Chapter 13 Essentials of the Pediatric Well Child Visit

There are multiple components of the pediatric well child visit that provide an overall snapshot of the child’s well-being and an opportunity to identify concerns. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, published by the American Academy of Pediatrics (AAP) describes four activities in the health supervision visit: disease detection, disease prevention, health promotion, and anticipatory guidance. The Bright Futures model is centered on a strength-based approach whose goal is to identify and build on the strengths in each family. It is important for the pediatrician to realize that often everything cannot be addressed in a single encounter. The allotted time for the visit is about 20 minutes. A key to effectiveness is to assess the family situation, know your patient, and target what will be most useful to them. The frequency of well visits in the first 2 years of life provides an opportunity to assess and address nonemergent issues over time. Parental concerns should be elicited and addressed, and the parental-child interaction should be observed at each visit. Other priorities will be specific to the child’s age and expected developmental milestones. With older children, school performance should be discussed.

During each well visit encounter growth, development, and sensory functions (hearing and vision) are assessed, and immunizations are administered according to the AAP recommended schedule. A complete physical examination is recommended. Growth charts and the 2011 recommended immunization schedule are included at the end of this chapter (Figures 13-1 to 13-9). When assessing development, it is important to understand there is a range of normal for attainment of each milestone. Development may occur in spurts separated by plateaus, rather than follow a smooth trajectory. Also, the rate of development in an otherwise normal child can sometimes be impacted and slowed significantly by a major acute illness, a chronic health condition, or major surgery.

Figure 13-1 Length and weight for girls, from birth to age 36 months.

Figure 13-2 Head circumference and length-to-weight ratio for girls, from birth to age 36 months.