2 month old visit

KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

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Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

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Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

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Family Life

AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

Health Library 2 Month Well-Child Visit

Find another condition or treatment, healthy baby development and behavior.

Below are milestones most babies will reach between now and 4 months old. Talk with your doctor at your baby’s next well-visit if your baby is not yet reaching these milestones or there are skills your baby no longer shows each day.

Social and Emotional Milestones

• Smiles on their own to get your attention
• Chuckles when you try to make them laugh
• Looks at you, moves or makes sounds to get or keep your attention

Language and Communication Milestones

• Makes cooing sounds like “oooo” or “aahh”
• Makes sounds back when you talk to them
• Turns their head toward the sound of your voice

Thinking and Learning Milestones

• If they are hungry, opens their mouth when they see breast or bottle
• Looks at their own hands with interest

Physical Development Milestones

• Holds head steady without support when you are holding them
• Holds a toy when you put it in their hand
• Uses arms to swing at toys
• Brings hands to mouth
• Pushes up onto elbows/forearms when on tummy

Healthy Ways to Help Your Baby Learn and Grow

Development.

• Smile, talk and respond positively to the sounds your baby makes
• Sing and play music for your baby. Read together every day to help your baby learn language.
• Hold and cuddle with your baby often, giving praise and lots of loving attention.
• Lay your baby on their tummy to play. Put toys at eye level to encourage lifting the head to see the toys. Do not leave your baby alone. Take breaks when your baby is tired.
• Notice the signals your baby gives when feeling playful or tired. Are they trying to play with you by making sounds and looking at you, or are they yawning, getting fussy and needing to rest? Responding to your baby’s cues will make your baby feel safe and loved.
• Use simple routines each day for feeding, sleeping, bathing and playing.
• Limit your screen time when caring for your baby. This helps you respond to your baby’s needs and encourages your baby to learn and grow.
• Never hit or shake your baby. Your baby’s brain could be damaged. Your baby could die as a result. If you need a break to calm down, put your baby in a safe place and walk away. Check on your baby every 5–10 minutes. Your baby may cry a lot in the first few months, but it will get better!
• Many infants have more periods of fussing and crying at this age. Some crying is normal, but many parents wonder if their child has colic. Talk with your baby’s doctor if you have questions or concerns. Learn more about colic, as well as tips for calming your baby.
• Feed your baby only breast milk or formula until 6 months old.
• If breastfeeding, feed your baby on demand, usually 8–12 times in 24 hours. Give your baby vitamin D drops (400 IU a day). Continue to take your prenatal vitamins with iron and eat a healthy diet.
• If formula feeding, feed your baby on demand, usually 6–8 times in 24 hours. Hold your baby so you can look at each other during feedings. Always hold your baby’s bottle. Never prop a bottle.
• Look for signs your baby is hungry, such as putting hands to mouth, smacking/licking lips or turning the head toward the breast or bottle. Watch for signs your baby is full, such as closing the mouth or turning the head away.
• Create a schedule for naps and bedtime.
• Remember the ABCs of safe sleep:
• Alone —The safest place for your baby to sleep is alone in the crib / bassinet. It’s good to have the crib / bassinet in the room where you sleep, but don’t let the baby sleep in your bed.
• Back —Always place your baby on its back to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS).
• Crib —Always put your baby to sleep in an empty crib or bassinet with a snug, firm mattress and tight-fitting sheet. Don’t have any blankets, crib bumpers, stuffed animals, toys or sleep positioners inside the crib with your baby.
• Swaddling should not be used once your baby is rolling over.
• Learn more about safe sleep for infants.

Vehicle Safety

• Use a rear-facing car seat in the backseat of your vehicle. Learn more about car seat safety and installation.
• Never leave your baby alone in a car. Practice safe behaviors that prevent you from forgetting your baby in the car, like putting your purse or cell phone in the back seat. Learn more about the dangers of hot cars and how to keep your child safe.

Home Safety

• Never leave your baby alone in the tub, near water or in high places like a changing table, bed or couch.
• Avoid drinking hot liquids while holding your baby. Prevent tap water burns by setting the temperature of your water heater to 120°F or below.

This information is to support your visit with your child’s doctor. It should not take the place of the advice of your pediatrician.

Sources: Centers for Disease Control and Prevention, Bright Futures (4th Edition) by the American Academy of Pediatrics

Last Updated 06/2023

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Doctor Visits

Make the Most of Your Baby’s Visit to the Doctor (Ages 0 to 11 Months)

Take Action

Babies need to go to the doctor or nurse for a “well-baby visit” 6 times before their first birthday.

A well-baby visit is when you take your baby to the doctor to make sure they’re healthy and developing normally. This is different from other visits for sickness or injury.

At a well-baby visit, the doctor or nurse can help catch any problems early, when they may be easier to treat. You’ll also have a chance to ask any questions you have about caring for your baby.

Learn what to expect so you can make the most of each well-baby visit.

Well-Baby Visits

How often do i need to take my baby for well-baby visits.

Babies need to see the doctor or nurse 6 times before their first birthday. Your baby is growing and changing quickly, so regular visits are important.

The first well-baby visit is 2 to 3 days after coming home from the hospital, when the baby is about 3 to 5 days old. After that first visit, babies need to see the doctor or nurse when they’re:

• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old

If you’re worried about your baby’s health, don’t wait until the next scheduled visit — call the doctor or nurse right away.

Child Development

How do i know if my baby is growing and developing on schedule.

Your baby’s doctor or nurse can help you understand how your baby is developing and learning to do new things — like smile or turn their head to hear your voice. These are sometimes called “developmental milestones.”

At each visit, the doctor or nurse will ask you how you’re doing as a parent and what new things your baby is learning to do. 

By age 2 months, most babies:

• Lift their head when lying on their stomach
• Look at your face
• Smile when you talk to them
• React to loud sounds

See a complete list of milestones for kids age 2 months .

By age 4 months, most babies:

• Bring their hands to their mouth
• Make cooing sounds
• Hold toys that you put in their hand
• Turn their head to the sound of your voice
• Make sounds when you talk to them

See a complete list of milestones for kids age 4 months .

By age 6 months, most babies:

• Lean on their hands for support when sitting
• Roll over from their stomach to their back
• Show interest in and reach for objects
• Recognize familiar people
• Like to look at themselves in a mirror

See a complete list of milestones for kids age 6 months . 

By age 9 months, most babies:

• Make different sounds like “mamamama” and “bababababa”
• Smile or laugh when you play peek-a-boo
• Look at you when you say their name
• Sit without support

See a complete list of milestones for kids age 9 months . 

What if I'm worried about my baby's development? 

Remember, every baby develops a little differently. But if you’re concerned about your child’s growth and development, talk to your baby’s doctor or nurse. 

Learn more about newborn and infant development .

Take these steps to help you and your baby get the most out of well-baby visits.

Gather important information.

Take any medical records you have to the appointment, including a record of vaccines (shots) your baby has received and results from newborn screenings . Read about newborn screenings .

Make a list of any important changes in your baby’s life since the last doctor’s visit, like:

• Falling or getting injured
• Starting daycare or getting a new caregiver

Use this tool to  keep track of your baby’s family health history .

What about cost?

Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on your insurance plan, you may be able to get well-child visits at no cost to you. Check with your insurance company to find out more.

Your child may also qualify for free or low-cost health insurance through Medicaid or the Children’s Health Insurance Program (CHIP). Learn about coverage options for your family.

If you don’t have insurance, you may still be able to get free or low-cost well-child visits. Find a health center near you and ask about well-child visits.

To learn more, check out these resources:

• Free preventive care for children covered by the Affordable Care Act
• How the Affordable Care Act protects you and your family
• Understanding your health insurance and how to use it [PDF - 698 KB]

Ask Questions

Make a list of questions to ask the doctor..

Before the well-baby visit, write down 3 to 5 questions you have. Each well-baby visit is a great time to ask the doctor or nurse any questions about:

• How your baby is growing and developing
• How your baby is sleeping
• Breastfeeding your baby
• When and how to start giving your baby solid foods
• What changes and behaviors to expect in the coming months
• How to make sure your home is safe for a growing baby

Here are some questions you may want to ask:

• Is my baby up to date on vaccines?
• How can I make sure my baby is getting enough to eat?
• Is my baby at a healthy weight?
• How can I make sure my baby is sleeping safely — and getting enough sleep?
• How can I help my baby develop speech and language skills?
• Is it okay for my baby to have screen time?
• How do I clean my baby's teeth?

Take a notepad, smartphone, or tablet and write down the answers so you can remember them later.

Ask what to do if your baby gets sick.

Make sure you know how to get in touch with a doctor or nurse when the office is closed. Ask how to reach the doctor on call, or if there's a nurse information service you can call at night or on the weekend.

What to Expect

Know what to expect..

During each well-baby visit, the doctor or nurse will ask you about your baby and do a physical exam. The doctor or nurse will then update your baby’s medical history with all of this information.

The doctor or nurse will ask questions about your baby.

The doctor or nurse may ask about:

• Behavior — Does your baby copy your movements and sounds?
• Health — How many diapers does your baby wet each day? Does your baby spend time around people who are smoking or using e-cigarettes (vaping)?
• Safety — If you live in an older home, has it been inspected for lead? Do you have a safe car seat for your baby?
• Activities — Does your baby try to roll over? How often do you read to your baby?
• Eating habits — How often does your baby eat each day? How are you feeding your baby?
• Family — Do you have any worries about being a parent? Who can you count on to help you take care of your baby?

Your answers to questions like these will help the doctor or nurse make sure your baby is healthy, safe, and developing normally.

Physical Exam

The doctor or nurse will also check your baby’s body..

To check your baby’s body, the doctor or nurse will:

• Measure height, weight, and the size of your baby’s head
• Take your baby’s temperature
• Check your baby’s eyes and hearing
• Check your baby’s body parts (this is called a physical exam)
• Give your baby shots they need

Learn more about your baby’s health care:

• Read about what to expect at your baby’s first checkups
• Find out how to get your baby’s shots on schedule

Content last updated March 30, 2023

Reviewer Information

This information on well-baby visits was adapted from materials from the Centers for Disease Control and Prevention and the National Institutes of Health.

Reviewed by: Sara Kinsman, M.D., Ph.D. Director, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

Bethany Miller, M.S.W. Chief, Adolescent Health Branch Maternal and Child Health Bureau Health Resources and Services Administration

Diane Pilkey, R.N., M.P.H. Nursing Consultant, Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration

September 2021

You may also be interested in:

Breastfeed Your Baby

Take Care of Your Child's Teeth

Eat Healthy During Pregnancy: Quick Tips

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Baby's doctor visits: The 2-month checkup

At the 2-month checkup, the doctor will weigh and measure your baby, do a complete physical, address any concerns you have, and ask questions about their eating, sleeping, and crying habits (among other things). Your baby will likely get two shots and an oral vaccine.

2-month vaccines

What the doctor will do at the 2-month checkup.

To prepare for your baby's 2-month checkup, learn what will happen at the visit. You may also want to consider the questions the doctor is likely to ask and jot down answers beforehand.

Your baby will typically receive the pneumococcal , DTaP , Hib , and polio vaccines (combined in two shots) and the rotavirus vaccine (given orally). They'll also get the second hepatitis B now if they didn't get it at the 1-month checkup.

A nurse or medical assistant may administer the vaccines. This is usually done at the end of the appointment in case your baby gets upset (which could make the exam part of the visit difficult), and so you can have some privacy to comfort them.

Find out how to make shots less painful for your baby and more about the immunizations your baby needs .

Weigh and measure your baby

You'll need to undress your baby completely for weighing. The doctor weighs your baby, measures length and head circumference, and plots the numbers on a growth chart .

The chart enables you to see how your baby compares with other children the same age. But it doesn't matter whether your baby's in the 5th or the 95th percentile, as long as their rate of growth is steady from one visit to the next.

Do a complete physical

• Heart and lungs: Uses a stethoscope to listen for a heart murmur or breathing problems.
• Eyes : Checks for signs of congenital eye conditions and other problems. May also check for blocked tear ducts and discharge.
• Ears: Looks for signs of infection and observes how your baby responds to sound.
• Mouth: Looks for signs of thrush (an oral yeast infection) among other things.
• Head: Checks the soft spots (fontanels) and the shape of your baby's head. Also checks to see if your baby's head is developing a flat spot (now's the time to catch it).
• Body: Checks your baby's reflexes and muscle tone, and examines the skin for rashes .
• Belly: Presses gently on the abdomen to check for a hernia or any enlarged organs.
• Genitals: Opens your baby's diaper and checks for signs of infection.
• Hips and legs: Moves your baby's legs around to look for problems in the hip joints.

Address any other concerns

Your doctor may recommend giving your baby a vitamin D supplement of 400 IU daily.

They'll also address any health concerns (such as reflux , baby acne , and diaper rash ), ask you some questions, and help you understand what's normal at this age.

Ask questions

• How is your baby sleeping? At this age, many babies are starting to sleep a little longer at night – maybe even staying asleep for a 4- or 5-hour stretch – and less during the day. They're still snoozing 14 to 16 hours a day on average.
• When, how, and how often is your baby eating? Most 2-month-olds still eat every two to three hours, though they may begin to eat slightly less often later this month. The doctor asks feeding questions to determine whether your baby is getting enough breast milk or formula to thrive.
• What are your baby's bowel movements like? Soft poops are best, but color can vary. Dry or pellet-like stools are a sign of dehydration or constipation , so tell your doctor if you notice this.
• What is your baby's crying pattern? If your baby is particularly fussy or colicky , the doctor may suggest ways to soothe them . Have you noticed a change? Many babies begin to "settle" at about 8 weeks.
• How's your baby's head control? Head control is an important developmental milestone. By now your baby should be able to hold their head up when they're on their stomach.
• Can your baby push up on their forearms? This development in your baby's strength and coordination could happen this month or next.
• How does your baby respond when you talk to them? At this age, your baby could be cooing on their own and at you – it's one of the first steps in their language development .
• Does your baby smile? Most babies are smiling voluntarily by this age – it's one of their earliest social behaviors.
• Have you noticed anything unusual about your baby's eyes or the way they look at things? At every well-baby visit, the doctor should check the structure and alignment of the eyes and your baby's ability to move them correctly.
• How's your baby's hearing? Hearing is mature from birth, so if your baby's not turning toward voices, especially familiar ones, tell the doctor.
• What's your baby's posture like? By now your baby should have relaxed a bit from the scrunched-up fetal position. Their legs should come down when they're lying on their back. If your baby's overly limp – they feel like they'll slip out of your arms – or has uneven movements, tell your doctor.
• Are you giving your baby tummy time when they're awake? Supervised tummy time – when your child is awake and active – helps babies learn to push up, roll over , and eventually crawl . It also helps them avoid getting a flat spot on the back of their head.

Learn more:

• Your 2-month-old baby's development
• 2-month-old sleep : Your complete guide
• What's in store at the 4-month doctor visit

Was this article helpful?

How can I make getting shots less painful for my child?

The pneumococcal vaccine

The Hib vaccine

The rotavirus vaccine

BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

CDC. Vaccines at 1 to 2 months. https://www.cdc.gov/vaccines/parents/by-age/months-1-2.html Opens a new window [Accessed November 2022]

CDC. Recommended Vaccinations for Infants and Children, Parent-Friendly Version. https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html Opens a new window [Accessed November 2022]

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Bright Futures Information for Parents: 2 Month Visit

Here are some suggestions from Bright Futures experts that may be of value to your family.​​

How is Your Family Doing?

If you are worried about your living or food situation, talk with your health care professional. Community agencies and programs such as WIC and SNAP can also provide information and assistance.

Find ways to spend time with your partner. Keep in touch with family and friends.

Find safe, loving child care for your baby. You can ask your health care professional for help.

Know that it is normal to feel sad about leaving your baby with a caregiver or putting him into child care.

Feeding Your Baby

Feed your baby only breast milk or iron-fortified formula until she is about 6 months old.

Avoid feeding your baby solid foods, juice, and water until she is about 6 months old.

Feed your baby when you see signs of hunger. Look for her to:

• Put her hand to her mouth.
• Suck, root, and fuss.

Stop feeding when you see signs your baby is full. You can tell when she:

• Closes her mouth
• Relaxes her arms and hands
• Burp your baby during natural feeding breaks.

If Breastfeeding... Feed your baby on demand. Expect to breastfeed 8 to 12 times in 24 hours.

Give your baby vitamin D drops (400 IU a day).

Continue to take your prenatal vitamin with iron.

Eat a healthy diet.

Plan for pumping and storing breast milk. Let your health care professional ​know if you need help.

• If you pump, be sure to store your milk properly so it stays safe for your baby. If you have questions, ask your health care professional.

If Formula Feeding... Feed your baby on demand. Expect her to eat about 6 to 8 times each day, or 26 to 28 oz of formula per day.

Make sure to prepare, heat, and store the formula safely. If you need help, ask us.

Hold your baby so you can look at each other when you feed her.

Always hold the bottle. Never prop it.

How Are You Feeling?

Take care of yourself so you have the energy to care for your baby.

Talk with your health care professional or call for help if you feel sad or very tired for more than a few days.

Find small but safe ways for your other children to help with the baby, such as bringing you things you need or holding the baby’s hand.

Spend special time with each child reading, talking, and doing things together.

Your Growing Baby

Have simple routines each day for bathing, feeding, sleeping, and playing.

Hold, talk to, cuddle, read to, sing to, and play often with your baby. This helps you connect with and relate to your baby.

Learn what your baby does and does not like.

Develop a schedule for naps and bedtime. Put him to bed awake but drowsy so he learns to fall asleep on his own.

Don’t have a TV on in the background or use a TV or other digital media to calm your baby.

Put your baby on his tummy for short periods of playtime. Don’t leave him alone during tummy time or allow him to sleep on his tummy.

Notice what helps calm your baby, such as a pacifier, his fingers, or his thumb. Stroking, talking, rocking, or going for walks may also work.

Never hit or shake your baby.

Use a rear-facing–only car safety seat in the back seat of all vehicles.

Never put your baby in the front seat of a vehicle that has a passenger airbag.

Your baby’s safety depends on you. Always wear your lap and shoulder seat belt. Never drive after drinking alcohol or using drugs. Never text or use a cell phone while driving.

Always put your baby to sleep on her back in her own crib, not your bed

• Your baby should sleep in your room until she is at least 6 months old.
• Make sure your baby’s crib or sleep surface meets the most recent safety guidelines.

If you choose to use a mesh playpen, get one made after February 28, 2013.

Swaddling should not be used after 2 months of age.

Prevent scalds or burns. Don’t drink hot liquids while holding your baby.

Prevent tap water burns. Set the water heater so the temperature at the faucet is at or below 120°F /49°C.

Keep a hand on your baby when dressing or changing her on a changing table, couch, or bed.

Never leave your baby alone in bathwater, even in a bath seat or ring.​

What to Expect at Your Baby's 4 Month Visit

We will talk about:

• Caring for your baby, your family, and yourself
• Creating routines and spending time with your baby
• Keeping teeth healthy
• Feeding your babu
• Keeping your baby safe at home and in the car

Helpful Resources:

• Information About Car Safety Seats: www.nhtsa.gov/parents-and-caregivers
• Toll-free Auto Safety Hotline: 888-327-4236

Consistent with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition

The information contained in this webpage should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original handout included as part of the Bright Futures Tool and Resource Kit, 2nd Edition.

Inclusion in this webpage does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this webpage. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this handout and in no event shall the AAP be liable for any such changes.

Last Updated

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2-Month Vaccines: What You Should Know

2-month vaccinations, diphtheria, tetanus, acellular pertussis (dtap), haemophilus influenzae type b (hib), polio vaccine (ipv), pneumococcal conjugate vaccine (pcv), hepatitis b (hbv), rotavirus (rv), side effects, when to contact the pediatrician, when to call 911.

At their 2-month wellness check, babies are usually scheduled to receive several vaccines, including:

• Diphtheria , tetanus , acellular pertussis ( DTaP )
• Haemophilus influenzae type B ( Hib )
• Inactivated polio vaccine ( IPV )
• Pneumococcal conjugate vaccine ( PCV )
• Hepatitis B vaccine ( HBV )
• Rotavirus vaccine ( RV )

This article discusses recommended vaccinations, possible side effects, and how to comfort infants during and after their appointment.  

SDI Productions / Getty Images

While babies are born with a fairly strong immune system, there are some diseases that can be severe and are hard to fight on their own. Vaccinations are given to help their immune system prevent these diseases. 

The Centers for Disease Control and Prevention (CDC) recommends an immunization schedule that includes six vaccinations for 2-month old babies.

Most vaccinations are given as a shot. However, the rotavirus vaccine (RV) is given by mouth through liquid drops. 

Alternate Names for Vaccinations

Vaccinations may also be referred to as:

• Innoculation
• Immunization

Comforting Your Baby

Write down questions you have and bring available shot records with you to the appointment. It’s also helpful to pack your baby’s favorite toy, pacifier, or blanket to comfort them during the visit.

During the appointment, you can help your baby by:

• Holding them
• Distracting them with toys or singing
• Smiling and whispering reassuring words

After the appointment, you can comfort your baby by:

• Breastfeeding or bottle-feeding
• Offering a pacifier
• Swaddling with their favorite blanket
• Giving them Tylenol (acetaminophen) as needed for pain if approved by your healthcare provider

The DTaP vaccination is given in five doses. The first dose begins at 2-months and the final at 4-6 years old. DTaP helps prevent the following diseases:

• Tetanus  
• Pertussis (whooping cough)

Is it DTaP or Tdap?

Both the DTaP and Tdap are vaccines that protect against the same diseases. The first five doses given are the DTaP. Tdap is the booster given around 11 years or older. 

Haemophilus influenzae type B ( Hib ) is often confused with seasonal influenza ( flu ) because of their similar names. However, these are two different diseases. Seasonal influenza is a virus, while Hib is a bacteria that can cause:

• Pneumonia (lung infection)
• Sepsis (bloodstream infection)
• Epiglottitis (swelling in the upper airway or windpipe) 

The Hib vaccine is scheduled as three or four doses depending on the brand. It is given at the following ages:

• 6 months (if needed depending on vaccine brand)
• 12-14 months

Hib Statistics

Between 1989 and 2000, Hib rates in the United States dropped by 99% due to vaccinations.

In the late 1940s, polio was a highly feared disease that caused paralysis. After polio vaccinations, infections in the U.S. decreased dramatically.  

Children in the U.S. get a shot called an inactivated polio vaccine (IPV). Other countries may use an oral polio vaccine (OPV).

IPV is given over four doses at the following ages:

• 6-18 months

Polio Cases in the United States

No cases of polio have originated in the U.S since 1979. In 1993 one case came into the country through travel. Healthcare providers may choose to increase the pace of polio vaccines for children traveling to a high-risk country.

The pneumococcal conjugate vaccine ( PCV ) protects against a bacterial infection that causes ear or sinus infections, meningitis, and pneumonia.

The PCV vaccine is given in four doses at the following ages:

• 12-15 months

Pneumococcal Disease

Streptococcus pneumoniae or pneumococcus are bacteria that cause pneumococcal disease. Immunization against these diseases is important because they can be invasive and severe.

Hepatitis B (HBV) is a potentially serious viral infection that causes damage to the liver. It is passed through body fluids or from mother to baby. The hepatitis B vaccine ( HBV ) is given in three doses at the following ages:

• Shortly after birth
• 1-2 months 

Protecting Your Baby from Hepatitis B After Delivery

Moms can have hepatitis B without symptoms and unknowingly pass it to their babies at birth. This is why infants usually receive the first dose within the first 12 hours of their life.

Rotavirus (RV) is a gastrointestinal virus that causes stomach pain, severe vomiting, diarrhea, and dehydration (loss of fluid). The RV vaccination is given as drops in the mouth. 

There are two brands of this vaccine. One brand is given at 2- and 4-months-old. The other brand includes a third dose given at 6-months-old.

If babies experience side effects after vaccines they are usually mild.

The most common side effects include:

• Soreness, redness, or swelling at the site of the shot 
• Low-grade fever (100-102 degrees or lower) 

Less common side effects include:

• Fussiness or irritability
• Loss of appetite
• Diarrhea or vomiting

What About Severe Side Effects?

Severe side effects or allergic reactions are very rare. If you are concerned about this possibility, talk to your healthcare provider before the appointment.

What to Do If Your Baby Has Side Effects

To help minimize mild reactions, you can try the following:

• A cool cloth to reduce redness and swelling 
• A room temperature sponge bath for low-grade fevers
• Feed your baby more often for comfort and hydration
• Give Tylenol (acetaminophen) if approved by your pediatrician

Medications to Reduce Fever and Discomfort

Motrin or Advil (ibuprofen) is usually not given to babies less than 6-months-old. Tylenol (acetaminophen) is safe for infants 2-months-old and up with approval from their healthcare provider. Children should not receive aspirin unless directed by their healthcare provider.

If your baby has any of the following symptoms, contact their healthcare provider:

• Fever greater than 104 degrees
• Redness at the shot site larger than 1 inch or lasting longer than three days
• High-pitched crying lasting over one hour
• Nonstop crying for three hours or more
• Fussiness for more than three days 
• Severe vomiting or diarrhea

If you think your infant is having a life-threatening emergency or any of the following rare reactions, call 911 immediately:

• Trouble breathing
• Trouble swallowing
• Lethargy (not moving or very weak)
• Not waking up

Vaccinations are usually given at an infant’s 2-month wellness visit to help protect them from preventable diseases. You can help comfort your baby by holding them and offering them their favorite blanket, pacifier, or toy. Vaccination side effects are generally mild and can be treated at home to ease any discomfort.

A Word From Verywell

It's understandable that parents may have concerns about infant vaccinations. It's important to know that while mild reactions are possible, severe ones are extremely rare. A child's safety is paramount, so you shouldn’t hesitate to discuss any concerns with your child’s healthcare providers. Vaccinations play a crucial role in safeguarding your child's health and providing protection against serious diseases, and the benefits of timely vaccination far outweigh the minimal risks.

Centers for Disease Control and Prevention (CDC). Vaccines for your children: 1-2 months .

Centers for Disease Control and Prevention (CDC). Immunization schedules .

Centers for Disease Control and Prevention (CDC). 9 things to make shots less stressful .

Centers for Disease Control and Prevention (CDC). DTaP (diphtheria, tetanus, pertussis) vaccine: What you need to know.

Immunization Action Coalition. Ask the Experts: Haemophilus influenzae type b (Hib) .

Centers for Disease Control and Prevention. Hib vaccination: What everyone should know .

Centers for Disease Control and Prevention (CDC). Vaccines and preventable diseases: polio .

Centers for Disease Control and Prevention (CDC). Pneumococcal vaccine recommendations .

Centers for Disease Control and Prevention (CDC). Pneumococcal disease .

Centers for Disease Control and Prevention (CDC). Hepatitis B .

Centers for Disease Control and Prevention (CDC). Rotavirus . 

Seattle Children’s Hospital. Immunization reactions .

Daley M, O'Leary S, Nyquist A, et al. Current Diagnosis & Treatment: Pediatrics . 25th ed. New York: McGraw Hill;Chapter 10:2022.

Immunization Action Coalition. After the shots . Immunize.org.

St Louis Children’s Hospital. Acetaminophen (Tylenol) dose table .

Contemporary Pediatrics. 2021 CDC vaccine schedule .

By Brandi Jones, MSN-ED RN-BC Jones is a registered nurse and freelance health writer with more than two decades of healthcare experience.

The 2-Year-Old Checkup

Medical review policy, latest update:.

Medically reviewed to ensure accuracy.

The physical checkup

Developmental milestones, more about your toddler, 2-year-old vaccines, questions to ask your doctor.

Believe it or not, the time of frequent well-baby visits is coming to an end. After taking your child for another appointment around her half birthday (when she's 30 months old), you'll book a 3-year checkup . Trusted Source American Academy of Pediatrics AAP Schedule of Well-Child Care Visits See All Sources [3] From then on, it’s just a single yearly visit.

Updates history

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Baby among 5 people killed as a swarm of tornadoes hits heartland: Officials

"My prayers are with those who lost loved ones," Oklahoma Gov. Kevin Stitt said.

At least five deaths, including one of a 4-month-old child in Oklahoma, were confirmed Sunday from a severe storm that swept through the heartland, spawning multiple tornadoes across four states, including a powerful pair of twisters that touched down in Nebraska, officials said.

Emergency officials in Hughes County, Oklahoma, said the baby was one of four people killed in storms that struck Holdenville. One person died from storm-related injuries at a sports bar in Sulphur that was hit by a tornado, officials said. At least 30 people were injured in Sulphur, including 20 who were at the sports bar, according to officials.

Oklahoma Gov. J. Kevin Stitt confirmed Sunday afternoon that at least four people were killed in the storms that slammed his state.

One person was reported dead in Marietta, Oklahoma, and two people were killed in Ada, Oklahoma, Stitt said.

A state of emergency was declared in 12 Oklahoma counties, authorities said.

Sunday night, the National Weather Service in Norman, Oklahoma, announced a preliminary determination of "at least" an EF3 tornado in Sulphur and also "at least" an EF3 in Marietta.

President Joe Biden spoke to Oklahoma Governor Kevin Stitt on Sunday, according to the White House. The president offered the "full support of the federal government" after Saturday's fatal tornadoes.

Gov. Governor Jim Pillen Sunday night issued an emergency declaration for Douglas, Lancaster and Washington Counties, making the eligible to "receive assistance funding through the state for recovery."

A man who was injured and hospitalized when a tornado hit Minden, Iowa, on Friday, has also died, his family confirmed Sunday to Omaha, Nebraska, ABC affiliate KETV .

A tornado tore through Minden in Pottawattamie County around 6 p.m. on Friday, destroying 40 to 50 homes, or about half the town, according to the Pottawattamie County Sheriff's Office. County officials confirmed that three people were injured in the tornado.

Iowa Gov. Kim Reynolds toured the devastated town on Sunday and activated emergency policies.

As communities were left reeling from the devastating twisters, a new tornado watch was issued Sunday afternoon for portions of eastern Texas just as two funnel clouds were confirmed near Rosebud and Freestone, Texas, officials said. The tornado watch will be in effect until 9 p.m. CT.

Sunday marks the third day of the severe weather outbreak across the heartland states. More than 22 million people are under a threat of violent storms Sunday in Texas, Louisiana, Oklahoma, Arkansas, Missouri, Kansas and Illinois.

Holdenville, a town of about 6,000 people 77 miles southeast of Oklahoma City, was left reeling after a violent tornado touched down near the city late Saturday amid a statewide tornado outbreak.

A search for victims and an assessment of damage was launched Saturday night after storms passed through the area, Hughes County Emergency Management officials said.

A Holdenville family told Oklahoma City ABC affiliate station KOCO that a relative lost their home in the storm and remained hospitalized Sunday.

At one point, crews searched the damaged Holdenville home for the child before finding the baby, who was pronounced dead at a hospital, according to the Hughes County emergency manager.

"My prayers are with those who lost loved ones as tornadoes ripped through Oklahoma last night," Oklahoma Gov. Kevin Stitt said in a statement Sunday. "Thank you to Oklahoma Emergency Management and those who have worked through the night to keep Oklahomans safe and have worked to clear debris and assess damage."

A destructive tornado also hit Sulfur, Oklahoma, in Murray County, destroying buildings and scattering debris for miles, authorities said. At least four other people were injured in Sulphur, including three with major injuries, officials said.

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An ABC News crew in Sulphur on Sunday observed several damaged businesses, including one with a collapsed roof and others with broken windows. Several cars were seen flipped over in the downtown area.

"I never dreamed it could do this much damage," Julie Cox, a Sulphur business owner, told ABC News.

Cox's business, Pamper Me Boutique, was destroyed, and she tearfully told ABC News she let her insurance lapse due to the economy and now doesn't know how she will rebuild.

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Tornadoes were reported Saturday across Oklahoma, Texas, Kansas and Nebraska, officials said. There were nearly 120 tornado reports in the last two days, according to the National Weather Service.

NWS teams were working Sunday to confirm the tornado reports but cautioned that the numbers are constantly being adjusted as new reports come in and duplicates are removed.

An enhanced risk for severe thunderstorms is in the outlook Sunday from eastern Texas to southern Missouri, as well as the possibility of strong tornadoes, damaging wind and large hail.

While Oklahoma was taking the brunt of the tornado outbreak, Nebraska endured the strongest tornadoes confirmed on Saturday.

Preliminary information suggests that two "strong, rare tornadoes" touched down in Douglas County, Chris Franks with the National Weather Service said during a press briefing Saturday. The NWS found evidence of EF-2 and EF-3 tornado damage there following Friday's storms, Franks said.

No fatalities have been reported so far following the Nebraska storms, officials said.

Widespread damage was reported in the Elkhorn neighborhood of Omaha, officials said. New photos emerged Sunday showing numerous destroyed homes in the area.

MORE: Tornadoes by the numbers: Damage reported across 14 states

"For that big of a storm, to have the property damage that was so extensive, without the loss of life," Douglas County Emergency Management Director Paul Johnson said during the press briefing. "It's a tremendous attribute to the city of Omaha."

Another tornado emergency was issued Saturday for Knox City, Texas, where a large and damaging tornado was reported near the town. Baseball-sized hail was also reported with this tornadic storm, officials said.

A tornado was also confirmed Saturday near the intersection of Kansas, Nebraska and Missouri. The confirmed tornado was eight miles north of Robinson, Kansas.

Storms are forecast to continue Sunday across the multistate region with heavy rain expected at times.

A flood watch remains in effect Sunday for a large area in the southern Plains and Ozarks, covering portions of seven states. Flash flood warnings were issued Saturday night and into Sunday morning as many communities reported 2 to 5-plus inches of rainfall and emergency officials urged residents to avoid flooded roads.

ABC News' Jessica Gorman, Vanessa Navarrete and Alexandra Faul contributed to this report.

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Missing Texas 2-month-old located, Amber Alert canceled

SAN ANTONIO (Gray News) - Police in Texas have canceled an Amber Alert after locating a 2-month-old boy they said had been abducted.

The San Antonio Police Department says the child was located Friday morning. He was last seen on April 11.

No other information has been released, including whether anyone was arrested.

The child was believed to be with Marisa Pena, 42, and Eddie Gomez, 51.

Copyright 2024 Gray Media Group, Inc. All rights reserved.

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Vaccines at 1 to 2 Months

Vaccinations are safe and effective for children to receive at the recommended ages.

CDC recommends COVID-19 vaccination for everyone aged 6 months and older. If your child has not gotten vaccinated yet, talk to his or her doctor about getting it as soon as possible.

Vaccines your baby should get

During the first months of your baby’s life, routine vaccines can help protect your child from a variety of serious or potentially fatal diseases.

At 1 to 2 months, your baby should receive vaccines to protect them from the following diseases:

1st dose of 5

A DTaP vaccine is the best protection from three serious diseases: diphtheria, tetanus, and whooping cough (pertussis). All three of these diseases can be deadly for people of any age, and whooping cough is especially dangerous for babies.

See Related:   DTaP vaccination

1st dose of 3 or 4

Hib disease is a serious illness caused by the bacteria Haemophilus influenzae type b (Hib). Babies and children younger than 5 years old are most at risk for Hib disease. It can cause lifelong disability and be deadly. Doctors recommend that your child get three or four doses of the Hib vaccine (depending on the brand).

See Related: Hib vaccination

2nd dose of 3

Hepatitis B is an infectious and potentially serious disease that can cause liver damage and liver cancer. If babies are infected at birth, hepatitis B can be a lifelong, chronic infection.  There is no cure for hepatitis B, but the hepatitis B vaccine is the best way to prevent it.

See Related:  Hepatitis B vaccination

1st dose of 4

Pneumococcal disease can cause potentially serious and even deadly infections. The pneumococcal conjugate vaccine  protects against the bacteria that cause pneumococcal disease.

See Related:  Pneumococcal vaccination

Polio is a disabling and life-threatening disease caused by poliovirus, which can infect the spinal cord and cause paralysis. It most often sickens children younger than 5 years old. Polio was eliminated in the United States with vaccination, and continued use of polio vaccine has kept this country polio-free.

See Related: Polio vaccination

1st dose of 2 or 3

Rotavirus can be very dangerous, even deadly for babies and young children. Doctors recommend that your child get two or three doses of the Rotavirus vaccine (depending on the brand).

See Related: Rotavirus vaccination

Additional protection for your baby during RSV season

Babies who are 1 to 2 months old should receive an RSV immunization (if not previously received) to protect them against severe RSV disease.

Respiratory Syncytial Virus (RSV)

RSV is a common cause of severe respiratory illness in infants and young children. Those infected with RSV can have difficulty breathing and eating and sometimes may need respiratory support or hydration in the hospital. An RSV immunization uses monoclonal antibodies to protect infants and young children from severe RSV disease. This immunization gives your baby’s body extra help to fight an RSV infection.

Infants younger than 8 months old during RSV season (typically fall through spring) should get a one-dose RSV immunization to protect them against RSV. This dose should be given shortly before or during the RSV season.

Care for your child after vaccinations

Call 911 if you think your child might be having a severe allergic reaction after leaving the vaccination site.

Give your child extra care and attention

Pay extra attention to your baby for a few days. If you see something that concerns you, call your baby’s doctor.

• Read the Vaccine Information Sheet(s) your baby’s doctor gave you to learn about side effects your baby may experience.
• Offer breastmilk or formula more often. It is normal for some babies to eat less during the 24 hours after getting vaccines.

Treat mild reactions

Sometimes children have mild reactions from vaccines, such as pain at the injection site or a rash. These reactions, also called side effects, are normal and will soon go away.

• Use a cool, damp cloth to help reduce redness, soreness, and/or swelling at the injection site.
• Reduce fever with a cool sponge bath.
• Ask your baby’s doctor if you can give your baby a non-aspirin pain reliever.

See which vaccines your child needs to stay on-track with routine vaccinations.

Birth to 6 years

7 to 18 years

Take a short quiz to get a list of vaccines your child may need based on their age, health conditions, and other factors.

Child vaccine quiz

• How to Hold Your Child During a Vaccination
• Make Shots Less Stressful
• Travel and Vaccines
• Keeping Track of Vaccine Records
• The Vaccines for Children (VFC) Program
• How Vaccines Prevent Diseases
• Vaccines & Immunizations

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Did TikTok videos inspire a teen’s suicide? His mom says she found graphic evidence

After Mason Edens took his own life, Jennie DeSerio looked for answers. She believes she found them in his TikTok account, where he had liked dozens of graphic videos about breakups, depression and suicide.

Editor’s note: This story includes graphic descriptions of videos that refer to self-harm. If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 800-273-8255, contact the Crisis Text Line by texting HOME to 741741 or visit SpeakingOfSuicide.com/resources .

It had been four months since Jennie DeSerio’s son died by suicide. Wracked by grief and wondering what she didn’t know, she picked up his phone and decided to go through his TikTok account.

What she found horrified her.

Shortly before he died, she found, her 16-year-old, Mason Edens, had liked dozens of graphic videos about breakups, depression and suicide. She knew Mason had recently been through a bad breakup — she didn’t know what he was watching on a platform that he was increasingly engrossed with. 

DeSerio said she found at least 15 videos Mason liked that directly promoted suicide, some of which are still on the platform more than a year later. At least five specifically promoted the method he had used. 

NBC News reviewed the videos and found that some had accrued tens of thousands of likes. TikTok uses likes as a signal for its “For You” page algorithm, which serves users videos that are supposed to resonate with their interests. 

“I completely believe in my heart that Mason would be alive today had he not seen those TikTok videos,” DeSerio said.

She’s now part of a lawsuit with eight other parents against several social media companies over what they say are product defects that led to their children’s deaths. The lawsuit alleges that TikTok targeted Mason with videos that promoted suicide and self-harm. Their suit is one of a group of lawsuits pursuing a novel legal strategy that argues that social media platforms like TikTok are defective and dangerous because they are addictive for young people. Advocates hope that can be a way for people to get justice for harms allegedly caused by social media.

In at least four other active lawsuits brought against TikTok and other social media companies, parents have said TikTok content contributed to their children dying by suicide. In another lawsuit , filed this month, two tribal nations sued TikTok, Meta, Snap and Google alleging that addictive and dangerous designs of social media platforms have led to heightened suicide rates among Native Americans. Google said the allegations are “not true,” and Snap said it was continuing to work on providing resources around teenage mental health.  Suicide is a complex issue, and the Centers for Disease Control and Prevention says it is rarely caused by a single circumstance or event. “Instead, a range of factors — at the individual, relationship, community, and societal levels — can increase risk. These risk factors are situations or problems that can increase the possibility that a person will attempt suicide,” the CDC says on its suicide prevention website .  

A TikTok spokesperson said the company couldn’t comment on ongoing litigation but said, “TikTok continues to take industry-leading steps to provide a safe and positive experience for teens,” noting that teen accounts are set to private by default and that teens have an opt-out 60-minute screen time allowance before they’re prompted to enter a passcode. 

TikTok has clear policies against content that promotes suicide or actions that could lead to self-harm, but in a sea of billions of videos, some content that glorifies suicide is still slipping through the cracks.     

DeSerio said Mason became so hooked on TikTok that he struggled to sleep sometimes, which led to anxiety issues. Friends said he found an emotional outlet on TikTok in particular as he was going through his first heartbreak.  

“A 16-year-old boy should never be sent videos like that on TikTok. They’re not going to self-regulate until there’s true accountability,” she said of social media companies.

Mason loved sports and the outdoors. “We were always playing basketball, throwing the football. We were always just outside doing something,” his friend Braxton Cole-Farmer said. “Mason didn’t like just sitting at home doing nothing. If we didn’t have anything to do, we’d just go drive.”

“He was always there for everybody. If anybody just needed a friend to talk to, he wouldn’t judge you based on what’s going on in your life,” he said.

Cole-Farmer said that Mason would retreat into his phone when he was having a tough time but that it wasn’t a cause for concern. 

“I mean, all of us are teenagers. We’re all addicted to our phones. So, like, seeing that, we didn’t really catch a red flag on it, because my generation of teenagers are always on their phone.”

In the months before he died, Mason had been in a turbulent relationship that family and friends said ended in a breakup. He was heartbroken, and the fallout rippled through his life at school. At first, Mason’s parents thought it was normal teenage sorrow. But a few weeks after the breakup, Mason and his mom decided he might need professional help and began actively trying to arrange a therapy visit.

DeSerio said Mason knew the breakup had made his anxiety worse and was taking proactive steps to try to feel better.

“He was showing some anger that he didn’t usually express,” she said.

DeSerio said the family had very open lines of communication, talking about mental health, anxiety and potential treatments in the week leading up to Mason’s death. She said what she heard and saw from him didn’t seem like an emergency. 

“There were also a lot of really happy times in those two weeks, too,” she said.

What she didn’t see was what Mason was consuming online — videos that included graphic and detailed depictions and methods of self-harm.

Mason liked one video in which an audio overlay said, “I wanna put a shotgun to my f------ mouth and blow my brains out,” with accompanying text about depression. The audio from that post was eventually removed, but the video remains up. Another described a plan to die by suicide, along with commentary about relationship issues.

One video he liked — it had over 67,000 likes — has text reading “what are your plans for the future?” over slow-motion video of a firearm discharging. That video is no longer available on the platform. 

Even though the videos clearly allude to suicide when their elements are taken together, it appears that many of them avoided detection by TikTok’s automated moderation system. According to TikTok, the auto-moderation system is designed to pick up various types of signals that might indicate a community guidelines violation, including keywords, images, titles, descriptions and audio in a video. 

TikTok declined to comment on how or why the videos Mason liked evaded its moderation system.

In addition to watching and liking the videos that mentioned suicide, Mason posted TikTok content the day he died about a rapper named Lil Loaded. Lil Loaded gained notoriety on TikTok after he reportedly died by suicide following a breakup. 

After he died, Lil Loaded became a frequently cited figure among some communities on TikTok, where dozens of videos that are still on the platform glorified his death, some with over 1 million views. Most of the videos use Lil Loaded’s image or name as shorthand for dying by suicide in reaction to a breakup.

One video that was still on the platform as of early April and had over 100,000 views included an audio clip saying “oh god, why am I even living bro, why do I live?” along with text over a video reading, “bout to pull a lil loaded.”

Mason’s stepbrother, Anthony, 16, said Mason changed his TikTok profile photo the day he died to a photo of Lil Loaded and joked with him before school that he was going to “pull a Lil Loaded.” 

Anthony said he asked Mason whether he was suicidal, but Mason said he was just joking around. 

That evening, Nov. 14, 2022, DeSerio tried to take Mason’s phone away from him so he could get a good night’s sleep, something she said she regularly did for his mental health. But Mason has just gotten his phone back after having been grounded for fighting at school, DeSerio said. When she tried to take it away from him again, he ran across the room and punched her.

DeSerio said she was shocked. He had never been violent toward her, and it wasn’t like the Mason she knew.

Mason’s mother and stepfather, Dave, took his phone away. 

While Jennie and Dave regrouped, Mason, crying and emotional, went to his room and locked the door without their realizing.

When Dave realized that Mason had gone to his room, he ran there and pounded on the door, trying to get him to unlock it.

But Mason was already gone. The 16-year-old died from a self-inflicted gunshot wound. 

Social media companies have been immunized from legal responsibility for most content on their platforms by Section 230, a law enacted by the passage of the 1996 Communications Decency Act that says the platforms can’t be treated as publishers of content posted by third parties. The law has generally insulated social media companies from lawsuits about content on their platforms, but advocates of stricter regulations have recently been pushing to find novel legal strategies to hold tech companies accountable. 

DeSerio’s lawsuit and hundreds of others aim to sidestep Section 230 by tying their claims to the legal concept of defective product design.

DeSerio’s suit describes TikTok’s design as manipulative, addictive, harmful and exploitative.

“TikTok targeted Mason with AI driven feed-based tools,” it says. “It collected his private information, without his knowledge or consent, and in manners that far exceeded anything a reasonable consumer would anticipate or allow. It then used such personal data to target him with extreme and deadly subject matters, such as violence, self-harm, and suicide promotion.”

California courts and a federal court are both waiting to begin hearing groups of cases making such arguments, which could open social media companies to a variety of claims around product safety.

Matthew Bergman and his firm, the Social Media Victims Law Center, are representing DeSerio and the other plaintiffs in her case. 

“It is our contention that TikTok in particular is an unreasonably dangerous product, because it is addictive to young people,” he said. 

Bergman contends that Mason took his own life because of what he viewed on TikTok.

“TikTok, in order to maintain his engagement over a very short period of time, deluged him with videos promoting that he not only take his life, but that he do so” in a specific way, Bergman said. 

Content that promotes suicide and self-harm has been a persistent issue for TikTok and other social media platforms for years. In November, Amnesty International released a research report that found that teens’ accounts on TikTok that expressed interest in mental health quickly went down a rabbit hole of videos about the topic that eventually led to numerous videos “romanticizing, normalizing or encouraging suicide.” 

Suicide rates among young people in the U.S. increased 67% from 2007 to 2021, according to the Centers for Disease Control and Prevention. In 2022, suicide rates for young people slightly decreased. Mental health professionals have said the U.S. is in the midst of a teen mental health crisis .

Lisa Dittmer, a researcher at Amnesty International, told NBC News that through interviews with teens, the organization found that “there were times they just weren’t in a capacity to actively counter that impulse to seek out depressive thinking. That would amplify the voice in their heads that said ‘life is all pain and pointless.’”  TikTok criticized Amnesty International’s research in a statement, saying its categorizations of mental health-related videos were overly broad.

The TikTok app immediately presents users with short-form videos, often from the “For You page,” which uses an algorithm that chooses which videos to serve people next. The recommendation system is one of the most powerful features of the platform. It has been repeatedly characterized as addictive by groups like Amnesty International and the Social Media Victims Law Center and as knowing users better than they know themselves . In a document reportedly seen by The New York Times in 2021, TikTok explained that the algorithm was optimized to keep users on the platform for as long as possible and coming back for more, analyzing how every person who uses it interacts with each video. According to the Times report, the equation considers what videos users like, what they comment on and how long they watch certain videos. NBC News hasn’t verified the document.

TikTok has said it has made efforts to try to prevent content rabbit holes, providing tools to enable users to restart their recommendation algorithms and filter out videos including certain words. TikTok also allows parents to oversee teen accounts and further customize screen time and content controls.

But Dittmer said teens who tried using the tools described them as ineffective in their interviews. 

Dittmer said young people dealing with mental health issues were susceptible to falling into depressive rabbit holes on TikTok.

“It’s not so much that your average teenager will automatically turn depressive or suicidal from being on TikTok, but for young people who have that thinking in their head, TikTok will just latch on to your interest and your vulnerability and amplify that relentlessly,” she said. 

Megan Chesin, a psychology professor at William Paterson University in New Jersey who has studied the connection between media and suicide, said the primary risk of social media for susceptible people is that the content could be encouraging or instructive.

“The risk, of course, is that individuals, like this adolescent that you’re writing about, learn something or are given permission or capability to die by suicide through what they see or understand on social media,” Chesin said. “The more you are exposed to something, the lower your threshold for acting on your own thoughts or desires to die can be.”

At a House of Representatives hearing last May, Rep. Gus Bilirakis, R-Fla., played videos found on TikTok that promoted suicide for TikTok CEO Shou Chew, asking him whether TikTok was fully accountable for its algorithm. Two of the videos included graphic descriptions of suicide via firearms. Chew responded by saying, “We take these issues very seriously, and we do provide resources for anybody that types in something suicide-related.”

While DeSerio waits for her own story to be heard in court, she has poured her efforts into bringing attention to how social media can affect children and teens.“Every day I wake up knowing that I need to share the larger message in order to save another child, another mother from this grief,” DeSerio said.

DeSerio agreed to be filmed for a documentary about Mason’s story that is in production, and in January, she and Mason’s stepfather flew to Washington, D.C., to be present as Chew testified in front of the Senate Judiciary Committee along with other tech CEOs about child safety issues and social media.

“It’s standing in front of all of society and challenging the ‘norm.’... Sometimes it’s really scary,” she said. 

Along with other parents, DeSerio was in the audience, holding a photo of Mason.

As Meta CEO Mark Zuckerberg stood in an unprecedented moment during the hearing, apologizing to parents for their suffering, DeSerio stood, as well, holding Mason’s photo above her head. 

The image would be broadcast around the world in photos and videos of the deeply emotional confrontation between one of the world’s most powerful people and the parents who have been trying to get his attention for years.

“I thought my purpose as his mom died that night with him,” DeSerio said. “Little did I know that my purpose just transformed.” 

Ben Goggin is the deputy editor for technology at NBC News Digital.

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Teenage woman killed, four other injured in one-car rollover crash in willington, uncategorized, subscriber only, as charles announces a return to public-facing duties, a look at recent events involving the royals.

FILE – Britain’s King Charles III, center, walks in the Coronation Procession after his coronation ceremony at Westminster Abbey in London, May 6, 2023. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (AP Photo/Kirsty Wigglesworth, Pool, File)

FILE – German President Frank-Walter Steinmeier, right, and his wife Elke Buedenbender, left, welcome Britain’s King Charles III and Queen Camilla, in front of the Brandenburg Gate in Berlin, March 29, 2023. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (AP Photo/Matthias Schrader, File)

FILE – Britain’s King Charles III, second right, pays a visit to the Notre-Dame de Paris Cathedral rebuilding site in Paris, Sept, 21 2023. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (Christophe Petit Tesson/Pool via AP, File)

FILE – Britain’s King Charles III inspects the guard of honor on a visit to meet Royal Marines and Kenyan Marines at Mtongwe Naval Base, in Mombasa, Kenya on Nov. 2, 2023. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (Luis Tato/Pool Photo via AP, File)

FILE – Britain’s King Charles III, center, poses for a photograph with secondary school students during his visit to the Eastlands Library to learn about a project that restores old libraries and encourages reading amongst children in the community in Makadara district of Nairobi, Oct. 31, 2023. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (Thomas Mukoya/Pool Photo via AP, File)

FILE – Britain’s King Charles III and Queen Camilla greet people after attending the Easter Matins Service at St. George’s Chapel, Windsor Castle, England, March 31, 2024. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (Hollie Adams/Pool Photo via AP, File)

FILE – Britain’s King Charles III leaves The London Clinic in central London, Jan. 29, 2024. King Charles III was in hospital to receive treatment for an enlarged prostate. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer (AP Photo/Alberto Pezzali, File)

FILE – A montage of the front pages of some of Britain’s Sunday newspapers pictured in London, March 24, 2024. Support has poured in from around the world for Kate, the Princess of Wales, after she revealed in a candid video message that she is undergoing chemotherapy for cancer following major abdominal surgery. (AP Photo/Alastair Grant, File)

FILE – Britain’s King Charles III and Queen Camilla arrive to attend the Christmas day service at St Mary Magdalene Church in Sandringham in Norfolk, England, Dec. 25, 2023. King Charles III is on the comeback trail. The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer. (AP Photo/Kin Cheung, File)

By DANICA KIRKA (Associated Press)

LONDON (AP) — King Charles III is on the comeback trail.

The 75-year-old British monarch will slowly ease back into public life after a three-month break to focus on his treatment and recuperation after he was diagnosed with an undisclosed type of cancer.

In a nod to the help he’s received recently, Charles plans a visit to a cancer treatment center on Tuesday as he gingerly steps back into the spotlight afforded to the monarch.

Though the royals are normally quite busy in the upcoming warmer months, Charles plans a less-packed summer program with his attendance determined closer to the time of each event.

Charles will continue to perform all of his state duties, including reviewing government documents and meeting with Prime Minister Rishi Sunak, as he has done since his diagnosis was disclosed on Feb. 5, the palace said.

Here’s a timeline of recent events in the royal family since Charles became king:

— Sept. 8, 2022: Charles becomes king upon the death of his mother, Queen Elizabeth II.

— March 29,2023: Charles makes first foreign visit as monarch to Germany, wowing lawmakers with his command of German.

— May 6, 2023: The new monarch is crowned at Westminster Abbey.

— Sept. 20, 2023: Charles makes state visit to France , making stop at fire-damaged Notre Dame cathedral.

— Oct. 31, 2023: Charles makes state visit to Kenya; expresses sorrow and regret for past violence committed against Kenyans as they sought independence.

— Dec. 25, 2023: Charles attends Christmas service at Sandringham, the royal estate on the eastern English coast, alongside other royals.

— Jan. 16, 2024: Kate, 42, undergoes abdominal surgery.

— Jan. 17: Kensington Palace reveals that Kate is recovering from a planned operation. Officials say her condition isn’t cancer-related but did not specify what surgery it was.

— Jan. 21: Prince Andrew’s ex-wife, Sarah, Duchess of York, says she has malignant melanoma, a form of skin cancer.

— Jan. 26: Charles is admitted to a London hospital for a three-day stay for his prostate treatment.

— Jan. 29: Kate and Charles are both discharged from the London Clinic. Charles is photographed leaving the hospital with Camilla and waving at well-wishers. Kate is not pictured leaving the hospital.

— Feb. 5: Buckingham Palace announces that Charles has cancer .

— Feb. 7: Prince Harry arrives in the U.K. from California to visit his father.

— Feb. 11: Charles cheerfully waves to well-wishers after leaving church services near his country estate in eastern England , his first public outing since his cancer diagnosis.

— Feb. 27: William pulls out of a memorial service for his godfather, the late King Constantine of Greece, due to a “personal matter.” His office declines to elaborate but says Kate continues to do well.

Later on the same day, Buckingham Palace says Thomas Kingston, the son-in-law of Prince Michael of Kent, has died at the age of 45. Prince Michael is a cousin of Elizabeth.

— March 1: An inquest hears that Thomas Kingston died from a “traumatic head wound” on Feb. 25. A gun was found near his body at his parents’ home.

— March 10: Kensington Palace releases a photo of Kate surrounded by her children to mark Mother’s Day in Britain. The photo, the first official one since she underwent surgery, was retracted hours later by The Associated Press and other news agencies over concerns it had been digitally manipulated.

— March 11: Amid speculation about her health sparked by the edited family photo, Kate issues an apology on social media for the “confusion” caused. She says she “occasionally experiments with editing” like many amateur photographers.

— March 22: In a video address, Kate announces she is undergoing treatment for cancer , including chemotherapy. She says she is getting stronger every day, but needs to focus on her recovery.

— March 31: Charles attends Easter Service at St. George’s Chapel in Windsor, shaking hands and greeting well-wishers who waited in the cold outside the service.

— April 26: Buckingham Palace announces Charles will return to public-facing duties.

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