Essential Questions For Your Newborn’s First Pediatrician Visit

Congratulations! You’ve made it through the hard months of pregnancy and the major physical and emotional event of the birthing process to safely deliver your new bundle of joy to the world.  Leaving the hospital with your new baby can feel both incredibly exciting and overwhelming—but luckily, chances are your baby’s first appointment with their primary care provider (PCP) is right around the corner. The American Academy of Pediatrics (AAP) currently recommends that newborns are formally evaluated by their pediatrician or pediatric nurse practitioner 3-5 days after birth. The timing of these first appointments is optimal to help make sure your baby (and you!) are right on track and settling in nicely at home, and to help answer the 500 new questions you will immediately have the second you make it to the hospital parking lot post-discharge.

These first visits provide the opportunity for your child’s PCP to evaluate them for jaundice, track their weight loss, and identify any potential problem areas as soon as possible so they may intervene when appropriate. The nuts and bolts of a physical examination aside, first pediatrician appointments are essential in establishing a strong, collaborative relationship with your baby’s primary healthcare team right off the bat that will serve your newborn and your family for years to come. To help make the most of your appointment, I recommend you keep a running list of questions that have cropped up for you and/or your partner since leaving the hospital. Coming prepared with a list of questions ready to discuss will help ensure you use the short time you are allocated with the pediatrician as efficiently as possible, and will help you feel more organized amidst what can sometimes feel like the chaotic first few days and weeks with a newborn (read: sleep deprivation, postpartum healing, hormone fluctuations, etc., etc.)

If you’re feeling stuck with how to prepare for this appointment or aren’t sure what questions to ask, you can start with this list of essential questions, organized by category, and tailor it to your family’s specific scenario and needs:

Findings on physical exam:

1.       What is my baby’s current weight? Tracking a baby’s weight in the first few weeks of life is important, as weight can be a reliable indicator of feeding issues and overall health. Most babies are expected to lose weight after birth—a trend which should begin to correct itself in the first few weeks of life. While their weight is a good thing to have on your radar, don’t waste too much time or energy stressing about it. You can be confident that if their weight becomes an issue, their PCP will intervene.

2.    Were there any other concerns or findings you identified on their physical exam? The vast majority of newborns will fly through their physical exam with no issues. Occasionally, their PCP may pick up minor abnormalities or variations that were not detected at the hospital, such as a “stork bite,” rash, or hemangioma (a type of benign birthmark). Less frequently, a PCP might identify something that warrants both their attention in the office and your attention at home over the next few days or weeks. Asking about any such findings empowers you as a parent to be an active member of your child’s healthcare team, and understand the finer details of your baby’s health. What your newborn’s doctor knows about them, you should know too!

Feeding:

1.   Are baby’s current feeding patterns normal? If you are breastfeeding your baby, clarifying how long and how often feeds are currently occurring can help reassure that you are right on track in your breastfeeding journey. Knowing that your current picture is well within expectations can alleviate a lot of stress and anxiety that many moms feel in the early stages of establishing a breastfeeding relationship.

2.   Do you have any suspicion my baby might have an oral restriction? If you are having difficulty or physical pain with feeds, describing your feeding experience in addition to their findings on a physical exam can help your baby’s PCP identify any tongue or lip ties as soon as possible and explore the possibility of revising these.

3.       How can I most safely prepare formula for a newborn (if applicable)? Recommendations for newborn formula can vary between the US and Canada, and between various states and provinces. Your baby’s PCP is the local expert on recommendations in your area regarding ready-to-feed formula, powdered formula, and appropriate water sources for mixing.

4.   How much formula should I be giving, and how often? If you are formula feeding or combination feeding, talk to your baby’s doctor about how often and how much your baby is currently taking. Based on their cues, weight, and behavior, they may have additional recommendations for how you can adjust your child’s feeding schedule or volume to optimize their intake.

5.   How should I expect feeding patterns to change between now and our next visit? As newborns experience explosive growth and development in the first few weeks of life, their feeding requirements change. Knowing what to expect in the coming days and weeks can help you feel less stressed when feeding demands suddenly ramp up or plateau.

6.   Are my baby’s diaper patterns normal? Should I expect them to change in the coming days or weeks? Knowing what is normal regarding the frequency of wet and dirty diapers, as well as the consistency of newborn stools, is helpful in gauging your baby’s effective feeding and hydration status. Knowing what is “normal” with regard to the consistency of their stools will reassure you that they are in line with expectations for their age and feeding source.

General Care and Health:

1.   What are your recommendations regarding pacifiers/soothers? When is it best to introduce one? Recommendations regarding the use and introduction of a pacifier/soother can vary significantly. Speak to your baby’s doctor at this first visit regarding your goals for using a pacifier, if you are interested in using one. They can help clarify the pros and cons of using pacifiers and help identify an optimal time to introduce one based on your baby’s needs, behavior, and feeding considerations.

2.   How often should I be bathing my baby? Bathing recommendations can vary substantially based on the season, local climate, and any skin sensitivities your individual baby may already display.

3.   What is the safest way to bathe my baby? Clarify whether your baby’s pediatrician recommends using soap/shampoo, which brands they specifically recommend (if any), which environment they find the easiest for parents to manage bath time in, and what recommendations they have for a safe water temperature.

4.   How do I best care for my newborn’s umbilical cord? When should I expect it to resolve? Ask if there are any special considerations or care techniques you should be aware of, and never be afraid to ask for a demonstration for any recommendations they may give you! Your baby’s pediatrician can also give you a rough estimate of when to expect the cord stump to fall off or “resolve,” so that it doesn’t surprise or concern you when it does.

5.   How do I best care for my son’s circumcision (if applicable)? If you have a newborn boy who you have decided to circumcise, their doctor will include this site in the physical exam to ensure it is healing correctly. Ask if they have any additional recommendations for care over the next few days or weeks, and ask when they expect the site to be fully healed.

6.   What is the best way to clean my uncircumcised baby (if applicable) If you have a newborn boy who you have chosen not to circumcise, you will likely receive a quick lesson on diapering and cleaning from your postpartum nurses with particular respect to foreskin. Ask any clarifying questions you have, and take the opportunity to demonstrate your current practices to ensure there are no additional recommendations or techniques you can incorporate into your diapering routine.

7.   What are your recommendations for a safe sleep environment? Most parents are familiar with safe sleep environments by the time they leave the hospital. Ask your baby’s PCP to review guidelines and feel free to describe their current sleep environment to make sure there are no elements present which could be tweaked to offer a safer environment.

8.   What “red flags” should I be aware of that deserve a phone call or a visit to your office? Newborns are quirky! They regularly present physiologic variants which can make many parents nervous, but in reality are completely normal (irregular breathing patterns, sneezing, irregular sleep, spit-up, “mottled” skin, purple-ish hands and feet). Ask what behaviors might appear concerning but in actuality are not. Conversely, ask about any “red flag” behaviors, signs, or symptoms that might warrant a phone call, or a visit to the office or local emergency department.

Resources:

1.   Is there a lactation counselor or lactation consultant on staff? Should feeding issues become a problem, many pediatric offices have a lactation counselor or lactation consultant on staff to provide a formal evaluation and recommendations. Clarify if this is a resource the office provides—if not, know your local Mama Coach is always there to provide support.

2.   Does the office offer a dedicated nurse line to call or direct messaging system if I have questions? Should additional questions or concerns arise, what kind of communication does the office offer? Many offices now offer direct-messaging through electronic health records or similar systems, while others have established triage lines staffed by nurses who can provide medical advice for minor issues over the phone, or advise you to visit the office for a problem which might require a higher level of attention and care.

3.   Are there phone triage resources available after-hours or on the weekends? While some offices offer triage services 24/7, others utilize contractors to take patient calls after-hours. Others offer no services outside of normal business hours, and instead advise patients to visit their local urgent care or emergency department if they have immediate medical concerns. Knowing the protocol for your office both on and off-hours can help minimize stress and confusion when you are trying to reach your child’s provider in times of illness, and can streamline the process to expedient care.

4.   Is the office open on the weekends? A simple truth we all come to embrace—there are no “off-days” in parenting. The same principle is true of childhood illness and injury. Clarify what services your pediatrician offers over the weekend, and ask for recommendations on other local providers or urgent care centers that can be utilized in the event your child needs to be seen when their PCP’s office might be closed.

Your next visit:

1.   When will our next visit be? Newborn appointment schedules can vary by region, insurance coverage, and office policy. Ask when your baby’s next scheduled visit will be.

2.   What can I expect to happen at the next visit? If your office follows a well-child schedule with less frequent appointments, it is possible that their next visit will include routine immunizations. Knowing the agenda for the next appointment is helpful in minimizing stress the day of, and for planning what and who to bring to the next visit.

3.   What developments or changes should I expect to see in my baby between now and our next scheduled appointment? As babies change rapidly in the first few months and weeks of life, ask their PCP what you can expect to see with regards to their physical development, behavior, feeding patterns, diaper patterns, and sleeping patterns. Knowing that these changes are on the horizon can help you feel less stressed when they arise, and you can feel reassured that your baby is growing and developing right on track!

When thinking about what questions to ask at your baby’s first appointment, or what questions you have regarding your baby’s health, it is essential that you keep in mind that no question is too silly, too small, or too embarrassing to raise with your child’s healthcare provider. Parents are the unparalleled leaders of their child’s healthcare team—but their primary care providers play an essential supporting role. Asking questions during routine care visits is an efficient way to utilize their expertise and leverage their knowledge and experience to optimize the health of your family. Good luck at that first newborn appointment. You’ve got this, Mama!

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