child wellness information
Check-ups / Physicals


Well Child check-ups are an integral part of managing your child's health needs. These visits allow us to monitor your child's development, growth, and nutrition.

An infant's first visit should be 2-3 days after discharge, especially for nursing babies. If your baby left the hospital before 24 hours, you must come in for a visit two days after discharge to complete the required state metabolic screen (the "PKU.") It is extremely important that your baby receive this screening!

We recommend vaccinations according to the guidelines of the American Academy of Pediatrics. At the time of the appointments, we will determine if the patient's immunizations are up to date. If needed, we will administer the necessary vaccines at this time. Vaccinations may vary from patient to patient depending on the specific situation, as new immunizations become available, or the recommended schedule changes.

Additionally, we will perform a full physical examination to determine the patient's physical well-being. During the evaluation, we will, also, note how your child's development compares to that of other children of the same age. We will discuss nutrition and safety as well as any other issues specifically pertinent to the patient.

Certain tests are an integral part of a routine well child visit. Although not necessarily all inclusive, screenings and tests may include those listed below:

  • Vision Screenings
  • Hearing Screenings
  • Anemia Screenings
  • High Cholesterol
  • Glucose
  • Tuberculosis Screenings

Bring all forms (college, sports participation, camp, etc.) to the well check-up/physical appointment, so that additional charges can be avoided at a later date. There is no charge for forms that are filled out at the time of an actual well-child appointment.

Our college students need to call to schedule a well check-up six to eight weeks ahead to reserve their appointment. We want to make sure that we can see them before they return to their colleges. Note: We can see college students until they are 21 years of age.

Our practice schedules appointments up to twelve months ahead of time for your convenience. Please schedule your appointments as far in advance as possible, so that we can accommodate a time convenient to you.

Occasionally, an illness occurs on the day of a child's or adolescent's well check up visit. Please call your concerns to our attention when you check in, so that we can attend properly to all your health needs. If this happens, then we may need to change your appointment status to a sick visit and reschedule the physical for a later date depending on what symptoms your child has.

Dr. Vayman may recommend additional appointments for complicated illnesses and/or health problems and concerns that are discussed and evaluated at the time of your child's well check-up visit.

If your child has an illness or problem, like recurrent earaches or stomach aches, we can usually treat these conditions and complete the well check-up in the same visit. In these cases, please, be aware that these are two separate services and may be charged separately, even if they occur in the same visit.

If known in advance, please notify our secretary of your child's or adolescent's health problem when you schedule your well check-up. We appreciate you helping us meet all your child's health care needs.

Immunization Schedule


If you need Adobe reader click here to get the latest version Check Up and Immunization Schedule

FLU VACCINES ARE RECOMMENDED ANNUALLY for 6 months of age and older

Note: After the 5 year booster, a tetanus shot (Tdap or Td) is recommended every 5-10 years. If your child sustains an open or penetrating wound and more than five years have elapsed since the last booster, an additional booster may be needed. Please, call our office for recommendations.

If your child is behind on their immunizations, please see the following schedule:

If you need Adobe reader click here to get the latest version CDC Recommended Catch-up Immunization Schedule

for Children that missed Immunizations (Aged 4 months to 18 years)

Growth & Development

Developmental Milestones by Age

The changes babies and toddlers go through are made up of different skills, like walking and talking. These skills, or developmental milestones, usually happen by certain ages. Although each child is unique and develops at his or her own pace, watching to see when a child reaches these milestones can help a parent know how their child is developing.

If there are concerns about how a child is growing and learning, consult with the child's doctor.

Developmental milestones for age 3 months to age 36 months are listed below.

I'm 3 months old! I...

  • turn toward bright colors and lights
  • follow moving toys or faces with my eyes
  • recognize or know the bottle or breast
  • respond to loud or new sounds
  • reach for and grasp toys or hair
  • wiggle and kick my legs and arms
  • lift my head and shoulders up while on stomach
  • smile back at parents or other family members
  • make sounds, like gurgling, cooing or babbling

I'm 6 months old! I...

  • turn toward voices
  • reach for toys and pick them up
  • roll over front-to-back and back-to-front
  • play with my toes
  • help hold bottle during feedings, if bottle fed
  • know faces of family members
  • babble, squeal, and repeat vowel sounds, like ooh, -ae, -e
  • sit by leaning on my hand

I'm 9 months old! I...

  • copy sounds or gestures
  • reach for crumbs or other small things with my thumb and fingers
  • move toys from one hand to the other hand
  • I straighten my arms to support myself when I'm on my stomach
  • understand the word "No"

I'm 12 months old! I...

  • respond to my name
  • may be scared of strangers
  • look for an object if you hide it from me, even if I can't see it
  • crawl on my hands and knees
  • pull myself to a standing position
  • walk by holding onto furniture
  • can drink from a cup with your help
  • enjoy playing games, like peek-a-boo or patty cake
  • say 1 to 2 words

I'm 15 months old! I...

  • use gestures
  • like to look at pictures in a book
  • can hold a crayon in my fist
  • hand toys to you when you ask me
  • can point to pictures you name, if the things in the picture are familiar to me
  • walk alone without help

I'm 18 months old! I...

  • like to pull and push things
  • follow simple directions
  • pull off shoes and socks
  • feed myself sometimes
  • step off low objects and keep balance
  • turn 2 to 3 pages of a book at a time
  • can point to one body part
  • can name one object
  • like to copy your words or actions

I'm 21 months old! I...

  • can name 2 objects
  • like to pretend-play
  • can put together a simple picture puzzle if it has only 2 or 3 large pieces
  • like to throw balls
  • like to play alone with toys for a short time
  • say "No" a lot

I'm 24 months old! I...

  • use 2 to 3 words together, like "No, Mommy" or "More cookies"
  • say names of toys and people
  • feed myself with a spoon
  • turn one page at a time
  • point to hair, eyes and nose when someone asks me
  • show affection to family members and pets
  • run short distances without falling

I'm 36 months old! I...

  • answer simple questions
  • walk up steps, alternating feet
  • put my clothes on by myself
  • open simple containers
  • like to play with other children
  • repeat simple rhymes and songs
  • use 3 to 5 word sentences
  • name at least one color correctly
  • jump in place
  • express my emotions
Communication and Hearing

A list of typical milestones in the normal development of communication and hearing during the first two years of life.

Making Sounds and Learning to Talk

Here are some things to be looking for to help you see if your baby is hearing and talking.

0-3 months

  • Turns toward voice
  • Laughs
  • Smiles in response to other people smiling
  • Coos
  • Squeals with delight

6 months

  • Babbles with consonant-vowel combinations
  • Looks directly at you
  • Turns towards sound
  • Makes raspberries
  • Attempts to imitate sounds
  • Reacts to loud, angry voices
  • Babbles for attention

9 months

  • Responds to name
  • Produces four or more different sounds
  • Frequently uses syllables ba, da, ka
  • Understands "no" and "bye-bye"
  • Imitates sound

12 months

  • Plays peek-a-boo
  • Repeats sounds and gestures for attention
  • Searches for an object he/she has seen hidden
  • Uses long babbling sentences that are inflected (jargon)
  • Understands simple commands
  • Gives toys on request
  • Points to objects desired
  • Says two or three words
  • Imitates familiar words
  • Shakes head for "no"
  • Likes to imitate sounds of familiar animals
  • Waves bye-bye

18 months

  • Can say about 20 words
  • Recognizes pictures of people and things he/she knows well
  • Points to three body parts (for example, nose, eyes, mouth)
  • Begins to combine two words (for example, "all gone" or "go bye-bye")
  • Brings familiar objects to you when asked
  • Can point to five objects
  • Imitates words and sounds more clearly

21 months

  • Produces a few short phrases

24 months

  • Talks in two and three word sentences (for example, "Daddy go work")
  • Uses pronouns me/mine
  • Follows two-step commands (for example, "Pick up your shoe and bring it to me")
  • Uses these speech sounds: p,b,m,w,h,n
  • Says or uses about 300 words
  • Answers simple "wh" (where, what, why) questions by pointing or other actions
  • Knows four to eight body parts
  • Communicates what he/she wants


Do you know that one in 750 infants born each year has significant hearing loss? A baby's hearing can be tested as early as one day after birth. It is never too soon to test a child's hearing, and treatment is available at every age.

  • Why is hearing so important? Your baby must hear well in order to learn to talk. As your baby hears sound and words, the foundation for speech and language is being laid. This learning begins at birth!
  • Who can develop a hearing problem? A child can be born with a hearing problem or can develop one at any age. Some infants are more likely to have a hearing problem and are considered to be "at risk" for hearing loss. These children should have their hearing tested as soon as possible after birth.
  • When can you have your baby's hearing tested? A baby's hearing can be checked as soon as one day after birth, so don't "wait and see." If you suspect your baby has a hearing problem, contact an audiologist or a physician immediately.
  • How can you tell if your baby has a hearing problem? Infants respond to sound in very predictable ways. An audiologist is a professional trained to evaluate hearing and can test your child at any age. Use the Communication Developmental chart on the back as a simple guideline to check your baby's hearing and communication development.
  • What can be done if your baby has hearing loss? There are many ways to help a hearing impaired child develop speech and language. After the hearing evaluation, an individualized treatment program will be developed by your baby's audiologist and other professionals.

Hearing 0-4 months Milestones

  • Startles (jumps or blinks) to loud sounds
  • Can be soothed by a familiar voice
  • Says “coo” or “ahh” sounds
  • Stops playing and appears to listen to sounds or speech
  • Watches a speaker's face
  • AUsually awakens when sleeping quietly and someone talks or makes a loud noise

Risk Criteria for Hearing Loss

  • Family history of childhood hearing loss
  • Mother had rubella (German Measles), cytomegalovirus (CMV), toxoplasmosis, herpes or syphilis present at birth of infant and/or during pregnancy
  • Birth weight less than 3lbs 5oz (1500 grams)
  • Unusual ear, eye, head or neck development, including cleft lip or palate, absent philtrum, low hairline, ear tags or pits, etc.
  • Severe jaundice (hyperbilirubinemia) that required an exchange blood transfusion
  • Presence of bacterial meningitis
  • Apgar score of 3 or less at 5 minutes after birth, failure to initiate spontaneous respiration by 10 minutes or hypotonia persisting to 2 hours of a
  • Need for prolonged mechanical ventilation of 5 or more days duration (e.g., Waadrdenburg or Usher's syndrome)
  • Certain ototoxic drugs or medications including, but not limited to, aminoglycosides used for more than 5 days

Risk Criteria for Hearing Loss for infants 29 days to 2 years

  • Parents/caregivers have concerns regarding hearing, speech, language and/or developmental delay
  • Presence of neonatal risk factors that are associated with progressive sensorineural hearing loss (e.g., CMV, prolonged mechanical ventilation, heredity)
  • History of head trauma
  • Presence of neurodegenerative disorders such as neurofibromatosis, myoclonic epilepsy, Werdnig-Hoffman disease, Tay-Sach's disease, infantile Gaucher's disease, Nieman-Pick disease, any metachromatic leukodystrophy, or any infantile demyelinating neuropathy
  • History of childhood infectious diseases associated with sensorineural hearing loss (e.g., mumps, measles)
Vision Care

Why do you want to have your baby's vision screened?

If a vision problem is detected before the age of 1, then many of the problems can be completely corrected. This includes lazy eye, near sightedness, and far sightedness. If the problem can be completely corrected, then your child may not have to wear glasses as an adult. If the problem can't be completely corrected, then early intervention can stop the problem from becoming worse and in many cases find a way to treat the problem.

Approximately 1 in 14 children have some degree of vision impairment. Most of which, like lazy eye for example, can be treated and cured if detected early enough in a child's life. If left undetected, however, seemingly harmless inconveniences in a child's vision can actually cause severe vision impairment or even blindness once adulthood is reached.

Programs like InfantSEE aims to eliminate the vision issues of American infants. This program involves volunteer optometrists who will test your 6-12 month old baby, FREE OF CHARGE, for things like lazy eye, strabismus, glaucoma, significant refractive errors like far-sightedness, near-sightedness, astigmatism, and retinal blastoma. Not only is this program free, but it is also conducted in such way as to be a fun experience with bells, puppets, and lights.

Vision Screening and Vision Resource Information:

Dental Care

Dental care should begin when a child gets their first tooth.

Why should my child see a pediatric dentist? Parents choose a pediatric dental specialist for their child's oral health care just as they would see a pediatrician for medical needs. After completing a four-year dental school curriculum, two to three additional years of rigorous training is required to become a pediatric dentist. This specialized program of study and hands-on experience prepares pediatric dentists to meet the unique needs of infants, children and adolescents, including children with special health care needs.

When should my child first see a dentist? Why so early? According to the American Academy of Pediatric Dentistry (AAPD), your child should see the dentist between the ages of 2 and 3. Early examination and preventive care will protect your child's smile now and in the future. The most important reason to begin so early is to establish a thorough prevention program. Dental problems can begin early. A big concern is Early Childhood Caries (also know as baby bottle tooth decay or nursing caries). The earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits.

Why are baby teeth so important? It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth or baby teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front teeth last until 6-7 years of age, the back teeth aren't replaced until age 10-13.

What is Baby Bottle Tooth Decay? Baby Bottle Tooth Decay is a condition of widespread dental caries in young children caused by frequent and long exposures of an infant's teeth to liquids that contain sugar including milk, breast milk, formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. As your child sleeps the rate of swallowing and salivary flow decreases, and the liquid pools around your child's teeth giving bacteria an opportunity to produce acids that attack tooth enamel. If you must give your child a bottle as a comfort at bedtime, it should contain only water.

After each feeding, wipe the baby's gums and teeth with a damp washcloth or soft toothbrush to remove plaque. The best way to do this is to sit down and place your child's head in your lap so you can see into your child's mouth easily.

When do I need to begin brushing my child's teeth? Begin daily brushing as soon as your child's first tooth erupts. Brush teeth at least twice a day, after breakfast and before bed using a soft child-sized toothbrush and only a smear-sized amount of toothpaste. Increase toothpaste to a pea-sized amount as your child learns to spit after brushing. At about age three, begin teaching your preschooler to brush by gripping the brush with your child and guiding it around the mouth.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush can't reach. Flossing should begin when any two teeth touch. You should floss your child's teeth until he or she can do it alone.

What type of toothpaste should my child use? Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Young children, especially pre-school aged children, should not swallow any toothpaste. Careful supervision and only a small pea-sized amount on the brush are recommended. If not monitored, children may easily swallow over four times the recommended daily amount of fluoride in toothpaste.

How safe is fluoride? Fluoride is documented to be safe and highly effective. Research indicates water fluoridation, the most cost effective method, has decreased the decay rate by over 50 percent. Only small amounts of fluoride are necessary for the maximum benefit. Proper toothpaste amount must be supervised, and other forms of fluoride supplementations must be carefully monitored in order to prevent a potential overdose and unsightly spots on the developing permanent teeth. Do not leave toothpaste tubes where young children can reach them. The flavors that help encourage them to brush may also encourage them to eat toothpaste.

How does fluoride work? When the element fluoride is used in small amounts on a routine basis it helps to prevent tooth decay. It encourages "remineralization," a strengthening of weak areas on the teeth. These spots are the beginning of cavity formation. Fluoride occurs naturally in water and in many different foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish and supplements. Fluoride is effective when combined with a healthy diet and good oral hygiene.

How often should my child see the dentist? The American Academy of Pediatric Dentistry recommends a dental check-up at least twice a year for most children. Some children need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns or poor oral hygiene.

Regular dental visits help your child stay cavity-free. Teeth cleanings remove debris that build up on the teeth, irritate the gums and cause decay. Fluoride treatments renew the fluoride content in the enamel, strengthening teeth and preventing cavities. Hygiene instructions improve your child's brushing and flossing, leading to cleaner teeth and healthier gums.

Tooth decay isn't the only reason for a dental visit. We provide an ongoing assessment of changes in your child's oral health. For example, your child may need additional fluoride, dietary changes, or sealants for ideal dental health. We may also identify orthodontic problems and suggest treatment to guide the teeth as they emerge in the mouth.

When will my child get his/her first tooth? Children's teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the sequence and timing of their eruption may vary.

Permanent teeth begin erupting around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).


tooth development

How can I help my child enjoy good dental health?

The following steps will help your child be part of the cavity-free generation:

  • Beware of frequent snacking
  • Brush effectively twice a day with a fluoride toothpaste
  • Floss once a day
  • Have sealants applied when appropriate
  • Seek regular dental check-ups
  • Assure proper fluoride through drinking water, fluoride products or fluoride supplements

How do I handle dental emergencies at home?

  • Toothache: Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. If the pain still exists, contact the office. DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen apply cold compresses and contact the office immediately.
  • Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take your child to the hospital emergency room.
  • Chipped or Fractured Tooth: Contact the office immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If you can find the broken tooth fragment, bring it with you to the office.
  • Knocked Out Permanent Tooth: Find the tooth and holding it by the crown (not the root portion), rinse it gently in cool water. DO NOT scrub or clean it with soap. Inspect the tooth for fractures. If it is sound, try to replace the tooth in the socket and hold it there with clean gauze or a washcloth. If you can't put the tooth back in the socket, place it in a clean container with milk, saliva or water. Get to the dental office immediately. (Call the emergency number if it's after hours.) The faster you act, the better your chances of saving the tooth.
  • Severe Blow to the Head or Jaw Fracture: Go immediately to the emergency room of your local hospital. A blow to the head can be life threatening.

Can dental injuries be prevented?

Absolutely! First, reduce oral injury in sports by wearing mouth guards. Second, always use a car seat for young children. Require seat belts for everyone else in the car. Third, child-proof your home to prevent falls, electrical injuries, and choking on small objects. Fourth, protect your child from unnecessary toothaches with regular dental visits and preventive care.

Additional links on Dental Topics and Resources:


Good nutrition is critical for healthy growing infants, children, adolescents and adults.

The US Department of Agriculture has developed a Food Pyramid for Young Children with main nutritional guides that can be used in feeding children ages 2-6.

Child's Pyramid Food Serving Guide

Early Childhood Nutrition

An important goal of early childhood nutrition is to ensure children's present and future health by fostering the development of healthy eating behaviors.

During the first 2 years after birth, infants and toddlers consume an increasingly complex diet, moving from a largely milk based diet to one that includes a variety of table foods consumed by other family members.

Although recommendations exist regarding use of breast milk, formula, and cow's milk, there are few authoritative guidelines for feeding solid foods to children younger than 2 years of age. Existing infant feeding recommendations encourage parents and caregivers to introduce foods other than breast milk and formula as children show signs of developmental readiness and expand their eating skills.

babies and toddlersParents and caregivers should be encouraged to offer a wide variety of vegetables and fruits daily, with emphasis on dark green, leafy, and deep yellow vegetables and colorful fruits.

They should offer desserts, sweets, sweetened beverages, and salty snacks only occasionally, offering nutrient dense, age appropriate foods as alternatives (e.g., fruit, cheese, yogurt, and cereals).

Water, milk, and diluted 100% fruit juices should be offered as alternative beverages. Because family food choices influence what foods are offered to children, family based approaches to developing healthy eating habits may be helpful.

The low vegetable and fruit consumption by infants and toddlers is a major concern. Daily consumption of a wide variety of vegetables and fruits is a cornerstone of a healthy diet at every age.

Food provides the energy and nutrients a baby or toddler needs to be healthy. For a baby, breast milk has all the necessary vitamins and minerals. Infant formulas imitate breast milk. For children younger than 2, up to 50 percent of calories should come from fat. Whole milk is a good source of fat after age 1. You can switch to low-fat milk after age 2 or 3.

Some other things to watch for:

  • Make sure your child gets enough iron
  • Toddlers between 1 and 3 need 500 milligrams of calcium each day.
  • Dietary fiber is important after age 3 because it might prevent diseases later on
  • Don't feed your baby eggs, citrus fruits and juices, cow's milk or honey until after his or her first birthday
  • Don't feed your child seafood, peanuts or tree nuts before age 2 or 3

More Nutrition Information

More Nutrition Information can be found under the NEWBORN & INFANT TAB


Routine supplementation is not necessary for healthy, growing children who consume a varied diet. For children and adolescents who cannot or will not consume adequate amounts of micronutrients from any dietary sources, the use of mineral supplements should be considered. No supplements other than an age appropriate multi-vitamin should be taken without consulting with our office.


The prevalence of obesity among children aged 6 to 11 has more than doubled in the past 2 decades. The rate among adolescents aged 12 to 19 more than tripled.

Obesity is the result of caloric imbalance (too few calories expended for the amount of calories consumed) and is mediated by genetics and health. Obese young people have at least one additional risk factor for heart disease, such as high cholesterol or high blood pressure. In addition, children who are obese are at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem.

Obese young people are more likely than children of normal weight to become overweight or obese adults, and therefore more at risk for associated adult health problems, including heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.  Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related diseases.

Parents should be aware of their own lifestyle and nutrition as children learn to model their parents' eating behavior. Increased physical activity is a critical component of childhood obesity prevention and treatment, because low-energy diets may compromise the nutrient status of growing children.

Sedentary behavior has been associated with overweight among children. Parents have an important responsibility in this area, because they serve as role models for active lifestyles and provide opportunities for children to be physically active.

In older children, the most common problem related to nutrition is obesity. The goal of helping your child who is overweight requires a combination of lifestyle and dietary changes. These include routine exercise, limiting television and computer playing time, restricting high calorie snacks, and developing healthy eating habits. Frequently these changes need to involve the whole family in order to be successful.

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