Why are Physicals Important!?

Development Surveillance
Detect and prevent developmental delays and possible diseases so they can be treated early

Measurements 
Both growing too slowly or too fast may indicate a nutritional or other health problem.

Screenings

   – Lead 
     Toxic Lead Levels cause behavioral and learning difficulties, anemia, seizures, and other medical problems. 

   – Vision 
     Performing well at school can be very difficult if a child has vision problems.

   – Blood Pressure / Hypertension  
     Reducing blood pressure during childhood and adolescence will result in a reduced risk of heart disease and death in adulthood.

   – Oral Health
     A dental sealant or a topical fluoride is crucial in preventing tooth decay

Vaccinations
Keeps you from getting and spreading the diseases such as Measles or polio, which cause life-altering changes or death. 

Behavioral Assessment
Mental health problems affect about 1 in 10 children and young people; they include depression, anxiety, and conduct disorder. 

Anticipatory Guidance 
A crucial part of pediatric care has been shown to reduce caregiver anxiety and ER/Urgent Care Visits.

Get access to community resources
Having access to resources such as food banks, shelters, mental or behavioral health experts, etc.

What to expect during a 12-Month-Old Physical

DEVELOPMENTAL SURVEILLANCE

  • Social Language and Self-Help
    • Looks for hidden objects
    • Imitates new gestures
  • Verbal Language
    • Uses Dada or Mama specifically
    • Also uses 1 other word
    • Follows directions with gestures
  • Gross Motor
    • Takes first independent steps
    • Stands without support
  • Fine Motor
    • Drops an object in a cup
    • Picks up small objects with 2 fingers
    • Picks up food to eat

BEHAVIORAL HEALTH

  • 3Developmental Screening
  • 4Psychosocial/Behavioral Assessment

5PHYSICAL EXAMINATION

  • History
    • Initial/Interval
  • Measurements
    • Length/Height and Weight
    • Head Circumference
    • Weight for Length
    • 1Blood Pressure*
  • Sensory Screening
    • 2Vision*
    • Hearing*
  • 11Oral Health*
    • 12Fluoride Varnish.
    •  6 Months Thru 5 Years
    • 13Fluoride Supplementation*
  • 14 Procedures
    • 7Anemia
    • 8/9Lead*
    • 10Tuberculosis*

6Immunization

  • 1st Dose 
  • Measles, mumps, rubella (MMR)
    • 12 Month  15 Month
  • Varicella (VAR)
    • 12 Month  15 Month
  • Hepatitis A (HepA)
  • 3rd Dose 
  • Hepatitis B (HepB)
    • 1 Month  18 Month
  • Haemophilus influenza type b (Hib)
  • Inactivated poliovirus (IPV: <18 yrs)
    • 1 Month 18 Month
  • 4th Dose 
  • Pneumococcal conjugate (PCV13)
    • 12 Month  15 Month
  • Influenza (IIV)
    • Annual vaccination 1 or 2 doses
  • recommended age for catch-up immunization
    • Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs)
  • Recommended age for certain high-risk groups
    • Meningococcal (MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)
  1. Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years. 7 //pediatrics.aappublications.org/content/140/3/e20171904).  
  2. Instrument-based  screening may be used to assess risk at ages 12 and 24 months //pediatrics.aappublications.org/content/137/1/e20153597
  3. See: //pediatrics.aappublications.org/content/118/1/405.full
  4. This assessment should be family-centered and may include an assessment of the child’s social-emotional health, caregiver depression, and social determinants of health. //pediatrics.aappublications.org/content/135/2/384
  5. At each visit, age-appropriate physical examination is essential, with infants totally unclothed and older children undressed and suitably draped. The extent of the physical examination is determined by both the reason for the visit and diagnostic considerations raised during the taking of the history. //pediatrics.aappublications.org/content/127/5/991.full).
  6. Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. 
  7. Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition.
  8. For children at risk of lead exposure, see //pediatrics.aappublications.org/content/138/1/e20161493
  9. Perform risk assessments or screenings as appropriate, based on universal screening requirements for patients with Medicaid or in high prevalence areas.
  10. Testing should be performed on the recognition of high-risk factors. Tuberculosis testing per recommendations of the AAP Committee on Infectious Diseases. 
  11. Recommend brushing with fluoride toothpaste in the proper dosage for age. //pediatrics.aappublications.org/content/134/6/1224
  12. Once teeth are present, fluoride varnish may be applied to all children every 3–6 months in the primary care or dental office. //pediatrics.aappublications.org/content/134/3/626
  13. If the primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626
  14. These may be modified, depending on the entry point into the schedule and individual needs.

12-Month-Old Anticipatory Guidance

Social Determinants of Health

◊ Risks (living situation and food security; tobacco, alcohol, and drugs) ◊ Strengths and Protective Factors (social connections with family, friends, child care and home 1visitation program staff, and others)

  • Tell me about your living situation. Do you have the resources you need to care for your child?
    • Community agencies can help you with concerns about your living situation.
  • Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more?
    • 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 quitting smoking.
  • Discuss with your caregiver your child’s medical needs, and your feelings about diet /discipline/oral health/physical activity/media use.
  • Maintain ties with friends, and community.

Establishing routines:

◊ Adjustment to the Child’s Developmental Changes and Behavior ◊ Family Time ◊ Bedtime ◊ Nap Time ◊ Teeth Brushing ◊ Media

  • When your child is troublesome, what do you do?
    • Use positive discipline as well as time-outs and distractions; praise for good behaviors.
  • Carve out family time every day; establish consistent daily routines.
  • Continue 1 nap a day; follow nightly bedtime routine with quiet time, reading, singing, and favorite toy.
  • Establish a teeth-brushing routine.
  • How much time each day does your child spend watching TV or playing on a tablet, smartphone, or other digital devices? Is a TV on in the background while your child is playing in the room?
    • Avoid TV and other digital media with toddlers; consider making a family media use plan (www. healthychildren.org/MediaUsePlan).

Feeding and appetite changes 

◊ Self-feeding ◊ Continued Breastfeeding ◊ Transition to Family Meals ◊ Nutritious Foods

  • 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 the child to decide how much to eat.

Establishing a dental home

◊ First Dental Checkup ◊ Dental Hygiene 

  • Visit the dentist by the time child is 12 months old or after the first tooth erupts.
  • Brush the child’s teeth twice a day with a small smear of fluoridated toothpaste, and a soft toothbrush.
  • If the child is still using a bottle, offer only water. Avoid added sugars.

Safety 

◊ Car Safety Seats ◊ Falls ◊ Drowning Prevention ◊ Water Safety ◊ Sun Protection ◊ Pets ◊ Safe Home Environment: poisoning

  • Car Seats
    • Use a rear-facing car safety seat until the child is highest weight or height allowed by the manufacturer
    • Make necessary changes when switching seats to forward-facing
    • Never place the vehicle safety seat in the front seat of a car with a passenger airbag; the backseat is safest.
  • Use stair gates; keep furniture away from windows; install window guards.
  • Stay within arm’s reach when near water (“touch supervision”); empty buckets, pools, and bathtubs immediately after use.
  • Use hat/sun protection clothing, and sunscreen; avoid prolonged exposure when the 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;
    • Poison Help number (800-222- 1222) at each telephone, including cell.

Goals For 12 Month Checkup:

◌ Be gentle and patient ◌ Get more sleep ◌ Make a budget ◌ Leave your work at the office ◌ Focus on self-care ◌ Meditate as a family ◌ Find an outlet ◌ “cell-free” zone ◌ Spend more time with your partner ◌ Take more baths ◌ Have a girls’/boys’ night ◌ Be more flexible ◌ See your child for who they are ◌ Teach your child to speak up ◌ Help those less fortunate ◌ Drink more water ◌ Find 30 minutes a day of “me” time ◌ Challenge yourself ◌ Focus on experiences, not things ◌ Make health a priority ◌ Start—or finish—a degree ◌ Inform yourself ◌ Maintain balance ◌Laugh often ◌ Cook dinner more frequently ◌ Ask for help ◌ Have designated “cheat” days ◌ Stop having FOMO ◌ Say “I love you” more often 

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