with us.

SAFETY
At PrimeCare Pediatrics we are also concerned about your baby's safety, remember to always use the car seat every time your child travels in a vehicle. Your baby should remain rear-facing in their car seat until 20 pounds and 12 months of age. The back seat is preferred for all children under age 12 years. Do not secure a pacifier around a baby's neck with a string. Now that your baby will soon be rolling over, be especially attentive, watching for potential falls. Protect electric outlets and cords from baby's exploring fingers. Passive smoke is dangerous to the baby's health now and as they grow. Walkers are potentially dangerous as well and, in fact, may actually delay your child's walking.

GENERAL WELL-BEING
Most of the illnesses your baby may now begin to experience will be caused by viruses, while some may be caused by bacteria. Babies build immunity with each exposure to the different viruses and bacteria. The frequency of these viral illnesses can be frustrating for child, parent and physician, but generally are not cause for alarm. Antibiotics are used only for bacterial infections. Many bacteria have developed resistance to antibiotics. For this reason we prescribe antibiotics with caution. If your child is running a fever he may need to be checked. The appropriate dose of acetaminophen (Tylenol) is 5-7 milligrams per pound every 4 hours as needed for relief. Ibuprofen (Motrin) is not recommended until after 6 months of age.

NEXT APPOINTMENT
Schedule an appointment for your child’s six-month physical. Your baby is due to have additional immunizations at that visit.
DEVELOPMENT
Watch your baby sit with some support. He may also roll over completely and pick up and pass objects from hand to hand. Talk to your baby. He will continue to make more and more varied babbling noises and may begin to imitate sounds. This is an important part of language development. Many 6-month old babies will be sleeping through the night. If your baby does wake up in the middle of the night, give him time to get back to sleep on his own. If he does not stop crying within 20 minutes, check on the baby and verbally try to calm him. Try not to get into a waking routine but help him learn to put himself back to sleep. Avoid letting the baby go to sleep with a bottle in its mouth -- this will cause tooth decay. Some children get their first tooth around 6 months of age and most will chew on firm objects and drool a lot. NUTRITION If not started already, your child can begin to take solid foods now. Try to introduce cereal, then vegetables, and then fruits - some children may view fruits as a dessert. Adding one solid food at a time at intervals of several days is recommended. Your baby still needs breast milk or formula to ensure a healthy diet. It is not recommended to give your baby eggs, citrus fruits or strawberries until one year of age to help prevent food allergies later. You may want to prepare your own nutritious baby food. Food blenders will help you prepare food for placement in ice cube trays. After the food is frozen place it in a sealable bag in the freezer. Carefully warm the amount you desire to use for each feeding, testing to make sure it is not too hot before giving it to the baby. Commercial baby foods are also convenient.

SAFETY
Please do not change your rear-facing car seat to a forward facing one. Only children who have attained the age of 12 months and weigh at least 20 pounds, may use forward facing car seats. Once a baby is about 20 pounds and can sit well without assistance, and has reached 12 months of age, they can safely ride in a car seat restraint in a forward position in the back seat. ALWAYS use the car seat EVERY time your child travels in a vehicle. Do not secure a pacifier around a baby's neck with a string. Protect electric outlets and cords from baby's exploring fingers. Passive smoke is dangerous to the baby's health now and in the future. Walkers are potentially dangerous as well; and, in fact, may actually delay your child's walking.

GENERAL WELL-BEING
Most of the illnesses your baby may now begin to experience will be caused by a virus, while some may be caused by bacteria. Babies build immunity with each exposure to the different viruses and bacteria. The frequency of these viral illnesses can be frustrating for the child, a parent, and the physician, but generally are not cause for alarm. Antibiotics are used only for bacterial infections. Many bacteria have developed resistance to antibiotics. For this reason we prescribe antibiotics with caution. Stuffy noses can sometimes be helped with a saline solution. This can be purchased or made by mixing 1/8 teaspoon of salt in four [4] ounces of water. Place 2-4 drops in nostril followed by nasal aspiration with a bulb syringe. If your child is running a fever he will probably need to be checked. The appropriate dose of acetaminophen (Tylenol) is 5-7 milligrams per pound every 4 hours as needed for relief.

NEXT APPOINTMENT
Make an appointment for your child’s nine-month physical exam. Your baby may be due additional immunizations at that visit.
DIET and NUTRITION
At this age your infant may eat finger foods such as crackers, cooked pasta, cereal, and banana chunks as they learn to feed themselves. Your child is likely to swallow without chewing. Avoid nuts, popcorn, raw vegetables or other foods that need a lot of chewing. PrimeCare Pediatrics and the American Academy of Pediatrics encourage you to continue breast milk or infant formula until one year of age. Now is a good time to introduce your child to drinking from a training cup. This will be messy at first, but your child will get better with practice. Do not allow your child to take a bottle to bed. As your child approaches a year of age, begin offering three meals a day with nutritious between meal snacks. Our example as parents will greatly influence our children's eating habits. If your drinking water is not fluoridated, you may need to add a fluoride supplement. Please discuss this with us.

DEVELOPMENT and SLEEP Continue to talk to your baby. This encourages language development. Your baby's vocalization will become more recognizable as words. The first words are an impressive accomplishment. Your child may sleep as long as 12 hours at night and take 2 naps during the day. Establish a sleep routine. Experiment with different ways to help your child sleep. When awake, your 9-month-old may begin to explore with fingers, hands and mouth. Your child will start crawling and cruising also. You may notice how quick and active he has become. As a result of all this positive development, your child is able to get into many interesting and precarious situations. Your child's intellect and personality are developing quickly now. Continue to enjoy them as they amaze you with their advancement.

SAFETY
Car seats, smoke detectors, fire avoidance, poison prevention, hot water temperature, passive smoke and dental health are issues to consider now and in the future. "Kiddie locks" on cabinets and removal of dangerous items such as scissors, knives, cleansers or dangling electric cords are ways to help prevent injuries. Lowering your child's crib mattress is also recommended. Because accidents and ingestion of harmful material may take place, we recommend you have emergency numbers handy. If your baby has ingested a potentially dangerous substance, call Poison Control 4O4-616-9OOO for immediate advice. Babies may face forward in their car seats once they reach 20 pounds and are 12 months old. Soft, flexible, comfortable shoes with non-skid soles will help protect your child's feet. If you have a firearm, store it locked and separate from ammunition.

GENERAL WELL-BEING
The appropriate dose of acetaminophen (Tylenol) is 5-7 milligrams per pound every 4 hours as needed for relief. Ibuprofen is 5mg per pound every 6-8 hours. Teaching your child safe, polite and appropriate behavior is a very big job that is already underway. Many books have been written, and you may find these helpful:

The New Dare to Discipline by James Dobson
The New Strong Willed Child by James Dobson 
Good Behavior by Stephen Garber 
How to Really Love Your Child  by Ross Campbell 
Shepherding a Child’s Heart by Ted Trip 

NEXT APPOINTMENT
Your child’s next physical will be at 12 months old. Additional immunizations will be due at that time.
CONGRATULATIONS!!!
Your child is now one year old. You have enjoyed one of the most exciting years of your child's life. Breathe a sigh of relief and watch your child as he begins to talk, walk and balk.

NUTRITION
The bottle is now more of a convenience for us as parents than a necessity for the child. Now is the time to introduce a cup, if you have not already done so. After weaning from breast milk or formula, we recommend whole milk until 2 years of age. Your child will begin to eat independently and may be an erratic or picky eater. He is getting better at feeding himself. Give your baby some freedom, but not total control of eating. Offer nutritious foods, and make meal time a happy time. Our example as parents will greatly influence our children’s eating habits. In addition, you should be brushing your child's teeth at least once a day. No toothpaste is needed until he can spit on demand. The first dental checkup is usually around age 3 years. If your drinking water is not fluoridated, you may need to add a fluoride supplement. Please discuss this with us.

SAFETY
Concerns include car seat restraints, smoke detectors, fire avoidance, poison prevention, hot water temperature, passive smoke, dental health and general household safety. If not already done, "Kiddie locks" on cabinets and removal of dangerous items such as scissors, knives, cleansers or dangling electric cords can help prevent injuries. Lowering your child's crib mattress is also recommended. Children from 1-3 years of age are at the highest risk of poisoning. Protect your child by keeping medicines, cleaners, insecticides and beauty products out of sight and reach. Because accidents and ingestion of harmful materials may take place, we recommend you have emergency numbers handy. If your baby has ingested a potentially dangerous substance, call Poison Control 4O4-616-9OOO for immediate advice. Use gates at the top and bottom of stairways to prevent dangerous falls. Never leave your child alone in a bath or near containers of water, including wading pools. If left alone, children can drown in only one inch of water. If you have a firearm, store it locked and separate from ammunition.

DISCIPLINE
now becoming more a part of your child's life. Each child will respond differently to various approaches. Some children will be compliant; others will be strong-willed. Teaching your child safe, polite and appropriate behavior is a very big job that is already underway. Many books have been written and you may find these helpful:

The New Dare to Discipline by James Dobson
The New Strong Willed Child by James Dobson
Good Behavior by Stephen Garber
How to Really Love Your Child by Ross Campbell
Shepherding a Child’s Heart by Ted Trip

EDUCATION
more and more become a part of your child's life. Language development is very important. Reading to your child on a regular basis will give your child a head start on his educational journey.

NEXT APPOINTMENT
Make an appointment for your 15 month physical. Your baby may be due for additional immunizations at that visit.
DIET and NUTRITION
Your preschooler's growth rate has slowed from the rapid growth of infancy. This often will be manifested by a small appetite. Do not worry. Continue to offer regular small nutritious meals and scheduled snacks. Your preschooler will take in adequate calories over the course of a several days. You should be brushing your child's teeth at least once a day. No toothpaste is needed until he can spit on command. Dental visits should begin no later than age 3. If your drinking water is not fluoridated, you may need to add a fluoride supplement. Please discuss this with us.

SAFETY
Georgia law requires children under age 5 to remain in car safety seat and all persons must be in a seat belt at all times. Household injuries are very common in the preschool years. Keep sharp or hot object and poisons out of reach. If your preschooler has ingested a potentially dangerous substance, call Poison Control 4O4-616-9OOO for immediate advice. Now is a good time to begin teaching stranger safety. If you have a firearm, store it locked and separate from ammunition.

DEVELOPMENT/EDUCATION
Your child is learning and changing every day. Speech is gradually becoming more intelligible. You should be able to understand about half of your child's language at age 2 years, 3/4 by age 3 years and almost all by age 4 years. He is becoming more adept at jumping, running, kicking a ball and maneuvering stairs. Provide time for active outdoor play as well as indoor activities, such as coloring or building with blocks, which stimulate finger dexterity. Continue reading on a regular basis. Support your child's interest in toilet training, but do not let it become a power struggle.

DISCIPLINE
Your child's favorite word may be "NO" Try to help your child decide between acceptable alternatives rather than just "yes - no" options. Having a few simple rules that are consistently enforced will be more productive than multiple rules inconsistently enforced. Independence should be encouraged but molded -- Defiance should not be tolerated. Help your child develop respect toward authority figures, including you. Consequences for disobedience should be immediate, consistent and easily understandable. Time out for 1 minute per year of age may be helpful. Consistent boundaries and consequences actually help the child develop a healthy self esteem and let them know they are loved and cared for. Teaching your child safe, polite and appropriate behavior will continue to be a very big job. Many books have been written and you may find these helpful:

The New Dare to Discipline by James Dobson
The New Strong Willed Child by James Dobson
Good Behavior by Stephen Garber
How to Really Love Your Child by Ross Campbell
Shepherding a Child’s Heart by Ted Trip

NEXT APPOINTMENT
The American Academy of Pediatrics recommends that preschoolers receive checkups once a year. They will likely need immunizations at 4 or 5 years of age.
NUTRITION
Your child's growth rate will be in small spurts during childhood. Your child's appetite may also vary. As long as you are building and modeling good eating habits, do not worry. Continue to offer regular nutritious meals and scheduled snacks. Your child should be brushing her own teeth, though some supervision may be required. Regular dental visits should continue.

SAFETY
Seat belts are a must (and also the law). Children under 13 are safer in the back seat of an automobile. All persons should be belted firmly in their seats when in an automobile. Be a good example. Helmets should be worn while cycling and roller blading. They should also wear wrist guards and knee pads. Continue to discuss stranger safety with your child. If you have a firearm, store it locked and separate from ammunition. Safety Laws change; awareness on your part will help you comply with these and better protect your child.

DEVELOPMENT/EDUCATION
Learning is very exciting. There is much to learn and each of us has a different way of learning. Explore with your child their learning style. Be actively involved with your child's learning processes at home and school. You are your child's most important teacher. Continue to encourage reading on a regular basis. Spend time talking with your child each day – this will establish good patterns of communication before your child enters adolescence. Actively encourage and support your child in regular exercise. Limit TV and computer time as much as possible, these activities promote childhood obesity.

DISCIPLINE
Part of loving your child includes training him for now and in the future. Independence should be encouraged but molded -- defiance should not be tolerated. Consistent boundaries actually help your child develop a healthy self esteem and let her know she is loved and cared for. Rules that are consistent, immediately and appropriately enforced will be more effective than inconsistent enforcement of multiple rules. Loving yet firm discipline helps your child develop a healthy mindset that is not self-centered or unpleasant, but helps him to be self- controlled, outwardly focused, and a joy to be with. This is a very big job. Also, continue to help your child develop respect toward authority figures, including you. You are your child's most important teacher. Many books have been written, and you may find these helpful:

The New Dare to Discipline by James Dobson
The Strong Willed Child James Dobson
Good Behavior by Stephen Garber
Ready for Responsibility by Dr. Bob Barnes
How to Really Love Your Child by Ross Campbell
Age of Opportunity by Paul Tripp
Shepherding a Child’s Heart by Ted Trip

NEXT APPOINTMENT
We recommend school age children receive checkups once every 1-2 years or more often if you are concerned about a specific area of your child's growth or development. Reminder: Immunization schedules are ever changing. Ask if your child is up to date.
NUTRITION
Adolescent eating habits can be erratic at best. Encourage your teen to eat a variety of fruits and vegetables as part of a lower fat, high-fiber balanced diet. Water is a very good source of fluid. Milk and calcium continue to be important for strengthening growing bones.

SAFETY – EDUCATION
Seat belts are a must (and also the law). Also discuss with your teen the dangers of riding with a driver who has been drinking. If you have firearms, store them locked and separate from ammunition. Helping your adolescent learn to properly deal with anger will enhance their safety, education and joy in life. With early adolescence comes the ability to begin to think abstractly. Your teen may now think more in concepts and complex ideas. Just as it took time to walk, it may take time to think rationally with consistency. Keep lines of communication open by frequently discussing with your teen how he or she is responding to the many social, emotional, and sexual pressures of adolescence. Discuss with them the use of tobacco, alcohol, and drugs. Help your teen decide against substance use and sexual activity by discussing ways he/she can avoid or refuse them.

EXERCISE
It is easy to fall into a sedentary lifestyle. Encourage your adolescent to find a form of exercise that is healthy and enjoyable, and actively support him or her in it. Don’t depend on the school system to provide quality physical activity – your teen’s P.E. class may have been traded for computers or driver’s education.

IMMUNIZATIONS
Immunizations protect us from diseases. Frequently, a tetanus booster is needed around age 11-15. If not already obtained, the Hepatitis B series is also highly recommended.

NEXT APPOINTMENT
The American Academy of Pediatrics recommends that adolescents receive a physical each year.

There are a number of regularly scheduled well visits that are recommended for optimal health supervision of your baby. These visits usually begin once you leave the hospital.

What to expect at your Physicals

Check out the link below. You may find very useful information there for you and your family.

Medline Plus

Please contact us or your health care provider if you have any questions or need additional information.