The Well Child Exam section provides High Yield information for the USMLE, COMLEX, Medical School, Residency, and in the future career as a Physician. Prepare and Learn Ahead! Educating, Preparing, and Proving high-yield content, quizzes, and medical resources to students who are interested in the medical field.
Well Child Exam
Screening in infants
- All states require:
- PKU and Other common screening includes Hgb-opathies, galactosemia, other inborn errors of metabolism
- Lead poisoning:
- Screen at 1 year and 2 years when > 25% of homes were built before 1950 or when >10% of kids have venous lead concentrations of > 10 micrograms/mL. Also, target high-risk kids.
- Anemia:
- Screen at 6 months, 1 year, and annually. Use Hct or Hgb. Risk factors: drink > 24 oz cow’s milk, iron restricted diet, low birth weight or preterm, mom is iron deficient.
- Try an iron supplement, dietary modification – if fail to respond, investigate further.
- Hearing:
- Newborns – auditory brainstem response or evoked otoacoustic emission. Older infants/toddlers – question parents, snap fingers. > 4 yrs – office-based audiometry.
- Risk factors: FH, neurofibromatosis, bacterial meningitis
- Vision:
- Infants – red reflexes → r/o congenital cataracts and retinoblastoma. Screen for strabismus with symmetric reflection from the cornea, cover/uncover test – if strabismus, uncovered eye deviates to focus on the object. Refer to ophthalmology to avoid amblyopia! After 3 yrs, use vision chart (E’s, etc).
- TB:
- Screen kids who were born or who live in areas with high TB prevalence, or who live with someone who has TB. Do PPD.
- Hyperlipidemia:
- Screen between 2-10 yrs w/ serum fasting lipid panel if FH of dyslipidemia, FH or premature CV dz, unknown FH, other CV risk factors, overweight (85th-95th) or obese (95th), HTN (> 95th percentile), cigarette smoking, or DM
Physical development
- Head circumference: plotted in kids < 3 yrs
- BP in kids > 3 yrs
- Failure to thrive: weight below the 3rd or 5th percentile for age, or decelerations in growth that have crossed two major growth percentiles in a short period of time.
Skills Development
- Gross motor
- Fine motor/adaptive
- Language
- Social/personal skills
Leading causes of death
- < 1 yr: SIDS. Sleep on back!
- > 1 yr: accidents and injuries – especially car accidents.
- Kids should ride in back seat. If no back seat, only ride in front if no air bag or air bag is disabled. Rear facing car seat until 1 year AND > 20 lbs. Forward car seat until 40lbs, then booster seat. Can stop using the booster when can sit with back at the seat and legs over the front – at least 4’9” and 8-12 years. Don’t ride in the front seat until > 13 y/o.
- Set hot water heater < 120 degrees.
Nutrition
- Introduce cereal, baby foods, and water between 4-6 months
- Whole cow’s milk at 1 year. Continue until 2 yrs, then switch to 2%.
Vaccinations
- True CI: severe illness (not minor), history of anaphylactic rxn to a specific vaccine or a component (wheezing, hypotension).
- Specific vaccinations:
- HepB x3: 3 doses between birth and 1.5 years.
- Birth, 1-2 months, 6 months – 1.5 years
- Rotavirus (x2 if rotarix, x3 if rotateq): 3 doses between 2 months and 6 months
- 2, 4, 6 months
- Hib x3, maybe a booster: 3-4 doses between 2 months and 15 months
- 2, 4, 6 months, then booster 12-15 months
- DTap x5: 5 doses between 2 months and 6 years, then switch to Tdap 11-12 years.
- 2, 4, 6 months, 12-18 months, 4-6 yrs. Then Tdap at 11-12 yrs.
- Inactivated polio (NOT ORAL) x4: 4 doses between 2 months and 6 years
- 2, 4, 6-18 months, then 4-6 years
- MMR and varicella x2: once at one year, then once at 4-6 years
- 12-15 months, 4-6 yrs
- Hep A x2: 2 doses between 1-2 years
- Meningococcus (x1) and HPV (x3 over 6 months): 11-12 yrs. The antibodies are stronger when it’s given younger.
- HepB x3: 3 doses between birth and 1.5 years.
