What to Expect the First Year (114 page)
Read What to Expect the First Year Online
Authors: Heidi Murkoff
Even healthy babies spend a lot of time at the doctor's office. Well-baby checkups, which are scheduled throughout the first year, allow the doctor to keep track of your baby's growth and development, ensuring that everything's on target. But they're also the perfect time for you to ask the long list of questions you've accumulated since your last visit, and to walk away with a whole lot of advice on how to keep your well baby well.
To make sure you make the most of every well-baby visit:
Time it right.
When scheduling appointments, try to steer clear of nap-timesâand any time your baby's typically fussy. Also good to avoid: those peak hours at the doctor's office, when waiting rooms are packed and waits are long. Mornings are usually quieter because older children are in schoolâso in general, a pre-lunch appointment will beat the 4 o'clock rush. And if you feel you'll need extra time (you have even more questions and concerns than usual), ask whether it's possible to schedule it into the visit so you won't feel so hurried.
Follow office etiquette.
Arrive for appointments on time or, if the office perpetually runs late, call half an hour or so before a scheduled appointment and ask how much later you can safely arrive. If you must cancel, be sure to give at least 24 hours' notice.
Fill 'er up.
A hungry patient is a cranky and uncooperative patient. So show up for your well-baby visits with a well-fed baby, or plan to feed while you wait (once finger foods have been started, you can also bring a snack for the waiting room). Keep in mind, however, that overfilling a young baby's tank with breast milk or formula just before the appointment may mean baby is ripe for spitting up once the exam begins (and all of you may smell ripe afterward).
Dress for undressing success.
When choosing baby's wardrobe for the visit, think easy-on, easy-off. Skip outfits with lots of snaps that take forever to do and undo, and snug clothes that are difficult to pull over baby's head. And don't be too quick to undress your baby if he or she isn't a fan of being nakedâwait until the exam is about to begin before stripping down.
Make baby comfortable.
Few babies enjoy the poking and prodding of a doctor's examâbut many enjoy it even less when it takes place on the wide-open spaces of the exam table. If that's the case with your baby, ask if at least part of the exam can be done with baby on your lap. Keep in mind, though, that some older babies find the exam table paper fun to crinkleâand that can provide a welcome diversion.
Keep track.
Remember those 200 questions you wanted to ask the doctor? You won't, once you've spent 20 minutes in the waiting room and another 20 in the exam room trying to keep your baby (and yourself) busy and calm. So instead of relying on your memory, bring a list (on paper, on your phone) you can read off. Be sure, too, to jot down the answers to those questions, plus any other advice and instructions the doctor dispenses as well as baby's height, weight, immunizations received that visit, and so on.
Trust your instincts.
Your doctor sees your baby only once a monthâyou see your baby every day. Which means that you may notice subtle things the doctor doesn't. If you feel something isn't right with your babyâeven if you're not sure what it isâbring it up. Remember, you're a valuable partner in your baby's health care, and your instincts may be among the most perceptive diagnostic tools.
End a relationship that's not right.
Not feeling the love for your baby's doctor anymore? Even in the best of partnerships, there's bound to be some disagreement, but if you're starting to suspect that Dr. Right is really all wrong for you and your baby, it might be time to cut bait and switch doctors. To be sure you don't leave your baby's health care in the lurch, keep up the relationship while shopping around for a replacement. Once you have a new pediatrician on board, be sure to have your little one's medical records transferred.
Maybe you've heard about childhood diseases like measles, mumps, and polioâbut it's likely you have only the vaguest idea of what they actually are, and even more likely that you've never known anyone who's come down with any of them. The reason? Immunizationsâone of the most important and successful public health interventions in history. Because of immunization, widespread epidemics of smallpox, polio, diphtheria, measles, rubella, and mumpsâdevastating childhood diseases that were once serious threats to children in this countryâare mostly a thing of the past.
Mostly ⦠but not entirely. There are still outbreaks of childhood diseases around the world, even in the United States, usually among children who haven't been fully immunized or haven't been immunized at all. For vaccines to protect all children, all children have to be vaccinated. And while no parent likes to see a needle headed toward baby's tender skin, keeping up with the schedule of recommended immunizations is by far one of the best strategies to help keep your little one (and all the rest of the little ones in your community) healthy. Read on to find out more.
It helps to know what the needle that's headed your baby's way is loaded with. The following is a guide to the vaccines your little one will probably receive in the first year and beyond:
Diphtheria, Tetanus, acellular Pertussis vaccine (DTaP).
Your child needs five DTaP shots (though they are often given in combination with other vaccines to reduce the number of needle sticks your baby gets), and they're recommended at 2, 4, and 6 months, 15 to 18 months, and between 4 and 6 years. This combo vaccine protects against three serious diseases: diphtheria, tetanus, and pertussis.
Diphtheria is spread through coughing and sneezing. It begins with a sore throat, fever, and chills, and then a thick covering forms over the back of the throat, blocking airways and making breathing difficult. If it isn't properly treated, the infection causes a toxin to spread in the body that can then lead to heart failure or paralysis. About 1 in 10 of those affected will die.
Tetanus is not a contagious disease, but it is an extremely serious one. A person typically becomes infected if tetanus bacteria found in soil or dirt enters the body through a wound or cut. Symptoms include headache, irritability, and painful muscle spasms. In some cases, tetanus is fatal.
Pertussis (aka whooping cough) is a very contagious airborne bacterial infection that causes violent, rapid coughing and a loud “whooping” sound with inhalation. One in 10 children who get pertussis develop pneumonia, too. Pertussis can also lead to convulsions, brain damage, and even death.
Up to one-third of children who receive DTaP shots have very mild local reactions where the shot was given, such as tenderness, swelling, or redness, usually within 2 days of getting the shot. Some children are fussy or lose their appetite for a few hours or perhaps a day or two. A low fever may also develop. These reactions are more likely to occur after the fourth and fifth doses than after the earlier doses. Occasionally, a child will have a fever of over 104°F.
Are you adopting your baby from a country where health care practices aren't up to U.S. standards? Though your initiation into parenthood will be no different from that of parents who adopt or give birth in this country (a baby is a baby no matter where he or she is born), there may be some issues or questions unique to foreign adoptionâand your regular pediatrician may not always have the answers to those questions. That's why you might want to seek out a pediatrician who specializes in foreign adoption medicine, one with extensive experience in the medical, emotional, developmental, and behavioral issues of children born abroad (especially in developing countries) and adopted by parents in the United States. Such a doctor can offer preadoption counseling (including an assessment of potential health risks) based on existing medical records, and since those records are often incomplete or nonexistent, can also offer postadoption care, which routinely screens for problems specific to the child's country of origin.
While most adoptive parents don't need a consultation with an adoption medicine specialist, you might find it usefulâparticularly if you have reason to be concerned about your new baby's health. You can search for adoption doctors online or by asking your local pediatrician. Can't find one in your neighborhood? Ask your pediatrician if he or she can consult with one to get responses to your specific concerns.
Polio vaccine (IPV).
Children should receive four injections of inactivated polio vaccine (IPV)âthe first at 2 months, the second at 4 months, the third at 6 to 18 months, and the fourth at 4 to 6 years (except in special circumstances, such as when traveling to countries where polio is still common, in which case the schedule may be stepped up).
Polio (aka infantile paralysis), once a dreaded disease that left thousands of children physically disabled each year, has virtually been eliminated in the United States through immunization. Polio is caused by a virus that is spread through contact with the feces of an infected person (such as when changing diapers) or via throat secretions. It can cause severe muscle pain and paralysis within weeks, though some children with the disease experience only mild coldlike symptoms or no symptoms at all.
The IPV is not known to result in any side effects except for a little soreness or redness at the site of the injection and the rare allergic reaction. A child who had a
severe
allergic reaction to the first dose generally won't be given subsequent doses.
Vaccines are extremely safe, and they're even safer when both parents and doctors take the right precautions:
⢠Be sure your child receives a checkup before an immunization. If your baby has been sick, let the doctor know. A common cold or other mild illness isn't considered a reason to postpone a scheduled vaccine, but a fever might be. If the doctor suggests postponing immunization, make sure it's rescheduled as soon as your baby is feeling better.
⢠Ask about reactions. Reactions to vaccines are almost always very mild (a little fussiness, maybe some soreness at the injection site) and nothing to be concerned about. Still, it's a good idea to ask the doctor for a list of possible reactions and to watch your little one for any during the 3 days after immunization (or in the case of the MMR vaccine, in the week or two afterward). As a precaution, call the doctor if your baby experiences any of the following symptoms (these reactions usually are not serious). Keep in mind that any symptoms that seem related to a recent vaccination might actually be triggered by an unrelated illnessâanother good reason to call the doctor:
⢠A fever over 104°F
⢠Seizures/convulsions (jerking or staring with a lack of awareness and responsiveness for a brief time, like 20 seconds, is usually febrile (caused by fever) and is not serious)
⢠Major alterations in consciousness within 7 days of the shot
⢠Listlessness, unresponsiveness, excessive sleepiness
⢠An allergic reaction (swelling of mouth, face, or throat; breathing difficulties; immediate rash). Slight swelling and warmth at the injection site are common and nothing to be concerned about (a cool compress should bring relief)
Make a note of any reactions in your child's immunization or health record.
⢠Make sure that the vaccine manufacturer's name and the vaccine lot/batch number is noted in your child's chart, along with any reactions you report. Bring along your child's immunization record to every checkup so that it can be updated.
⢠Severe reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS) by your doctor or by you (see
vaers.hhs.gov/index
). If you believe your child may have been harmed by any vaccine, contact the Vaccine Injury Compensation Program (800-338-2382) or
hrsa.gov/vaccinecompensation
for information. This government program protects both those who produce the vaccine and those who receive it.
Think your days of routine vaccinations, booster shots, and lines like “This will just pinch a bit” are over, mom and dad (or grandma and grandpa ⦠or uncle and auntie)? Think again. Adults need vaccines, tooânot just because you want to be in good shape to take care of your children, but also because you want to do everything you can to lessen their risk of contracting serious illnesses. If you're vaccinated against preventable diseases, you're less likely to get these diseases and, in turn, pass them on to the little ones you loveâit's as simple as that.
The Centers for Disease Control and Prevention (CDC) recommends you (and any adults caring for your baby, including babysitters) receive the following vaccinations, depending on your medical history and other circumstances:
Influenza (aka the flu) vaccine.
If you have had any vaccine as an adult, it's probably this one. That's because the flu shot (or the nasal-spray flu vaccine) is recommended each year in the fall (ideally) or winter. The flu shot helps prevent some strains of the flu, which can be very unpleasant for adults and much more serious (even deadly) to babies, small children, the elderly, and anyone with a chronic medical condition or compromised immune system (including pregnant women). So you should be vaccinated if you're caring for a small child (or if you're pregnant), and make sure your little ones over 6 months old get vaccinated, too. Remember that you (and all other adults and children regularly in your baby's life) will need an annual flu vaccine each fall: The protection doesn't last, as it does for other vaccines, in part because flu strains vary from year to year.
Tetanus, Diphtheria, and Pertussis (Tdap) vaccine.
Tdap is the DTaP formulation for teens and adults. If you haven't had a booster for these serious diseases in the past 10 years (or weren't immunized as a child), you need one now, not only to protect yourself, but to protect your baby. Pertussis (whooping cough), for instance, is most often passed on to babies by their unvaccinated or not-fully-vaccinated parents. Choose the Tdap vaccine over the Td, which doesn't protect against pertussis. Expectant moms should receive a booster during every pregnancy, regardless of whether they have received one previouslyâit's recommended by the CDC during the third trimester (between 27 and 36 weeks).
Measles, Mumps, Rubella (MMR) vaccine.
While it's likely you're already immunized against these highly contagious diseases, sometimes immunity wears offâand that could be dangerous for you (especially if you plan to get pregnant again) and your unprotected baby. That's because these diseases are still present in other parts of the world and the prevalence of international travel means these serious illnesses can and do cross borders often. In fact, there have been numerous outbreaks of measles and mumps in this country in recent years.
Varicella vaccine.
If you didn't have chicken pox as a childâor were not vaccinatedâand you catch it as an adult, it could end up being a very serious case (it's much worse in adults than in children). What's more, contracting chicken pox when you're expecting or when you have a newborn can be very dangerous for your baby.
Also recommended for adults with particular risk factors are the hepatitis A vaccine (if you might be exposed to hepatitis A through your work or travel, if you live in a high incidence area, or if you take blood products to help your blood clot) and the hepatitis B vaccine (if you're a health care worker, dialysis patient, or someone who travels to countries where the disease is prevalent).