Well-child visits aim to do the following:
The American Academy of Pediatrics (AAP) has recommended preventive health care schedules (see Table 5: Approach to the Care of Normal Infants and Children: Recommendations for Preventive Care During Infancya, Table 6: Approach to the Care of Normal Infants and Children: Recommendations for Preventive Care During Early and Middle Childhooda, and Table 7: Approach to the Care of Normal Infants and Children: Recommendations for Preventive Care During Adolescencea ) for children who have no significant health problems and who are growing and developing satisfactorily. Those who do not meet these criteria should have more frequent and intensive visits. If children come under care for the first time late on the schedule or if any items are not done at the suggested age, children should be brought up to date as soon as possible. Children who have developmental, psychosocial, or chronic disease may require more frequent counseling and treatment visits that are separate from preventive care visits. If parents are high risk, are parents for the first time, or wish to have a conference, a prenatal visit with the pediatrician is appropriate.
In addition to physical examination, practitioners should evaluate the child's motor, cognitive, and social development and parent-child interactions. These assessments can be made by taking a thorough history from parents and child, making direct observations, and sometimes seeking information from outside sources such as teachers and child care providers. Tools are available for office use to facilitate evaluation of cognitive and social development (see Growth and Development: Childhood Development).
Both physical examination and screening are important parts of preventive health care in infants and children. Most parameters, such as weight, are included for all children; others are applicable to selected patients, such as lead screening in 1- and 2-yr-olds.
Anticipatory guidance is also important to preventive health care. It includes
Length (crown-heel) or height (once children can stand) and weight should be measured at each visit. Head circumference should be measured at each visit through 24 mo. Growth rate should be monitored using a growth curve with percentiles; deviations in these parameters should be evaluated (see Growth and Development).
Starting at age 3 yr, BP should be routinely checked by using an appropriate-sized cuff. The width of the inflatable rubber bag portion of the BP cuff should be about 40% of the circumference of the upper arm, and its length should cover 80 to 100% of the circumference. If no available cuff fits the criteria, using the larger cuff is better.
Systolic and diastolic BPs are considered normal if they are < 90th percentile; actual values for each percentile vary by sex, age, and size (as height percentile), so reference to published tables is essential (see tables for BP levels for the 50th to 99th percentiles for boys and girls, below). Systolic and diastolic BP measurements between the 90th and 95th percentiles should prompt continued observation and assessment of hypertensive risk factors. If measurements are consistently ≥ 95th percentile, children should be considered hypertensive, and a cause should be determined.