After two years of age, it is recommended that children and adolescents have an annual preventive well visit. For older children, these visits may incorporate a sports physical required by schools for sports participation. There may be vaccinations that are required or recommended at different age visits. For these checkups, a complete examination is performed from top to bottom. The importance of annual wellness visits cannot be understated. Children are assessed for appropriate height and weight growth, heart murmurs, and appropriate growth and development of different body parts. Between two years of age and when a child begins puberty, for both boys and girls, the average height gain is 2 inches per year and 5 pounds per year. If normal growth is not being achieved there may be an underlying cause that should be addressed. On occasion, even though a child may be feeling well and apparently normal, we will detect a heart murmur, low thyroid function, or indications of a malignancy. Often children complain of being fatigued, which may be the result of a child simply doing too much, however, fatigue may also be attributed to a vitamin deficiency, such as vitamin D, anemia, or the result of stress. Children may seem sad, anxious, or depressed at times and need coping skills discussed. They may have questions about their own body's development. Bypassing the recommended annual checkup for a brief sports encounter visit at a UTC or scheduled session at a school is not in your child's best interest. It has been our experience that significant health issues are not detected or addressed during these visits. As a result, we have seen bad health consequences and outcomes. We are now scheduling school break annual physicals. We recommend scheduling early so that we can better accommodate your choice of day, time, and provider. Delaying scheduling until just before school and extracurricular activities begin, may necessitate your child missing school or a school activity due to an already full schedule.

As a parent, you always want to keep your child safe. Read through this list of common safety tips to keep in mind when caring for your newborn. Please remember that this is not an exhaustive list and you should consult with your doctor about any safety concerns to do with your newborn. Feel free to give us a call at (859)-277-6516 with any questions. Here is a quick list of 16 safety tips for newborns: Never leave a baby of any age on an unguarded elevated surface, such as a counter or changing table. When the baby is on the elevated surface, the parent should face the baby and form a barrier with their body. The parent should keep a hand on the baby if looking away, to stop any movement before the baby can fall. Do not leave a baby unsupervised in the middle of any bed. Infants in a seat or carrier, even if buckled in, should be placed on the floor if left. Babies can tip over an infant seat or carrier. Do not put a baby, even if in an infant carrier, on the high shallow child seat of a grocery cart. The baby should instead be placed in the deeper and more protected section of the cart. Babies should sleep in their own beds or bassinets, and never with another person. Babies sharing a bed may be suffocated or roll out of the bed. Keep stuffed animals, pillows and bumper pads out of a baby's bed. The baby’s mattress should fit its bed tightly, without big gaps along the sides. Do not use safety pins around a baby. If their use is necessary, close them immediately upon removal from clothing. Do not allow any type of plastic bag around a baby. Keep long hair tied back when holding the baby to prevent hair strands from becoming twisted around fingers or toes. All children should be kept in an approved car seat of an appropriate size for the child. The child’s car seat should have wide straps over the chest and shoulders, as well as the lower part of the body. Be sure that the car seat is properly installed, preferably in the second row, directly behind the driver. A child should ride facing the rear for the first two years of life, and should never be allowed in the passenger seat under the age of 12. Install and routinely check smoke and carbon monoxide detectors. All household cleaners, medicines, poisons and plants should be kept far out of a child's reach. It is truly amazing how far a child will go to get a forbidden object. For easy access, the poison control center’s phone number should be listed on the fridge and in parents’ cell phones. Limit visitors over the first few weeks of an infant's life. Mothers need rest, and mothers and babies need uninterrupted time to establish their breastfeeding pattern. When visitors do arrive, the baby should be kept in a separate room, with only one or two visitors allowed to see the baby at a time. All visitors must be healthy. Visitors can visit with older children before visiting the new baby, which will allow parents control, prevent overstimulation for the baby, and offer older children some attention. Visitors will often bring a gift for the new baby but nothing for older siblings; parents may want to keep small gifts available to give to older children when visitors leave the house. A baby's room temperature should be kept between 68-72°. Plenty of sunshine and fresh air are healthy for mother and baby. Try not to overdress the baby; a general rule of thumb is that a baby should be dressed in one layer more than its parents are wearing. If it is very hot outside, a baby only needs a diaper and undershirt. For sleeping, parents may consider using a sleep sack or a sleeper instead of a blanket. Cribs: To safety-proof a crib, the slats must be less than 2 3/8 inches apart, the sides must be at least 26 inches above the mattress, and there should not be anything in the crib to help the baby climb out and over the top. No strings or cords should be dangling, and the mattress should be firm and tight-fitting. No plastic sheeting or pillows should be put in the crib. When a child reaches two years of age, a pillow may be placed under the fitted sheet for head elevation.

Breastfeeding is the natural way of feeding an infant. However, new moms are often concerned about their ability to supply the correct nutrition and volume of breast milk. Initially, breastfeeding will require patience. Nursing is usually easier at home and in familiar, quiet surroundings where it is less likely to be interrupted. Starting a Feeding Some babies grasp the nipple when it touches their cheek, but most are sleepy and will need help getting started. A mother should get into a comfortable position before nursing, either sitting or lying on her side. She should hold the nipple between her second and third fingers so that it protrudes, and then touch it to the baby's cheek. The baby’s rooting reflex usually causes it to turn towards the nipple and grasp it in the mouth. Expressing a small amount of milk before the baby begins to nurse can give the baby a taste and increase its interest for feeding. It can also make the areola less tense and easier to place in the baby's mouth. Mothers should try to get as much of the areola as possible in the baby's mouth to minimize sore nipples. Milk Supply New mothers should initially begin nursing for about three minutes on each side until her milk supply develops. Breastmilk will usually become more readily available by the second to fifth day after the baby’s birth, depending on the difficulty of the birth. Previous research reported that once the milk supply was established, a baby would consume approximately 50% of the supply within the first three minutes of feeding, and 80% of the supply within the first five minutes. However, lactation experts recommend that an infant feed for 20 minutes per side to receive the hindmilk. It may take a breast two hours to fill up after a feeding. A baby that feeds more frequently than once every two hours is likely grazing, taking in enough milk to feel satisfied but not getting full. This can result in the baby feeding more often while consuming less and less per feeding. Babies taking their mother's expressed milk or formula in a bottle can develop the same pattern. To prevent nipple soreness, suction should be broken with the finger or knuckle when terminating breastfeeding. Until the breastmilk develops, a creamy-looking substance called colostrum will be produced and released for the baby's nutritional needs. It is a highly nutritious, low-volume breast secretion. Colostrum prepares the infant’s digestive tract for milk, acts as a laxative, and contains immunity-builders Stimulation of the breast promotes the breastmilk supply to develop. While breastmilk will look thin and watery, like skim milk, it contains all the necessary nutrients for a baby with the exception of certain minerals and vitamins which will be given as a supplement. When the breastmilk supply develops, a tingling sensation across the breast will occur, followed by a heavy sensation in 6-8 hours. Mothers may initially overproduce the volume of breastmilk and experience leaking. It may take several weeks for a balance to be achieved. Breastmilk is digested more easily and emptied more quickly from a baby's stomach than formula. As a result, breastfed babies may want to be fed more often than babies receiving formula. Supplemental Feedings If necessary, babies may be offered supplemental formula feeding until the breastmilk supply is well established, which can be up to several weeks after birth. An elemental formula like Alimentum, or a soy-based product like Isomil sensitive soy, may be recommended for supplementation. It is recommended that babies not receive a formula based on cow’s milk for at least the first three days of life. If the baby has 3-6 wet diapers a day, is gaining weight, and seems content, it is getting enough milk per feeding. A benefit of supplemental formula feedings is that it allows other family members, including the dad, to more actively participate in the baby’s care. It also allows the mother rest and mental breaks. Once the milk supply is well-established, mothers may begin to pump breastmilk for supplementation. Pumping is effective when done between feedings, at least two hours after a feeding has been completed. Pumping is not as effective as nursing, so mothers shouldn’t worry if only a small volume is expressed. While expressed milk in the refrigerator should be discarded if not completely used within 36 hours, expressed milk stored in a thoroughly-washed container in the freezer will last up to nine months. Frozen expressed milk should be thawed by first moving it into the refrigerator for several hours, and then by holding it under warm running water or putting it in a bowl of warm water until it thaws. Mother Care Nursing a baby puts extra stress on a mother's body. A mother must get a lot of rest and try to nap at least once a day. She should not try to keep up with housework, laundry or shopping, and visitors should be kept to a minimum until the baby is well-adjusted and following a routine. A nursing mother must double her fluid intake and avoid coffee, tea, soda, and sweets, which can agitate or stimulate the baby. Every mother and baby differ, and a mother may find that certain foods she consumes cause her baby to have gas and discomfort. Mothers should avoid or minimize eating cabbage, brussels sprouts, beans, highly seasoned and spicy foods, citric fruits, chocolate, and anything that upsets her stomach. For some babies, the mother's intake of cow milk and dairy products may cause G.I. upset. It's worthwhile for mothers to keep a food and beverage diary tracking any association between mother's intake and baby’s fussiness, keeping in mind that it may take 4-6 hours for what she consumes to appear in breastmilk. The mother should avoid taking medications while nursing. The baby’s pediatrician should be contacted during office hours before any medications are used. Developing breastmilk robs a mother’s body of the nutrients it needs. She should focus on eating a well-balanced diet and continuing her prenatal vitamins. A poor diet can result in a tired mother with less milk, and consequently a fussy and demanding baby. Self-confidence and patience are very important to successfully nursing, and it frequently takes several weeks to establish a regular nursing routine. As mother and baby relax, the mother’s self-confidence will increase and she will feel tremendously satisfied. Nipple Care Most nursing mothers experience some nipple tenderness and find it helpful to use a product like lanolin ointment for several weeks after lactation begins. Shorter, five-minute interval feeding may be easier on the nipples. If nipples become tender, they should be exposed to air between feedings by wearing a nursing bra with the flaps down. Bra liners with plastic should be avoided, as they prevent air from getting to the nipples. Heat on the nipples, for instance by sitting in front of a heat lamp for 5-10 minutes, may also reduce discomfort. Mothers can wear a clean cotton handkerchief or gauze tucked inside their bra to catch leaking milk. Nipples should be cleansed with water, but frequent use of soap will dry out the nipples and should be avoided. Bottle Feedings All feedings should be a pleasant experience for both baby and feeder. When feeding from a bottle, the feeder should sit in a comfortable chair and hold the baby close, face-to-face. The baby should be held upright and burped after each feeding, or more frequently if the baby has gas problems. If a burp does not come easily, the baby can be laid on its stomach and have its back rubbed and patted, and then returned to a sitting position while having its back stroked and patted again. It is not uncommon for a baby to spit up some formula or breastmilk during burping. The baby should never be left unattended with a bottle propped up. The baby should also not be put to bed with a bottle, as this may contribute to serious tooth decay in later months and can lead to sleep problems and ear infections.

Feeding provides an infant with nutrition, oral gratification, emotional fulfillment, and a pleasant physical experience. Once satisfied, most babies are ready to sleep and should be put to bed, while some may fuss before sleeping. A baby's early feeding efforts might be frustrating and appear inadequate. Babies, like mothers, go through a lot during birth and tend to rest and recover for their first 3 to 4 days of life. Human breast milk is designed to best meet a baby’s nutritional needs. Formulas are man's best attempt to duplicate mother nature. Babies are typically fed on a three-hour schedule in the hospital. However, they are not usually hungry on this schedule. Once at home, a newborn may feed every 2 to 3 hours for several feedings, and may then sleep for up to six hours. This is perfectly acceptable and the baby will not starve during this time. Babies usually work themselves into a predictable feeding routine within their first 3 to 4 weeks at home. Babies suck for nutrition, but also for nurturing, to relax, and to go to sleep. If allowed, babies may continue to suck on their mother’s breast, causing nipple soreness and bleeding, or overeat from a bottle and throw up. A pacifier may be offered to a baby after a feeding if the baby still wants to suck. Pacifiers come in different shapes and sizes, and parents may need to try several before finding the specific pacifier their baby prefers. Parents may benefit from dividing the day into two time periods: from 8 a.m. to midnight, and from midnight until 8 a.m. The goal can be for babies to be awake more and feed more during the daytime, saving their deep sleep for the evening. Under this regimen, a baby who has been sleeping for three hours in the daytime should be woken, changed, played with, and offered a feeding. A cold, wet washcloth can be used to wipe the baby’s face and chest to provide stimulation. After midnight the baby should be allowed to sleep and should be fed only when waking on their own. Babies often initially feed 2-3 times after midnight before getting into a better routine. Half of all babies, including those that are breastfed, may sleep through the night by the age of 4 weeks.