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

Universal Screening	Action
Anemia	Hematocrit or hemoglobin
Lead (high prevalence area or insured by Medicaid)	Lead blood test
Oral Health (in the absence of a dental home)	Apply fluoride varnish after the first tooth eruption and every 6 months

 

Selective Screening	Risk Assessment*	Action if Risk Assessment Positive (+)
Blood Pressure	Children with specific risk Conditions or changes in risk	Blood pressure measurement
Hearing	+on risk screening questions
Lead (low prevalence area and not insured by Medicaid)	+on risk screening questions
Oral Health	Does not have a dental home The primary water source is deficient in fluoride.	Referral to dental home or, if not available, oral health risk assessment Oral fluoride supplementation
Tuberculosis	+on risk screening questions	Tuberculin skin test
Vision	+on risk screening questions	Ophthalmology referral

Immunizations

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 living situation, food security, tobacco, alcohol, and drugs in the household

Establish Routines for bedtime, family time, nap time, media

Dental

• Visit the dentist by 12 months or after first tooth, brush teeth.
• Only water in their bottle.
• Assess type of water the child drinks, is it fluoridated?
• Avoid sugary beverages and foods, such as candy, yogurt snacks, and fruit-flavored drinks.

Safety

• Assess safety, such as childproofing the home, car seat, close supervision, remove/lock guns with ammunition locked separately.
• The child is mobile now. Discuss dangers in the home, such as window blind cords, hot water temperature, heaters, medications, laundry products, and cleaning supplies.
• Review water dangers near or in the home. Children can drown in small amounts of water, including toilets. Drowning does not take very long, never leave a child alone around water.
• Encourage sunscreen when child is playing outside.