Your baby’s first year: fever, safe sleep, first teeth and checkups

American Academy of Pediatrics (AAP) · 2021 febrile infant guideline

1. Fever

Under 3 months (12 weeks): 100.4°F (38°C) or higher means call the doctor right away. The AAP says a fever in the first 12 weeks may be a sign of a serious infection. Your baby needs to be seen so the doctor can decide which tests are needed. The 2021 AAP guideline for doctors covers well-looking babies 8 to 60 days old with a temperature of 38.0°C or more.

• How to check. Under 3 months, a rectal temperature (in the bottom) gives the best reading. Do not use an ear thermometer before 6 months. Do not use a mercury thermometer.
• Medicine. The AAP says not to give acetaminophen to a child under 2 years without a doctor’s guidance. Ask before you give any fever medicine.

3 months and older: call the doctor right away if there is a fever and your child

• looks very ill, is unusually drowsy, or is very fussy;
• has a stiff neck, trouble breathing, a rash you cannot explain, or keeps throwing up or having diarrhea;
• has had a seizure;
• has been somewhere very hot, like a hot car;
• has a temperature above 104°F (40°C) again and again;
• has immune system or heart problems.

Also call if the fever lasts more than 24 hours in a child under 2, if your child seems to be getting worse, or still acts sick once the fever comes down.

AAP 2022 safe sleep recommendations

2. Safe sleep, every sleep

About 3,500 babies in the U.S. die each year from sleep-related causes (AAP 2022). These steps lower the risk, for naps and at night.

• On the back. Every nap and every night.
• Firm and flat. A crib, bassinet or play yard with a firm, flat mattress and a fitted sheet. Nothing tilted: a surface that slopes more than 10 degrees is not safe for sleep.
• Nothing else in the bed. No pillows, blankets, bumpers or soft toys.
• Your room, not your bed. Keep your baby’s own sleep space in your room for at least the first 6 months.
• Not on a couch or armchair. Falling asleep there with your baby is much more dangerous.
• Asleep in a car seat, swing or sling? Move your baby to a firm, flat surface, on the back, as soon as you can.
• Not too warm. One more layer than you would wear. No hat indoors once you are home from the hospital.
• A pacifier at sleep time helps, even if it falls out.
• No smoke or vapor near your baby. No alcohol, marijuana, opioids or illegal drugs during pregnancy or after birth.
• Tummy time when awake, with an adult watching.

U.S. Preventive Services Task Force 2021 · AAP

3. First teeth: fluoride varnish

Fluoride varnish is painted on baby teeth to help prevent cavities. The U.S. Preventive Services Task Force recommends it for all babies and young children, starting when the first tooth comes in.

• Where. Pediatricians are trained to put it on at checkups. A dental office can do it too.
• How often. 2 to 4 times a year, depending on your child’s cavity risk (AAP). The AAP says it is safe.
• Coverage. HealthCare.gov lists fluoride varnish for children as soon as teeth are present among the preventive services that, in most cases, you do not pay a copay or coinsurance for when an in-network provider gives them.
• Water. If your tap water does not have enough fluoride, the Task Force recommends fluoride drops or tablets from 6 months, prescribed by a doctor. Look up your water on CDC’s My Water’s Fluoride, or ask your water company.
• Dentist. The AAP says every baby should have a mouth and teeth check by 6 months, and ideally a dentist by 12 months.

At the next checkup, ask: “Can my baby get fluoride varnish today?”

Bright Futures / AAP schedule of well-child visits

4. Your baby’s checkup dates

The AAP and Bright Futures list a checkup at 3 to 5 days old, then at 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months, and at 3 years. Enter the birth date to see the date each one falls on.

Baby’s birth date

Bring your top three to five questions to each checkup (AAP). Ask which vaccines are due at that visit. HealthCare.gov lists well-baby and well-child visits among the preventive services that, in most cases, you do not pay a copay or coinsurance for with an in-network provider.

The date stays on this page. It is not saved, not put in the link, and not sent. Close the page and it is gone.

And you, the parent

CDC’s urgent maternal warning signs count for the whole year after birth. Read the 15 signs. Thoughts of harming yourself or your baby: call or text 988, or the National Maternal Mental Health Hotline, 1-833-TLC-MAMA (1-833-852-6262), 24/7.

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