Well-Child Visits for Infants and Young Children PDF

Well-Child Visits for Infants and Young Children Dr. Cecelia Hammond, DNP, MSN, FNP-BC, PMHNP-BC Well-Child Visits for Infants and Young Children ▪ The well-child visit allows comprehensive assessment of a child opportunity for further evaluation if abnormalities are detected. Well-Child Vi...

Well-Child Visits for Infants and Young Children Dr. Cecelia Hammond, DNP, MSN, FNP-BC, PMHNP-BC Well-Child Visits for Infants and Young Children ▪ The well-child visit allows comprehensive assessment of a child opportunity for further evaluation if abnormalities are detected. Well-Child Visits for Infants and Young Children A complete history includes birth history prior screenings Diet sleep dental care medical, surgical, family, and social histories This Photo by Unknown Author is licensed under CC BY-NC-ND Well-Child Visits for Infants and Young Children ▪ A head-to-toe examination should be performed including a review of Growth Immunizations and updated as appropriate Screening for postpartum depression in mothers of infants up to six months of age is recommended. This Photo by Unknown Author is licensed under CC BY-SA-NC Well-Child Visits for Infants and Young Children Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear-facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year. Well-Child Visits for Infants and Young Children Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns) provide anticipatory guidance promote good health allow the family physician to establish a relationship with the parents or caregivers. This Photo by Unknown Author is licensed under CC BY-NC-ND History The history should include a brief review of birth history; prematurity can be associated with complex medical conditions Evaluate breastfed infants for any feeding problems and assess formula-fed infants for type and quantity of iron-fortified formula being given. For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family and social histories should be reviewed and updated. Well-Child Visits for Infants and Young Children A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts. Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include an assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. This Photo by Unknown Author is licensed under CC BY-SA Anticipatory Guidance injuries remain the leading cause of death among children,\ pools and spas should be completely fenced with a self-closing, self-latching gate. Infants need a rear-facing car safety seat until two years of age or until they This Photo by Unknown Author is licensed under CC BY-NC-ND reach the height or weight limit for the specific car seat. Children should then Infants should not be left alone on any high surface, and stairs should be switch to a forward-facing car seat for as long as the seat allows, usually 65 to secured by gates. Infant walkers should be discouraged because they provide 80 lb (30 to 36 kg). Children should never be unsupervised around cars, no benefit and increase falls down stairs, even if stair gates are driveways, and streets. Young children should wear bicycle helmets while installed. Window locks, screens, or limited-opening windows decrease injury riding tricycles or bicycles. and death from falling. Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept Having functioning smoke detectors and an escape plan decreases the risk of unloaded and locked. fire- and smoke-related deaths. Young children should be closely supervised at all times. Small objects are a Water heaters should be set to a maximum of 120°F (49°C) to prevent scald choking hazard, especially for children younger than three years. Latex burns. balloons, round objects, and food can cause life-threatening airway Infants and young children should be watched closely around any body of obstruction. Long strings and cords can strangle children. water, including water in bathtubs and toilets, to prevent drowning. Swimming Dental Care Infants should never have a bottle in bed, and babies varnish for teeth if the water supply is insufficient. should be weaned to a cup by 12 months of age. Begin brushing teeth at tooth eruption with parents or Juices should be avoided in infants younger than 12 caregivers supervising brushing until mastery. months. Children should visit a dentist regularly, and an Fluoride use inhibits tooth demineralization and assessment of dental health should occur at well- bacterial enzymes and also enhances child visits. remineralization. The AAP and USPSTF recommend fluoride supplementation and the application of fluoride This Photo by Screen Time Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise, digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increase the risk of obesity and social-emotional delays. This Photo by Unknown Author is licensed under CC BY-SA Sleep To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS This Photo by Unknown Author is licensed under CC BY-SA-NC Diet and Activity The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods and an increased risk of atopic disease. Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. The introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year, decreases the likelihood that a child will develop food allergies. With approximately 17% of children being obese, many strategies for obesity prevention have been proposed Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities. The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. This Photo by Unknown Author is licensed under CC BY-NC-ND