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 30-Month-Old Physical?
3DEVELOPMENTAL SCREENING
- Social Language and Self-Help
- Urinates in a potty or toilet
- Spears food with a fork
- Washes and dries hands
- Increasingly engages in imaginary play
- Tries to get parents to watch by saying
- “Look at me!”
- Verbal Language
- 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
- Catches large balls
BEHAVIORAL HEALTH
- 4Developmental Screening
- 5Psychosocial/Behavioral Assessment
6PHYSICAL EXAMINATION
- History
- Initial/Interval
- Measurements
- Length/Height and Weight
- 1Body Mass Index
- 2Blood Pressure*
- Sensory Screening
- 3Vision*
- Hearing*
- 10 Oral Health*
- 11Fluoride Varnish.
- 6 Months Thru 5 Years
- 12Fluoride Supplementation*
- 7 Procedures
- 9Anemia
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 influenza 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)
- Screen, per //pediatrics.aappublications.org/content/120/ Supplement_4/S164.full
- Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age of 3 years. 7 //pediatrics.aappublications.org/content/140/3/e20171904).
- A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. Instrument-based screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age. //pediatrics.AAP publications. org/content/137/1/e20153596
- See: //pediatrics.aappublications.org/content/118/1/405.full
- 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
- 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).
- These may be modified, depending on the entry point into the schedule and individual needs.
- Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx.
- Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition.
- Recommend brushing with fluoride toothpaste in the proper dosage for age. //pediatrics.aappublications.org/content/134/6/1224
- 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
- If the primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626
30-Month-Old Anticipatory Guidance
Family routines
◊ Day and Evening Routines ◊ Enjoyable Family Activities ◊ Parental Activities Outside the Family ◊ Consistency in the Child’s Environment
- Maintain regular family routines (meals, quiet bedtime).
- Tell me how you have fun with your family.
- Encourage family exercise; take advantage of museums, and zoos.
- Maintain social contacts; do things outside the family.
- Reach an agreement with all family members on how best to support the child’s emerging independence while maintaining consistent limits. How well do you and your family agree on limits and discipline for your child?
Language promotion and communication
◊ Use of simple words and reading together
- Read together every day; go to the library.
- Is your child speaking in sentences? How frustrated does he become when others cannot understand what he is saying?
- Listen when a child speaks; repeat, using correct grammar.
Promoting social development
◊ Play with Her Children ◊ Giving Choices ◊ Limits on TV and Media Use
- Encourage play with other children, but supervise because the child is not ready yet to share/play cooperatively.
- Does your child enjoy making independent decisions? What are some of the new things your child is doing?
- Build independence by offering choices between 2 acceptable alternatives.
- Preschool considerations: Readiness for early childhood programs and playgroups, toilet training
- Limit TV and digital media to no more than 1 hour a day; monitor what the child watches.
- What are your plans for child care or preschool in the year ahead?
- Consider group child care, preschool program, organized playdates, or playgroups.
- Encourage toilet training success by dressing the child in easy-to-remove clothes; establish a daily routine; place on the potty every 1 to 2 hours; praise; provide a relaxed environment by reading/singing.
Safety
◊ Car Safety Seats ◊ Outdoor Safety ◊ Water Safety ◊ Sun Protection ◊ Fires and Burns
- Be sure the car safety seat is installed properly in the backseat. Harness straps should be snug.
- Make sure everyone else uses a seat belt.
- Supervise children outside, especially around cars, machinery, and dogs.
- Provide “touch supervision” near water, bathtubs, pools, and toilets.
- Use hat/sun protection clothing, and sunscreen; avoid prolonged exposure when the sun is strongest, between 11:00 am and 3:00 pm.
- When did you last change the batteries in your smoke detectors?
- Install smoke detectors on every level; test monthly; change batteries annually; fire escape plan; keep matches/hot objects out of sight/away from the child.
Goals For 2.5 Year 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
