Pediatrics Module 3: Well-Child Checks

Pediatrics and Adolescent Medicine Module 3: H&P; Well-Child Checks

• This module focuses on well-child checks in pediatrics and adolescent medicine.
• Well-child checks aim to identify developmental delays or risks in children.
• Child development includes four key domains: physical/motor skills, cognitive skills, language skills, and behavioral/social-emotional/mental health.
• Developmental milestones are tracked from birth.
• Screening tools, such as the ASQ-3, aid in identifying developmental concerns.
• Key factors affecting development include physical, social, and environmental elements.
• Development is predictable, measurable, and has a variable pathway.

Introduction to Development & Growth: Pediatric Health Maintenance

• Growth and development are monitored from birth.
• Screening helps to ensure that no issues are missed.
• Resources, such as the American Academy of Pediatrics and the Centers for Disease Control, are used.

4 Principles of Child Development

• Development is predictable.
• Pathways are measurable.
• There's a range of norms in development.
• Individual rates of development vary.
• The History and Physical (H&P) is variable, depending on the child's developmental level and understanding of norms.

To Recognize Abnormal Growth

• Key determinants of growth include maternal nutrition, intrauterine environment, genetics, environment and diet, and chronic illnesses.
• Parameters of growth include weight, length/height, weight-for-length or BMI, head circumference, and Tanner stages.
• Understanding normal growth patterns is essential to identify abnormalities.

How do Social Determinants of Health (SDoH) affect growth and development?

• Early life stressors and adverse childhood events (ACEs) can negatively affect growth and development.
• Negative effects include difficulties with coping skills, emotional regulation, reduced social functioning, cognitive delays, poor academic achievement, chronic diseases, and tobacco, alcohol, and drug use.
• Maltreatment, poverty, family instability, unsafe neighborhoods, lead exposure, and racism are some examples of SDoH.

Overcoming Adversity: Early Childhood Programs

• High-quality developmental and educational programs (like Head Start) are essential for improving outcomes.
• These programs improve health outcomes, learning, social skills, and school readiness.
• Supportive social services and classes for parents can aid children's academic achievement.

Well Child Checks (Why?)

• Well-child checks are essential for preventing illness via immunizations and promoting safety.
• Monitoring growth and development helps detect milestones, social behaviors, and learning patterns.
• Identifying parental concerns is vital and helps with sleeping, eating, development, and interactions with others.
• A team approach fosters strong relationships and addresses various needs of infants, children, and adolescents.

Standardized Developmental Screening Tools

• At minimum, screenings should occur at 9-months, 18-months, and 24 or 30-months of age, and any time concerns are raised.
• Examples of gross motor milestones include those like chin-up, visual tracking, reaching, sitting, unassisted, pincer grasp, crawling, and standing/cruising, with approximate ages.

Examples of Developmental Screening tools

• The Ages and Stages Questionnaire® (ASQ-3) assesses communication, gross motor skills, fine motor skills, problem-solving, and personal-social development.

Pediatric History (Infants and Toddlers)

• History encompasses birth, medical, family, social, developmental milestones.
• Key elements include feeding, sleeping, stooling/urination, and vaccinations.

Examples of Infant and Toddler Norms

• Typical feeding patterns (e.g., formula, solids, milk).
• Sleeping durations and frequency (e.g., newborns sleep more than toddlers).
• Stooling and urination frequencies.

History: School-Aged Children (4-11yrs)

• History includes birth (if applicable), medical, family, and social histories.
• Key elements include developmental milestones, feeding, sleeping, vaccinations, and school performance/

Pediatric Vital Signs

• Vital signs like heart rate, respiratory rate, systolic blood pressure, and diastolic blood pressure vary across different age groups.

Examples of Pediatric Growth Charts

• Growth charts are used to track child growth and compare to standards.
• Different charts exist for various ages and groups (e.g., WHO for 0-2 years, CDC for 2-20 years).

Normal Variants in Growth

• Variations, such as constitutional delay, familial short stature, congenital GH deficiency, and Turner syndrome, affect growth patterns.

Growth Chart Practice

• Plot children's growth parameters on appropriate growth charts.

Well-Child Checks: Components

• Visit context considers child's age and development.
• The agenda centers on family needs.
• Health supervision includes development history, observation of interaction, screenings, and vaccinations.

Timing of WCC: Infants, Toddlers & Children

• Specific schedules exist for well-child check-ups at various ages (i.e., newborns, 1-week old, 1, 2, 4..., 18 months).
• Routine checkup is recommended regularly through childhood and adolescence.

Class Discussion: Infants

• Special aspects/challenges of examining infants.

Childhood Vaccines: Practice!

• Vaccination schedule for various ages.

Toddlers & School-aged Children

• Unique examination considerations and well-child visit structure for this age group.

A note on Lead Screening

• Lead testing is required for all children enrolled in NM Medicaid at 12 and 24 months.

Group Work: 6 mo old WCC

• Case study involving a 6-month-old child for a well-check.
• Includes questions regarding growth, immunizations, milestones, solid food introduction, anticipatory guidelines and universal screening