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Well Child Visit

  1. What are the components of a well child physical exam?
    • Vision and fundoscopic exams
    • Hearing
    • Heart (especially murmurs)
    • Genital exam
    • Tanner staging
    • Other health screenings (lead, fluoride)
    • Immunizations
  2. What are some examples of developmental screening tests?
    • Ages and Stages Questionnaires
    • Battelle Developmental Inventory Screening Tool
    • Denver-II Developmental Screening Test
    • Parents' Evaluation of Developmental Status (PEDS)
  3. Divisions of the developmental assessment
    • Gross motor
    • Fine motor/visual perceptual/problem solving
    • Language
    • Adaptive
    • - Includes objective findings and parental report
  4. When do you screen for well child visits?
    • Newborn
    • 2 weeks
    • 2, 4, 6, 9, 12, 15, 18, 24 months
    • Yearly after
  5. Characteristics of primitive reflexes and examples of spinal cord/brainstem related primitive reflexes
    • Develop during gestation
    • Resolve by 3-6 months
    • Stronger and more sustained reflexes in those with central neurologic injuries (cerebral)
    • - Tonic neck
    • - Moro
    • - Positive support
    • - Walking
    • - Grasp
    • - Rooting
  6. Characteristics and examples of postural reactions
    • Appear with suppression of primitive reflexes
    • Precede voluntary motor function
    • - Head righting: lifts head in prone position
    • - Parachute: arm extension with falling
    • - Propping: anterior, lateral, and posterior
  7. One month
    • Gross motor:
    • - Chin off table in prone position
    • - Head will sag forward when held sitting
    • Fine motor:
    • - Visually fixates
    • - Hands are tightly fisted
    • Language:
    • - Alerts to sound; soothes when picked up
    • Parental guidance issues:
    • - Sleep (position)
    • - Feeding
    • - Crying
    • - Response
    • - Growth
    • Parental guidance safety:
    • - Car seats
    • - Exposure to smoking
    • - Shaking baby
  8. Shaken Baby Syndrome
    • Retinal hemorrhages usually diagnostic
    • - Intraocular hemorrhages
    • - Subconjuctival hemorrhages
    • - Eyelid ecchymosis
    • - Retinal detachment
  9. Two months
    • Gross motor:
    • - Chest off table when prone
    • - Head bob when held sitting
    • - Lift head 45 degrees in prone recurrently
    • Fine motor:
    • - Visually tracks past midline
    • Language:
    • - Social smile
    • Adaptive:
    • - Recognizes parents
    • Parental guidance issues:
    • - Sleep (position)
    • - Feeding
    • - Crying
    • - Growth
    • Parental guidance safety:
    • - Burns
    • - Sun exposure
    • - Smoking
    • - Car seats
    • - Shaking Baby
  10. Four months
    • Gross motor:
    • - Support weight on wrists/hands with arms extended in prone
    • - Roll over prone to supine
    • - Good head control with sitting
    • - Head held at 90 degrees in prone
    • Fine motor:
    • - Hands to midline (manipulate fingers)
    • - Bilateral reach
    • - Mouthing of objects
    • - Unfisted
    • Language:
    • - Cooing
    • - "Ah-goo"
    • - Orient to voice; laugh aloud
    • Parental guidance issues:
    • - Introduction of food
    • - Sleep
    • - Talking to baby
    • Parental guidance safety:
    • - Falling
    • - Car seats
  11. Six months
    • Gross motor:
    • - Sits propped or leaning on hands (with support)
    • - Anterior protective (propping) response
    • - Support full weight and bounce
    • Fine motor:
    • - Intentional grasp of cube
    • - Transfer of objects hand to hand
    • - Immature rake of pellet
    • - Lift a cup from the table
    • Language:
    • - Babbling "baba, gagaga" (constant sounds)
    • Adaptive:
    • - Stranger anxiety
    • Parental guidance issues:
    • - Lead screening
    • - Food
    • Parental guidance safety
    • - Child-proofing house
    • - Walkers
    • - Car seats
  12. Accident prevention
    • Walkers going down stairs (now wider), burns, wear helmets appropriately, poisoning (no ipecac), guns
    • Drowning #1 cause of accidental death < 5 yrs
    • Car seats
    • - Backward until 2 and 20lbs
    • - Forward until 4 or 40lbs
    • - Booster until 8 and 20lbs
  13. Nine months
    • Gross motor:
    • - Reciprocal crawl
    • - Pull to stand
    • - Sit erect indefinitely
    • - Let self down from furniture with control
    • Fine motor:
    • - Inferior pincer grasp of pellet held between ventral surfaces of thumb and index finger
    • - Look over edge for fallen toy
    • - Ring bell
    • Language:
    • - Orient to bell directly
    • - Gestured communication (pointing, bye-bye)
    • - Imitative games (peek-a-boo, pat-a-cake)
    • Adaptive:
    • - Finger feed (avoid choke foods)
    • - Hold own bottle
    • - Separation anxiety
    • Parental guidance issues:
    • - Table food
    • - Using cup
    • - Teeth
    • Parental guidance safety:
    • - Drowning
    • - Burns
    • - Car seats
  14. Lead poisoning screening
    9-12 months
  15. 12 months
    • Gross motor:
    • - Walk independently
    • - Posterior protective response with sitting
    • Fine motor:
    • - Intentional release (precise) of cube in cup
    • - Crayon mark
    • - Fine pincer grasp of pellet between fingertips
    • - Attempts release of pellet into bottle
    • Language:
    • - 2 words other than "mama" and "dada" or name of person
    • - 1 step gestured commands
    • - Immature jargoning (runs several unintelligible words together)
    • Adaptive:
    • - Liquids primarily from a cup (4oz juice/day)
    • Parental guidance issues:
    • - Weaning
    • - Brushing teeth
    • - Daycare
    • - Playing with baby
    • Parental guidance safety:
    • - Choking
    • - Child-proofing house
    • - Car seats
  16. 15 months
    • Gross motor:
    • - Stoops and recovers
    • - Run stiff legged
    • - Climb into chair
    • Fine motor:
    • - Uses cup
    • - Uses spoon
    • - Plays with blocks (stacks 3)
    • Language:
    • - 3 word vocabulary
    • Adaptive:
    • - Spoon feeds self
    • Parental guidance issues:
    • - Nutrition
    • - Feeding self
    • - Development
    • Parental guidance safety:
    • - Falls
    • - Car seats
  17. 18 months
    • Gross motor:
    • - Run well
    • - Walk upstairs with 1 hand held (20 months)
    • - Walk into large ball when shown how to kick it
    • Fine motor:
    • - Stack 4 cubes
    • - Scribble spontaneously
    • Parental guidance issues:
    • - TV
    • - Nutrition
    • - Language development
    • Parental guidance issues:
    • - Guns
    • - Lifejackets
    • - Traffic
    • - Poisons
    • - Matches
  18. 24 months
    • Gross motor:
    • - Walks up and down stairs holding rail and marking time
    • - Jump, both feet off the floor
    • - Kick ball on request
    • - Throws overhand
    • Fine motor:
    • - Stack 7 cubes
    • - Horizontal 3 cube train
    • - Imitate vertical and horizontal stroke
    • - Attempt to fold paper
    • Language
    • - 50 word vocabulary
    • - Use pronouns inappropriately (I, you, me)
    • - Follow a simple 2 step command
    • - 2 word sentences
    • Parental guidance issues:
    • - Toilet training
    • - TV
    • - Nutrition
    • - Games
    • - Language
    • Parental guidance safety:
    • - Guns
    • - Lifejackets
    • - Traffic
    • - Poisons
    • - Matches
  19. 27 months
    • Gross motor:
    • Fine motor:
    • - 4 block train with a smokestack
    • - Copy horizontal/vertical stroke
    • Language:
    • - Sophisticated body parts
  20. 30 months
    • Gross month:
    • - Up stairs alternating feet (30-36)
    • - Stand on one foot momentarily
    • - Jumps with both feet off the floor
    • Fine motor:
    • - Stack 8 cubes
    • - Imitate circular motion with crayon
    • - Fold paper with definite crease
    • - Holds pencil in adult fashion
    • Language:
    • - Speech 100% intelligible to primary caretaker
    • - Echolalia ceases
    • - Use pronouns appropriately
    • - Understand concept of "just one" and prepositions "on" and "under" 
    • - Repeat 2 digits
    • Adaptive:
    • - Pull up pants
    • - Potty training?
    • - Establish handedness
    • - Gets drink without help
  21. 36 months
    • Gross motor:
    • - Pedal tricycle
    • - Broad jump
    • - Alternate feet down stairs (3-4 years)
    • Fine motor:
    • - Stack 10 cubes
    • - 3 block bridge
    • - Copy circle
    • - Draw person with head and one other body part
    • Language:
    • - 250 word vocabulary minimum
    • - Speech 100% intelligible to a stranger
    • - Repeat 3 digits forward
    • - Ask questions about word meanings
    • - Concept of “big and little”, “behind and next to”
    • - Answer question “Are you a boy or girl” and “What do you do if you are tired/hungry”
    • - Concept of 2 items from a greater number
    • - 3 word sentences
    • - Name colors
    • Adaptive:
    • - Group play
    • - Shares toys
    • - Takes turns
    • - Plays well with others
    • - Knows name and age
    • Parental guidance issues:
    • - Hand washing
    • - Talking
    • - Peers
    • - Dentist
    • - TV
    • Parental guidance safety
    • - Home safety
    • - Car seat
    • - Helmets
  22. Vision screening
    • Between ages of 3 and 5 at least once
    • To detect presence of amblyopia or its risk factors
  23. 4 years
    • Gross motor:
    • - Hop on one foot
    • Fine motor:
    • - 5 block gate
    • - Copy square
    • Language:
    • - Concept of "long and short"
    • - Just 4 items from a greater number
    • - Answer questions "What do you do if you are cold?" and "What is a house made of?"
    • - Says a song or poem from memory
    • Adaptive:
    • - Button, dress with supervision
    • - Tells "tall tales"
  24. 5 years
    • Gross motor:
    • - Skip
    • - Balance on one foor for 5 seconds
    • Fine motor:
    • - 6 block staircase
    • - Copy triangle
    • - Prints first name
    • Language:
    • - Asks what a word means
    • Adaptive:
    • - Tie shoes
    • - Dress unsupervised
    • - Distinguish left from right
    • - Plays competitieve games
    • - Abides by rules
    • Language:
    • - Know phone number, address
    • - ID letters
    • - Know larger of two single digits
    • - ID coins
    • - Follow 3 step command
  25. DEET
    • Can be used over 2 months of age
    • Efficacy peaks at 30%
    • Stronger formulas no more effective
  26. Red Flags
    • Fisting beyond 3 months
    • Persistence of primitive reflexes beyond 6 months
    • Rolling prior to 3 months may indicate hypertonia
    • Mouthing of objects beyond 6-8 months
    • Handedness established below 12 months
    • Echolalia after 30 months
  27. Newborn immunizations
    Hepatitis B
  28. 2, 4, and 6 month immunizations
    • DTaP
    • IPV (inactivated polio vaccine)
    • Hep B
    • Hib (H influenza type B)
    • PCV (pneumonia)
    • RV (rotovirus)
  29. 12 month immunizations
    • MMR
    • Varicella
    • Hib
    • PCV
    • Hep A
  30. 15 month immunizations
    • DTaP
    • Hep A
  31. 4-6 year immunizations
    • DTaP
    • IPV
    • MMR
    • Varicella
  32. 11-12 year immunizations
    • HPV (3 doses)
    • MCV4 (meningococcal)
  33. 13 year immunizations
    • TDaP
    • HPV
  34. Influenza vaccine
    After 6 months
  35. Hepatitis B immunization
    • Newborn
    • 2, 4, and 6 months
  36. DTaP immunization
    • 2, 4, and 6 months
    • 15 months
    • 4-6 years
    • 13 years
  37. IPV immunization
    • 2, 4, and 6 months
    • 4-6 years
  38. Hib immunization
    • 2, 4, and 6 months
    • 12 months
  39. PCV immunization
    • 2, 4, and 6 months
    • 12 months
  40. RV immunization
    2, 4, and 6 months
  41. MMR immunization
    • 12 months
    • 4-6 years
  42. Varicella immunization
    • 12 months
    • 4-6 years
  43. Hep A immunization
    • 12 months
    • 15 months
  44. HPV immunization
    • 11-12 years
    • 13 years
  45. MCV4  immunization
    11-12 years
Author
Anonymous
ID
189553
Card Set
Well Child Visit
Description
Well child visit developmental milestones and immunizations
Updated

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