Physical Examination
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
At the 2-year visit, the child can be measured standing then calculate body mass index (BMI). Remember, BMI = kg/m2.
- BMI for age percentiles, Boys 2-20 years growth chart
- BMI for age percentiles, Girls 2-20 years growth chart
- BMI Calculator with phone app available
Screening
| Universal Screening | Action | |
| Development | Developmental screen | |
| Oral Health (in the absence of a dental home) | Apply fluoride varnish every 6 months. | |
| Selective Screening | Risk Assessment | Action if Risk Assessment Positive (+) |
| Anemia | + on risk screening questions | Hematocrit or hemoglobin |
| Blood Pressure | Children with specific risk conditions or change in risk | Blood pressure measurement |
| Hearing | + on risk screening questions | Referral for diagnostic audiologic assessment |
| Oral Health | Does not have a dental home | Referral to dental home or, if not available, oral health risk assessment |
| Primary water source is deficient in fluoride. | Oral fluoride supplementation | |
| Vision | + on risk screening questions | Ophthalmology referral |
Table Retrieved from: https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_EarlyChildhoodVisits.pdf
Immunizations
Recommended immunization schedule for children 18 years or younger:
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.
Encourage free play for up to 60 minutes a day. Check out the NFL Play 60 http://www.nfl.com/play60 nflrush.com Discuss age appropriate play.
Establish limits for media. The AAP recommends limiting television or digital media to one hour of high quality programming. Discuss importance of appropriateness.
Parent Resources:
Reference: American Academy of Pediatrics (2016, October 11). Dr. Ari Brown Offers Tips for Parents on Children and Media Use [Video File]. Retrieved from https://youtu.be/NJYUVyYMeEM
Create your personalized family media use plan: www.HealthyChildren.org/MediaUsePlan
Image from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/pages/media-and-children.aspx
Safety
- Assess safety, such as childproofing the home, car seat, close supervision, remove/lock guns with ammunition locked separately. Children should not sit in the front seat until 13 years of age.
- Make sure parents have the telephone number for the national poison help line 800-222-1222. Call the number immediately. Do NOT make the child vom
