Pediatrics 02: Infant well-child visits (2, 6, and 9 months)
User: Victoria Barrios
Email:
Date: August 21, 2026 9:51 AM
Learning Objectives
List the components of a pediatrics health care maintenance office visit.
Interpret standard growth charts to determine appropriate growth patterns in infants.
Summarize nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 months, including caloric requirements,
differences between formula and breast milk, and how and when to add solid foods to the diet.
Describe expected weight changes in healthy infants in the first two weeks of life.
Compare and contrast developmental surveillance and developmental screening at well child visits.
Distinguish normal developmental milestones at 2, 4, 6, 9 and 12 months of age.
Integrate anticipatory guidance and parental education on topics such as behavior, development, nutrition, safety, and immunizations
during well-child visits.
Describe common facial rashes of early infancy.
List normal primitive reflexes of infancy.
Explain how to elicit the Moro reflex and its value in the neurologic assessment of infants.List conditions associated with abnormal red
reflex in infants.
Knowledge
Components of a Well-Child Visit
Interval history
If this is the first visit, obtain a detailed birth history.
Ask if there have been any illnesses or problems since the previous visit.
Using the available medical records, review any visit notes, hospitalizations, lab results, and radiology reports since the last visit.
Ask about persistence or resolution of any previously identified medical issues.
Ask if there are any new concerns today.
Development
Developmental surveillance is recommended at every well-child visit when a validated developmental screening tool is not used.
Developmental surveillance may include eliciting parental concerns about development, reviewing a developmental history if
available, direct observation of the child, and identification of risk factors for developmental delays.
The American Academy of Pediatrics (AAP) recommends developmental screening with a validated tool at the 9-month, 18-month,
and 30-month visits.
One of several validated developmental screening tools may be used (e.g., the Parents' Evaluation of Developmental Status
[PEDS], or Ages and Stages Questionnaire [ASQ]).
Specific screening for autism spectrum disorder is recommended at the 18-month and 24-month visits.
Growth
Growth is best assessed using a standard growth chart and analyzing the growth trends for weight, height, and head circumference
(in younger children) over time.
Diet history
Inquire about feeding practices: breast milk or formula feeding (in infants), or types and frequency of solid food and drink (in older
children), and any feeding difficulties the parent has noted.
Family history
A family health history should be obtained at the initial visit and updated yearly.
Obtaining a family health history is an important component of the well-child visit that can provide information on genetic,
behavioral, and environmental risk factors.
Social history
Ask who lives in the household, who the primary caretakers are, and who takes care of the child when the parents are at work or
school.
Also assess for environmental safety risks (e.g., smokers, guns in the home, lead exposure).
© 2026 Aquifer, Inc. - Victoria Barrios () - 2026-08-21 09:51 EDT Page
, Mothers should be screened for postpartum depression during infant well-child visits at the 1-, 2-, 4-, and 6-month visits, both for
the well-being of mothers and because postpartum depression can adversely affect the critical period of infant brain development.
Physical exam
Anticipatory guidance
Each visit includes anticipatory guidance, which is your chance to help the parents anticipate the child's development and nutritional
needs and to advise them regarding the child's safety.
Immunizations and lab work
Age-specific recommended immunizations and screening labs are performed at the conclusion of the visit.
Nutrition Guidance
Breast milk
Breast milk is the preferred source of nutrition for most babies.
The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of age, followed by continued
breastfeeding as complementary foods are introduced, with continuation of breastfeeding as long as mutually desired by mother
and child for 2 years or longer. Medical contraindications to breastfeeding are rare.
Infants who are exclusively breastfed for 6 months or longer have a lower risk of lower respiratory infections, severe diarrhea, otitis
media and obesity.
Breastfeeding has benefits for the mother as well, including lowering the risk of Type II Diabetes Mellitus, some cancers (breast,
ovarian, and endometrial), and hypertension.
Babies who are exclusively or partially breastfed should receive 400 international units of supplemental vitamin D daily beginning
soon after birth. Formula-fed babies consuming less than 1 L of formula per day also require vitamin D supplementation.
Formula
Commercial formulas provide complete nutrition for those babies whose mothers are unable to or choose not to breastfeed. Available
formulas include those made with:
Cow's milk protein
Goat's milk protein
Soy protein
Hydrolyzed cow's milk protein
There are also specialized formulas that provide protein in the form of simple amino acids (the true elemental formulas).
Preparing the formula
Ready-to-feed formula: As the name implies, the formula is ready to feed as is.
Powder: For most formulas, the ratio is 2 oz water added for each scoop of powder.
Formula concentrate: The ratio is one part concentrate to one part water.
There is no need to give an infant extra bottles containing water only, because formula or breast milk fulfills maintenance fluid
requirements.
Transition to regular cow's milk
Infants should take breast milk or formula until 12 months of age. Whole fat or reduced fat (2%) cow's milk may be introduced at 12
months of age, but should be limited to no more than 2 cups (16 ounces) per day. According to the American Academy of Pediatrics:
Young infants cannot digest cow's milk as completely or easily as they digest breast milk or formula.
Cow's milk contains high concentrations of protein and minerals, which can stress a newborn's immature kidneys.
Cow's milk lacks iron, vitamin C, and other nutrients that infants need.
Cow's milk can irritate the lining of the stomach and intestine, leading to blood loss in the stool.
Cow's milk does not contain the optimal types of fat for growing infants.
Growth and Caloric Requirements from Birth to 2-Month-Old of Age
Term infants Infants born at > 37 weeks gestational age require 100 to 120
kcal/kg/day.
Most babies lose some weight in the first days after birth, then may
regain their birth weight as early as 1 week of age, but are usually
expected to have regained their birth weight by 2 weeks of age.
Following this, average daily weight gain for term infants is 20 to 30
grams.
Preterm infants Infants born at < 37 weeks gestational age require 115 to 130
kcal/kg/day.
© 2026 Aquifer, Inc. - Victoria Barrios () - 2026-08-21 09:51 EDT Page
User: Victoria Barrios
Email:
Date: August 21, 2026 9:51 AM
Learning Objectives
List the components of a pediatrics health care maintenance office visit.
Interpret standard growth charts to determine appropriate growth patterns in infants.
Summarize nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 months, including caloric requirements,
differences between formula and breast milk, and how and when to add solid foods to the diet.
Describe expected weight changes in healthy infants in the first two weeks of life.
Compare and contrast developmental surveillance and developmental screening at well child visits.
Distinguish normal developmental milestones at 2, 4, 6, 9 and 12 months of age.
Integrate anticipatory guidance and parental education on topics such as behavior, development, nutrition, safety, and immunizations
during well-child visits.
Describe common facial rashes of early infancy.
List normal primitive reflexes of infancy.
Explain how to elicit the Moro reflex and its value in the neurologic assessment of infants.List conditions associated with abnormal red
reflex in infants.
Knowledge
Components of a Well-Child Visit
Interval history
If this is the first visit, obtain a detailed birth history.
Ask if there have been any illnesses or problems since the previous visit.
Using the available medical records, review any visit notes, hospitalizations, lab results, and radiology reports since the last visit.
Ask about persistence or resolution of any previously identified medical issues.
Ask if there are any new concerns today.
Development
Developmental surveillance is recommended at every well-child visit when a validated developmental screening tool is not used.
Developmental surveillance may include eliciting parental concerns about development, reviewing a developmental history if
available, direct observation of the child, and identification of risk factors for developmental delays.
The American Academy of Pediatrics (AAP) recommends developmental screening with a validated tool at the 9-month, 18-month,
and 30-month visits.
One of several validated developmental screening tools may be used (e.g., the Parents' Evaluation of Developmental Status
[PEDS], or Ages and Stages Questionnaire [ASQ]).
Specific screening for autism spectrum disorder is recommended at the 18-month and 24-month visits.
Growth
Growth is best assessed using a standard growth chart and analyzing the growth trends for weight, height, and head circumference
(in younger children) over time.
Diet history
Inquire about feeding practices: breast milk or formula feeding (in infants), or types and frequency of solid food and drink (in older
children), and any feeding difficulties the parent has noted.
Family history
A family health history should be obtained at the initial visit and updated yearly.
Obtaining a family health history is an important component of the well-child visit that can provide information on genetic,
behavioral, and environmental risk factors.
Social history
Ask who lives in the household, who the primary caretakers are, and who takes care of the child when the parents are at work or
school.
Also assess for environmental safety risks (e.g., smokers, guns in the home, lead exposure).
© 2026 Aquifer, Inc. - Victoria Barrios () - 2026-08-21 09:51 EDT Page
, Mothers should be screened for postpartum depression during infant well-child visits at the 1-, 2-, 4-, and 6-month visits, both for
the well-being of mothers and because postpartum depression can adversely affect the critical period of infant brain development.
Physical exam
Anticipatory guidance
Each visit includes anticipatory guidance, which is your chance to help the parents anticipate the child's development and nutritional
needs and to advise them regarding the child's safety.
Immunizations and lab work
Age-specific recommended immunizations and screening labs are performed at the conclusion of the visit.
Nutrition Guidance
Breast milk
Breast milk is the preferred source of nutrition for most babies.
The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of age, followed by continued
breastfeeding as complementary foods are introduced, with continuation of breastfeeding as long as mutually desired by mother
and child for 2 years or longer. Medical contraindications to breastfeeding are rare.
Infants who are exclusively breastfed for 6 months or longer have a lower risk of lower respiratory infections, severe diarrhea, otitis
media and obesity.
Breastfeeding has benefits for the mother as well, including lowering the risk of Type II Diabetes Mellitus, some cancers (breast,
ovarian, and endometrial), and hypertension.
Babies who are exclusively or partially breastfed should receive 400 international units of supplemental vitamin D daily beginning
soon after birth. Formula-fed babies consuming less than 1 L of formula per day also require vitamin D supplementation.
Formula
Commercial formulas provide complete nutrition for those babies whose mothers are unable to or choose not to breastfeed. Available
formulas include those made with:
Cow's milk protein
Goat's milk protein
Soy protein
Hydrolyzed cow's milk protein
There are also specialized formulas that provide protein in the form of simple amino acids (the true elemental formulas).
Preparing the formula
Ready-to-feed formula: As the name implies, the formula is ready to feed as is.
Powder: For most formulas, the ratio is 2 oz water added for each scoop of powder.
Formula concentrate: The ratio is one part concentrate to one part water.
There is no need to give an infant extra bottles containing water only, because formula or breast milk fulfills maintenance fluid
requirements.
Transition to regular cow's milk
Infants should take breast milk or formula until 12 months of age. Whole fat or reduced fat (2%) cow's milk may be introduced at 12
months of age, but should be limited to no more than 2 cups (16 ounces) per day. According to the American Academy of Pediatrics:
Young infants cannot digest cow's milk as completely or easily as they digest breast milk or formula.
Cow's milk contains high concentrations of protein and minerals, which can stress a newborn's immature kidneys.
Cow's milk lacks iron, vitamin C, and other nutrients that infants need.
Cow's milk can irritate the lining of the stomach and intestine, leading to blood loss in the stool.
Cow's milk does not contain the optimal types of fat for growing infants.
Growth and Caloric Requirements from Birth to 2-Month-Old of Age
Term infants Infants born at > 37 weeks gestational age require 100 to 120
kcal/kg/day.
Most babies lose some weight in the first days after birth, then may
regain their birth weight as early as 1 week of age, but are usually
expected to have regained their birth weight by 2 weeks of age.
Following this, average daily weight gain for term infants is 20 to 30
grams.
Preterm infants Infants born at < 37 weeks gestational age require 115 to 130
kcal/kg/day.
© 2026 Aquifer, Inc. - Victoria Barrios () - 2026-08-21 09:51 EDT Page
