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
     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 and 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 ect.

What to except during a 24 Months Old Physical?

3DEVELOPMENTAL SCREENING

  • Social Language and Self-Help
    • Plays along with other children
    • Takes off some clothes
    • Scoops well with spoon
  • Verbal Language
    • Uses 50 words
    • Combines 2 words into short phrases
    • 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

BEHAVIORAL HEALTH

  • 4Autism Spectrum Disorder Screening
  • Developmental Surveillance
  • 5Psychosocial/Behavioral Assessment

6PHYSICAL EXAMINATION

  • History
    • Initial/Interval
  • Measurements
    • Length/Height and Weight
    • Head Circumference
    • 1Body Mass Index
    • 2Blood Pressure*
  • Sensory Screening
    • 3Vision*
    • Hearing*
  • 14 Oral Health*
    • Risk assessment
    • 15Fluoride Varnish.
    •  6 Month Thru 5 Years
    • 16Fluoride Supplementation*
  • Procedures
    • 9Anemia
    • 10/11Lead*
    • 12Tuberculosis*
    • 13Dyslipidemia*

8Immunization

  • Recommended age for certain high-risk groups
    • Meningococcal (MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)
    • Hepatitis A (HepA)
    • Pneumococcal polysaccharide (PPSV23)
  • Recommended age for catch-up immunization
    • Haemophilus influenzae type b (Hib)
    • Pneumococcal conjugate (PCV13)
    • Measles, mumps, rubella (MMR)
    • Varicella (VAR)
    • Hepatitis B (HepB)
    • Diphtheria, tetanus, & acellular pertussis (DTaP: <7 yrs)
    • Inactivated poliovirus (IPV: <18 yrs)
    • Hepatitis A (HepA)
  • Influenza (IIV)
    • Annual vaccination 1 or 2 doses
  1. Screen, per //pediatrics.aappublications.org/content/120/ Supplement_4/S164.full
  2. 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).  
  3. Instrument-based  screening may be used to assess risk at ages 12 and 24 months //pediatrics.aappublications.org/content/137/1/e20153597
  4. Screening should occur per //pediatrics.aappublications.org/content/120/5/1183.full
  5. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver depression, and social determinants of health. //pediatrics.aappublications.org/content/135/2/384
  6. At each visit, age-appropriate physical examination is essential, with infant 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).
  7. These may be modified, depending on entry point into schedule and individual need.
  8. Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. 
  9. Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition.
  10. For children at risk of lead exposure, see //pediatrics.aappublications.org/content/138/1/e20161493
  11. Perform risk assessments or screenings as appropriate, based on universal screening requirements for patients with Medicaid or in high prevalence areas.
  12. Testing should be performed on recognition of high-risk factors. Tuberculosis testing per recommendations of the AAP Committee on Infectious Diseases. 
  13. See //www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm
  14. Recommend brushing with fluoride toothpaste in the proper dosage for age. //pediatrics.aappublications.org/content/134/6/1224
  15. 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
  16. If primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626

24 Month Old Anticipatory Guidance

Temperament, development, toilet training, behavior, and discipline

◊ Risks (Intimate Partner Violence; Living Situation and Food Security; Tobacco, Alcohol, and Drugs) ◊ Strengths and Protective Factors (Parental Well-Being)

  • Do you always feel safe in your home? Has your partner ever hit, kicked, or shoved you, or physically hurt you or your child? Would you like information on where to go or who to contact if you ever need help?
    • 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).
  • Tell me about your living situation. What are your resources for caring for the 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 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.

Temperament and behavior

◊ Development ◊ Temperament ◊ Promotion of Physical Activity and Safe Play ◊ Limits on media use

  • What are some of the new things your child is doing?
    • Praise good behavior and accomplishments; listen to and respect your child.
  • Help child express feelings like joy, anger, sadness, frustration.
  • Encourage self-expression.
  • How does your child act around family members?
    • 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.
  • How much time each day does your child spend watching TV or playing on tablet, smartphone, or other digital device?
    • 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.

Assessment of language development

◊ How Child Communicates ◊ Expectations for Language ◊ Promotion of Reading

  • Model appropriate language.
  • What do you think your child understands?
    • 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.

Toilet training

◊ Techniques ◊ Personal hygiene

  • Begin 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.

Safety 

◊ Car Safety Seats ◊ Outdoor Safety ◊ Firearm safety

  • 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

Goals For 2 Year Check up:

◌ 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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