Routine Medical Care for the Well-Child Flashcards by lindsey King

routine well-child visit schedule

1 week, 1,2,4,6,9,12,15,18,24,30 months, 3 years, 4 years, 5 years and annually thereafter

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school physicals

K,6,9

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sports physicals

annual

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newborns lose…. in the first week of life

up to 10% of birth wt

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weight gain in the first 6 months

1 oz/day

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weight and height at one year

wt - 3X birth weight, height - 1.5X birth length

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weight and height at 2+ years

gain 2-3 kg/ year, grow 5-7 cm/ year

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30 month old

weights 30 lbs and is 30 in tall

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4 year old

weighs 40 lbs and is 40 in tall

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milestones from 1-12 months

1 month - smiles
2 months - vocalizes
3 months - lifts head           
4 months - reaches
5 months - rolls over
6 months - sits alone
7 months - crawls
8 months - pincer grasp
9 months - pulls to stand
10 months - “cruises”
11 months - stands alone
12 months - walks alone

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1 week visit

hx - feeding/I&O, sleeping
PE - W/L/HC, red reflex, hips, testes, jaundice in skin
screening - newborn blood and hearing if not done, bilirubin if jaundiced, immunization - Hep b #1 if not done
anticipatory guidance - sleep on back, car seats, illness s&s - fever, feeding, lethargic, etc.

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1 month

hx - diet, I/O, sleep, concerns
milestones - turns head to side, follows to midline, smiles
PE- W/W/HC, full exam
no screening
Hep B #2
anticipory guidance - crying peaks at 4-6 weeks, illness, sibling rivalry, support/relief for parents

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2 months

Hx
Milestones - smiles, vocalizes, follows past midline
PE- W/L/HC, full exam
no screening
immunization - DTap, Hib, IPV, PCV, Rota #1
anticipatory guidance - always watch, thumb-sucking, sleeping in crib now

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4 months

hx
milestones - lifts head, eyes follow 180 degrees, squeals, rolls front-to-back
PE- W/L/HC, full exam,
no screening,
immunization - DTaP #2, Hib #2, IPV #2, PCV #2, Rota #2
anticipatory guidance - feeding & solids, falls, choking, teething

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6 months

hx
milestones - sits alone, head lag gone, reaches for objects
PE- W/L/HC, full exam
no screening
immunization - DTaP #3, Hib #3, Hep B #3, PCV #3, Rota #3 if needed
anticipatory guidance - poisoning and OTC med doses, no walkers, gates, no unattended baths

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9 months

hx
milestones - teeth, crawls, pincer grasp, looks for dropped objects
PE- W/L/HC, full exam
developmental screening
immunization - IPV #3
anticipatory guidance - table foods, chocking hazards, stop night bottle, try spoon and cup

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12 months

hx
milestone - cruises, stands alone, walks?, says 1-2 words
PE - Wt and ht?, HC, Full exam
H/H screening
immunization - MMR, Varicella, Hep A
anticipatory guidance - whole/2% milk, time-out, allow to feed self when possible

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15 months

hx
milestone - two block towers, 3-6 words, hugs, takes lids off containers
PE - W/H/HC, full exam
no screening
immunization - PCV #4, Hib #4, DTaP #4, anticipatory guidance - appetite fall-off, childproof home, temper tantrums, masturbation

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18 months

hx
milestones - walks well/ runs, climbs, scribbles, points/asks for wants
PE - W/H/HC, full exam
screen- development, autism
no immunizations
anticipatory guidance - 3 meals with healthy snacks, injury prevention, toilet training?

24 months

hx
milestones - vocab of 50 words, 2-word phrases, 5-6 block towers, throws ball overhand, kicks ball
PE - H/W, BMI
screening - autism if didn’t pass 1st time
immunization - hep A #2
anticipatory guidance - decreasing appetite, low-fat milk, needs peers, safety incl. guns, sharing difficult, toilet training

30 months

hx
milestones - short sentences, 50% understandable by non-parents, jumps, points to 6 body parts
PE - H/W/BMI, practice BP
screening - development
anticipatory guidance - peer play opportunity, read books and talk to child, offer 2 choices, safety incl. swimming

3-4 years

milestones - all teeth, helps with dressing, 200-500 words, first/last name
PE - W/H/BP/BMI
screening - vision, hearing, oral health, no immunization
anticipatory guidance - 3 meals with limited snacks, appropriate TV, movies and internet, 911, sharing with peers, normal sexual curioisity

4-6 years

hx
milestones - skips, dresses/undresses, knows age and phone number,
full PE
screening - U/A, H/H, vision, hearing, oral health, immunization - DTaP #5, IPV #4, MMR #2, Varicella #2,
anticipatory guidance - school preparedness

7-10 years

hx, PE, screening - lipids at around 10, no immunizations

11-12 years

hx, physical, | vision screening at 12, depression annually, immunization Tdap x 1, HPV (3 dose series), MCV4 Dose #1

13-18 years

hx, physical screening - annual depression, STI/HIV 16-18 years, vision at 15 and 18, immunization - MCV4 dose #2 at 16

U/A

kindergarten, HS

H/H

12 months, kindergarten, HS

lead screening

preschool or with risk factors

preschool, kindergarten, 5th grade

lipids

10, 18+, or obesity, HTN, +FH

teething

eruption of primary teeth at 6 months (4-12), complete by age 3, may cause fussiness, drooling, decreased appetite, low-grade fever, tx with tylenol, teething rings, caution with topical anesthetics

thumb-sucking

nonnutritive sucking on fingers or pacifier, normal at first - reflex, self-soothing habit, most kids stop by 2-3, dental problem if 4+, gentle reminders work better than fancy, expensive things

toilet training

kids start around 18-24 months when they have adequate biological and neurological development, takes weeks - months to master, don't force issue, kids will win every time, if failing - stress, constipation, spina bifida occulta, genital anomalies evaluation

bedwetting

nocturnal enuresis, 5+ for girls, 6+ for boys, r/o diabetes, may be due to small bladder or deep sleeper, often +FH, tx: avoid late fluids, trial of alarms and meds, do not punish

discipline

age appropriate - redirection for infants, ifnore for toddlers, tim-out - 1 min/1 year of life, reward desired behavior, reason as they get older, make consequences predictable/immediate, discourage shame, scolding, spanking

safe bedding for infants

place baby on back on firm fitting mattress in a crib with current safety standards met, remove other things from crib and use a sleeper or sleeping clothing as alternative to blankets, make sure babies head is uncovered during sleep, no waterbed, sofa, soft mattress, pillow, etc to sleep

car seats -infant only

backwards until age 2 or 2+ until wt/ht too much for st

convertible car seats

forward facing, back seat until highest wt/ht for seat

booster seats

forward facing, backseat until tall enough for belt

seat belts only

4'9" and 8-12 years old, backseat only until 13

choking hazards

foods, small toy parts, balloons, coins, marbles, beads, necklaces, plastic bags, blinds cords

walkers

34 death since 1973, send 14,000 children to hospital annually, DO NOT help infants walk sooner

siblings

baby jealousy, toddler safety, less fighting with parental identification and talk about feelings, focus on unwanted behavior but most of all catch them being good!

accidental ingestions

meds, cleaning agents, plants, perfume, lead, insect baits, antifreeze, baby oil - call US National Poison Hotline