Well Child Care
Key Conditions
The benefits of well-child visits include:
- Prevention
- Tracking growth and development
- Raising any concerns
- Development of a team approach
Schedule of well-child visits
- The first week visit (3 to 5 days old)
- 1 month old
- 2 months old
- 4 months old
- 6 months old
- 9 months old
- 12 months old
- 15 months old
- 18 months old
- 2 years old (24 months)
- 2 ½ years old (30 months)
- 3 years old
- 4 years old
- 5 years old
- 6 years old
- 7 years old
- 8 years old
- 9 years old
- 10 years old
- 11 years old
- 12 years old
- 13 years old
- 14 years old
- 15 years old
- 16 years old
- 17 years old
- 18 years old
- 19 years old
- 20 years old
- 21 years old
Brief Summary of Well Child Visits (Newborn to 4 years):
|
Age |
History |
Preventative Care Measures |
Vaccines |
Suggested Anticipatory Guidance |
Common Medical Topics |
|
|
Newborn |
Interval Hx Feeding/vit D Elimination Sleep Development Family Hx Social Hx (where does pt live, with who does pt live with, smoke detectors, CO monitors, firearms)
Growth Exam |
|
Review birth hx (term, mom GP, prenatal labs, relevant preg hx, delivery hx/ APGARs), vit K, erythromycin, hep B, RSV, CCHD, hearing screen, breech delivery
Review stolic screen
Weight - compared to birth weight
Bilirubin
EPDS |
Hep B/Beyfortus if not received at birth |
Safe sleep
Feeding
Stool color (should no longer be black after 1st week of life)
Fever rules
|
Newborn skin rashes
Neonatal hyperbilirubinemia
Growth faltering/ailure to thrive
|
|
Weight check (1-2 weeks old) |
See above |
|
Review newborn metabolic screen
Weight - about 30 g per day
EPDS |
See above |
See above |
See above |
|
2 month old (6 week here at IHS) |
See above |
Makes sounds other than crying, reacts to sounds
Looks at your face, social smile
Raises head when prone, palms sometimes open
|
Weight - about 30 g per day
EPDS |
Pediarix (DTap, IPV, HepB) HiB PCV Rotavirus |
Vaccine Anticipatory Guidance
Safe sleep
Fever rules
Car seat |
Newborn skin rashes
Growth faltering/ailure to thrive
|
|
4 months old |
See above |
Looks at you, moves, or makes sounds to get or keep your attention
Chuckles
Coos, makes sounds back when you talk to them
Holds a toy when you put it in his hand
Pushes up onto elbows/forearms when on tummy
NO MORE HEAD LAG
|
Weight
EPDS
Consider iron supplementation if pt is still exclusively breastfed |
Pediarix (DTap, IPV, HepB) HiB PCV Rotavirus |
Introducing Solid Foods - Signs of Readiness: Shows interest in food, Sits with support, Can hold their head up, Opens their mouth when food is near, and Has lost the tongue thrust reflex.
How to Introduce Solids: Start with single-ingredient, pureed foods (e.g., rice cereal, sweet potato, banana) Offer small amounts (1-2 teaspoons) at first Introduce new foods one at a time to monitor for allergies Continue breastfeeding or formula as the primary source of nutrition
Car seat |
Failure to thrive
|
|
6 month old |
Interval Hx Feeding/vit D Elimination Sleep Development Family Hx Social Hx (where does pt live, with who does pt live with, smoke detectors, CO monitors, firearms, etc.)
Meds/allergies
Growth Exam |
Knows familiar faces/laughs/babbles/ blows bubbles/ squeals
Separation anxiety begins
Rolls from tummy to back, sits briefly without support
Reaches to grab toy
Holds bottle
Puts things in mouth |
Weight - birth weight doubles at 6 months
EPDS
Consider iron supplementation if pt is still exclusively breastfed |
Pediarix (DTap, IPV, HepB) HiB PCV Rotavirus
Flu shot if during flu season (will need booster 1 month after |
See above
|
Growth faltering/failure to thrive
|
|
9 month old |
Interval Hx Feeding Elimination Sleep Development Family Hx Social Hx (where does pt live, with who does pt live with, smoke detectors, CO monitors, firearms, etc.)
Meds/allergies
Growth Exam |
Plays peek-a-boo, looks for dropped object, holds arms out to be picked up, waves good-bye
Says Dada/Mama nonspecifically
Copies sounds parents make
Sits well without support, may pull self up to stand, crawls
Picks up food with 3 fingers + thumb, bangs objects together |
CBC w/o diff, lead
SWYC
Dental Varnish if has teeth and:
|
Flu shot if during flu season (will need booster 1 month after |
Gradually increase table foods to 3 meals and 2-3 snacks per day
Encourage transition from bottle to cup in next few months |
Developmental delay |
|
12 month old |
Interval Hx Feeding/dental Elimination Sleep Development Family Hx Social Hx (where does pt live, with who does pt live with, smoke detectors, CO monitors, firearms, etc.)
Meds/allergies
Growth Exam |
Puts something in a container, like a block in a cup
Calls a parent by specific name
Pulls up to stand
Pincer grasp |
Dental Varnish if has teeth and:
|
HiB PCV MMR VZV HAV DTAP (4 of 5) |
Ensure that sharp objects, cleaning supplies, and medications are out of reach.
Install safety gates at stairs and secure heavy furniture to prevent tipping.
Monitor for choking hazards.
Continue to use a car seat appropriate for the child's size.
Discuss the importance of supervision whenever around water. |
Developmental delay
|
|
15 month old |
See above |
Shows you an object they like
Claps when excited
Tries to say one or two words besides “mama” or “dada,” like “ba” for ball or “da” for dog
Follows directions given with both a gesture and words. For example, he gives you a toy when you hold out your hand
Stacks at least two small objects, like blocks
|
See above |
DTAP (4 of 5) |
See above |
Developmental delay
|
|
18 month old |
See above |
Points to show you something interesting
Helps you dress him by pushing arm through sleeve or lifting up foot
Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Walks without help, scribbles, drinks out of cup, feeds himself |
SWYC, MCHAT
Dental Varnish |
HAV (2 of 2) if 6 months after first dose |
See above |
Developmental delay
Behavior concerns, including temper tantrums
Sleep regression
|
|
2 year old |
See above |
Uses 2 word phrases.
Kicks a ball.
Begins parallel play.
Follows simple instructions. |
CBC w/o diff, lead (needs 2 before 2)
SWYC, MCHAT
Dental Varnish
Begin using BMI instead of weight-for-length to evaluate growth
Begin using CDC growth charts instead of WHO |
Catch-up vaccines if needed |
In addition to the above, discuss signs that the child may be ready for toilet training, such as showing interest in the toilet, staying dry for longer periods, and expressing discomfort with dirty diapers. |
Developmental delay
Behavior concerns, including temper tantrums
Sleep regression
Constipation
|
|
30 month old |
See above
|
Says about 50 words.
Uses things to pretend, like feeding a doll.
Takes some clothes off by himself, like loose pants or an open jacket. |
SWYC, MCHAT
Dental Varnish |
Catch-up vaccines if needed
|
See above |
See above |
|
3 year old |
Interval Hx Feeding/dental Elimination Sleep Development Preschool vs. At home Family Hx Social Hx (where does pt live, with who does pt live with, smoke detectors, CO monitors, firearms, etc.)
Meds/allergies
Growth Exam
|
Rides tricycle.
Talks well enough for others to understand, most of the time.
Join other children in play.
Draws a circle, when you show him/her how. |
Vision Screen
Dental Varnish
Start checking HR and BP |
Catch-up vaccines if needed
|
See above |
See above |
|
4 year old |
See above |
Likes to be a “helper”
Can tell you about one thing that happened today - “I went to the zoo.”
Names colors of things.
Holds crayon between fingers and thumb. |
Vision and Hearing screens
Dental Varnish
|
MMR (2 of 2) VZV (2 of 2) DTaP (5 of 5) IPV (4 of 4) |
Continue discussing the importance of using booster seats in vehicles and ensuring the home is childproofed to prevent injuries.
Kindergarten readiness: Encourage social skills like sharing and taking turns and assess if the child can follow simple instructions and express needs verbally. |
See above |