A new baby means lots of trips to the doctor in the first two years. Pamela Schoemer, MD from UPMC Children’s Community Pediatrics explains why the visits are important and what you can expect.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. A new baby means lots of trips to the doctors in the first two years, so why are they important and what can you expect? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Dr. Pamela Schoemer. She’s a pediatrician and medical director of quality, safety, and outcomes for UPMC Children’s Community Pediatrics. Thank you so much for joining us.
– Well, thank you for inviting me. This is such an important topic.
– Such an important topic and I can’t even imagine, especially for first-time parents, a new baby and you think, I need to go to the doctor all of these times? Why are these visits so important?
– So, these visits are so important, one thing, because as you just mentioned, you need to build that relationship with your pediatrician, somebody that is gonna help you parent through the next 18 or more years of life. But those new babies don’t come with an instruction booklet, so oftentimes, there are questions or problems that you can’t foresee, and so having those frequent visits with that pediatrician are gonna help to anticipate those, and they make you feel like a better parent because you know what to expect.
– Right, so in general, if a baby is healthy without any major medical conditions, how many times over the coming two years will a baby have to go to the doctor?
– So routine care would be about 10 times, average is about every other month, although more at the beginning and a little less frequently as you get closer to that two-year age.
– And so, when do these first begin? So after a baby is born, parents may know there are some immediate tests that take place in the hospital.
– Right, but then we actually recommend that you be seen by your pediatrician within about two to three days after leaving the hospital. The trip home and that transition can be a little tough, and sometimes you haven’t seen your pediatrician in the hospital, it’s been a different doctor, so you wanna build that relationship and kind of establish that care quickly.
– All right, so that very first visit when a patient comes to see you, what takes place?
– Obviously, in many cases, it’s your first trip to the office so you’ll meet with our staff and there’ll be some information gathering, and then one of our clinical staff will measure your baby, kinda make sure that they’re growing well, ask if you have any concerns. And then when the pediatric provider comes in, they’re gonna talk to you about things such as feeding, sleep, and even how the family is doing with the new one in the family.
– And so what happens what after that? When’s the next visit after that? And with each visit, are there things that are standard that you check for? And then with each visit, is there sort of a different milestone?
– Absolutely, so that first visit depends a little how weight’s going and newborn period, most babies will have lost weight so we’ll see them back for a weight check one or two times in that next couple of weeks to make sure things are going well. And then that next visit after that once the baby’s back to birth weight would be at a month of age. And again, it’s to review all of the issues that may have occurred. You’ll see a lot of patterns in our well visits. You know, when you first come in, just like that newborn visit, there’s information that’s gathered, the baby is measured or plotted on a growth curve so you can kind of follow that along, and then you’ll meet with the provider to talk about feeding and sleeping and skin care, answering your questions, all the things you’d anticipate. Each visit does kinda have its own emphasis, so a lot of times, that will direct the conversation. Most parents, when they come in with their newborn, the first question they ask is, when are their immunizations? And the first ones other than in the hospital, a newborn visit would be at two months. So oftentimes, that is the focus of that visit is talking through what we’re protecting against, what to expect, all of those.
– What are some of those immunizations at two months?
– Yeah, so at two months, you actually get a series of… And it can vary a little by practice to practice, but typically it’s three injections and one medicine by mouth, and it protects against things like tetanus and whooping cough, meningitis, pneumonia and then a stomach virus called rotavirus, which before immunization was about the number-two cause for hospitalization in infants. And now we don’t see it all that often, or certainly it doesn’t lead to hospitalization.. It sounds like a lot of vaccines at one time but really our immune system is meant to react to many things at a time. If you think about when we put our fingers in our mouth or we wash our skin, there’s a lot of germs. So in many cases, these vaccines given together actually enhance the immune response and give your baby better protection. We start young because that’s when the baby is most at risk for serious illness. So we know at two months, they can build an immune response and it will start to get them protected so that those serious diseases don’t impact their life.
– Yeah, is there any reason you would delay from the two months?
– So there are a few, but very few. Mostly, it would be because the baby itself had an immune problem or was ill. But even premature babies can get vaccines based on their time since birth, not their age when they were expected. So in most cases, we can start those right at two months.
– Yeah, all right, so we get the vaccines.
– Absolutely.
– The first vaccines out of the way, when they come back the next time, where are we and what are we doing?
– At four months and six months, it’s easy, those are the same immunizations. But I think that’s the time we really start to talk about social skills, them learning and getting their own little personality. And also, being prepared for starting to change food from maybe an all-liquid diet, be it formula or breast milk, just thinking about solids and that food readiness, and then baby-proofing the house because pretty soon that baby’s not gonna be stationary, they’re gonna be moving. So those are kind of more the focuses of that. Always answering people’s questions, which there are oftentimes many of, but that would be the focus in there.
– What are some of the most common questions you might get from parents at that age group?
– So at four months, I think, starting food and how to start foods is always one because everybody wants to put a finger-full of mashed potatoes or ice cream, and that philosophy has changed a lot over the time. So, we really do talk about food readiness and not every baby’s ready to eat at exactly the same age so we help the parent make that decision. And then of course, when do I expect in their development? When are they gonna be rolling? When are they gonna be moving? ‘Cause that’s what we all think about when we see babies, is we think about the cute little crawling baby across the floor.
– Right. How has that changed when it comes to food over time? What are some of the conversations you’re having now that are different from in the past?
– Right, so years ago, they actually talked about delaying the start of food, worried about food allergies, and that has changed. So really we talk about introduction a little earlier because we know that the immune system then builds up resistance to that, and they’re actually less likely to develop an allergy, rather than the philosophy before. And again, six months used to kinda be that age and now we recognize some babies at four months who are holding their head up well and reaching food and interested in getting that texture and teaching them to get that food off a spoon may actually help us with success later on to eliminate some picky eaters.
– Wow, that is so fascinating.
– Yes.
– And that’s, just as you were saying earlier, this is important for parents for a number of reasons. You tend to just think medical and health but something so social and so vital to be able to have that conversation.
– Absolutely, and in those first six months or so, we also see parents sometimes go through some postpartum depression, so we wanna make sure we’re screening for that and being cautious that the family, either parent, really has that support they may need because it’s not sometimes as picture perfect as we might want it to be and our own hormones, our own moods can get in the way and eliminate our ability to enjoy this process.
– And when you talk about rolling over and those types of milestones, when typically does that take place or is there a typical?
– So there is a typical and I kind of in my mind group it as six months and on is really the movement time. You always wanna be careful with rolling over because there are babies that a couple of days of life sometimes that by perpetual motion can kinda get themselves flipped over, so you never wanna leave a baby up high, but really that six months and on tends to be that time when the baby is gonna be exploring, physically, their environment.
– Okay, six months now, we have food under control, babies rolling over, when do we next come back to see you?
– So, six months is under the belt, so nine months is our next visit. And that’s really when we start to see some independence, that baby is probably pretty mobile at this point and time, or we’re certainly on the doorstep of it. But they’re also starting to express their independence of opinion. So we see a lot of kind of what we call separation anxiety where they decide who can hold them, they decide who they’re going to talk with, they decide all of those and that’s a big change for a lot of parents because instead of the smiley little baby that goes to anyone, they’re showing those preferences. And so oftentimes that’s a big focus along with kinda cleaning up some of the issues from previous visits.
– And is there anything in particular beyond that that you were looking for at this stage?
– Right, so at nine months, we typically also screened for lead toxicity, so it is a blood test that we do. Because the baby is exploring, there maybe lead in the environment that they are taking from their hands putting in their mouth or just ingesting, so we’ll do that. We also look for anemia at that age because they are transitioning away from ion fortified food with cereals, with formulas and we wanna make sure that, again, their stores are good enough to carry them into that next phase.
– So, that’s a blood test?
– It is a blood test. And again, each office is gonna be able a little different. At UPMC Children’s Community Pediatrics, we typically are able to do that right in our office so that parents have at least the hemoglobin or the iron test in the office, the lead test gets sent out and takes a couple of days.
– Okay, what happens after that?
– So, at nine months, then we move to a year and at a year, again, we’ve got more development, that’s when we get the questions that my baby is not quite walking yet, or how many words should we have, and of course, sleep. Somewhere along that first year, we want those sleep routines to be well established and that your baby is moving, if they aren’t we really need to kinda help encourage that because pretty soon they’re gonna wanna be climbing out of that bed and if they’re not good sleepers, you may find them anywhere in the house, let alone hear that thump that you don’t wanna hear as they fall out of bed.
– So when it comes to the milestones of walking, what is typical and what do you say to parents if their baby is not walking at that time?
– So it’s a little later than most people think, average is about 13 and a half months. So, walking I would say, average nine to 18 months, but again, once your baby is up and cruising or pulling to stand, they’re well on their way so that’s what we look for. If they aren’t there yet, we may refer them for some therapy to help them or just talk through ways that you can encourage it. Some babies may be held a little bit more and not have quite those opportunities, so we wanna encourage those parents to explore how they can help their child explore the world around them.
– Right. And so, it must be fun for you, as you see babies come in and you watch them grow this entire time.
– Absolutely. We really become part of the family in a lot of cases. Because as you mentioned, it’s not always medical, sometimes it’s about parenting, sometimes it’s about anticipatory guidance, what to expect next. And so those are fun, but it’s also fun to share in the achievements. When the baby walks at the fist time, we wanna know that and it’s just part of that marker of being a patient-centered medical home that we wanna be.
– All right, okay. What happens next, the next day I come back?
– So, I think staying a little bit with 12 months I think the thing everybody thinks about is terrible twos and tantrums, but really at a year you can start to kinda form some of the behaviors in yourself as a parent that helps to eliminate those.
– That’s interesting.
– [Pamela] Yeah.
– Tell me a little more about that.
– And that’s giving a child choices, we know that they make choices, but choices within limits, not what do you want, but do you want this or do you want that? Because it allows your child to be independent but you still have that control. Also, I always tell my parents, don’t ask the question you don’t want an answer to ’cause once they learn the word “no,” you’re gonna hear it often and if you’ve asked and they say “no” and you do it anyway, they’re kind of offended by that, they’ve told you no even if it’s something they wanna do. So phrasing things like it’s time to go to bed rather than do you wanna go to bed? So that you’ve let them know and expect it not that they have a choice whether this is the end of the day. And building routines into those as well so that they know what bedtime looks like or they know what bath time looks like, so they themselves can kind of prepare, play a role in it and feel part of it, but not be the bosses of the family.
– When you were talking about “no” and learning “no,” I know some parents that have tried never to say “no” but redirect, rephrase. And is that something that you think is a good idea?
– Absolutely, I think that works much better and to give them more attention when they are doing something you want them to be doing rather than what they are not, so distracting. If it’s safe, sometimes just some ignoring is also okay and saving “no” for times that it’s really danger when you wanna get their attention. If you say it less, you may also hear it a little bit less.
– Very good. Okay, so beyond one year, you think we’re starting to cruise but we’re still coming back to visit you.
– Absolutely. And some of this has to do with our immunization schedule because at all of the visits minus that nine month visit when we talk about the blood test, they are our routine immunizations. But at 15 and 18 months, again, that independent little person is weaning from formula breast milk to milk, to a cup, learning to feed themselves, and learning to play in different ways, learning their imagination, and the of course, learning their language skills. So we wanna assess and make sure that all of that is developing and that they are growing the way they should be.
– Right, and you touched on this earlier, if there is an issue or you do see a problem, it’s really about what happens next and what can we do to help this baby progress.
– So, it depends on the issue, whether we do some watchful waiting, we see, okay, is this within normal but just a little delayed and we’ll follow up with you maybe even a little sooner than that next well visit. Well, we have lots of services that we can use including evaluation for occupational or physical therapy, or, as they get older, even speech therapy. Occasionally, we need to do medical evaluations to make sure there is not a medical problem that’s causing it and that’s all part of that picture of making sure that we’re gonna get your child to the potential that they have as they get older.
– Yeah, and so you mentioned this as well, with every visit, with the exception of that nine month there are immunizations.
– There are.
– What do you wanna say to parents about the importance of those and how many things our baby is protected by by the time they come and see you, just a ballpark.
– Gonna make me count?
– [Tonia] Yeah.
– But it’s more than 15. We talked about some of the early ones but in that second year we are gonna get protection against measles, mumps, and rubella, chickenpox, hepatitis A, which is a foodborne illness, and again, boosters for those others. Yeah, we’re really protecting against things that can affect them, not only in infancy but life long. People sometimes ask about the chickenpox vaccine because many of us have survived chickenpox, but we forget that if we’ve had chickenpox we’re gonna get shingles as we get older. If we never get chickenpox, not only do we spare that serious illness, but we spare something in adulthood as well. So it’s really just important and as a pediatrician, I think it’s one of the most important things I do, I’m not sure, it’s my patients who always feel that way. But in my career of actually seeing children have bad outcomes from many of these diseases that we can now protect against, so families don’t have to deal with that.
– Right, so that’s so important. All right, we are moving on.
– [Pamela] Yeah.
– Where are we now?
– Absolutely, so I think at that 15, 18 month we’re talking about tantrums, we are talking about development, we are still making sure and checking in that we are doing dental care, that we’re sleeping well, that we’re eating well, all of those other topics that were kind of in the beginning as well and then helping to empower that parent to know what is next and then eventually they graduate to that two-year visit and we probably celebrate the two-year visit just as much as the one-year visit. Two-year-olds tend to like parties better than one-year-olds. So and at that visit they have typically already finished those childhood immunizations. So sometimes that visit is also a little more fun that there isn’t a shot involved.
– Yeah, so after those, how often does someone have to come back and see you?
– So we do a two and a half year physical because there is a lot of development that still occurs in that second year. So we wanna make sure that we are checking in with growth and development, but then stating at three its yearly, and yearly up until more old. That doesn’t change even as whether you are a toddler, a preschooler or an adolescent, you really should be getting yearly watch visit.
– Right, and so I wanna ask you, what do you want to say to parents about how to prepare for this appointments and really what you want them to be thinking when they come to see you and get to spend time with you?
– You know, you prepare for your relationship with your pediatrician, sometimes even before the baby is born. So, go and meet, go see the office and make sure it’s a good fit location wise and personality wise.
– And that’s not odd.
– That is not.
– Someone who’s going to be a new parent can call up an office and say, “I’m looking for a pediatrician, can I come and check you out?”
– Absolutely. And it’s something that you would want to see because if people aren’t open to kinda meet you then are they gonna be there as well when you need them? So you want that welcoming environment. But I think for each visit, it’s really about writing down your questions, think about what has been going on, what you may have had questions about and also be prepared to update with what’s changed. So if your baby has been ill, if you’ve seen another provider, kinda be prepared to let your pediatrician know that. They obviously may have gotten notification about that but if you saw somebody outside of a system, they may not have, so that way you can add that to the medical record and the discussion. Many practices would also send out information ahead of time, so that might be educational information, or it might be some gathering information about development or eating habits, and that will save you if you do that before you get to the visit, trying to feel rushed when you’re there.
– Right.
– And don’t save everything for your checkup, if you’re really having a concern in between that’s why we are here. Ask beforehand so that your well visit isn’t necessarily about a cold or a stomach virus, or an illness, but it’s really about those important subjects that we kinda talked about.
– Are there dumb questions? What do you wanna say to parents about the–
– There are no dumb questions and going to other sources to get answers to questions sometimes is a dumb way to get the answer though.
– And you’re talking about it for searching online?
– Yes. Well, and dumb is probably not the correct word but it may not be the most up to date or the medical standard. Like we talked about with food, what great grandma did feeding wise 40 or 50 years ago may look very different to what’s recommended now. So, make sure that you check what your beliefs are, what your practices are and if you’re not sure what our recommendation is, ask, have it be a conversation just like we are having now.
– How did you end up in this field of medicine and wanting to be in pediatrics and do you see all of these kids as your family?
– Let me answer that last part first. They are definitely my family, and I take their concerns and their joys home with me everyday, and I share in those. So that is a huge part of my job satisfaction, it’s building those relationships. But the way I got into this is, first of all, who couldn’t wanna go to work with kids? And when you get to partner with families, to work towards a common goal, and that’s a healthy child. But personally, I also had some medical concerns when I was a child, and so I learned good and bad from the physicians that took care of me and it helped shake the kind of pediatrician that I am.
– Thank you so much for coming in and spending time with us today with some great information, I’m sure lots of new parents out there would be so thankful when they get to hear you. Thank you for your time today.
– Thank you for allowing me to share. And again, when you have questions, talk to your pediatrician.
– Thanks, again. I’m Tonia Caruso, thank you for joining us. This is UPMC HealthBeat.