Two-Month Checkup

Date ______________________________________

A.  MEASUREMENTS                   

Length _________________ in     (         %tile) 

Weight ___________ lb ___ oz    (          %tile) 

Head Size ______________ cm    (         % tile)

B.  IMMUNIZATIONS

Your child will receive the following:                               

Usually the DTap, Hib, and IPV are given as a combination vaccine, so your child will receive just two injections and one oral vaccine.  Although most infants do fine with these immunizations, a small percentage of infants may experience fever or fussiness.  This should subside within 48 hours.  You can give acetaminophen if your child develops a fever.

C.  LABORATORY STUDIES AND PROCEDURES 

No routine tests are performed today.

D.  FEEDING 

Your baby needs breast milk or infant formula until he is one year old.  Two-month-old babies usually drink about 4 ounces every 3 to 4 hours.  Do not let him lie down with a bottle because this can lead to tooth decay or ear infections.  It is very important that you check with us before switching formulas.  If your baby is breastfed primarily, continue to give him vitamin D, one dropperful by mouth once daily.

Always hold your baby when you feed him.  He will learn that you are there to meet his needs.  Feeding is a great time for warm, relaxed contact with your baby. 

Feeding solids to infants younger than six months of age increases the risk of food allergies as well as increases the risk for developing obesity.  For these reasons, we do not recommend you start solid foods until your baby is at least six months old. 

While some fish are a healthy part of a nursing mother’s diet, other fish should be avoided because they contain high levels of mercury.  These fish include shark, swordfish, king mackerel, and tilefish.  Fish or shellfish that are low in mercury include shrimp, canned light tuna, salmon, Pollock, and catfish.  Up to two meals per week of fish low in mercury are safe to consume.

E.  DEVELOPMENT AND BEHAVIOR 

Two-month-old babies are able to lift their heads briefly.  They reach for objects.  They like to watch smiling faces, and may return the smile.  Speak gently to your baby and she may coo in response.  Be sure to give your baby “tummy time” when she is awake so she can learn to push up and roll around.  She will enjoy new noises, brightly colored toys, and moving objects. 

Crying is normal for babies, and is their main form of communication.  You cannot spoil a child this age by meeting her needs quickly.  Do your best to determine why your baby is crying and meet that need.  However, there are times when babies will cry no matter what you do.  In those cases, it is acceptable to let her cry for 10 to 15 minutes before going through the process to try to quieten her again.  For more information and reassurance about your baby's crying, visit http://www.purplecrying.info/index.php?loc=mb1r3p6.

Visit http://www.aap.org/family/2004PAFBrochure.pdf for a downloadable developmental checklist that covers ages three through fifteen months.

F.  SLEEP 

Many babies awaken every 3 to 4 hours, but others sleep through the night.  It is best to place your baby in the crib when he is drowsy yet still awake.  That way he will learn how to put himself to sleep.  Keep your baby on his back to sleep to minimize the risk of Sudden Infant Death Syndrome (SIDS).  Pillows and crib bumpers are not safe.

G.  GENERAL INFORMATION AND SUGGESTIONS 

(1) VITAMINS, IRON, AND FLUORIDE: The formulas which we recommend contain the recommended amounts of vitamins, so additional vitamins are not necessary.  We may recommend fluoride if you have a well water supply with little or no natural fluoride.   

(2)  ILLNESS:  Continue to avoid large crowds when possible.  Be firm in not allowing individuals with even minor illnesses to hold or kiss your baby.  Be sure that everyone washes their hands or uses hand sanitizer before handling your infant. 

(3)  HEAD SHAPE:  Having infants sleep on their backs has reduced the risk of SIDS by nearly half.  However, we are seeing more infants with flattened or misshapen heads.  To prevent flattening on one side of the head, alternately place your baby’s head at opposite ends of the bed.  A baby usually turns his face to the center of a room, causing one side to be flattened if he is always placed in the same position.  Also make sure that when your baby is awake, he spends time on his tummy several times a day.

H.   SAFETY TIPS 

(1)  CAR SEAT SAFETY:  Motor vehicle accidents are the leading cause of death and serious injury after the first month of life.  Infants are required by law to remain in a rear-facing car seat in the back seat of a vehicle until they are BOTH one year of age AND at least 20 pounds.  For more information, visit http://www.buckleupnc.org/.  Carefully follow the manufacturer's recommendations to be certain the seat is properly installed in your vehicle. Remember, NEVER seat children in the front seat of cars with or without a passenger-side air bag.  For more information, call the National Highway Traffic Safety Administration at 1-800-424-9393, or visit their web site http://www.nhtsa.dot.gov/.  

(2)  CHOKING:  Should your baby ever choke, first attempt to remove all visible food or objects from his mouth.  Do not sweep blindly with your fingers because this could push the object in further.  If she cannot breathe and is turning blue, attempt to dislodge the object using a series of back blows and chest thrusts, as described in detail in the AAP book, "Caring for Your Child, Birth to Five."  If these measures are unsuccessful, call 911.   Prevention is the key, so do not put necklaces or strings around your baby’s neck, and keep drapery or blind cords away from the crib.  Use only unbreakable toys without small parts or sharp edges. 

(3) FIRES AND BURNS:  Be sure to check smoke detectors monthly.  Develop and practice a fire escape plan.  Place safety plugs in electrical outlets.  Keep all electrical appliances out of the bathroom to avoid electrical shock.  Do not cook with your baby in your arms or at your feet.  Check formula temperatures carefully and do not warm it in a microwave oven since this may result in scalds from uneven heating.  Turn your hot water heater down to 120 degrees F (50 C).  Be sure to check the bathwater with your elbow to prevent scalding. 

(4)  WATER SAFETY:  Never leave an infant or toddler alone in a bathtub, even for a moment.  Supervise your child continuously around any kind of water. 

(5)  FALLS:  Keep crib and playpen sides up at all times.  Do not use walkers.  Install safety gates to prevent falls down stairways.  Check drawers, tall furniture, and lamps to make sure they cannot fall over easily. 

(6)  SUN EXPOSURE:  Avoid direct sun exposure whenever possible.  Sunscreens are not officially approved in babies younger than six months of age. 

(7)  INSECT REPELLANTS:  During the time of year when mosquito bites are common, the AAP recommends that you protect your child with products that have 30% DEET as the active ingredient.  Other repellants simply do not work consistently or for long.  Do not use products that contain both sunscreen and repellant.  Apply the repellant with 30% DEET to exposed areas of skin, but avoid the nose, mouth, and eyes.  Wash the repellant off when you bring your baby back inside.  DEET is safe to use in infants as young as 2 months.

For additional safety tips, visit http://www.aap.org/healthtopics/safety.cfm

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The next checkup is at 4 months of age.  Your child will be receiving immunizations at that visit as well as a complete checkup.

Last modified: Monday February 16, 2015