Providing comprehensive medical care for children is an integral and enjoyable part of family medicine that defines a critical distinction between the family physician and other medical specialists. The provision of well child care through a series of periodic examinations forms the foundation for the family physician to build lasting relationships with entire family and their community and to establish the patient's medical home.
Better nutrition, safety methods, and immunizations have significantly improved the health of US children, but serious childhood health problems persist. Inadequate or delayed prenatal care, childhood obesity, failure to optimize intellectual potential, and poor management of developmental delay are examples of remaining critical issues. Barriers to health care such as insufficient health literacy and lack of insurance coverage compound these issues. One of the key reference guides for pediatric health promotion is the third edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, which was funded by the US Department of Health and Human Services. Bright Futures outlines a system of care that addresses basic concerns of child rearing such as nutrition, parenting, safety, and infectious disease prevention with focused attention on evidenced-based health components and interventions.
The components of routine well child care include the following:
- History taking
- Monitoring physical parameters of growth
- Developmental/behavioral assessment
- Physical examination
- Screening tests and procedures
- Anticipatory guidance
- Administration of immunizations
The underlying purpose is to identify concerns about a child's development and to intervene with early prevention or treatment to optimize eventual capabilities. Family physicians need to comfortably identify common normal variants as well as abnormal findings that may require referral.
One widely accepted schedule for the periodicity of routine well child visits (Table 1-1) provides ample opportunities to observe the child and family at critical junctures during a child's growth and development. The periodicity table can be downloaded for direct clinical use from http:// brightfutures.aap.org/clinical_practice.html. It provides a structured framework for anticipatory guidance and developmental screening recommendations at appropriate intervals.
Table 1-1. Proposed Schedule of Routine Well Child-Care Visits. |Favorite Table|Download (.pdf)
Table 1-1. Proposed Schedule of Routine Well Child-Care Visits.
Any encounter, even for an acute illness, is an opportunity to update health screening, provide anticipatory guidance, and administer immunizations. Recognized problems such as growth delay can necessitate additional checkups for more intense follow-up. Supplemental visits may also be required if the child is adopted or living with surrogate parents; is at high risk for medical disorders as suggested by the pregnancy, delivery, or neonatal history; exhibits psychological disorders as suggested by speech delay, persistent temper tantrums, or poor school performance; or if the family is ...