INITIAL HISTORY
MEASUREMENTS:
- Length/Height and Weight
- Head Circumference
- Blood Pressure (if risk factors)
SENSORY SCREENING
- Vision/Hearing (if risk factors)
DEVELOPMENTAL/BEHAVIORAL HEALTH
Psychosocial/Behavioral Assessment: Parent Screening Questionnaire (SEEK)
Developmental Surveillance: DENVER
Nutrition
Discuss With Parents
- Offering their child food every 2 to 3 hours. (Children’s capacity to eat at any one time is limited.)
- Giving their child opportunities to develop eating skills (chewing, swallowing) by offering a variety of foods and eating at a family table.
- Offering age-appropriate foods (cut food into small pieces) and continuing to monitor the size of foods.(Chewing and swallowing functions are not completely developed until about age 8.)
- Making eating easier for their child by using spoons, cups, and dishes with steep sides (bowls).
- Being patient as their child’s skill at eating a variety of foods increases.
- Providing a relaxed atmosphere during meals and snacks. (Children should not be rushed, because trying new foods takes time.)
- Discouraging television viewing and encouraging interactive activities (talking, playing, singing, and reading together).
PHYSICAL EXAMINATION
PROCEDURES:
Immunization (if delayed)
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.
Hib (Haemophilus Influenzae type b): This infection may lead to breathing problems, meningitis, blindness, brain damage, paralysis, hearing loss and death. Before the vaccine, Hib meningitis killed 600 children each year and left many other children with deafness, seizures and mental retardation.
Prevnar (Pneumococcus): This infection leads to ear infections, sinus infections, pneumonia, meningitis, sepsis (infection of the blood) and brain damage.
MMR (Measles, Mumps, Rubella): This vaccine works to prevent three infections.
- Measles (rubeola) causes runny nose, cough, conjunctivitis, rash, pneumonia, ear infections, brain damage, seizures and death. It is estimated that if the measles vaccine were stopped, approximately 2.7 million people would die worldwide.
- Mumps causes swollen glands, headaches, deafness, brain damage, meningitis, swelling of the testicles and sterility in males.
- Rubella (German Measles) causes fever, rash, swollen glands, birth defects such as deafness, blindness, mental retardation and heart defects, and can cause miscarriage and premature birth in pregnant women. Prior to this vaccine rubella affected over 20,000 newborns over half of which were deaf and with many suffering from blindness and mental retardation
Varicella (Chicken Pox): This causes an itchy rash with many sores and may lead to lung damage, brain damage and death. Prior to this vaccine approximately 4 million people got chicken pox, causing 11,000 hospitalizations and 100 deaths each year.
Hepatitis A: This infection causes loss of appetite, nausea, vomiting, stomach pain, jaundice (yellow skin and eyes), bleeding problems, fever and headaches. It may cause prolonged weakness and serious illness in individuals already suffering from liver disease.
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
ORAL HEALTH
Fluoride Varnish
ANTICIPATORY GUIDANCE
The first priority is to attend to the concerns of the parents. In addition, the Bright Futures Early Childhood Expert Panel has given priority to the following topics for discussion in this visit:
Communication and social development
- Individuation, separation, finding support, attention to how child communicates wants and interests
- When possible, allow child to choose between 2 options acceptable to you.
- Stranger anxiety and separation anxiety reflect new cognitive gains; speak reassuringly.
- Take time for self, partner. Seek support from other parents.
- Use simple, clear words and phrases to promote language development and improve communication.
Sleep routines and issues
- Regular bedtime routine, night waking, no bottle in bed
- Maintain consistent bedtime and nighttime routine; tuck in when drowsy but still awake.
- If night waking occurs, reassure briefly; give stuffed animal or blanket for self-consolation.
- Don’t give bottle in bed. Don’t put TV/computer/digital device in child’s bedroom.
- Temperament, development, behavior, and discipline: Conflict predictors and distraction, discipline and behavior management
- Modify child’s environment to avoid conflict/ tantrums. Use distractions; accept messiness; allow child to choose (when appropriate).
- Praise good behavior and accomplishments.
- Use discipline for teaching/protecting, not punishing. Use time-outs to avoid negative attention.
- Teach child not to hit, bite, use aggressive behavior. Model this yourself.
Healthy teeth
- Brushing teeth, reducing caries
- Schedule first dental visit if child hasn’t seen dentist yet.
- Brush teeth twice a day with small smear of fluoridated toothpaste, soft toothbrush.
- Prevent tooth decay by good family oral health habits (brushing, flossing), not sharing utensils or cup.
- If child uses nighttime bottle, use water only.
Safety
- Car safety seats and parental use of seat belts, safe home environment: poisoning, falls, and fire safety
- Use rear-facing car safety seat until child is highest weight or height allowed by manufacturer; make necessary changes when switching seat to forward facing; never place vehicle safety seat in front seat of car with passenger air bag;backseat safest.
- Make sure everyone uses a seat belt.
- Remove poisons/toxic household products; keep Poison Help number (800-222-1222) at every phone, including cell; use stair gates; keep furniture away from windows; install window guards.
- Install smoke detector on every level; test monthly/change batteries annually; make fire escape plan; set home hot water less than 120°F.
Anticipatory Guidance
