Well-Child Care

Care for children is an important part of most family physicians’ practice, especially for those of us who practice in rural areas or places with fewer pediatricians. It also is a key element of residency training, when exposure to pediatric care builds the skills and confidence that help new family physicians maintain a broad scope of practice.¹

This edition of FP Essentials provides a comprehensive overview of well-child care by age groups. Section One focuses on newborns and infants from birth to age 12 months and provides useful tips and updates on screening and anticipatory guidance. Section Two addresses well-child care for toddlers and preschool-aged children ages 1 to 5 years, when nutrition, sleep, safety, behavior concerns, and toilet training are part of the conversation. Section Three focuses on school-aged children from ages 6 to 12 years. In this group, use of screen media increases dramatically, growth and development remain important issues, and children often begin to bring their own questions and concerns to their physician. Section Four covers the well-child care needs of adolescents ages 13 to 17 years. I knew nicotine vaping was common among adolescents, but I was surprised to learn that marijuana use is now more common than cigarette use.

I hope you find this edition of FP Essentials helpful for your practice. When you have finished studying it and are ready to submit your posttest answers, please tell us what was most useful and what we can do to improve. We look forward to hearing your ideas for topics you would like covered in future editions.

Karl T. Rew, MD, Associate Medical Editor
Clinical Associate Professor
Departments of Family Medicine and Urology
University of Michigan Medical School, Ann Arbor

Leigh Morrison, MD, FAAFP, is a clinical assistant professor in the Department of Family Medicine and core faculty for the Family Medicine Residency Program at the University of Michigan (UM) Medical School in Ann Arbor. She completed an academic medicine fellowship and currently serves as director of the UM Medical School Academic Medicine Fellowship. Dr. Morrison has content expertise in well-child care and has published on various health topics in youth and adolescent health care.

Jessica E. Barnes, MD, is a clinical instructor in the Department of Family Medicine at the UM Medical School. She is an academic medicine fellow at UM and serves as core faculty for the UM Family Medicine Residency Program. Dr. Barnes has clinical interests in dyslipidemia, inpatient medicine, leadership and advocacy in medicine, and evidence-based pediatric care.

Katherine Turner, MD, IBCLC, is a clinical assistant professor in the Department of Family Medicine at the UM Medical School. She is certified in breastfeeding and lactation medicine by the North American Board of Breastfeeding and Lactation Medicine. Dr. Turner is service director of the UM Family-Mother-Baby service. She provides obstetric care and inpatient newborn care, and practices breastfeeding medicine. She has content expertise in infant care and has authored publications on this topic.

Anna McEvoy, MD, is a clinical assistant professor in the Department of Family Medicine at the UM Medical School. She completed an academic medicine fellowship and currently serves as core faculty for the UM Family Medicine Residency Program. She also works at a community health center that serves adolescents and young adults ages 12 to 25 years and their children, where she is the education coordinator. Dr. McEvoy has content expertise in adolescent medicine and has coauthored several publications on well-child care and adolescent care.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Administer on-time vaccinations for all children ages birth to 18 years as recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices with catch-up vaccinations when needed.
• Counsel families on infant feeding support, including breastfeeding support and guidance for introduction of solid foods, as well as nutrition and physical activity for children of all ages.
• Manage newborn issues, including neonatal opioid withdrawal syndrome, hyperbilirubinemia, and abnormal newborn genetic test results.
• Screen all children ages 18 months and 2 years for autism spectrum disorder (ASD) using an ASD-specific screening tool.
• Screen all children starting at time of first tooth eruption to age 12 years to determine if their primary water source is deficient in fluoride, and prescribe an oral fluoride supplement if necessary.
• Discuss with children and families important safety issues and strategies for injury prevention.
• Discuss with children and caregivers screen media use, sleep, and substance use.
• Perform behavior counseling on sexually transmitted infection (STI) prevention, and screen for STIs in sexually active adolescents.