Check-Ups

During the first two years of your baby's life, you will probably spend more time in the paediatrician's office than you ever will again. Regular checkups, called well-baby visits, help your doctor make sure that your child's weight gain and growth are on track, his development is progressing normally, and he's eating well and getting the nutrients he needs. The visits also prepare parents for what to expect in terms of baby care and developmental milestones before the next exam.

Your first well-baby visit will probably be a day or two after coming home from the hospital or birthing centre. Dr Bisiwe will want to check your newborn for problems, such as jaundice, heart murmurs, and feeding difficulty, which sometimes aren't apparent until the third or fourth day of life. After that, we recommend a checkup at 2 weeks, followed by visits at 2, 4, 6, and 9 months, 12, 15, and 18 months, and 2 years.

Why so many visits? Your baby's body and mind are changing at a phenomenal rate, and frequent checkups can reveal deviations from what's normal. Dr Bisiwe is on the lookout for any medical issues that may affect your baby because detecting problems early make it easier to correct. In addition, these visits coincide with the schedule of immunization shots your child will receive.

Charting Growth

At each visit, your paediatrician will measure your child's height and weight and mark them on a growth chart. Your doctor uses the chart to determine how your baby is growing compared with other children of the same age and gender. Percentiles are the lines on the growth chart; they tell you how many children are above or below your baby's measurement.

Bigger is not necessarily better, however. How long or short or heavy an infant is at any point in time is less important than how that relates to where he was at a previous point. Small children are just as healthy as large ones as long as they are growing steadily - which means they are progressing along a single percentile over time.

So don't get caught up in worrying too much about what percentile your child is in - it's all relative.

When a child's weight gain or growth drops off its original curve, this could be a sign of a health problem, but there are many normal reasons that children "fall off the curve." Infants are born at a weight determined partly by their mother's nutrition and other influences in the womb. A newborn may be big because her mother is diabetic, for example, but the baby's weight percentile may drop off in the first few months of life as she veers toward her genetically determined size.

Another important measurement taken at every visit is the head circumference, which is used to gauge the baby's brain growth. Your child's brain grows the most during the first two years of life. Again, parents are often worried about whether their baby's head is too big or too small. Although either extreme can indicate a problem in rare instances - a head could be growing too fast because something is creating pressure, for example - usually, it is simply due to genetics. By measuring the mom's and dad's head, we can figure out whether a big (or small) cranium is a family trait.

Poking and Probing

At each visit, Dr Bisiwe will give your child a thorough physical examination. Her skin will be checked for birthmarks and her eyes will be checked with a special light to make sure there is a "red reflex" - the red glow responsible for red-eye in photographs. (This indicates that there isn't anything, including cataracts, obstructing her vision.) The shape of your child's head and the size and form of the soft spots will be examined. Dr Bisiwe will look in the baby's mouth to make sure the palate has formed properly and he may also feel the neck and collarbone to see if there is a fracture from delivery, a common complication that heals quickly.

Dr Bisiwe will listen to your baby's heart for murmurs and irregular rhythms, check the lungs to make sure they are clear, and examine the nipples for any discharge or swelling (normal in the first weeks of life but not after that). The doctor will feel the abdomen carefully to see if there is any enlargement of organs such as the liver, spleen, or kidneys or any abnormal masses. Then she will stretch your baby's legs to check for a birth defect called hip dysplasia - a too-shallow hip socket that can cause hip dislocation and affect walking. This manoeuvre often makes infants cry, but it's an important one. If hip dysplasia is found, putting the baby in a special splint for several weeks to a few months can correct it. As with many problems, finding and treating this defect early prevents complications later on.

Guiding Development

Dr Bisiwe will ask you questions about how your child is doing - whether she's hit typical milestones, is active, and is feeding and sleeping okay. Although everyone wants their child to be ahead of the pack, the truth is that "normal" covers a broad range when it comes to reaching developmental milestones. For example, some children start to walk at 10 months while others crawl until 15 months. Both scenarios are normal, and hitting milestones earlier doesn't mean a baby is innately more intelligent.

Nonetheless, these discussions with your doctor are an opportunity for you to bring up any concerns you have about baby's development or health - say, if your 14-month-old hasn't said his first word or your 8-month-old is having trouble sleeping through the night.

Your doctor should also give you relevant safety information for your baby's age. For example, Dr Bisiwe warns the parents of a 4-month-old who hasn't yet turned over that their child may do so for the first time when left unattended in the middle of an adult bed, and could roll off. And tells the parents of a 9-month-old who is pulling up to be sure to babyproof her environment, so that it's free of dangling appliance cords and tablecloths that she can pull down.

Well-baby visits are a chance for you to address your concerns - parents are usually the first ones to notice a problem - and to get comfortable with your doctor before you have to bring your child in sick with a cold or an ear infection. Come prepared with questions and an open ear - you are an equal partner in your baby's health.