Health supervision of the well child

[Mary Mallozziberg]

Well-child visits aim to do the following:

Promote health
Prevent disease through routine vaccinations and education
Detect and treat disease early
Guide parents to optimize the child’s emotional and intellectual development

The American Academy of Pediatrics (AAP) has recommended preventive health care schedules (see Table: Recommendations for Preventive Care During Adolescence[a], see Table: Recommendations for Preventive Care During Early and Middle Childhood[a], and see Table: Recommendations for Preventive Care During Adolescence[a] ) for children who have no significant health problems and who are growing and developing satisfactorily. Children who do not meet these criteria should have more frequent and intensive visits. If children come under care for the first time late on the schedule or if any items are not done at the suggested age, children should be brought up to date as soon as possible.
Children who have developmental delay, psychosocial problems, or chronic disease may require more frequent counseling and treatment visits that are separate from preventive care visits.
If the pregnancy is high risk (see Overview of High-Risk Pregnancy) or if the parents are first-time parents or wish to have a conference, a prenatal visit with the pediatrician is appropriate.
In addition to physical examination, practitioners should evaluate the child’s motor, cognitive, and social development and parent-child interactions. These assessments can be made by

Taking a thorough history from parents and child
Making direct observations
Sometimes seeking information from outside sources such as teachers and child care providers

Tools (eg, the#160;Modified Checklist for Autism in Toddlers [M-CHAT-R/F]; 1) are available for office use to facilitate evaluation of cognitive and social development.
Both physical examination and screening are important parts of preventive health care in infants and children. Most parameters, such as weight, are included for all children; others are applicable to selected patients, such as lead screening in 1- and 2-year-olds.
Anticipatory guidance is also important to preventive health care. It includes

Obtaining information about the child and parents (via questionnaire, interview, or evaluation)
Working with parents to promote health (forming a therapeutic alliance)
Teaching parents what to expect in their child’s development, how they can help enhance development (eg, by establishing a healthy lifestyle), and what the benefits of a healthy lifestyle are