#40 – Well Child Visits



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2015 American Academy of Pediatrics Schedule for Preventive Pediatric Health

 

2018 Centers for Disease Control Immunization Schedule

 

Denver Developmental Milestones



Initial Office Visit (within 2 weeks)

 

Development

  • Rooting and suckling reflex strong
  • Indiscriminate tight grasp of hands
  • Responds to light, noise, and movement
  • Lift head from supine
  • Follow to midline
  • Regained birthweight

 

Anticipatory Guidance

  • Feeding
    • Encourage breastfeeding and its benefits:
      • Decreased risk of infections
      • Decreased SIDS risk
      • Decreased obesity risk
      • Increases emotional connection
    • Frequency
      • On-demand, but generally every 2-4 hours
    • Amount
      • 1 oz/kg/day
    • Reflux
  • Sleeping
    • Back to sleep
  • Fever
  • Jaundice

Vaccinations

  • Hepatitis B #1 (if not given in hospital)

 


2 Month Visit

 

Development

  • Smile socially and start cooing
  • Lift head from prone
  • Turns head towards sounds and follow past midline
  • Push up on arms from prone
  • Recognize parents

 

Anticipatory Guidance

  • Feedings
    • Start to delay middle of the night feedings
  • Sleep
    • Move to another room to help with self-soothing

Vaccinations

  • Hepatitis B #2
  • Rotavirus #1
  • DTaP #1
  • HIB #1
  • Pneumococcal #1
  • Polio #1

 


4 Month Visit

 

Development

  • Neonatal reflexes will begin to disappear
  • Smiles spontaneously
  • Likes to play/interact with people
  • Begins to babble
  • Different cries for different complaints
  • Reach with one hand
  • Uses hands and eyes together
  • Hold head unsupported and support on forearms when prone
  • Start rolling over prone to supine
  • Brings hands to mouth

 

Anticipatory Guidance

  • Feeding
    • 32oz/day = max
    • 4-5 feedings per day
    • Start to introduce rice cereal and solid foods
      • Counsel that stools will change
      • One food at a time
  • Sleeping
    • May start to sleep through the night
      • Counsel to start a bedtime routine
      • No more middle of night feedings

Vaccinations

  • Rotavirus #2
  • DTaP #2
  • HIB #2
  • Pneumococcal #2
  • Polio #2

 


6 Month Visit

 

Development

  • Doubled birth weight
  • Stranger danger
  • Likes to look at self in the mirror
  • Responds to name
  • Imitate speech
  • Voice happy and displeasure
  • Pass objects from hand to hand
  • Rollover in both directions
  • Sits unsupported

 

Anticipatory Guidance

  • Feeding
    • Increase solid foods and decrease formula
    • Introduce sippy cup
  • Sleeping
    • Separation anxiety common

Vaccinations

  • Rotavirus #3 (if indicated)
  • DTaP #3
  • HIB #3 (if indicated)
  • Pneumococcal #3
  • Polio #3
  • Hepatitis B #3
  • Influenza #1
  • Fluoride (if needed)

 


9 Month Visit

 

Development

  • Crawls
  • Understands “no”
  • Starts saying “mama” and “dada” indiscriminently
    • Takes 9 months to be a “mama”
  • Can point
  • Immature pincer grasp
  • Pull to stand and cruise
  • Wave “bye-bye”
  • Object permanence begins to develop

Anticipatory Guidance

  • Feedings
    • Milk/formula down to 24oz/day
    • Solid foods at meal time
    • Introduction of finger foods
  • Sleep
    • Should be through the night
    • Limit naps to 2x/day
  • Introduce brushing as teeth should begin erupting
  • Discipline plans

Vaccinations

  • Catch-up (if needed)
  • Influenza #2

 


12 Month Visit

 

Development

  • Begin walking unsupported
  • Increased vocabulary
  • Follow simple, one-step commands
  • Imitates actions and words
  • Help with dressing

Anticipatory Guidance

  • Feeding
    • Introduce cow’s milk not to exceed 24oz/day
    • Ween from bottle
    • Juice not to exceed 8oz/day
  • Sleep
    • Bedtime ritual is important
  • Discipline and Behavior Counseling
    • Set limits and be consistent
  • Can transition to forward facing car seat with harness if they exceed current manufacturers height/weight recommendations
  • Routine CBC for anemia screening

Vaccinations

  • HIB #3 or #4
  • Pneumococcal #4
  • MMR #1
  • Varicella #1
  • Hepatitis A #1

 


15 Month Visit

 

Development

  • Kick and roll ball
  • Can undress themselves
  • Play hide and seek
  • Attempts to name objects
  • Vocabulary up to 5 words
  • Build towers
  • Needs social interaction
    • Thought they don’t play well with others (sharing)

Anticipatory Guidance

  • Feeding
    • 3 balanced meals per day with 1-2 snacks
    • Introduce utensils
  • Sleeping
    • Down to 1 nap per day
    • Temper tantrums will be more common
    • Have crib on lowest rung
    • Child stays in room for bedtime
  • Discipline and Behavior
    • Praise for good behavior and redirect bad

Vaccinations

  • DTaP #4
  • HIB #4 (if indicated)
  • Hepatitis A #2

 


18 month Visit

 

Development

  • Plays simple pretend
  • Likes to explore, but needs parent close
  • Name body parts
  • Scribbles on their own
  • Climb stairs
  • Turn pages in books while reading
  • Put simple puzzles together

Anticipatory Guidance

  • Feedings
    • Drinking from cup exclusively and using utensils
    • Decrease milk to 16oz/day
  • Discipline and Behavior
    • Introduce “timeouts” for discipline

Vaccinations

  • Catch-up (if needed)

 


2 year Visit

 

Development

  • Gets excited and enjoys playing with others
  • Use two word sentences
  • Knows names of familiar people
  • Shows defiant behavior (Terrible Two’s)
  • Increase autonomy and self-expression
  • Echolalia
  • Begins to sort colors and shapes
  • Follow two-step commands
  • Build towers of 4-6 blocks
  • Start running
  • Throw and kick balls
  • Walk up and down stairs
  • Vocab up to 50 words and use two-word sentences

Anticipatory Guidance

  • Growth
    • 2-3 inches and 3-6 pounds for the year
  • Transition to toddler bed
  • Naps down to 1 a day
  • Begin potty training
  • Safety
    • House needs to be “babyproof” at this point
      • Door latches, baby gates, outlet covers, cabinet locks

Vaccinations

  • None

 


3 Year Visit

 

Development

  • Pedal a tricycle
  • 300 words in vocabulary
  • Sort objects by color and shape
  • Uses 3-5 word sentences
  • Repeat their name, age, and gender
  • Can play well with others (takes turns in games)
  • Follow 2-3 step commands
  • Copy a circle
  • Alternate feet on stairs

Anticipatory Guidance

  • Growth
    • 2-3 inches and 3-6 pounds from previous visit
  • Encourage autonomy and exploration with boundaries

Vaccinations

  • DTaP #5
  • Polio #4
  • MMR #2
  • Varicella #2

 


4 Year Visit

 

Development

  • Play “mom and dad”
  • Play is more creative with make-believe
  • Tell stories and ask questions
  • Sing songs
  • Play board games
  • Copy and recognize letters
  • Uses scissors
  • Understand the concept of counting
  • Copy a square (4 sides)
  • Speak in 4-5 word sentences
  • Increased emotional range and understands them

Anticipatory Guidance

  • Growth
    • 40 inches and 40 lbs at 4 years
  • Thrive on praise
  • Be consistent and balanced in discipline

Vaccinations

  • None

 


5 Year Visit

 

Development

  • Wants to be with and like friends
  • Follows rules more
  • Use future tense
  • Use full sentences
  • Fully aware of gender
  • Fully potty trained
  • Likes to sing, dance, and act
  • Count 10 objects correctly
  • Stand on one-leg for 10 seconds or longer
  • Draw a person with body parts
  • Can tell difference between real and make-believe

Anticipatory Guidance

  • Sibling jealously is common
  • Prepare for kindergarten
  • Start instilling morality in decision making
  • TV Guidelines
    • 1 hour per day max
    • Don’t use as a reward
    • Talk with other adults in house on plan

 



References

  1. 2015 Recommendations for Preventive Pediatric Health Care. Pediatrics. 2015;136(3):e727-e729 [link]
  2. 2018 CDC Immunization Schedule for Children and Adolescents 18 years or younger. [link]
  3. CDC – Developmental Milestones [link]
  4. Scharf RJ, Scharf GJ, Stroustrup A. Developmental Milestones. Pediatrics in review. 2016; 37(1):25-37; quiz 38, 47. [pubmed]

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