The first priority is to listen to the concerns of the parents. Always observe the parent-child interaction during the entire visit. Reinforce positive interactions and discuss any concerns. If there are siblings in the room, how do they interact with the child? Is the parent positive about the child?

Bright Futures gives priority to these topics during the 15-month visit [PDF]

Communication and Social Development	Sleep Routines:	Temperament, development, behavior, and discipline	Healthy teeth	Safety
Attention to how a child communicates wants and interests Separation	Regular bedtime routine Night waking No bottle in bed	Discipline Behavior management		Car seats Falls Fire Safety Poisoning

SUBJECTIVE DATA [15 Month]

Interval History

What happened since the last health supervision visit? Be sure to include any parent concerns.

Examples

• “What are you most proud of since our last visit?”
• “What do you like most about your son/daughter?”
• “What questions or concerns do you have about your child?”

Ask about past history. Any visits to the emergency department or urgent care? Any changes in the health of anyone in the family?

Development

Any specific concerns?

Language Development and Self-help	Motor Development
Does your child: Imitate scribbling? Drink from cup? Point to ask for something? (Points to refrigerator when he wants a drink?) Understands/follows simple directions? Says 203 words with meaning	Gross Motor Stoops to pick up objects? Crawls up a few steps? Runs? Fine Motor Puts object in and takes out of cup? Uses crayon?

Review of Systems

Do you have any concerns about your child’s

• Development
• Skin
• HEENT
• Breathing
• Stomach
• Genitals / Rectum

OBJECTIVE DATA [15 Months]

Always plot the weight, length, and head circumference on a growth chart. You are looking for trends. Do not just look at the numbers obtained during the visit. How do they compare to the last well visit? Last well visit the weight was at the 25th percentile but this time it is at the 75th percentile….what happened? https://www.cdc.gov/growthcharts/charts.htm

Your examination is not head to toe but least invasive to most invasive.

Screening

Table Retrieved from: https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_EarlyChildhoodVisits.pd

Immunizations

Embed code for immunization schedule

From CDC National Immunization Program: www.cdc.gov/vaccines

Anticipatory Guidance

Review the priorities listed in the beginning of the module. These questions will vary from family to family and visit to visit. You can modify the questions to match your communication style.

Assess communication and social development.

Encourage toddler’s autonomous behavior, curiosity, and sense of emerging independence. Give the child choices, such as 2 options that are both acceptable. Let him choose between 2 books for reading or between 2 fruits for a snack.

Discuss stranger anxiety and separation anxiety. Do not make fun of his fear. Encourage parents to let him explore at his own pace.

Establish a regular bedtime routine. Some toddlers will still be experiencing some night waking. Prepare the parents for night waking to recur at 18-20 months of age. Discuss the importance of not giving a bottle to sleep with, or letting him sleep in the parents’ bed. No digital media in the child’s bedroom.

Dental

• Brush teeth twice each day with small smear of fluoridated toothpaste.
• Allow the child to brush their teeth sometimes.

Safety

• Assess safety, such as childproofing the home, car seat, close supervision, remove/lock guns with ammunition locked separately.
• Discuss dangers in the home, such as hot liquids or food where the child can reach window blind cords, hot water temperature, heaters, medications, laundry products, and cleaning supplies.
• Use gates at the top and bottom of stairs.
• Working smoke detector in every level of the house, especially bedrooms.