Pediatricians are a remarkable group. They've made the choice to pursue a career caring for the most innocent and tender patients imaginable. Their ultimate goal is to partner with parents in providing quality health care so that a child can grow healthy and strong. They want to be of help whenever needed, and they're often the voice of reason and reassurance that every new parent occasionally needs.
Once newborns make their grand debuts, they'll begin a series of regular visits to the pediatrician's office. The American Academy of Pediatrics recommends that a baby is seen by its doctor at two to four days after birth, and at two, four, six, nine, and twelve months of age. These regular baby visits allow a pediatrician to check for proper growth in terms of weight and height, administer vaccines, as well as provide an opportunity to identify any significant issues in a baby's development which can be best dealt with by acting quickly in terms of diagnosis and treatment.
Pediatricians want to communicate effectively with parents. They will often provide detailed information, meant to inform caregivers and keep them in the loop in regards to their child's care. During visits, a pediatrician will make every effort to answer any questions or concerns a parent may have. They'll often invite questions and engage in as much conversation as time allows in order to make parents comfortable. They're also taking a silent inventory. A pediatrician is afforded the unique opportunity to get a glimpse at the well-being and quality of care a child is receiving. In addition to the obvious things a pediatrician checks during a visit like the baby's heart and lungs, weight, height, ears, etc., there is a host of other things they're silently inspecting as well. What follows is a list of 15 things a pediatrician is checking without saying:
15 Baby's Ability To Make Eye Contact
Many parents pay close to attention to their baby's ability to make eye contact from an early age. Current information suggests that parents will notice their newborns begin to make direct eye contact around 6 to 8 weeks old. However, it's important to note that babies meet these milestones in their development at very unique times. Each child is different, and parents must not worry if their baby demonstrates certain abilities before or after the average time frame noted.
Ultimately, a baby's ability to effectively maintain eye contact is helpful in assessing their neurological growth and ability to communicate. Generally, if a baby has not demonstrated the ability to make eye contact by three months of age, a pediatrician may recommend vision testing to look for a root cause. Again, it's important to understand that babies meet developmental milestones at their own pace. That said, many pediatricians check a newborn baby's tendency toward making eye contact in early visits without saying as much to parents. Ultimately, pediatricians want to do everything within their power to aid and assist new parents, not alarm them. For this reason, they'll often look for eye contact without specifically mentioning that they're checking this important milestone.
14 Parents' Demeanor And Comfort In Their New Role
Pediatricians are medical doctors with years of extensive educating and training under their collective belts. They know their stuff. They're also human beings, and they do enjoy creating some type of rapport with their patients and their patients' parents. For this reason, pediatricians often make a concerted effort in the early visits to get a sense for a parent's unique preferences and parenting style.
They may listen for cues that parents are overwhelmed or sleep deprived, so that they can most effectively recommend techniques for getting a better night's sleep out of their new bundle of joy. They may also look for any indications that parents are uneasy or concerned about something they're not willing to voice. In this instance, the pediatrician will often try to befriend the parent and connect with them in a peer-like way, perhaps by referring to their own personal experience with children, or by mentioning something they've heard is helpful from other patients. Either way, parents should absorb this information for what it is, an attempt to help in one of the most challenging yet rewarding phases in life... parenthood.
13 Condition Of Diaper Area
Young children are generally completely unclothed during pediatric visits, so that the doctor can more readily assess their overall health. Because newborns are prone to skin conditions, as well as other ailments which may make themselves known via discoloration or bruising of the skin, staff will ask parents to undress a baby and leave only a diaper on for the examination. As part of the doctor's normal routine, they will briefly open the diaper and may check the baby's genitals as well as buttocks for any obvious irritation or injury.
In many instances, the doctor will not voice to parents that they're looking for diaper rash, irritation, or in worst case scenarios, signs of neglect (such as severe rash from a lack of adequate diaper changes or cleaning). They may find it awkward to do so, so they'll silently look and assess the area, saying nothing if there is no cause for concern. Parents should not interpret this as a lack of communication; rather, it's a simple courtesy extended so as not to alarm parents for no reason.
12 Formation Of Baby's Soft Spot
While many pediatricians are comfortable acting as educators, others may prefer to quickly and silently check certain boxes off without explaining what they're doing. Checking a baby's fontanel (commonly called the "soft spot") on the top of the head is one thing a parent may note happening without much explanation coming from the doc.
In fact, many pediatricians call the process of palpating, or gently feeling around the area of the soft spot on a newborn, equal to a "handshake" with their new patient. It's often the very first thing they do when they get their hands on a new baby. This is because the structure and formation of the area is a proverbial window into the baby's brain and how things are growing. Doctors will look to be sure that the area isn't extremely sunken in, which can be a sign of dehydration in certain instances. They're also noting the size of the fontanel, which doesn't close for several years and allows room for growth of the brain and proper fusing of the skull. Because mentioning things like brain size and skull structure to parents can be a bit overwhelming, most pediatricians silently take note of this area and move on unless they have reason for concern.
11 Age Appropriate Child Proofing In Place
Baby-proofing is a vital part of providing care and protection for young children. Many new parents are surprised by how quickly their little ones become mobile, either by crawling or finding other inventive ways to roll and scoot about their homes. Often times, pediatricians implement forms or surveys that staff will ask parents to complete prior to entering an examination room. Through this paperwork, doctors can inquire about necessary precautions that should be taking place in the home to prevent or lessen the possibility of injury to a baby ready to explore.
Though the pediatrician may not verbally address the issue, they're sure to consider this an important aspect of their young patient's care and are most definitely willing to answer questions in regards to common injuries or hazards they see in their practice. Many pediatricians will ask questions regarding the home's hot water heater, and the necessity of setting the maximum temperature to no more than 120 degrees F in order to lessen the possibility for severe burns to baby. Others will rely on the paperwork they've implemented to assess whether or not appropriate safety protocols are being followed, and if not, they'll make note to address the issue moving forward.
10 Baby's Neck Control
Newborns are born with very little muscle control in their necks. As a result, their heads require full support for several months. As they grow, their bodies naturally strengthen as a result of normal activity experienced throughout the day. Without much discussion, a pediatrician might hold a newborn up in a way that allows them to demonstrate some development of head control. With the rise in popularity and stressed importance of "tummy time," many parents worry unnecessarily that their child isn't far enough along in their neck strength. The truth is, this ability will develop as a newborn grows, and parents can relax knowing that tummy time takes many shapes. Simply holding a newborn against their chest and allowing them to practice head control counts. Parents can also recline back, with baby on his or her tummy on top of them, as another effective alternative to traditional tummy time which most parents will agree doesn't go over all that well in the early months.
By about six months of age, babies should have good neck control and be able to steadily turn their head from side to side. In the event this milestone seems slightly delayed, a pediatrician will often suggest increased tummy time exercises to encourage muscle strengthening.
9 No Excessive Bruising
Child abuse is an unspeakable act but a tragic reality for some. The ultimate goal of every pediatrician is to provide care and support to their tiny charges. They want to make every attempt possible to protect the innocent and vulnerable patients they see each day. As mandated reporters of suspected child abuse, pediatricians are legally responsible to immediately notify authorities if they even suspect that a child is being physically or emotionally abused in any way, so they are diligent in looking for signs or symptoms of trouble.
This does not mean in any way that pediatricians are out to accuse parents or suspect the worse. In fact, they understand best the dedication and energy required to care for small children. So, without saying anything at all, they do a visual inspection of baby as a whole at every opportunity. In the event that a baby has excessive bruising, obvious injuries, or neglected wounds, a pediatrician can investigate further in order to determine their origin and whether or not they feel the child's well-being is at risk moving forward.
8 Head Shape
Babies are born with soft and pliable skull bones, designed to allow passage through the birth canal. With the popularity of the Back to Sleep campaign, which urges parents to place newborns flat on their backs to sleep, many newborns experience a flattening at the back of the head as a result of the consistent pressure placed there during rest. In addition, spending extended amounts of time in the same position, such as in a favorite swing or bouncy seat, can cause a flattening in one area of the head (most commonly at the back of the head). This can result in a misshapen appearance known as Plagiocephaly or flat head syndrome.
Again, since pediatricians are often busy and focused on communicating important matters, they tend not to voice the things they're mentally checking unless they suspect an issue may need some action or correction. So, without obvious discussion, they may cup and gently explore baby's head, looking for signs of uneven pressure or misshapen structure. There are various exercises and positioning tips available to correct Plagiocephaly, as well as helmets and customized devices for more advanced cases in the event the pediatrician feels compelled to begin treatment.
7 Position And Mobility Of Hips
Pediatricians check a baby's hips at every visit until the toddler is steadily and smoothly walking. While this portion of the examine may seem bizarre, as the doc often puts what appears to be significant pressure on the baby's hips as they move and rotate them about, it's an important part of checking a baby's physical growth. The pediatrician is actually looking for signs of developmental hip dysplasia, which is a congenital malformation of the hip joint thought to affect one in every 1,000 babies.
The pediatrician is looking for difficulty in the range of motion, or a telltale "click" from the hips which can indicate a problem. If they have any concerns, a simple ultrasound will be helpful in determining the best course of action. In most cases, correcting the issue is as simple as a pelvic harness, worn by baby for a few weeks to months.
6 Condition Of Mouth And Throat
So much of a baby's development in the early months depends on successful feeding. Whether exclusively breastfeeding, bottle feeding, or taking a combination of breast milk and formula, babies must get proper nutrition to thrive. As a common part of any well-baby exam, many pediatricians will quickly inspect the inside of baby's mouth and get a good look at their throat. In general, they're checking for any sores, infection, or physical hindrances to baby getting the best latch at mom's breast or the ability to most effectively suck from a bottle.
One common condition that can affect the mouth is thrush, which is actually a yeast infection of the mouth. The infection can be passed back and forth from mom to baby while breastfeeding. By doing a quick inspection, pediatricians can rule out any ailments that may prevent baby from effectively feeding. Pediatricians can also help to confirm teething if parents are concerned about increased fussiness, drooling, or gumming by doing a quick oral inspection.
5 Is Baby Meeting Developmental Milestones
Milestones are nothing new to parents. They read about them and are typically well aware of the things baby should be doing at a certain age. That said, there's so much room in what's considered the "normal" time frame for baby to meet certain goals that worrying about milestones can be pointless and exhausting. After all, baby will crawl just as soon as he or she is ready.
Knowing this, pediatricians are extremely sensitive to not alarming parents if a baby seems delayed in specific areas. They will often refrain from asking if baby can sit unassisted, and will instead position baby in a way on the exam table that allows them to inconspicuously check their stability. They might stand baby up while supporting their upper body to check for the child's tendency to bear weight evenly on their feet and legs. These aren't sneaky tests; they're simply the doctor's way of assessing overall development through the use of firsthand experiments.
4 Appropriate Feeding Schedule
Think about a time you've wanted to ascertain some information in a way that didn't seem nosy or bossy. Maybe you wanted to know where your spouse was after work, but you didn't want to appear suspicious, so you go the route of asking how their day was, and if they did anything special. This is often the method pediatricians use to determine if a baby is being fed adequately. While there is much wiggle room in what a baby needs nutritionally, there are certain standards which help to benefit a child in terms of growth and development.
In order to figure out if a baby is getting enough, too much, or improper nutrition, a pediatrician might ask, "How are his eating habits?" By asking the parent about the baby's performance, it allows the doctor a unique opportunity to information gather in terms of what the parents are providing without sounding as though they're questioning mom or dad's decision making. "What are you feeding him?" or "Are you feeding him enough?" is very different in tone, and can prevent many parents from feeling that they're in a safe place with someone who only wants to help.
3 Safe Sleeping Environment
Pediatricians understand the risks of unsafe sleeping environments to newborns and infants. They're often well versed in the latest research, and it's their responsibility to stay up to date on current guidelines in terms of what can be done to best protect baby. That said, the vast majority of them do not want to sound condescending or judgmental in any way.
While baby's safety is their first priority, building a relationship with that baby's parents is often the best way to influence the situation and effect change. Instead of a pediatrician saying, "Is he sleeping through the night yet?" they'll often ask if mom or dad are managing to get good sleep themselves. By approaching the situation in a peer-like way that seems conversational, they make parents comfortable sharing any struggles baby might be facing in getting a good night's sleep. It just might open doors to having safe sleeping conversation, and it may even alert the pediatrician to an area the parent could use guidance in, in hopes of correcting a problem before any real consequences arise.
2 Baby's Vision
A baby's vision can be difficult to assess in the early stages since strength and clarity develops as baby grows, and there's little ability to know first hand what baby is processing. That said, there are certain diagnostic tests professionals can use that accurately enable the professional to determine if a baby's vision is developing as it should. For the first couple months of life, a newborn may have difficulty controlling the movements of their eyes as a unit. One may wander, or appear lazy, and this is completely normal.
By three to four months of age, their ability to focus on an object eight to ten inches from their face should strengthen. A pediatrician might make an effort to move into this position with a baby, in order to assess their ability to track movement and control their eyes adequately. Because it's not worth alarming parents about something that's a bit difficult to determine in the first place, many doctors won't specifically mention that they're doing a quick vision check.
1 Healthy Attachment To Parent
Pediatricians are observers by nature. They have to be on the look out for silent cues, since baby often isn't able to describe or explain what ails them. A pediatrician must notice a baby's intermittent ear tugging and then investigate a potential ear infection or teething pain. Similarly, they have to pay attention to behavioral issues that can indicate gas pain or other invisible causes. Often times, they have only the information provided by parents to work with, and they must be great at prying for other details to confirm their suspicions of a diagnosis.
Another way that they may silently assess the factors contributing to a baby's well-being is by observing how the primary caregiver interacts with the child, and the child's obvious attachment or lack thereof to that person. There's no judgement in this assessment; it's simply an informational tool the pediatrician can use in determining if a child is developing emotional bonds that are a good indication of solid development as a whole.