Well Child Visits: What to Expect

Full physical exam

Your clinician will do a head-to-toe exam.  Your baby’s birth story, medical history, and family situation help them know how best to advise if you have any questions or your baby gets sick. This is the best time to discuss any medical concerns.

Review your immunization schedule and develop a plan:

Most immunization schedules around the world are the same for the first three rounds, though the spacing may be different. A big difference that can be confusing is that different countries supply different combination immunizations. If your child was born in Malawi and you are following the Malawian guidelines, then the government issued baby book will have all the information you need and you can get the immunizations at the government sites.  If your child was born in another country and you initiated immunizations there, then I can help you make a plan that will adhere to both to Malawian guidelines and your home country requirements as much as possible. Private immunizations are available to purchase from local pharmacies for boosters beyond the Malawian schedule.

Administer a developmental surveillance and screening:

For children under 5, your clinician will ask questions about developmental milestones as part of developmental surveillance. They are also looking for healthy development throughout the visit. I use the ages and stages from the CDC for routine check-ups.

The best time for developmental screening is at 9 months, 18 months, 24-30 months and anytime you have a concern.  I administer an evidence-based developmental screen (SWYC) to help identify developmental, behavioral, and family-based concerns.  It will take about 10 minutes for you to fill out the questionnaire and we can discuss any concerns at the appointment. The purpose of the screening is not to diagnose a child with a disability, but to identify children that would benefit from early intervention. The brain grows significantly the first three years of life and we see the greatest long-term results when needs are identified and children get early intervention.  

 Measure and plot on the growth chart: weight, height, and head circumference.

Baby scales are available at all of the government immunization clinics. Be sure that your baby’s weight and length get recorded with each visit. Your child’s growth should follow the growth chart curve. It’s helpful to consistently use the same chart, so be sure to bring the baby book that you have been using since birth (Malawi, SA, etc…). You can also use a printed WHO growth chart.

Address any concerns:

This is a good time to look to the next stage of development. Your clinician will be happy to answer any questions you may have. This is a good time to talk about feeding, sleeping, safety, preventive health and/or parenting. This website is also designed to keep you informed. 

Safety and preventive health:

As you look ahead to the next stage of development, your clinician will discuss safety concerns and preventive health needs specific to the next stage. I’m in the process of developing resources that I’ll post to this website following the American Academy of Pediatrics Bright Futures, but adapted to Malawi’s context.

Well Baby Visit Schedule: 

Well baby visits are a part of a country’s preventive health plan.  In Malawi, babies get a full check-up at birth and when Mom sees her OB usually a week after delivery.  Then the babies get weighed with each scheduled immunization visit. If any concerns they can schedule an appointment to see a provider.  I recommend that babies following this basic plan also schedule a developmental check and physical exam at 9 months and between 2 to 2.5 years. The government immunization techs are not trained to do developmental screens.

In many countries well baby visits are scheduled with each immunization visit. I encourage parents that are wanting to follow their home country’s immunization schedule to make well baby appointments for the same times.  Your home country’s baby book provides a useful guide for your clinician. After the first year, children should have an exam every year until adulthood.

Cost:

At ABC Community Clinic the well-baby exam costs 12,000 Malawian Kwacha. There is an additional 2,000 MK service charge for the government’s private immunization clinic. Contact me directly or ABC clinic reception to schedule an appointment.

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