Infant care during the first year of life is of particular importance. During this period many neurodevelopmental, metabolic, and physical disorders become apparent. Abnormalities recognized and promptly addressed may improve or at least preserve overall function and quality of life. Anticipatory guidance, addressing parental concerns, and maintaining appropriate levels of immunizations are the priority in well infant exam care. Early childhood home-visiting services can improve child health and family well-being: the American Academy of Pediatrics (AAP) recognizes home visits as an integral part of a comprehensive early childhood system.[1]Duffee JH, Mendelsohn AL, Kuo AA, et al. Early childhood home visiting. Pediatrics. 2017 Sep;140(3):e20172150.
https://publications.aap.org/pediatrics/article/140/3/e20172150/38307/Early-Childhood-Home-Visiting
http://www.ncbi.nlm.nih.gov/pubmed/28847981?tool=bestpractice.com
Parental expectations regarding care of a well infant range from a short conversation answering specific questions or concerns to a complete examination, screening tests, and age-specific immunizations.[2]Reijneveld SA, de Meer G, Wiefferink CH, et al. Parents' concerns about children are highly prevalent but often not confirmed by child doctors and nurses. BMC Public Health. 2008 Apr 18;8:124.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-124
http://www.ncbi.nlm.nih.gov/pubmed/18423036?tool=bestpractice.com
Although there is no direct evidence of benefit from repeated physical exams, they are routine in most US pediatric practices.[3]Moyer VA, Butler M. Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics. 2004 Dec;114(6):1511-21.
http://www.ncbi.nlm.nih.gov/pubmed/15574609?tool=bestpractice.com
[4]Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: guidelines for health supervision of infants, children, and adolescents, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
https://shop.aap.org/bright-futures-guidelines-for-health-supervision-of-infants-children-and-adolescents-4th-edition-1
[5]Glazener CM, Ramsay CR, Campbell MK, et al. Neonatal examination and screening trial (NEST): a randomised, controlled, switchback trial of alternative policies for low risk infants. BMJ. 1999 Mar 6;318(7184):627-31.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27766
http://www.ncbi.nlm.nih.gov/pubmed/10066201?tool=bestpractice.com
The age-specific recommendations and priorities included are based on current "Bright Futures" recommendations from the AAP, which encourage the most comprehensive level of screening and management.[4]Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: guidelines for health supervision of infants, children, and adolescents, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
https://shop.aap.org/bright-futures-guidelines-for-health-supervision-of-infants-children-and-adolescents-4th-edition-1
Additional recommendations from the Cochrane databases and other organizations such as the American Academy of Family Physicians (AAFP), the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the US Preventive Services Task Force (USPSTF) are also included:
CDC: infants and toddlers (approximate ages 0-3)
Opens in new window
USPSTF: pediatric recommendations
Opens in new window
WHO: recommendations on maternal and newborn care for a positive postnatal experience
Opens in new window
WHO: pregnancy, childbirth, postpartum and newborn care: a guide for essential practice (3rd edition)
Opens in new window
WHO: improving early childhood development
Opens in new window
AAP: Bright Futures
Opens in new window
Log in or subscribe to access all of BMJ Best Practice