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Chapter 1 Index
A. General Information
about the well child examination
--Prenatal Visit |
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Well Child Check-Up:
Its Importance in Pediatrics
Philosophy of having pediatricians doing well check-ups:
The time spent doing well check-ups is important in getting to know children
and families. A bond is created during these interactions that usually
results in trust. Later, when children are ill, this trust is important to
both the doctor and family. Creative ways of performing well check-ups
exist; for instance, some people have group well check-ups where physicals
are done in the office, and then questions and answers are done with as many
as 10-15 sets of parents asking questions at the same time. This method is
a practical, timesaving method of doing the check-up; you will have to
decide for yourself if this way would be as satisfying for you.
Managed care companies often prefer for nurse practitioners, or nurse
specialists to do the check-ups since they would cost the companies less.
While an occasional visit with the nurse practitioner would be reasonable,
again the issue of the development of trust between doctor and patient gets
raised. There is no question that having ancillary people do well check-ups
is timesaving for the doctor, but trust in the doctor is hard to achieve
with this approach.
When to do well check-ups: The Academy of Pediatrics now
recommends doing check-ups at the following times: several days of age (if
early discharge), 2-4 weeks of age, 2 months, 4 months, 6 months, 9 months,
12 months, 15 months, 18 months, 2 years, 3 years, 4-5 years, 5-6 years and
every other year thereafter.
Benefits of the well child check-up: Parents can be
reassured about growth and development; doctors can make an impact on
anticipatory guidance issues such as smoking, car seats, ipecac, etc.;
immunizations can be kept current. (See
appendix for examples of what might be asked at each physical exam.)
General Issues to concentrate on at different check-ups (in
addition to immunizations)
| Age of check-up |
What to emphasize during the check-up |
| 2-4 weeks |
Sleep position; car seats; smoking; feeding issues;
reassure! |
| 2 months |
Sleep position, feeding, sleeping, smoking, car seats |
| 4 months |
Food: may start cereal, stage 1 - minimize juices |
| 6 months |
Stage 2 foods; minimize salt, sugar; ipecac; choking on
food |
| 9 months |
Table food; what to avoid; start cup; ipecac; car seats;
poisons |
| 12 months |
Daycare issues; food; sleep (Ferber); behavioral issues |
| 15 months |
Words, interactions, social awareness; start spoon; stop
bottle |
| 18 months |
Spoon, fork; words; behavioral; sleep; social issues |
| 24 months |
Sentences; interactive; toilet training; illness
frequency |
| 36 months |
Daycare - preschool; go to dentist (some go earlier;
peer group |
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