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The Well Visit Routine

Jennifer Beam


Baby's first year can seem full of apprehensions, questions and concerns for new parents. Is baby eating enough? Growing and developing on schedule? Getting enough sleep? Many, many other questions are constantly popping up as well. Between the constant everyday concerns and the routine well-child visits, you may feel as if you spend more time in the pediatrician's office than at home. While you can't prepare yourself for the unexpected, you can prepare yourself for the routine checkups by knowing what's involved with each visit, and familiarizing yourself with the ever-changing schedule of immunizations.

Routine Well Visits

You can expect baby to have seven routine appointments from birth to 18 months. Besides checking and charting weight, length and head circumference, and the physical examination, each visit will involve those dreaded shots. The schedule of immunizations has changed a great deal over the years, but through research and the development of new vaccines, we can protect our children from many dreadful—and sometimes fatal—diseases better than ever before.Routine Immunizations

The schedule is still consistent with vaccinations that protect against hepatitis B (hepB), diphtheria, pertussis (whooping cough) and tetanus (DTP), polio (IPV), measles, mumps, rubella (MMR) and H.Influenza type B (HIB), yet we can now add protection against chicken pox and even some forms of meningitis and ear infections. The first of all the vaccinations is typically given between birth and two weeks of age, and the last around 15 months. The American Academy of Pediatrics, in cooperation with the CDC, releases a Schedule of Immunizations each year. You can see the most recent chart of recommended immunizations for ages birth to age four.New Vaccines

With the release of the two newest vaccines, varicella (chicken pox) and prevnar also known as PCV (pneumococcal conjugate vaccine), parents have had many questions and concerns. According to the immunization nurse for Montgomery County Health District in Ohio, the prevnar and varicella vaccines are offered and recommended to all children in accordance with the schedule of immunizations. The question most often raised is whether the protection from the chicken pox vaccine will last a lifetime. Parents want to know if their child will still be protected as an adult, when the risk of complications from chicken pox is greater. Research indicates that the vaccine does offer lifetime protection in those who develop the antibodies. The varicella vaccine is a live virus injection given between 12 and 15 months of age, with the majority of recipients developing the antibodies as if they had the full blown disease. In the future, as with the MMR, two injections may be necessary, if research finds that not everyone does develop the antibodies with just the initial injection. The hope is that the vaccine will inoculate chicken pox in the future, as was the case with small pox. The medical community is in agreement that this will only happen if 100% of children are being vaccinated. The varicella vaccine is not a requirement for entrance into public schools as of yet.

The Pneumococcal Conjugate Vaccine—known as PCV or prevnar—seems to be widely accepted as beneficial and safe. It protects against pneumococcal bacteria, and the vaccine is administered through a series of four injections beginning at 2 months of age. Healthcare providers will administer the vaccination to older babies, but they will not receive all four injections. It is estimated that between 20 and 40 percent of ear infections are caused by pneumococcal bacteria, and that it is the leading cause of bacterial meningitis. Experts say children who are regularly attending a daycare environment are at a greater risk of exposure to pneumococcal, and often benefit the most from the vaccine. It is currently not a required vaccination for entrance into public schools; however, some states require the vaccine for daycare entry.Polio Is Now Injectable

Another recent change in immunization is in the polio vaccine. As recently as 1998 the polio vaccine was still being given orally. Due to the increase in VAPP or Vaccination Associated Polio Paralysis, where approximately two in one million children were displaying symptoms of polio associated with the live virus vaccine, the recommendation changed in 1999. Because of polio being inoculated, the risk has all but vanished, and the current recommendation is the inactive injectable polio vaccine.Routine Blood Work

Along with the scheduled immunizations, you can also look forward to blood work. It is likely that the recommendation for hemoglobin will be made at nine months of age. This is the only routine blood work done after birth, unless because of circumstances, your doctor would recommend a check for lead levels. This is usually only done for children who live in older homes where lead-based paint may be present or those who live in homes where the possibility for lead contamination exists due to a potential occupational exposure from a parent living in the home.

While it is true that well-child visits are not necessarily on our top ten things-to-do list, they are essential to our children's health. Knowing what to expect, and being prepared, is essential to a parent's sanity. Since some babies become cranky, tired, and can even exhibit a low-grade fever after certain shots, try to schedule your appointments for a day and time when you and your little one can relax afterwards. Taking off to the photographers for a landmark portrait is probably not a good idea after shot day, but going home and enjoying a quite story or soothing bath might be just the thing to ease your babe's discomfort.

Jennifer Beam is a freelance writer from Ohio, writing for multiple websites and radio. She has a background in cosmetology, salon management, and business administration. She is a married mother of two terrific boys, and one lazy golden retriever.

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