services

Well Child Checks

Newborn (Birth - 2 months)

First Visit: 3-5 days

Height, weight, head circumference
Assessment of feeding - type, amount, frequency
Assessment of behavior and development
Physical exam
Bilirubin monitoring (if indicated)
Hearing screen (if not previously done)
Vaccines: Hepatitis B (if not previously given)
Anticipatory guidance

Two Month Visit

Height, weight, head circumference

Assessment of feeding - type, amount, frequency

If breastfeeding: Provide 8 to 12 feedings in 24 hours. Give baby vitamin D (400 IU per day). Mothers should continue prenatal vitamin with iron.
If formula feeding: Prepare/store formula safely; feed 6 to 8 times in 24 hours; 26 to 28 oz formula total; hold baby semi-upright; don’t prop bottle

Assessment of behavior and development

Social Language and Self-help – Smiles responsively; makes sounds that show happiness/upset
Verbal Language (Expressive and Receptive) – Makes short cooing sounds
Gross Motor – Lifts head and chest when on stomach – Keeps head steady when held in a sitting position
Fine Motor – Opens and shuts hands; briefly brings hands together

Physical exam

Vaccines: Dtap, IPV, Hib, Hep B, PCV20, Rota

Anticipatory Guidance

Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
Handle unwanted advice by acknowledging, then changing, subject.
Take time for self, partner. Maintain social contacts.
Choose quality child care; recognize that separation is hard.
Have postpartum checkup; talk with partner about family planning.
Anxiety, depression are common after birth; getting enough sleep/physical activity and eating healthy helps. Talk with me if feelings last more than 2 days.
Spend time with your other children; engage them in care of baby if appropriate.
Hold, cuddle, talk, sing to baby.
Learn baby’s temperament, personality.
Pay attention to baby’s cues for sleep; develop schedule for naps and nighttime sleep. Put baby to bed awake but drowsy.
Avoid TV and other digital media with baby.
Use “tummy time” when awake.
Calm baby by stroking head, gentle rocking, walking with baby in stroller.
Never hit or shake baby.
Expect 6 to 8 wet cloth diapers per day or 5 to 6 wet disposable diapers, 3 to 4 stools per day; no extra fluids; burp baby at natural breaks in feeding.
Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air bag. Keep baby in car safety seat at all times during travel.
Use seat belt; don’t drive after using alcohol or drugs.
Put baby to sleep on back; choose crib with slats less than 2⅜" apart; don’t use loose, soft bedding; have baby sleep in your room in own crib.
Don’t drink hot liquids while holding baby; set home water temperature less than 120°F.
Don’t leave baby alone in tub, high places (changing tables, beds, sofas); keep hand on baby (“touch supervision”).

Infancy (4 months - 1 year)

4 month Visit

Height, weight, head circumference
Assessment of feeding - type, amount, frequency

If breastfeeding: Recognize growth spurts. Give baby vitamin D (400 IU per day).
If formula feeding: Prepare/store formula safely; 8 to 12 times in 24 hours; 30 to 32 oz total; hold baby semi-upright

Assessment of behavior and development

Social Language and Self-help – Laughs aloud – Looks for parent or another caregiver when upset
Verbal Language (Expressive and Receptive) – Turns to voices – Makes extended cooing sounds
Gross Motor – Supports self on elbows and wrists when on stomach – Rolls over from stomach to back
Fine Motor – Keeps hands unfisted; plays with fingers in midline; grasps object

Physical exam

Vaccines: Dtap, IPV, Hib, Hep B, PCV20, Rota

Anticipatory Guidance

Maintain social contacts; make time for self, partner; spend time with your other children.
Make quality child care arrangements.
Continue calming strategies when baby is fussy.
Spend time talking/playing with baby.
Create daily routine for feeding/naps/bedtime.
Avoid TV and other digital media with baby.
Use quiet (reading, singing) and active (“tummy time”) playtime; provide safe opportunities to explore.
Don’t share spoons; don’t clean pacifier in your mouth; maintain good dental hygiene.
Use cold teething ring to relieve teething pain.
Don’t put baby in crib with a bottle; never prop bottle when feeding.
Clean gums 2 times per day; use soft cloth/ toothbrush with tap water
Exclusive breastfeeding for about the first 6 months is ideal; iron-fortified formula is recommended substitute.
Delay solid foods until baby is 6 months old
Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air bag. Keep baby in car safety seat at all times during travel.
Use seat belt; don’t drive under the influence of alcohol or drugs.
Put baby to sleep on back; choose crib with slats less than 2⅜" apart; don’t use loose, soft bedding.
Avoid burn risk while holding baby (drinking hot liquids, cooking, ironing, smoking); set home water temperature less than 120°F.
Don’t leave baby alone in tub, high places (changing tables, beds, sofas); keep hand on baby (“touch supervision”).
Keep small objects, plastic bags away from baby. Avoid infant walkers.

6 month Visit

Height, weight, head circumference
Assessment of feeding - type, amount, frequency

Exclusive breastfeeding for about the first 6 months, then breast milk and solid foods from about 6 to 12 months, is ideal; iron-fortified formula is recommended substitute
If breastfeeding: Continue as long as mutually desired. Continue vitamin D/iron supplementation.
If formula feeding: Don’t switch to milk. Contact WIC/community resources for help.
Determine whether baby is ready for solids; introduce single-ingredient foods one at a time; provide iron-rich foods; respond to hunger, fullness cues. https://downloads.aap.org/AAP/PDF/AAP-SolidFoods-2017-08-22-WEB.png
Position baby for feeding so you can see/talk to each other.

Assessment of behavior and development

Social Language and Self-help – Pats or smiles at own reflection – Looks when name is called
Verbal Language (Expressive and Receptive) – Babbles; makes sounds like “ga,” “ma,” or “ba”
Gross Motor – Rolls over from back to stomach – Sits briefly without support
Fine Motor – Passes a toy from one hand to another – Rakes small objects with 4 fingers – Bangs small objects on surface

Physical exam

Vaccines: Dtap, IPV, Hib, Hep B, PCV20,

Anticipatory Guidance

Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
Ask for help if you feel depressed, overwhelmed.
Depend on your social network.
Choose trusted, responsible child care provider.
Use high chair/upright seat so baby can see you.
Engage in interactive, reciprocal play. Talk/sing/ read to, play games with baby.
Avoid TV and other digital media with baby.
Continue regular daily routines; put baby to bed awake but drowsy.
Continue calming strategies when baby is fussy.
Clean teeth/gums 2 times per day with soft cloth/ toothbrush and small smear of fluoridated toothpaste (no more than a grain of rice).
Don’t prop bottle or use bottle in bed.
Avoid baby foods/juices that baby sucks out of bag or pouch.
Don’t share spoons; don’t clean pacifier in your mouth.
Wash vegetables and fruits before serving; limit juice to 2 to 4 oz per day.
Use rear-facing car safety seat in backseat; never put baby in front seat of vehicle with passenger air bag.
Infants who reach maximum height/weight allowed by their rear-facing–only car safety seat should use a convertible or 3-in-1 seat approved for use rear facing to higher weights/heights (up to 50 lb and 49 in).
Put baby to sleep on back; choose crib with slats less than 2⅜" apart; don’t use loose, soft bedding; lower crib mattress; never leave baby in crib with drop side down; choose mesh playpen with weave less than ¼".
Do home safety check (stair gates, barriers around space heaters, cleaning products).
Don’t leave baby alone in tub, high places (changing tables, beds, sofas).
Keep household products (cleaners, medicines) locked and out of baby’s sight. Put Poison Help number (800-222-1222) at all telephones, including cell.
Keep baby in high chair/playpen when in kitchen.
Avoid burn risk (drinking hot liquids, cooking, ironing, smoking); set home water temperature less than 120°F.
Keep small objects, all plastic bags away from baby.
To prevent choking, limit finger foods to soft bits.
Avoid sun exposure; use hat/infant sunscreen.

9 month Visit

Height, weight, head circumference
Assessment of feeding - type, amount, frequency

Continue breastfeeding on demand if mutually desired. Continue 400 IU Vitamin D supplementation as long as you are breastfeeding or 6400 IU for Mom.
If formula feeding, offer 3-4 bottles/day, 6-8 ounces/bottle of iron fortified infant formula.
Gradually increase table foods; ensure variety of foods, textures.
Provide 3 meals and 2 to 3 snacks a day.
Encourage use of cup

Assessment of behavior including ASQ3-9 Months

Social Language and Self-help – Uses basic gestures (holding arms out to be picked up, waving bye-bye) – Looks for dropped objects; plays game like peekaboo and pat-a-cake – Turns consistently when name called
Verbal Language (Expressive and Receptive) – Says “Dada” or “Mama” nonspecifically – Looks around when hearing things like “Where’s your bottle?” or “Where’s your blanket?” – Copies sounds that parent makes
Gross Motor – Sits well without support – Pulls to stand; transitions well between sitting and lying – Crawls on hands and knees
Fine Motor – Picks up food to eat; picks up small objects with 3 fingers and thumb – Lets go of objects intentionally; bangs objects together

Physical exam

Vaccines: Flu vaccine, RSV vaccine (seasonal)

Anticipatory Guidance

Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
Make time for self, partner; maintain social contacts.
Keep consistent daily routines.
Provide opportunities for safe exploration; be realistic about abilities.
Recognize new social skills, separation anxiety; be sensitive to temperament.
Play with cause-and-effect toys; talk/sing/read together; respond to baby’s cues.
Avoid TV, videos, computers; consider making a family media use plan (www.healthychildren. org/MediaUsePlan).
Use consistent, positive discipline (limit use of the word no, use distraction, be a role model).

Use rear-facing car safety seat in backseat until child is at least 2 years old; never put baby in front seat of vehicle with passenger air bag.
Use seat belt; don’t drive under the influence of alcohol or drugs.
Avoid heatstroke; never leave baby in car alone.
Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
Do home safety check (stair gates, barriers around space heaters, cleaning products, electric cords).
Don’t leave heavy objects, hot liquids on tablecloths.
Put Poison Help number (800-222-1222) at each telephone, including cell.
Use “touch supervision” near water, pools, bathtubs.
Install operable window guards

12 month Visit

Height, weight, head circumference
Assessment of feeding - type, amount, frequency

If breastfeeding, continue to nurse on demand and offer 400 IU of Vitamin D/ day or 6400 IU/day for Mom
May transition to whole or plant based milk, offer milk with meals and/or snacks, 24 ounces/day.
May drink water in addition to milk. Avoid juice and other sugar sweetened beverages.
Encourage self-feeding; avoid small, hard foods.
Provide healthy food and snacks; be sure caregivers do the same.
Feed 3 meals and 2 to 3 snacks a day. Toddlers tend to graze. Trust child to decide how much to eat.
Sit together as a family to eat meals

Assessment of behavior and development

Social Language and Self-help – Looks for hidden objects – Imitates new gestures
Verbal Language (Expressive and Receptive) – Uses Dada or Mama specifically – Uses 1 word other than Mama, Dada, or personal names – Follows directions with gestures, such as motioning and saying, “Give me (object).”
Gross Motor – Takes first independent steps – Stands without support
Fine Motor – Drops an object in a cup – Picks up small object with 2-finger pincer grasp – Picks up food to eat

Physical exam
Vision Screen
Lead level and Hemoglobin level screening
Fluoride varnish (if teeth present)
Vaccines: MMR, Varicella, Hep A

Anticipatory Guidance

Visit the dentist by the time child is 12 months old or after first tooth erupts.
Brush child’s teeth twice a day with small (grain of rice sized) smear of fluoridated toothpaste, soft toothbrush.
If child is still using bottle, offer only water. Avoid added sugars.
Use rear-facing car safety seat until child is highest weight or height allowed by manufacturer and until at least 2 years of age; make necessary changes when switching seat to forward facing; never place vehicle safety seat in front seat of car with passenger air bag; backseat safest.
Use stair gates; keep furniture away from windows; install window guards.
Stay within an arm’s reach when near water (“touch supervision”); empty buckets, pools, bathtubs immediately after use.
Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
Keep child away from pet feeding area; monitor interactions between child and pet.
Remove/lock up poisons/toxic household products; keep Poison Help number (800-222- 1222) at each telephone, including cell.

Toddler (15 months - 3 years)

15 month Visit

Height, weight, head circumference
Assessment of feeding - type, amount, frequency

https://downloads.aap.org/AAP/PDF/PickyEaters_Infographic.png

Assessment of behavior and development

Social Language and Self-help – Imitates scribbling – Drinks from cup with little spilling – Points to ask for something, get help – Looks around after hearing things like “Where’s your ball?” or “Where’s your blanket?”
Verbal Language (Expressive and Receptive) – Uses 3 words other than names – Speaks in sounds like an unknown language – Follows directions that do not include a gesture
Gross Motor – Squats to pick up objects – Crawls up a few steps – Runs
Fine Motor – Makes marks with crayon – Drops object in, takes object out from container

Physical exam
Fluoride varnish
Vaccines: PCV20, Hib,

Anticipatory Guidance

When possible, allow child to choose between 2 options acceptable to you.
Stranger anxiety and separation anxiety reflect new cognitive gains; speak reassuringly.
Take time for self, partner. Seek support from other parents.
Use simple, clear words and phrases to promote language development and improve communication.
Maintain consistent bedtime and nighttime routine; tuck in when drowsy but still awake.
If night waking occurs, reassure briefly; give stuffed animal or blanket for self-consolation.
Don’t give bottle in bed. Don’t put TV/computer/ digital device in child’s bedroom.
Modify child’s environment to avoid conflict/ tantrums. Use distractions; accept messiness; allow child to choose (when appropriate).
Praise good behavior and accomplishments.
Use discipline for teaching/protecting, not punishing. Use time-outs to avoid negative attention.
Teach child not to hit, bite, use aggressive behavior. Model this yourself.
Schedule first dental visit if child hasn’t seen dentist yet.
Brush teeth twice a day with small smear of fluoridated toothpaste, soft toothbrush.
Prevent tooth decay by good family oral health habits (brushing, flossing), not sharing utensils or cup.
If child uses nighttime bottle, use water only.
Use rear-facing car safety seat until child is highest weight or height allowed by manufacturer and minimum 2 years old; make necessary changes when switching seat to forward facing; never place vehicle safety seat in front seat of car with passenger air bag; backseat safest.
Make sure everyone uses a seat belt.
Remove poisons/toxic household products; keep Poison Help number (800-222-1222) at every phone, including cell; use stair gates; keep furniture away from windows; install window guards.
Install smoke detector on every level; test monthly/change batteries annually; make fire escape plan; set home hot water less than 120°F.

18 month Visit

Height, weight, head circumference
Assessment of feeding - type, amount, frequency

https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-One-Year-Old.aspx

Assessment of behavior and development including MCHAT screen for autism and ASQ3-18 months

Social Language and Self-help – Engages with others for play – Helps dress and undress self – Points to pictures in book, to object of interest to draw parent’s attention to it – Turns, looks at adult if something new happens – Begins to scoop with spoon – Uses words to ask for help
Verbal Language (Expressive and Receptive) – Identifies at least 2 body parts – Names at least 5 familiar objects
Gross Motor – Walks up steps with 2 feet per step with hand held – Sits in small chair – Carries toy while walking
Fine Motor – Scribbles spontaneously – Throws small ball a few feet while standing

Physical exam
Fluoride varnish

Vaccines: Hep A, DTap

Anticipatory Guidance

Anticipate anxiety/clinging in new situations.
Spend time with child each day; plan ahead for difficult situations, and try new things to make them easier.
Be consistent with discipline/enforcing limits.
Wait until child is ready for toilet training (dry for periods of about 2 hours, knows wet and dry, can pull pants up/down, can indicate bowel movement).
Read books about using the potty; praise attempts to sit on the potty.
Prepare toddler for new sibling by reading books; avoid new developmental demands on toddler; take action to ensure own health.
Encourage language development by reading and singing; talk about what you see.
Use words that describe feelings and emotions to help child learn about feelings.
Use simple language to give your child instructions.
Make time for technology-free play every day; use consistent bedtime routine of reading/songs, not media.
Use methods other than TV or other digital media for calming (distraction, removal from trigger, going outside, addressing hunger/tiredness).
If you choose to introduce media now, choose high-quality programs/apps and use them together; limit viewing to less than 1 hour per day; be aware of own media use habits; discuss family media use plan (www.healthychildren.org/MediaUsePlan); avoid TV during meals.
Offer variety of healthy foods/snacks, especially vegetables/fruits/lean protein.
Provide 1 bigger meal, multiple small meals/snacks; trust child to decide how much to eat.
Provide 16 to 24 oz milk
Juice is not a necessary drink. If you choose to give juice, limit to 4 oz daily and always serve it with a meal.
Continue to offer new foods; let toddler experiment by touching and mouthing.
Use rear-facing car safety seat until child is highest weight or height allowed by manufacturer and until at least 2 years old; make necessary changes when switching seat to forward facing; never place car safety seat in front seat of vehicle with passenger air bag; backseat is safest.
Make sure everyone uses a seat belt.
Remove/lock up poisons/toxic household products; keep Poison Help number (800-222-1222) at each telephone, including cell.
Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
Childproof home (medications, cleaning supplies, heaters, dangling cords, small/sharp objects, plastic bags); keep child away from heavy/hot objects.
Install smoke detector on every level; test monthly; change batteries annually; fire escape plan; keep child out of driveway when cars moving.

2 year Visit

Height, weight, head circumference, BMI
Assessment of feeding - type, amount, frequency

https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Selecting-Snacks-for-Toddlers.aspx

Assessment of behavior and development

Social Language and Self-help – Plays alongside other children (ie, parallel play) – Takes off some clothing – Scoops well with spoon
Verbal Language (Expressive and Receptive) – Uses 50 words; combines 2 words into short phrase or sentence – Follows 2-step command – Names at least 5 body parts – Speaks in words that are 50% understandable to strangers
Gross Motor – Kicks a ball – Jumps off the ground with 2 feet – Runs with coordination – Climbs up a ladder at a playground
Fine Motor – Stacks objects; turns book pages – Uses hands to turn objects like knobs, toys, lids – Draws lines

Physical exam
Vision screen
Lead and Hemoglobin screening
Fluoride Varnish
Vaccines: flu vaccine (seasonal)

Anticipatory Guidance

Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
Community agencies can help you with concerns about your living situation.
Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
Take care of self; maintain social contacts.
Create opportunities for family time.
Spend time with each child; resolve sibling conflict without taking sides.
Do not allow hitting, biting, aggressive behavior. Model this yourself.
Praise good behavior and accomplishments; listen to and respect your child.
Help child express feelings like joy, anger, sadness, frustration.
Encourage self-expression.
Learn child’s way of reacting to people/situations.
Encourage free play for up to 60 minutes per day; give child age-appropriate play equipment.
Make time for learning through reading, talking, singing, exploring environment, not screens.
Limit TV and other digital media to no more than 1 hour of quality programming per day; avoid TV during meals.
Model appropriate language.
Should be able to follow simple 1- or 2-step commands.
Read/look at books together every day; child may want same story over and over.
Begin toilet-training when child is ready (dry for periods of 2 hours, knows wet and dry, can pull pants up/down, can indicate bowel movement).
Plan for frequent toilet breaks (up to 10 times a day).
Teach to wash hands.
Be sure car safety seat is installed properly in backseat. Harness straps should be snug.
Make sure everyone else uses a seat belt.
Supervise child outside, especially around cars, around machinery, in streets.
Use bike helmet.
Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately

30 month Visit

Height, weight, BMI
Assessment of feeding - type, amount, frequency

Assessment of behavior and development including ASQ3-30 month

Social Language and Self-help – Urinates in a potty or toilet – Spears food with fork – Washes and dries hands – Increasingly engages in imaginary play – Tries to get parent to watch by saying, “Look at me!”
Verbal Language (Expressive and Receptive) – Uses pronouns correctly
Gross Motor – Walks up steps, alternating feet – Runs well without falling
Fine Motor – Copies a vertical line; grasps crayon with thumb and fingers instead of fist – Catches large balls

Physical exam

Vaccines: flu vaccine (seasonal)

Anticipatory Guidance

Maintain regular family routines (meals, quiet bedtime).
Encourage family exercise; take advantages of museums, zoos. Tell me how you have fun with your family.
Maintain social contacts; do things outside the family.
Reach agreement with all family members on how best to support child’s emerging independence while maintaining consistent limits.
Read together every day; go to the library.
Listen when child speaks; repeat, using correct grammar.
Encourage play with other children, but supervise because child not ready yet to share/play cooperatively.
Build independence by offering choices between 2 acceptable alternatives.
Limit TV and digital media to no more than 1 hour a day; monitor what child watches.
Consider group child care, preschool program, organized playdates or playgroups.
Encourage toilet training success by dressing child in easy-to-remove clothes; establish daily routine; place on potty every 1 to 2 hours; praise; provide relaxed environment by reading/singing.
Be sure car safety seat is installed properly in backseat. Harness straps should be snug.
Make sure everyone else uses seat belt.
Supervise child outside, especially around cars, machinery, dogs.
Provide “touch supervision” near water, bathtubs, pools, toilet.
Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
Install smoke detectors on every level; test monthly; change batteries annually; fire escape plan; keep matches/hot objects out of sight/away from child.

3 year Visit

Height, weight, BMI
Blood pressure
Assessment of feeding - type, amount, frequency

https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-Three-Year-Old.aspx

Assessment of behavior and development

Social Language and Self-help – Enters bathroom and urinates by herself – Puts on coat, jacket, or shirt by herself – Eats independently – Engages in imaginative play – Plays in cooperation and shares
Verbal Language (Expressive and Receptive) – Uses 3-word sentences – Speaks in words that are 75% understandable to strangers – Tells you a story from a book or TV – Compares things using words like bigger or shorter – Understands simple prepositions, such as on or under
Gross Motor – Pedals a tricycle – Climbs on and off couch or chair – Jumps forward
Fine Motor – Draws a single circle – Draws a person with head and 1 other body part – Cuts with child scissors

Physical exam
Vision screening
Fluoride varnish
Vaccines: flu vaccine (seasonal)

Anticipatory Guidance

Community agencies can help you with concerns about your living situation.
Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
Show affection in family; handle anger constructively; give child opportunities to make choices.
Take time for self, partner; create opportunities for family to spend time with the child. Playing with siblings and peers: Play opportunities and interactive games, sibling relationships
Encourage play with appropriate toys and safe exploration; expect fantasy play. Tell me about your child’s typical play.
Encourage interactive games with peers; explain importance of taking turns.
Help your children develop good relations with each other.
Read, sing, play rhyme games together; let child “tell” story; practice reading wherever you go.
Encourage child to talk about friends, experiences.
Always have cool water available.
Provide 16 to 24 oz low-fat/fat-free milk daily.
Juice is not a necessary drink. If you choose to give juice, limit to 4 oz daily and always serve it with a meal.
Offer variety of healthy foods/snacks, especially vegetables, fruits, lean protein.
Trust child to decide how much to eat.
Encourage opportunities for physical activity for child, family.
Limit TV and other digital media to no more than 1 hour a day; monitor what child watches; consider making a family media use plan (www.healthychildren.org/MediaUsePlan).
Continue to use properly installed, size appropriate rear-facing or forward-facing car safety seat with 5-point harness. Keep car safety seat in the backseat.
Prevent choking by cutting food into small pieces.
Supervise all play near streets/driveways; don’t allow child to cross street alone.
Move furniture away from windows; install operable window guards.
Provide “touch supervision” near water, bathtubs, pools, toilet.
Teach child about safety around pets.
Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately; ask if firearms in other homes where child plays; if so, ensure same safety precautions are used before letting child play there.

Preschool Years (4 years - 5 years)

4 year old visit

Height, weight, BMI
Blood Pressure

Assessment of feeding - type, amount, frequency

https://www.healthychildren.org/English/ages-stages/preschool/nutrition-fitness/Pages/Feeding-and-Nutrition-Your-4-to-5-Year-Old.aspx

Assessment of behavior and development

Social Language and Self-help – Enters bathroom and has bowel movement by himself – Brushes teeth – Dresses and undresses without much help – Engages in well-developed imaginative play
Verbal Language (Expressive and Receptive) – Answers questions like “What do you do when you are cold?” or “…when you are sleepy?” – Uses 4-word sentences – Speaks in words that are 100% understandable to strangers – Draws recognizable pictures – Follows simple rules when playing board/ card games – Tells parent a story from book
Gross Motor – Skips on 1 foot – Climbs stairs, alternating feet without support
Fine Motor – Draws a person with at least 3 body parts – Draws simple cross – Unbuttons and buttons medium-sized buttons – Grasps p

Physical exam
Hearing and vision screening
Fluoride varnish
Vaccines: MMR, Varicella, Dtap, IPV

Anticipatory Guidance

Community agencies can help you with concerns about your living situation.
Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
Teach your child rules for how to be safe with adults: (1) no adult should tell a child to keep secrets from parents; (2) no adult should express interest in private parts; (3) no adult should ask a child for help with his/her private parts.
Maintain or expand participation in community activities.
Always have cool water available.
Provide 16 to 24 oz low-fat/fat-free milk daily.
Juice is not a necessary drink. If you choose to give juice, limit to 4 oz daily and always serve it with a meal.
Offer variety of healthy foods/snacks, especially vegetables, fruits, lean protein.
Trust child to decide how much to eat.
Create calm bedtime ritual; enjoy mealtimes without TV; ensure child brushes teeth twice a day with pea-sized fluoridated toothpaste.
Give child time to finish sentences; encourage speaking skills by reading/talking together. Keep answers short and simple.
Read together daily; ask child questions about the stories.
Children are very sensitive, either easily encouraged or hurt; model respectful behavior and apologize if wrong; praise when demonstrates sensitivity to feelings of others.
Provide opportunities for your child to play with other children.
Visit your child’s preschool/child care program; become actively involved; talk with your child about what she’s learning.
Limit TV and video to no more than 1 hour a day; no TV in bedroom; supervise any Internet use; consider making a family media use plan (www.healthychildren.org/MediaUsePlan).
Make opportunities for daily play; be physically active as a family.
Continue to use a size-appropriate forward facing car safety seat installed in backseat.
Supervise all outdoor play; never leave child alone; don’t allow to cross street alone.
Be sure swimming pools are fenced; use life jacket; teach child to swim. ■ Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
Teach child about safety around pets.
Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately. Ask if firearms in other homes where child plays; if so, ensure same safety precautions before letting child play there.

5 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance/readiness
Physical exam
Hearing and vision screening
Fluoride varnish
Vaccines: flu vaccine (seasonal)
Anticipatory guidance

Grade School (6 years - 12 years)

6 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Hearing and vision screening
Fluoride varnish
Vaccines: flu vaccine (seasonal)
Anticipatory guidance

7 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Fluoride varnish
Vaccines: flu vaccine (seasonal)
Anticipatory guidance

8 year old visit

9 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Fluoride varnish
Vaccines: flu vaccine (seasonal)
Anticipatory guidance

10 year old visit

11 year old visit

Height, weight, BMI
Blood pressure
Lipid screening
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Vaccines: HPV, Tdap, Meningitis
Anticipatory guidance

Teen Years (12 years - 17 years)

12 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Vision Screening
Mental Health Screening with PHQ-9
Vaccines: HPV, Tdap, Meningitis (if not previously given)
Anticipatory guidance

13 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Hearing screen
Mental health screening with PHQ-9
Vaccines: HPV, Tdap, Meningitis (if not previously given
Anticipatory guidance

14 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Mental health screening with PHQ-9
Vaccines: HPV, Tdap, Meningitis (if not previously given
Anticipatory guidance

15 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Vision screening
Sexually transmitted infection screening on urine (when appropriate based on patient risk)
Mental health screening with PHQ-9
Vaccines: HPV, Tdap, Meningitis (if not previously given
Anticipatory guidance

16 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Hearing screen
Sexually transmitted infection screening on urine (when appropriate based on patient risk)
Mental health screening with PHQ-9
Vaccines: HPV, Tdap, Meningitis (if not previously given
Anticipatory guidance

17 year old visit

Height, weight, BMI
Blood pressure
Assessment of diet
Assessment of behavior and development, school performance
Physical exam
Sexually transmitted infection screening on urine (when appropriate based on patient risk)
HIV screen (recommended for all adolescents once between ages 15-21 yo)
Mental health screening with PHQ-9
Vaccines: HPV, Tdap, Meningitis (if not previously given
Anticipatory guidance

Emerging Adults (18 years - 21 years)

Call today to schedule an appointment with Dr. Johnston

Become a patient

services

Well Child Checks

Newborn (Birth - 2 months)

Infancy (4 months - 1 year)

Toddler (15 months - 3 years)

Preschool Years (4 years - 5 years)

Grade School (6 years - 12 years)

Teen Years (12 years - 17 years)

Emerging Adults (18 years - 21 years)

Call today to schedule an appointment with Dr. Johnston

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