Well Child Visits

Congratulations! Your baby is finally here. Your baby’s first visit to our office takes place during his or her first week of life, usually 1-2 days after you are discharged from the hospital. Babies typically lose weight right after birth, and we will monitor this closely.

We do a lot at this visit, including:

• Check your baby’s weight.
• Monitor for signs of jaundice.
• Check to see how your baby is feeding.
• Answer questions about your new baby.
  

Immunizations:

• HepB#1 (if not given in hospital)

Helpful Info:

• Caring for Your Newborn

The 2 Week Visit (sooner if you have concerns!) is a time to talk about how your family is acclimating to the newest addition. Feeding, bowel habits and sleeping are common topics. If you need support with breastfeeding, ask to meet with Dr. Michalko who also sees patients as an IBCLC/lactation consultant or schedule a lactation visit with a community provider.

By 2 weeks of age, your baby will likely have regained his or her birth weight. Please remember that it is important to always put your baby to sleep on his or her back in a flat, firm and separate sleep space to reduce the risk of SIDS. As always, we are here to answer questions and offer anticipatory guidance.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Remind you to give your baby a daily supplement of 400 IU of vitamin D drops if you are breastfeeding.
  

Immunizations:

• None

Tests/Screens/Assessments:

• Follow-up on Newborn Metabolic Screen (done in hospital)

Helpful Info:

• Back to Sleep, Tummy to Play

Families are usually settling in by this visit. Feeding, sleeping and bowel habits are sometimes a concern. At this visit, we will track your baby's growth and development and answer any questions. Your baby may be starting to smile now and that helps a lot!

Immunizations:

• None

Tests/Screens/Assessments:

• Post Partum Depression Assessment

Helpful Info:

• Back to Sleep, Tummy to Play

Many babies seem more fussy or colicky at this age. This improves with time. Some babies start sleeping longer stretches, though it is normal to have frequent night wakenings through a baby's first year of life.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s first set of immunizations. Immunizations are safe, effective and keep your child and our community healthy. During this visit, you will be able to discuss any questions you may have about immunizations.
  

Immunizations:

• Vaxelis#1 (DTaP, HIB, IPV, Hep B)
• Vaxneuvance/PCV#1
• Rotavirus#1

Helpful Info:

• Crying and Your Baby: How to Calm a Fussy or Colicky Baby
• Purple Crying

Your baby is becoming more active and verbal. Be careful not to leave your baby unattended, especially on a bed, couch or changing table. They move faster than you think!

Babies need only breast milk or formula for the first 4-6 months of life. We will talk at this appointment about the appropriate time to introduce solid foods and what foods to introduce first. Feeding first foods can be lots of fun, but the majority of your baby's calories will still come from breast milk or formula. 

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s  set of immunizations. Immunizations are safe, effective and keep your child and our community healthy. During this visit, you will be able to discuss any questions you may have about immunizations.
  

Immunizations:

• Vaxelis#2 (DTaP, HIB, IPV, HepB)
• Vaxneuvance/PCV#2
• Rotavirus#2

Tests/Screens/Assessments:

• None

Helpful Info:

• Starting Solid Foods

Your baby will begin to move more and will be able to sit up independently for short periods of time. Now is the time to start baby-proofing your house. You should move the mattress in your baby's crib down to the lowest level.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss the introduction of fluoridated water to encourage the development of strong and healthy teeth. If you have city or rural water,  your water is fluoridated. If you have well water,  you should have your water tested for fluoride.
• Screen for post-partum depression.
  

Immunizations:

• Vaxelis#3 (DTaP, HIB, IPV, HepB)
• Vaxneuvance/PCV#3
• Rotavirus#3
• Influenza vaccine (during flu season)

Tests/Screens/Assessments:

• Oral  Health Surveillance

Helpful Info:

• Teething
• Solid Starts Resource

Your baby may be starting to crawl, pulling to a stand and cruising on furniture. Babies will want to touch everything - this is how they learn. This is a messy time! Have fun and be patient.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Discuss your baby's upcoming dental care. Your baby should see a dentist at 1 year of age. You should be brushing your child's teeth with an infant toothbrush and a tiny smear of fluoride toothpaste. 
  

Immunizations:

• Influenza vaccine (during flu season)

Tests/Screens/Assessments:

• Survey of Well-being of Young Children (SWYC)
• Oral Health Surveillance

Helpful Info:

• Teething

At this age, your baby can transition from breast milk or formula to cow’s milk. However, it is healthy to continue breast milk, if that is what you prefer, for your baby. Your baby no longer needs formula. Most babies need 3 meals, 2-3 snacks per day, and no more than 24 ounces of whole cow's milk per day. Many babies drink less milk than this, 12-20 ounces per day. Your baby will be able to eat many of the foods you eat, but be careful to avoid small, hard foods that can cause choking.

It is time to wean your child from the bottle and offer all liquids in a sippy cup. It is much easier to wean your child now than if you wait until they are older.

Your baby will be outgrowing the infant carrier car seat. Continue to have your baby in a rear facing car seat until at least age 2.

We do a lot at this visit, including:

• Measure your baby’s weight, length, and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss dental health and apply fluoride varnish to your baby’s teeth.
• Screen your baby for vision abnormalities with our ocular photoscreen device.
  

Immunizations:

• HepA#1
• MMR#1
• Vaxneuvance/PCV#4
• Influenza vaccine (during flu season)

Tests/Screens/Assessments:

• Hemoglobin Surveillance
• Lead Surveillance
• Oral Health Surveillance
• Fluoride Varnish

Helpful Info:

• Playing Is How Toddlers Learn

Your child may be able to climb and run, so be sure to safety proof your home.

Poison control is available 24 hours a day: 1-800-222-1222 - keep this number handy in your cell phone and on your refrigerator.

We do a lot at this visit, including:

• Measure your baby’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
  

Immunizations:

• Pentacel#4 (DTaP, HIB, IPV)
• Varicella#1
• Influenza vaccine (during flu season)

Tests/Screens/Assessments:

• Fluoride Varnish

Helpful Info:

• Choking Prevention and First Aid for Infants and Children

At 18 months, your child understands much more than he or she can say in words. Use words to describe your child’s feelings and gestures. Read and sing to your child often. When reading, use simple words to talk about the pictures.

We do a lot at this visit, including:

• Measure your child’s weight, length and head size and record on a growth curve.
• Provide your baby’s immunizations.
• Discuss dental health and apply fluoride varnish to your baby’s teeth.
• Discuss temper tantrums.
  

Immunizations:

• HepA#2
• Influenza vaccine (during flu season)

Tests/Screens/Assessments:

• Survey of Well-being of Young Children (SWYC)
• MCHAT Questionnaire (Autism Screening)
• Oral Health Surveillance
• Fluoride Varnish

Helpful Info:

• Is Your Toddler Communicating With You?

At this age, your 2 year old may go from trying to be independent to wanting you; this is normal. It is better for toddlers to play than to watch TV. Even having television playing in the background interrupts healthy toddler play - background music is a better choice.

Children must remain rear-facing in the carseat until age 2, though they are safer rear-facing and can remain facing backwards until they outgrow the height or weight limit of the seat.

We do a lot at this visit, including:

• Measure your child’s weight, length, head size and body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit.  Your child may need immunizations if they are behind on their shots.
• Review your child’s development with you using the MCHAT (Autism screening tool) questionnaire.
• Test for lead exposure with a finger prick in the office.
• Discuss dental health and apply fluoride varnish to your child's teeth.
• Discuss toilet training and discipline.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• MCHAT Questionnaire
• Anemia Surveillance
• Lead Surveillance
• Oral Health Surveillance
• Fluoride Varnish

Helpful Info:

• Playground Safety

Your baby is now firmly in the toddler years. One moment they seem so big and the next still very small. This is the "do-it-myself" time.

We do a lot at this visit, including:

• Measure your child’s weight, length, head size and record on a growth curve
• Most of our patients do not have immunizations due at this visit.
• Discuss dental health  (if they have not yet seen a dentist, they should!)
• Discuss healthy meals/snacks, avoid juice.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Survey of Well-being of Young Children (SWYC)

Helpful Info:

• Snacks for Toddlers

Your child will likely be moving into a world of make believe that they create with their imagination. Toys for dress up and make believe are important at this age. Read books, sing songs and play rhyming games with your child each day.

Toddlers should remain rear facing in the carseat until they outgrow the weight or height limit of their seat before being turned forward.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Most of our patients do not have immunizations due at this visit.  Your child may need immunizations if they are behind on their shots or during flu season.
• Discuss dental health and apply fluoride varnish to your child's teeth.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Oral Health Surveillance
• Vision Testing
• Fluoride Varnish

Helpful Info:

• Toilet Training

Four year olds often like to sing, dance and act. They like to tell "tall tales" and make up stories.  Enjoy these fun moments with your little one!  Parents should continue to help with brushing teeth even though your child will want to do it all by themselves.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Provide your child's immunizations.
• Discuss dental health and apply fluoride varnish to your child's teeth.
  

Immunizations:

• Proquad (MMR#2, Varicella#2)
• Quadracel (DTaP, IPV)
• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Oral Health Surveillance
• Vision Testing
• Hearing Testing
  

Helpful Info:

• Encourage Your Child to Be Physically Active

At this age, your child needs more independence. However, you need to set clear limits. A regular bedtime and consistent bedtime routine are important. Be a great role model. Show an interest in what they are learning.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Review your child’s speech and development.
• Discuss exercise and nutrition.
• Discuss kindergarten readiness.
• Discuss dental health and apply fluoride varnish to your child's teeth.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Oral Health Surveillance
• Vision Testing
• Hearing Testing
  

Encourage good learning by helping your child organize a distraction-free time to do homework and ensuring eleven hours of sleep each night. Teach your child what to do if there is a fire and have practice fire drills. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index  and record on a growth curve.
• Screen your child's hearing and vision.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Review safety issues.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Oral Health Surveillance
• Vision Testing
• Hearing Testing

Continue to encourage good nutrition and exercise for your child. This is the time he or she is building good health habits for a lifetime! There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

Your child should remain in a booster seat in the back seat of car until he/she is 4'9" tall AND at least age 8.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index  and record on a growth curve.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Review safety issues.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Surveillance
• Hearing Surveillance

Helpful Info:

• Growing Up Healthy: Fat, Cholesterol, and More

Positive self-image is important as your child begins to enter the changes that come with puberty. Empower them to feel good about themselves, their interaction with others and praise their effort more than the outcome.

Your child should remain in a booster seat in the back seat of car until he/she is 4'9" tall AND at least age 8.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index and record on a growth curve
• Measure your child’s blood pressure and heart rate
• Screen your child's vision and hearing
• Review your child’s school performance and development
• Discuss involvement in activities
• Discuss sleep
• Discuss anticipating pubertal changes
• Discuss exercise and nutrition
• Review safety issues
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Testing
• Hearing Testing

Helpful Info:

• Developing Your Child’s Self-Esteem

Your child be is becoming more responsible and will be able to take on more tasks such as taking care of his/her own room. He or she may also start reading independently for pleasure.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Review safety issues.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Surveillance
• Hearing Surveillance

Helpful Info:

• The Importance of Family Routines

Your ten year old still requires adult supervision when you are away. Watching TV with your child allows you to discuss any controversial topics that may come up, but limit screen time to 2 hours per day. Family mealtime is important to keeping communication open and fostering healthy lives.

We do a lot at this visit, including:

• Measure your child’s weight, height, and body mass index and record on a growth curve
• Measure your child’s blood pressure and heart rate
• Screen your child's vision and hearing
• Provide your child’s immunizations
• Review your child’s school performance and development
• Discuss involvement in activities and peer relationships
• Discuss sleep
• Discuss exercise and nutrition
• Discuss puberty changes to expect or that may be starting to occur
  

Immunizations:

• Flu vaccine (during flu season)
• Tdap, HPV#1

Tests/Screens/Assessments:

• Vision Testing
• Hearing Testing
• Lipid Profile (completed once between 9-11 years)

Your child may be transitioning to middle school at this age. He or she may be participating in more group activities. Expand your conversations about healthy living practices to include tobacco, drug and alcohol avoidance.

We do a lot at this visit, including:

• Measure your child’s weight, height, and body mass index and record on a growth curve.
• Provide your child’s immunizations.
• Screen your child for anemia and dysipidemia per AAP recommendations.
• Review your child’s school performance and development.
• Discuss exercise and nutrition.
• Discuss puberty changes to expect or that may be starting to occur.
  

Immunizations:

• MCV#1
• HPV#2

Tests/Screens/Assessments:

• Vision Surveillance
• Hearing Surveillance

Helpful Info:

• Substance Abuse Prevention

Your child will be in middle school at this age. Continue your conversations about healthy living practices to include tobacco, drug and alcohol avoidance. Your child should be able to assume more responsibility for personal hygiene and chores. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

We do a lot at this visit, including:

• Measure your child’s weight, height, and body mass index and record on a growth curve.
• Screen your child's vision.
• Review your child’s school performance and development.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
• Discuss puberty changes to expect or that may be starting to occur.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Hearing Surveillance
• Adolescent Depression Screening
• Vision Testing

Even though friends are becoming more important at this age, having a caring adult to provide a listening ear and from which to obtain accurate health information is equally important. Foster open communication with your child. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of this visit with the parent out of the room.

We do a lot at this visit, including:

• Measure your child’s weight, height, and body mass index and record on a growth curve.
• Review your child’s school performance and development.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
• Discuss puberty changes to expect or that may be starting to occur.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Surveillance
• Hearing Surveillance
• Adolescent Depression Screening

Helpful Info: 

• Teens
• Behavior

Your child may be showing an increasing interest in extracurricular activities. Have conversations about risk taking behaviors, driving, alcohol, drug use, family rules and expectations. Discuss media and internet safety. Make certain that they have an adult they can confide in if they are unable to communicate with you. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have a portion of this visit with the parent out of the room.

We do a lot at this visit, including:

• Measure your child’s weight, height, and body mass index and record on a growth curve.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Review your child’s school performance and development.
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Surveillance
• Hearing Surveillance
• Anemia Surveillance
• Adolescent Depression Screening

Helpful Info: 

• Teens
• Behavior

Your teen may be adjusting to the transition to high school. Development of family relationships continues to be important, but it is also normal for teens to place more and more emphasis on their peer relationships. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of this visit with the parent out of the room.

We do a lot at this visit, including:

• Measure your child’s weight and length and record on a growth curve.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Review your child’s school performance.
• Reinforce healthy choices and risk behavior avoidance.
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.).
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
  

Immunizations:

• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Anemia Surveillance
• Adolescent Depression Screening
• Vision and Hearing Testing

Helpful Info: 

• Teens
• Behavior

Congratulations! You are solidly in the teen years! It is exciting to see the wonderful person your child is becoming. Possible conflict can arise at this time as your teen assesses your family values versus those of culture and peers. Keep the lines of communication open and give them additional responsibility while being present for them when they inevitably make mistakes. Be supportive and allow them to develop resilience and self-pride. During the teen years, we provide the opportunity for your teen to have a portion of the visit with the parent out of the room.

We do a lot at this visit, including:

• Measure your teen’s weight, height and body mass index and record on a growth curve
• Measure your teen’s blood pressure and heart rate
• Complete sports physical forms and discuss sport safety (if your teen is participating in sports, please bring any forms to the appointment)
• Review your teen’s school performance and development
• Discuss involvement in activities and peer relationships/dating
• Discuss sleep
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet
• Reinforce healthy choices and risk behavior avoidance
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.)
• Complete NY driver's permit.
  

Immunizations:

• MCV4#2
• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Testing
• Hearing Testing
• Urine STI screening
• Anemia screening

Helpful Info: 

• A Message to Parents of Teen Drivers

Your child is getting closer to finishing high school and entering the adult world. Making mistakes are a normal part of growing up. Continue to provide emotional support and guidance for them during this time. There are no scheduled immunizations at this visit unless your child is behind and needs to catch up on immunizations.

During the teen years, we provide the opportunity for your teen to have at least a portion of this visit with the parent out of the room.

We do a lot at this visit, including:

• Measure your child’s weight, height, and body mass index and record on a growth curve.
• Complete sports physical forms and discuss sport safety (if your child is participating in sports).
• Review your child’s school performance.
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.).
• Reinforce healthy choices and risk behavior avoidance.
• Discuss exercise and nutrition, particularly in association with increased awareness of body image and diet.
  

Immunizations:

• MenB 
• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Surveillance
• Hearing Surveilllance
• Anemia Surveillance
• Adolescent Depression Screening
• Urine STI Screening

Helpful Info: 

• Teens
• Behavior

Your child is now transitioning to adult life! They will still look to you for support and guidance, but will be more on their own when it comes to decision making. 

During the teen years, we provide the opportunity for your teen to have at least a portion of this visit with the parent out of the room.

We do a lot at this visit, including:

• Measure your child’s weight, height and body mass index and record on a growth curve.
• Provide immunizations.
• Screen your child's vision.
• Discuss transitions to life after high school—whether that be work, travel, vocational school or college.
• Discuss importance of responsible decision making and recognizing healthy -vs- unhealthy relationships.
• Complete college physical forms and any required college screening labs/tests.
• Perform any recommended yearly screening tests (depending on family history, sexual activity etc.).
• Reinforce healthy choices and risk behavior avoidance.
• Transition your child to an adult care provider.
  

Immunizations:

• MenB 
• Flu vaccine (during flu season)

Tests/Screens/Assessments:

• Vision Surveilllance
• TB Surveillance
• Anemia Surveillance
• Dyslipidemia Surveillance
• Adolescent Depression Screening
• Urine STI screening

Helpful Info: 

• Teens
• Behavior