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ESSENTIALS OF WELL-CHILD CARE

Providing a comprehensive patient-centered medical home for children and assisting in the progressive transition to adulthood are integral components of family medicine. The provision of well-child care through a series of periodic examinations forms the foundation for the family physician to build lasting relationships with the entire family, a critical distinction between the family physician and other medical specialists.

Enhanced nutrition, mandated safety standards, and expanded schedules for immunizations have significantly improved the health of US children, but serious childhood health problems persist. Inadequate prenatal care leading to poor birth outcomes, poor management of developmental delay, childhood obesity, lack of proper oral health, and learning disabilities are some examples of ongoing issues.

A key reference guide for childhood health promotion is the third edition (currently in revision) of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, funded by the US Department of Health and Human Services. The guidelines give providers a comprehensive system of care that addresses basic concerns of child rearing such as nutrition, parenting, safety, and infectious disease prevention with focused attention on evidence-based health components and interventions.

One widely accepted schedule for routine well-child visits (Table 1-1) is available in Bright Futures (http://brightfutures.aap.org/clinical_practice.html) (currently in revision). Seven visits are suggested during the first year, followed by an additional four visits by 2 years of age, and yearly visits until adulthood, coinciding with critical junctures during growth and development. Table 1-1 provides a structured framework for anticipatory guidance, exam features, and developmental screening recommendations at appropriate intervals.

Table 1–1.Proposed schedule of routine well-care visits.

The most important components of a preventive well-child visit include the following: (1) developmental/behavioral assessment; (2) physical examination, including measurement of growth; (3) screening tests and procedures; and (4) anticipatory guidance. The specific goal of each visit is to assess each component, identify concerns about a child’s development and intervene with early treatment, if available, or monitor closely for changes. Another essential, recognized component is adherence to the most recent schedule of recommended immunizations from the Advisory Committee on Immunization Practices (of the US Public Health Service) and the Centers for Disease Control and Prevention (ACIP/CDC) (see Chapter 7).

The overall purpose of well visits is to engage the caregivers to partner with the physician to optimize the physical, emotional, and developmental health of the child. Family physicians need to comfortably identify common normal variants as well as abnormal findings that may require referral. Parents should be encouraged to use these dedicated well visits to raise questions, share observations, and advocate for their child, as they know their child best. Parents should be advised to bring in a list of questions during each visit and maintain ...

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