INITIAL HISTORY
MEASUREMENTS:
- Length/Height and Weight
- Blood Pressure
- BMI
SENSORY SCREENING
- Vision/Hearing
DEVELOPMENTAL/BEHAVIORAL HEALTH
Psychosocial/Behavioral Assessment: Pediatric Symptoms Checklist (PSC)
Developmental Surveillance
Nutrition
Discuss With Parents
- Increasing their child’s awareness of new foods by making sure the child sees family members and friends trying and enjoying them.
- Teaching their child about new foods by growing, preparing, and talking about them.
- Sharing stories, drawing pictures, and singing songs about food to help their child become familiar with them.
- Helping their child become more fit (stability, agility, endurance, and coordination).
- Turning off the television during mealtimes.
- Limiting total entertainment media time (watching television, playing computer or video games) to no more than 1 to 2 hours of quality programming a day.
- Encouraging interactive activities (talking, playing, singing, and reading together).
PHYSICAL EXAMINATION
PROCEDURES:
Immunization (MMR, VZV, DTap, IPV, flu)
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.
IPV (Polio): This infection leads to paralysis, difficulty breathing and death. Before the vaccine, 20,000 cases of polio were reported each year in the United States. Many children were left on crutches, in wheelchairs and on iron lungs.
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.
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 (if risk factors)
- Anemia
- Dislipidemia
- Tuberculosis
ORAL HEALTH
Dentist Visit Biannual
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 (living situation and food security; tobacco, alcohol, and drugs; intimate partner violence; safety in the community), strengths and protective factors (engagement in the community)
- 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.
- 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).
- Teach your child rules for how to be safe with adults: (1) no adult should tell a child to keep secrets from parents; (2) no adult should express interest in private parts; (3) no adult should ask a child for help with his/her private parts.
- Maintain or expand participation in community activities.
School readiness
- Language understanding and fluency, feelings, opportunities to socialize with other children, readiness for structured learning experiences, early childhood programs and preschool
- Give child time to finish sentences; encourage speaking skills by reading/talking together. Keep answers short and simple.
- Read together daily; ask child questions about the stories.
- Children are very sensitive, either easily encouraged or hurt; model respectful behavior and apologize if wrong; praise when demonstrates sensitivity to feelings of others.
- Provide opportunities for your child to play with other children.
- Visit your child’s preschool/child care program; become actively involved; talk with your child about what she’s learning.
- Developing healthy nutrition and personal habits: Water, milk, and juice; nutritious foods; daily routines that promote health
- Always have cool water available.
- Provide 16 to 24 oz low-fat/fat-free milk daily.
- Juice is not a necessary drink. If you choose to give juice, limit to 4 oz daily and always serve it with a meal.
- Offer variety of healthy foods/snacks, especially vegetables, fruits, lean protein.
- Trust child to decide how much to eat.
- Create calm bedtime ritual; enjoy mealtimes without TV; ensure child brushes teeth twice a day with pea-sized fluoridated toothpaste.
- Give child time to finish sentences; encourage speaking skills by reading/talking together. Keep answers short and simple.
- Read together daily; ask child questions about the stories.
- Children are very sensitive, either easily encouraged or hurt; model respectful behavior and apologize if wrong; praise when demonstrates sensitivity to feelings of others.
- Provide opportunities for your child to play with other children.
- Visit your child’s preschool/child care program; become actively involved; talk with your child about what she’s learning.
Media use
- Limits on use, promoting physical activity and safe play
- Limit TV and video to no more than 1 hour a day; no TV in bedroom; supervise any Internet use; consider making a family media use plan ( www.healthychildren.org/MediaU... ).
- Make opportunities for daily play; be physically active as a family.
Safety
- Belt-positioning car booster seats, outdoor safety, water safety, sun protection, pets, firearm safety
- Continue to use a size-appropriate forward facing car safety seat installed in backseat.
- Supervise all outdoor play; never leave child alone; don’t allow to cross street alone.
- Be sure swimming pools are fenced; use life jacket; teach child to swim.
- Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
- Teach child about safety around pets.
- Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately. Ask if firearms in other homes where child plays; if so, ensure same safety precautions before letting child play there.
Anticipatory Guidance
