This blog was written in conjunction with pediatric medical resident, Ashley Bedner, DO.
What are the components of a well-child check?
There are things you can expect every time you visit your pediatrician. These include:
- Checking vital signs such as temperature, heart rate and respiratory rate
- Checking height, weight and head circumference (in infants) and assessing growth curves
- Questions about the child’s diet, elimination and sleeping habits
- Assessing developmental milestones by asking parents about the child’s speech and motor skills
- Full physical exam
- Age-specific immunizations
- Guidance regarding safety, nutrition, family dynamics and discipline
There are aspects of the well-child check that occur only at certain visits. These include:
- Developmental screenings that occur at nine months,18 months and 24 months (and will be the focus of the remainder of this post)
- Annual blood pressure screening, starting around three years of age
- Anemia screening through evaluating hemoglobin levels at one and two years of age
- Screening for lead toxicity at one and two years of age
- Annual vision and hearing screening, starting around three years of age
- Fluoride application, starting with first eruption of teeth until child is receiving routine dental visits (typically around four to five years old)
Developmental screening is a very important component of all pediatric visits because speech and motor delays can have lifelong implications for the child’s well-being and quality of life. It is important to catch those at risk and refer them to appropriate therapies as early as possible.
How is my child screened?
Modified checklist for autism in toddlers (MCHAT)
Performed at 18- and 24-month well-child visits, the MCHAT is a 20-question survey that looks at certain activities and developmental skills children should be doing based on their current age. This questionnaire aids in identifying those at risk of developing autism spectrum disorders including autistic disorder, Asperger’s syndrome and pervasive developmental disorders.
Based on the answers provided, children are classified as low-risk, medium-risk or high-risk. Medium-risk children should have a follow-up MCHAT administered, and those at high-risk should be immediately referred for further evaluation and early intervention.
Current prevalence of autism is about one in 68 children, with higher prevalence in boys. The average age of diagnosis is four years old. The aim of this screening tool is earlier diagnosis and intervention.
Ages and Stages Questionnaire (ASQ)
This is a screening tool that aids in identifying risk for developmental delays. It is estimated that developmental delays, learning disorders and behavioral or social/emotional problems affect one in six children. The aim of this tool is to identify children at risk for delays prior to school entry.
The screening evaluates the child’s skills in five categories:
- Gross Motor
- Fine Motor
- Problem Solving
Grading can be based on caregiver answers or observation of the child performing skills during a visit. Scores are converted into normal, at-risk or delayed categories. Those in the at-risk category should be provided home exercises and learning activities, and their doctor should follow up at their next visit. Those with obvious delays should be referred for further evaluation and treatment, which may include speech therapy, physical therapy or occupational therapy.
The screening is performed at 9-, 18- and 24-month well-child visits.
Your child’s well visits serve many purposes, but they are primarily an opportunity for your pediatrician to ensure your child is growing and developing properly. It is important to catch delays and disorders as early as possible to ensure children get the treatment necessary to help them function optimally.
We are all human, and things come up in our schedules that cause us to miss appointments. However, it is vital that you call and reschedule. One missed checkup could mean a late diagnosis, and early intervention is key.
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