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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.

Health care for infants and children has changed markedly over the past half century. Prior focus on infectious disease and illness prevention has shifted to largely behavioral and environmental concerns. Paramount among behaviors is the issue of screen time, including television, iPads, computers, and cell phones. Environmental concerns such as water purity continue to be problematic. Of course, safety should always be emphasized. However, family physicians should remember that the goal of child care is to allow the child and family to experience joyous childrearing. Too often a well-child visit focuses on difficulties and not on pleasantries. Part of making certain that the child has a happy childhood is to limit toxic experiences such as corporal punishment that have been linked to later adult difficulties such as early myocardial infarction. Limiting negative experiences necessitates investigation into whether the parents and other family members are doing well, part of every family physician’s goals.

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, learning disabilities, and substance abuse are examples of ongoing dilemmas.

A key reference guide for childhood health promotion is the fourth edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (https://brightfutures.aap.org/clinical-practice/Pages/default.aspx), funded by the US Department of Health and Human Services. The guidelines give providers a comprehensive system of care that addresses basic concerns of childrearing such as nutrition, parenting, safety, dental care, and infectious disease prevention with focused attention on evidence-based health components and interventions. Bright Futures materials include interim history forms for parents, well-child chart notes for each recommended visit, and anticipatory guidance sheets to be given to parents at the visit’s conclusion. It also lists and describes numerous community resources, some of which are designed to address medical or behavioral issues and some of which are designed to enhance childrearing.

One widely utilized, online schedule for routine well-child visits (Table 1–1) is the Bright Futures/AAP Periodicity Schedule (https://www.aap.org/en-us/Documents/periodicity_schedule.pdf). Following a prenatal visit, seven visits are suggested during the first year, five visits age 12 to 30 months, and then yearly visits until adulthood at age 21 years. Table 1–1 provides a structured framework for anticipatory guidance, examinations, and growth and developmental screening at appropriate intervals.

Table 1–1.Schedule of routine well-care visits....

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