INITIAL HISTORY

MEASUREMENTS:

• Length/Height and Weight
• Blood Pressure
• BMI

SENSORY SCREENING

• Vision/Hearing

DEVELOPMENTAL/BEHAVIORAL HEALTH

• Psychosocial/Behavioral Assessment: Pediatric Symptoms Checklist-Youth (Y-PSC)
• Developmental Surveillance
• Tobacco, Alcohol, or Drug Use Assessment: CRAFFT, DAST
• Depression Screening: PHQ-9
• Nutrition:

Common Nutrition Concerns

• Decrease in consumption of milk and other milk products.
• Increase in consumption of sweetened beverages, especially soft drinks.
• Limited intake of fruits and vegetables.
• Higher consumption than recommended of foods high in fat, especially saturated and trans fats.
• Rise in overweight and obesity.
• Increase in body image concerns. (See Key Indicators of Nutrition Risk for Children and Adolescents.)

Nutrition Supervision

• A child’s nutrition status should be evaluated during nutrition supervision visits or as part of health supervision visits.
• Health professionals can do the following:
• Begin nutrition supervision by selectively asking interview questions or by reviewing a questionnaire filled out by parents before the visit. Continue by conducting screening and assessment and providing anticipatory guidance. Recognize that interview questions, screening and assessment, and anticipatory guidance will vary from visit to visit and from child to child.
• See Strategies for Health Professionals to Promote Healthy Eating Behaviors.

Discuss With Parents, the Child, or Both

Eating Behaviors and Food Choices

• Increasing the variety of foods the child eats and finding ways to incorporate new foods into the child’s diet.
• Making healthy foods choices based on Dietary Guidelines for Americans (fruits, vegetables, grain products [especially whole grain]; low-fat [1%] and fat-free [skim] milk products [milk, cheese, yogurt]; and lean meats, poultry, fish, beans, eggs, and nuts).
• Energy requirements are influenced by growth, physical activity level, and body composition.
• Children ages 2 to 8 need to drink 2 cups of low-fat (1%) or fat-free (skim) milk per day or consume the equivalent from other milk products (cheese, yogurt).
• Children ages 9 and older need to drink 3 cups of low-fat (1%) or fat-free (skim) milk per day or consume the equivalent from other milk products.
• Providing a vitamin D supplement of 400 IU per day for children who do not obtain 400 IU per day of vitamin D through vitamin D–fortified milk (100 IU per 8-oz serving) and vitamin D–fortified foods (fortified cereals, eggs [yolks]).
• Eating 3 meals and 1 to 2 snacks per day. Choosing healthy foods for meals and snacks rich in complex carbohydrates (whole-grain products, fresh fruits and vegetables).
• Making family mealtimes a priority.
• Providing a relaxed atmosphere for mealtimes and getting rid of distractions (television).
• Limiting foods high in calories and low in nutrients.
• Limiting foods high in fat, especially high in saturated and trans fats (chips, french fries), and foods (candy, cookies) and beverages (fruit drinks, soft drinks) high in sugar.
• Enrolling child in school breakfast and lunch programs, if needed. (See Federal Nutrition Assistance Programs.)

PHYSICAL EXAMINATION

PROCEDURES

Immunization (Tdap, MCV, HPV, flu)

Influenza: This infection causes high fever, chills, severe muscle aches, headaches, pneumonia, swelling of the brain and death. There are still thousands of deaths every year in the U.S. from influenza related complications

DTaP (Diphtheria, Tetanus, Pertussis): This vaccine works to prevent three infections.

• Diphtheria may cause a sore throat, suffocation, paralysis, heart failure, coma and even death. Before the vaccine, diphtheria caused more than 15,000 deaths in children each year.
• Tetanus causes severe muscle spasms (including the mouth and jaw), breathing problems, severe heart damage, lung infections, coma and death.
• Pertussis causes “Whooping Cough.” It may lead to severe coughing, pneumonia, seizures, brain damage, and death. Pre-vaccine, over 200,000 cases and up to 9,000 deaths were reported each year.

Gardasil (HPV): Human papillomavirus will affect an estimated 75% to 80% of males in females in their lifetime. For most, HPV could cause significant consequences: cervical, vaginal, and vulvar cancers in females. Other types could cause genital warts in males and females

Menactra (Meningococcal): This infection causes an inflammation of the protective layer around the brain and spinal cord. Meningococcal disease spreads like the flu, passing from person to person through everyday activities.

• Anemia
• Dislipidemia
• Tuberculosis
• Sexually Transmitted Infections
• HIV (if risk factors)

ORAL HEALTH

ANTICIPATORY GUIDANCE

• The first priority is to address the concerns of the adolescent and parents. In addition, the Bright Futures Adolescence Expert Panel has given priority to the following additional topics for discussion in the 4 Early Adolescence Visits: Social determinants of health: Risks (interpersonal violence, living situation and food security, family substance use), strengths and protective factors (connectedness with family and peers, connectedness with community, school performance, coping with stress and decision-making)
• Learn to manage conflict nonviolently; walk away if necessary. Talk with parent/trusted adult if you are bullied.
• When dating or in sexual situations, no means NO. No is OK.
• Teach your child nonviolent conflict-resolution skills. Discuss Internet safety. Explain expectations about time with friends/dating.
• Community agencies can help you with concerns about your living situation.
• Programs like SNAP are available to help you if you have concerns about your food situation.
• Don’t use tobacco/e-cigarettes; talk with me if you are worried about family member drug/alcohol use.
• Spend time with your family; help out at home, in the community; follow family rules.
• Making and keeping friends is an important life skill.
• Take responsibility for schoolwork; talk with parent/trusted adult about problems at school. Pursue your interests outside of school.
• Involve your child in family decision-making; encourage her to think through problems.
• Physical growth and development: Oral health, body image, healthy eating, physical activity and sleep
• Brush teeth twice a day; floss once.
• Continue dentist visits; give fluoride if dentist recommends it. Support healthy self-image by praising activities/ achievements, not appearance.
• Eat when you’re hungry; stop when you’re satisfied.
• Eat breakfast; eat vegetables/fruits/whole grains/ lean protein; have 24 oz or more low-fat/ nonfat dairy/other dairy daily.
• Limit foods and drinks high in sugar/saturated fats/refined grains and low in nutrients.
• Drink water.
• Support healthy weight and help your child choose healthy eating (provide healthy foods, eat together as a family, be a role model).
• Be physically active 60 minutes a day.
• Use safety equipment during sports.
• Consider making family media use plan (www.healthychildren.org/MediaUsePlan), which can help balance child’s needs for physical activity, sleep, school activities, and unplugged time; decide on rules for media time in time left over after all other activities; take into account quantity, quality, location of media use.
• Get enough sleep.
• Emotional well-being: Mood regulation and mental health, sexuality
• Find ways to deal with stress.
• Tell me your concerns about your child’s behavior, moods, mental health, or substance use.
• Recognize that hard times come and go; talk with parents/trusted adult. Get accurate information about physical development, sexuality and sexual feelings toward opposite or same sex; talk with me/parents/trusted adults.
• Talk with your child about the physical changes that occur during puberty, including menstruation for girls.
• If you have questions about adolescent sexual development, sexual orientation, or gender identity, ask me.
• Risk reduction: Pregnancy and sexually transmitted infections; tobacco, e-cigarettes, alcohol, prescription or street drugs; acoustic trauma
• Don’t smoke/vape, drink alcohol, or use drugs; avoid situations with drugs/alcohol; don’t share your own or others’ prescription medications; support friends who don’t use; talk with me if concerned about your own or a family member’s use.
• Talk with your child about tobacco/alcohol/ drugs; praise her for not using; be a role model.
• The safest way to prevent pregnancy and STIs is to not have sex, including oral sex.
• Plan how to avoid risky situations; if sexually active, protect against STIs/pregnancy.
• Know child’s friends and activities; clearly discuss rules, expectations.
• Talk about relationships, sex, values; encourage sexual abstinence; provide opportunities for safe activities.
• Wear hearing protection when exposed to loud noise (concerts, lawn mowing). Keep earbud volume moderate.
• Safety: Seat belt and helmet use, sun protection, substance use and riding in a vehicle, firearm Safety
• Wear seat belt, helmet, protective gear, life jacket.
• Wear seat belt; don’t allow ATV riding.
• Use sunscreen; wear hat; avoid prolonged sun exposure between 11:00 am and 3:00 pm.
• Don’t ride in car with person who has used alcohol/drugs; call parents/trusted adult for help.
• Help youth make plan for handling situation in which she feels unsafe riding in a car.
• Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.

Anticipatory Guidance

• English
• Spanish