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During the first two years of life, your newborn will mature into a toddler, reaching milestones along the way. The years are packed with doctor’s visits and medical screenings as well as decisions about breastfeeding, vaccines and teething remedies. Parenting a young child can be overwhelming, and it’s important to stay well-informed.
After birth, a baby will undergo a screening to look for certain rare but serious conditions. This is so a sick baby can be treated before developing more serious health problems.
Less than 1 percent of screened babies are diagnosed with one of the conditions they’re tested for.
All states require newborn screening for every infant, but the number of conditions for which a baby is tested varies. Most screening programs include blood tests and a hearing test; some states do heart defect screenings, too.
The federal government has made recommendations to guide states in the development of their programs. There are currently more than 30 conditions on the national Recommended Uniform Screening Panel.
Medical experts recommend parents bring their newborns and babies for regular doctor visits to keep them healthy. You and your baby will likely be visiting the doctor’s office nine times in the first 24 months for routine well-baby visits alone.
A doctor may recommend one or more vaccinations for your baby at the time of a well-baby visit, depending on the stage of your child’s development. Typically, vaccines are given at birth, 2 months, 4 months, 6 months, 12 months, 15 to 18 months and 24 months. The U.S. Food and Drug Administration (FDA) has approved 10 different types of vaccines that are routinely given between a child’s birth and second birthday.
During routine well-baby visits, doctors will also weigh babies and assess their development. Every baby is unique, and some may achieve developmental milestones early while others may be behind the curve. Parents should be aware of warning signs that could indicate something is not right.
Experts say newborns lose about 5 to 10 percent of their birth weight immediately after birth. But by about 2 weeks, babies typically start gaining weight and growing rapidly. A newborn grows faster in the first few months than at any other point in life. Babies typically double their birth weight by 6 months old and triple their birth weight by 12 months old.
Most babies learn to crawl between 7 and 10 months of age and are walking by 15 months. As early as 6 months, babies may use real words such as “mama” and “dada,” and they should be forming sentences by their second birthday.
A newborn may sleep up to 17 hours a day in the first month of life — but no more than one to two hours at a time. Most babies don’t start sleeping through the night until after the first 3 months, or until they weigh at least 12 pounds. By age 6 months, more than 65 percent of babies are able to sleep through the night on a regular basis.
The decision of whether to breastfeed or formula feed your baby is a personal one. If your baby is breastfeeding, it's important that he or she be fed every two to three hours, eight to 12 times a day. Babies who are bottle feeding will normally eat every three to four hours in the first few weeks.
The American Academy of Pediatrics, the American Medical Association and the World Health Organization recommend breastfeeding until at least 12 months — in part because it helps guard against infections, prevent allergies and protect against several of chronic conditions.
The FDA warns mothers to avoid taking certain medicines while breastfeeding because of a potential for the medicine to be excreted in human milk and cause harm to the baby.
Certain medicines, however, can make breastfeeding unsafe. The FDA warns mothers to avoid taking drugs such as Cymbalta, Pradaxa and Prilosec while breastfeeding because of a potential for the medicine to be excreted in human milk and cause harm to the baby.
From birth to age 4 months, your baby’s digestive tract is still developing. For that reason, solid foods are off-limits. Your baby’s diet should be restricted to breast milk or formula only. However, by age 6 months, your baby should begin showing signs of being ready to try solids.
After just one week of life, your baby should be able to recognize and respond to your voice by getting quiet or smiling, though your baby won’t be able to understand what you’re saying at first. But infants with hearing loss may not respond to familiar voices when spoken to and may not startle when there is a close-by loud noise.
Although rare, some infants at birth may lose all or some of the ability to hear sound in one or both ears.
Sometimes hearing loss worsens over time, and children who had normal hearing as infants can also develop hearing loss as they get older. Exposure to certain medicines in the womb or after birth can be the source of hearing loss.
A baby’s first eye exam happens in the delivery room. After that, babies should typically have their eyes inspected each time they visit the doctor’s office for a well-baby visit, according to the American Academy of Pediatrics. After two weeks of life, babies can typically focus on objects 8 to 14 inches away. By this age, babies tend to focus on parents’ faces during feedings. Next, you might catch your baby studying his or her hands and feet. By age 3 months, babies can be easily distracted by something they see and find interesting.
Your baby will also need to see a pediatric dentist no later than his or her first birthday. The American Dental Association recommends babies have their first dental appointment within six months of their first tooth poking through. During the first visit, the dentist will examine the baby’s mouth and provide the parent with information about protecting children’s teeth and establishing good dental habits.
Most babies begin cutting teeth around 6 months, although it could happen as early as 3 months or as late as 14 months. The first growth of teeth through the gums and the accompanying phenomena is known as teething.
To help ease the discomfort, you can give your teething baby something to chew on, such as a firm, rubber teething ring or a washcloth that’s been chilled in the refrigerator. You can also rub your finger gently over your baby’s sore gums or, if your baby eats solids, give him or her cold foods such as applesauce or yogurt.
Some doctors may recommend giving a teething baby who is 6 months or older Infants’ Tylenol. It’s important to ask the baby’s doctor for the correct dosage before administering the medicine. Tylenol is relatively safe when taken at the correct dosage; however, ingesting too much of the drug can result in serious complications, including liver failure.
In September 2016, the FDA put out a news release advising consumers to stop using homeopathic teething tablets and gels and dispose of any in their possession. The agency warned it had received reports of seizures in infants and children who were given these products.
In April 2011, the FDA warned consumers that use of benzocaine, the main ingredient in over-the-counter gels and liquids applied to gums or mouth to reduce pain, is associated with a rare but potentially deadly condition called methemoglobinemia, which causes a significant drop in the amount of oxygen carried through the blood stream. Benzocaine gels and liquids include Anbesol, Hurricaine, Orajel, Baby Orajel and Orabase.
Birth defects affect 1 in 33 babies every year in the U.S. and cause 1 in 5 infant deaths. “Every 4 ½ minutes, a baby is born with a birth defect in the United States,” according to the CDC. “That means nearly 120,000 babies are affected by birth defects each year.” There are 4,000 different types that range from mild birth defects that can go untreated to severe ones that cause disabilities or require medical intervention. Women who used certain medicines — such as Topamax, Zoloft, Zofran, Prozac, Paxil, Depakote, Lexapro, Celexa and Accutane — during pregnancy have reported giving birth to babies with structural birth defects, which occur when a baby is born with missing or malformed body parts.
In the U.S., birth defects have accounted for over 139,000 hospital stays during a single year, resulting in $2.6 billion in hospital costs alone.
As toddlers morph into children, they continue to need routine check-ups at their doctors’ offices. Your child should see a doctor at ages 3, 4, 5, 6 and 8.
A primary care doctor may recommend 4-year-olds receive another round of vaccines, including diphtheria, tetanus, acellular pertussis (DTaP); varicella (chicken pox); measles, mumps, rubella (MMR) and polio (IPV).
Any child may develop allergies. Allergic reactions can affect the eyes, nose, throat, lungs, skin and gastrointestinal tract. Some allergies happen only at certain times of the year. These are known as seasonal allergies. Others can happen any time someone comes in contact with a substance that causes an allergic reaction, known as an allergen.
Allergic reactions range from annoying to serious or life-threatening. A potentially life-threatening allergic reaction is referred to as anaphylaxis and can happen within seconds of exposure to an allergen or not until hours later. If anaphylaxis is not treated quickly, it can be fatal. Symptoms of anaphylaxis start out the same as other allergic reactions but escalate rapidly.
Anaphylactic reactions are rare, and doctors encourage anyone diagnosed with a life-threatening allergy to carry an epinephrine auto-injector (EpiPen) in case of emergency. Epinephrine reduces swelling and raises blood pressure. After children use injectable epinephrine, they should be rushed to the hospital.
Allergies can lead to other childhood ailments such as allergic rhinitis and ear infections. These conditions can affect sleep and a child’s overall quality of life. Children who suffer from symptoms of these conditions should see an allergist for possible testing and treatment.
Allergic Rhinitis (Hay Fever) — Airborne allergens can cause allergic rhinitis — or hay fever. Symptoms of this condition include a runny and itchy nose, sneezing, postnasal drip and nasal congestion. Despite its name, hay fever is not caused by hay and doesn’t bring about fever. It affects as much as 40 percent of children. In 2014, the FDA approved two immunotherapy products for use in children that are taken under the tongue for treatment of hay fever caused by certain pollens.
Ear Infections — A child with allergies may suffer from inflammation and fluid buildup in the ears. These conditions can foster ear infections and hearing issues. Allergies can lead to earaches and can cause ears to itch, pop or become stopped-up. Zithromax (Z-Pak) is commonly used in children to treat ear infections.
Research shows that bullying behavior can start as early as age 3. Both children who are bullied and those who bully others may have serious lasting health problems as a result of these actions.
A 2017 study by University of Pittsburgh researchers, for example, found that children who are bullied experience mental and physical health issues that can last well into adulthood. The study shows that bullied children are more likely to have trouble with finances and to be treated unfairly by others. They are also more pessimistic about their futures, according to the study.
On the other hand, the study revealed bullies are more likely to be stressed, hostile and aggressive, and to smoke cigarettes and marijuana. Both bullies and their victims are at a higher risk of heart disease, which is the leading cause of death for both men and women.
Doctors may prescribe the use of prescription drugs to treat the health effects of bullying. For example, children who suffer from depression or anxiety disorders (two health effects of bullying) may be prescribed selective serotonin reuptake inhibitors (SSRIs), such as Prozac. It’s important for parents to be aware that all SSRIs carry risks. The drugs’ labels feature a black box warning — the FDA’s most stringent warning — for an increased risk of suicidal thoughts and behaviors in children.
Childhood obesity levels are at an all-time high, according to the FDA. Since the 1970s, the percentage of children with obesity in the U.S. has more than tripled, according to the CDC. At present, about one in five school-aged children is obese.
Parents who are worried their children may be obese should talk with their children’s doctor. As part of routine check-ups, doctors calculate children’s body mass index (BMI) and determine whether a child’s weight is in an unhealthy range.
Proton Pump Inhibitors, which may be prescribed to treat heartburn in obese children, are linked to bone and kidney injury.
To date, there are no medications approved for use in children to control obesity. The FDA has approved two medications for long-term weight management in adults; however, these drugs were not studied in children and are not approved for use in anyone under 18 years old.
However, children who develop conditions as a result of obesity may be prescribed drugs intended to treat those problems. For example, a child with obesity who develops heartburn may be prescribed a proton pump inhibitor, such as Prilosec, Nexium or Prevacid. Though these drugs are proven to alleviate heartburn, long-term use of these medicines is linked to serious side effects, including bone and kidney injuries.
The preteen years bring about rapid changes in physical and mental development. For many this includes puberty, which can start as early as age 8 or 9 in girls and as early as age 9 or 10 for boys.
Girls begin to develop breasts as young as 8, grow body hair at an increased rate and begin menstrual cycles about two years after they begin developing breasts. Growth spurts tend to peak around age 11 and conclude around age 16.
Boys see genital growth around the age of nine, their voices begin to change and they begin to grow body hair at an increased rate around age 12. Growth spurts peak around the age of 13 and slow around 18.
This time in life is also marked by mental growth.
Older children should see their doctors for routine check-ups at ages 10, 11 and 12. At the latter two visits, your child’s doctor may suggest three vaccines: the tetanus, diphtheria acelluar pertussis (Tdap) vaccine, the human papillomavirus (HPV) vaccine and the meningitis (MCV) vaccine. The CDC also recommends preteens get a seasonal flu vaccine every year.
Childhood developmental or learning disorders are often diagnosed when a child is of school-age. Mental illnesses, however, can be hard for a parent to identify. Although children can develop the same mental health conditions as adults, they sometimes express them in different ways. In 2013 alone, more than 8.3 million children were taking psychiatric drugs. About half of the medicated children were between the ages of 6 and 12.
Anxiety disorders are a group of mental disorders branded by feelings of anxiety and fear. Children may have more than one anxiety disorder. More than 2 million children were on anti-anxiety medications in 2013. The age group with the largest number of medicated children was ages 6 to 12 years.
It’s perfectly normal for your child to stress about grades or an upcoming sporting event. However, if your child worries excessively or if anxiety and fear affect your child’s ability to perform daily activities, your child may be suffering from GAD. Doctors may prescribe Cymbalta, a serotonin-norepinephrine reuptake inhibitor (SNRI) as treatment. In 2014, the FDA approved Cymbalta for the treatment of generalized anxiety disorder in children ages 7 to 17. SNRI medications carry serious risks, including birth defects, skin disease, suicidal thoughts and liver toxicity. The FDA also warns of Cymbalta discontinuation syndrome, which is when a person experiences withdrawal side effects after stopping Cymbalta. Effexor, another SNRI, has not been approved by the FDA for use in children, but some doctors prescribe it for older teens as an off-label treatment for depression and anxiety.
Children with OCD experience unwanted and intrusive thoughts — or obsessions. They feel compelled to repeat rituals and routines to try to lessen their anxiety. OCD can affect children as young as 2 or 3, though most children with OCD are diagnosed around age 10. The FDA has approved several drugs to help control the symptoms of OCD in children, including Prozac, Zoloft and Luvox.
Children with Tourette syndrome may make unusual movements or sounds known as tics. The FDA has approved haloperidol, pimozide and aripiprazole to treat tics. All three medications have the potential to cause unwanted side effects, so most doctors prescribe the blood pressure medications guanfacine or clonidine. This is known as “off-label” use because the FDA has not approved either drug for treatment of tics.
Every child can feel sad or depressed at times, but mood disorders are more extreme and harder to manage than typical sadness. Doctors may prescribe antidepressants or antipsychotics to treat mood disorders in children. SSRIs are popular antidepressants, despite an increased risk of suicidal thoughts in children. Prozac is the only SSRI approved for use in children older than 8 years of age. Antipsychotics prescribed to children include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone).
Two percent of children ages 6 to 12 experience depression before hitting puberty.
These new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and movement disorders. Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.
Nearly 2.2 million children were on antidepressants in 2013, and more than 830,000 were taking antipsychotics. In addition, doctors often prescribe the anti-seizure drug Depakote for children with bipolar disorder, a use not approved by the FDA. The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults.
Doctors have been diagnosing children as young as 4 with ADHD. In the past nearly 30 years, the number of children diagnosed with ADHD has grown six-fold. Scientists estimate about 5 percent of children actually have ADHD, but the CDC shows that 15 percent are diagnosed.
Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects of these drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes. Data from 2013 showed more than 4.4 million children were on ADHD drugs.
Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.
For years, Type 1 diabetes — formerly known as juvenile diabetes — was the common type of diabetes in children. But as childhood obesity continues to rise, doctors are diagnosing more children with Type 2 diabetes.
There is no cure for Type 1 diabetes, and the disease does not go away on its own. It requires lifelong treatment. Children with the disease need daily insulin injections or an insulin pump to control the levels of glucose in their blood.
One glucose-lowering medication, metformin, is FDA-approved for use in children with Type 2 diabetes. Metformin can cause a serious and sometimes deadly side effect called lactic acidosis, which is when lactic acid builds up in the blood. This condition is rare and mostly occurs in people whose kidneys were not working properly.
The FDA has approved a number of different drugs for diabetes in adults, such as sodium-glucose co-transporter-2 (SGLT2) inhibitors. Some adult diabetes drugs are currently being studied for use in children.
Children are particularly vulnerable to the potentially harmful side effects of drugs during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk.
Over-the-counter medications should be taken with similar caution, and parents should not always give children the same drugs as adults. Aspirin, for example, is not recommended for anyone younger than 20 because of the risk for Reyes syndrome, a condition involving swelling of the liver and the brain. Cough and cold medicines containing antihistamines aren’t recommended for children without first consulting a doctor.
Emily Miller holds five Health Literacy certificates from the Centers for Disease Control and Prevention as well as a Bachelor of Science in Journalism from the University of Florida. She is a member of The Alliance of Professional Health Advocates, the American Association for the Advancement of Science and the Society for Technical Communication. Emily was diagnosed with a chronic illness as a child and has firsthand experience with many of the topics she writes about as a member of the Drugwatch team. She is an award-winning journalist who has reported on health and legal news for reputable organizations, including the South Florida Sun Sentinel, San Antonio Express-News, UF Health News and Reporters Committee for Freedom of the Press. She draws on her background as both a patient and a journalist to help readers understand complex health and legal topics.