OBJECTIVE DATA [3 YEAR]

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 3-year visit:

  • child can be measured standing then calculate body mass index (BMI).   Remember, BMI = kg/m2.
  • blood pressure should be measured.

BMI for age percentiles, Boys 2-20 years growth chart [PDF]

BMI for age percentiles, Girls 2-20 years growth chart [PDF]

BMI Calculator with phone app available [WEB Link]

Screening

Universal Screening Action
Vision Objective measure with age-appropriate visual acuity measurement using HOTV or LEA symbols. Instrument-based measurement may be used for children who are unable to perform acuity testing.
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
Hearing + on risk screening questions Referral for diagnostic audiologic assessment
Lead If no previous screen and + on risk screening questions or change in risk Lead blood test
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
Tuberculosis + on risk screening questions Tuberculin skin test

*See the Evidence and Rationale chapter for the criteria on which risk screening questions are based.

Immunizations

From CDC National Immunization Program

Anticipatory Guidance from Bright Futures

Review the priorities listed at 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 Risks:

  1. Living Situation and Food Security
  2. Risks:   Tobacco, Alcohol, and Drugs

Resource:

  • 800-QUIT-HOW (800-784-8669); TTY (800-332-8615 is a national telephone helpline that is routed to local resources.
  • typical play
  • interaction with other children
  • sharing

Play with Siblings and Peers

Assess play:

Nutrition and Physical Activity

  • Recommend 16 to 24 ounces of low-fat or fat-free milk or fortified soy beverage each day.
  • Juice is not a necessary drink, limit to 4 ounces daily and always serve with a meal.
  • Offer a variety of foods.
  • Children at this age usually eat one larger meal and multiple smaller meals and snacks.
  • Limits screen time to no more than 1 hour a day.   Try to watch TV together and make it interactive.

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 helpline 800-222-1222.   Call the number immediately.   Do NOT make the child vomit.
  • High risk foods, such as hot dogs and grapes should be cut into smaller pieces.   Avoid large masses, such as a big scoop of peanut butter, large marshmallows, and chewing gum.

 

Reference: Bright Futures

https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_EarlyChildhoodVisits.pdf

 

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