INITIAL HISTORY
MEASUREMENTS
- Length/Height and Weight
- Head Circumference
- Blood Pressure (if risk factors)
SENSORY SCREENING
- Vision/Hearing
DEVELOPMENTAL/BEHAVIORAL HEALTH
Psychosocial/Behavioral Assessment: Parent Screening Questionnaire (SEEK)
Autism Spectrum Disorder Screening: M-CHAT
Developmental Surveillance: DENVER
Nutrition:
Discuss With Parents
- Giving their child opportunities to develop eating skills (chewing, swallowing) by offering a variety of foods and eating at a family table.
- Allowing their child to self-regulate food intake by serving himself from bowls and plates. (This is messy at first, but with practice this self-help skill can be mastered.)
- Handling their child’s food jags (wanting to eat only a particular food) by serving the favorite food along with other healthy foods.
- Turning off the television during mealtimes.
- Limiting total entertainment media time (watching television, playing computer or video games) to no morethan 1 to 2 hours of quality programming a day.
- Encouraging interactive activities (talking, playing, singing, and reading together).
PHYSICAL EXAMINATION
PROCEDURES:
Immunization (Hep A, flu)
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
- Lead testing
- Anemia
- Tuberculosis
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:
Social determinants of health
- Risks (intimate partner violence; living situation and food security; tobacco, alcohol, and drugs), strengths and protective factors (parental well-being)
- Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
- You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
- Community agencies can help you with concerns about your living situation.
- Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
- Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
- Take care of self; maintain social contacts.
- Create opportunities for family time.
- Spend time with each child; resolve sibling conflict without taking sides.
- Do not allow hitting, biting, aggressive behavior. Model this yourself.
Temperament and behavior
- Development, temperament, promotion of physical activity and safe play, limits on media use
- Praise good behavior and accomplishments; listen to and respect your child.
- Help child express feelings like joy, anger, sadness, frustration.
- Encourage self-expression.
- Learn child’s way of reacting to people/situations.
- Encourage free play for up to 60 minutes per day; give child age-appropriate play equipment.
- Make time for learning through reading, talking, singing, exploring environment, not screens.
- Limit TV and other digital media to no more than 1 hour of quality programming per day; avoid TV during meals.
Assessment of language development
- How child communicates and expectations for language, promotion of reading
- Model appropriate language.
- Should be able to follow simple 1- or 2-step commands.
- Read/look at books together every day; child may want same story over and over.
Toilet training
- Techniques, personal hygiene
- Begin when child is ready (dry for periods of 2 hours, knows wet and dry, can pull pants up/down, can indicate bowel movement).
- Plan for frequent toilet breaks (up to 10 times a day).
- Teach to wash hands.
Safety
- Car safety seats, outdoor safety, firearm safety
- Be sure car safety seat is installed properly in backseat. Harness straps should be snug.
- Make sure everyone else uses a seat belt.
- Supervise child outside, especially around cars, around machinery, in streets.
- Use bike helmet.
- Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
Anticipatory Guidance
