Well-Child Visits for Infants and Young Children

 

Am Fam Physician. 2018 Sep 15;98(6):347-353.

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Postpartum depression screening is recommended for mothers.

B

22, 23

Developmental surveillance should be performed at each visit, with formal screenings at nine, 18, and 30 months.

C

14

Immunization history should be reviewed and updated (if appropriate) at each visit.

C

32, 33

Visual acuity screening should be performed once between three and five years of age.

B

26, 27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Postpartum depression screening is recommended for mothers.

B

22, 23

Developmental surveillance should be performed at each visit, with formal screenings at nine, 18, and 30 months.

C

14

Immunization history should be reviewed and updated (if appropriate) at each visit.

C

32, 33

Visual acuity screening should be performed once between three and five years of age.

B

26, 27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Clinical Examination

HISTORY

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions.1 Evaluate breastfed infants for any feeding problems,2 and assess formula-fed infants for type and quantity of iron-fortified formula being given.3  For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all

The Author

KATHERINE TURNER, MD, is an assistant professor in the Department of Family Medicine at Carle Foundation Hospital, Urbana, Ill.

Address correspondence to Katherine Turner, MD, Carle Foundation Hospital, 611 W. Park St., Urbana, IL 61801. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

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