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Preventive Health Care Visits in Children

By

Deborah M. Consolini

, MD, Thomas Jefferson University Hospital

Last full review/revision Jul 2021| Content last modified Jul 2021
Click here for the Professional Version
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Scheduled visits to the doctor (also called well-child visits) provide parents with information about their child's growth and development. Such visits also give parents an opportunity to ask questions and seek advice, for example, about toilet training Toilet Training Most children can be taught to use the toilet when they are between 2 years and 3 years old. Using the toilet to defecate is usually accomplished first. Most children can be trained to control... read more . The American Academy of Pediatrics recommends that after the first year of life children should see their doctor for preventive health care visits at 12, 15, 18, 24, and 30 months of age and then yearly until age 10. Visits can be made more often based on the advice of the doctor or the needs of the family.

Examination

At each visit, several measurements are taken, screening procedures are done, and vaccinations Childhood Vaccination Schedule Most doctors follow the vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC—see the schedule for infants and children and the schedule for older children... read more are given depending on the schedule. Height and weight Weight Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more are checked, and head circumference Head Circumference Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more is measured until the child is 36 months old. Good growth is one indicator that the child is generally healthy. The child's actual size is not nearly as important as whether the child stays at or near the same percentile on the height and weight charts Height and Weight Charts for Boys and Girls 2 to 10 Years of Age Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more at each visit. A child who is always in the 10th percentile is likely fine (although smaller than most children of the same age), whereas a child who drops from the 35th percentile to the 10th may have a medical problem. Beginning at age 3, blood pressure is measured at each visit.

The doctor also monitors how the child has progressed developmentally (see Childhood Development Childhood Development Between the ages of 1 and 13, children's physical, intellectual, and emotional capabilities expand tremendously. Children progress from barely tottering to running, jumping, and playing organized... read more ) since the last visit. For example, the doctor may want to know whether an 18-month-old child has begun speaking or whether a 6-year-old child has begun reading a few words (see Table: Developmental Milestones From Ages 18 Months to 6 Years* Developmental Milestones From Ages 18 Months to 6 Years* Between the ages of 1 and 13, children's physical, intellectual, and emotional capabilities expand tremendously. Children progress from barely tottering to running, jumping, and playing organized... read more ). In the same way, doctors often ask age-appropriate questions about the child's behavior. Does the 18-month-old child have tantrums Temper Tantrums Temper tantrums are violent emotional outbursts, usually in response to frustration. Frustration, tiredness, and hunger are the most common causes. Children may scream, cry, thrash, roll on... read more ? Does the 2-year-old child sleep through the night Sleep Problems in Children Most children sleep for a stretch of at least 5 hours by age 3 months but then have periods of night waking later in the first years of life, often when they have an illness. As they get older... read more ? Does the 6-year-old child wet the bed at night Urinary Incontinence in Children Urinary incontinence is defined as the involuntary release of urine occurring two or more times per month after toilet training. Incontinence may be present During the day (daytime or diurnal... read more ? Parents and doctors can discuss these types of behavioral and developmental issues during the preventive health care visits and together design approaches to any behavioral or developmental problems.

Finally, the doctor does a complete physical examination. In addition to examining the child from head to toe, including the heart, lungs, abdomen, genitals, spine, arms, legs, head, neck, eyes, ears, nose, mouth, and teeth, the doctor may ask the child to perform some age-appropriate tasks. To check gross motor skills (such as walking and running), the doctor may ask a 4-year-old child to hop on one foot. To check fine motor skills (manipulating small objects with the hands), the child may be asked to draw a picture or copy some shapes.

Screening

Preventive visits should include a check of vision and hearing. Vision screening typically begins at 3 years of age, if children are cooperative, but parents should let the doctor know before then if they have any concerns about their child's vision. At this age, vision tests include the use of charts and testing machines.

Hearing tests, after the newborn testing, typically begin at 4 years of age, but parents should let the doctor know before then if they have any concerns about their child's hearing.

Children over 2 years of age who are at risk of having high cholesterol levels should have a blood test. Children at risk include those who have family members with high cholesterol levels or who had a heart attack or stroke at an early age. All children should have a cholesterol test at age 9 to 11 years and again at age 17 to 21 years.

Children are screened for tuberculosis (TB) risk factors at all well-child visits. Risk factors include exposure to TB, being born in or having traveled to areas of the world where TB is common (countries other than the United States, Canada, Australia, and New Zealand and Western and North European countries), having a family member with TB, and having parents or close contacts who are recent immigrants from an area where TB is common or who have recently been in jail. Those with risk factors then usually have tuberculosis screening tests Screening Tests for Tuberculosis Tuberculosis is a chronic contagious infection caused by the airborne bacteria Mycobacterium tuberculosis. It usually affects the lungs. Tuberculosis is spread mainly when people breathe air... read more Screening Tests for Tuberculosis done.

The age of the child and various other factors determine whether other tests are done.

Safety

Child safety is discussed during preventive visits. Specific safety concerns are based on the age of the child. For example, the discussion might be focused on bicycle safety for a 6-year-old child. The following examples of injury prevention apply to children aged 12 months to 4 years:

  • Use an age-appropriate and weight-appropriate car seat. (Infants and toddlers should ride rear-facing until they outgrow the rear-facing weight or height limits of a convertible car seat. Convertible car seats have limits that will allow most children to ride rear-facing up to age 2 years. Once they are 2 years old or, regardless of age, have outgrown their rear-facing car seat, toddlers should sit in a forward-facing car seat with harness straps for as long as possible based on weight and height limits.)

  • Place car seats in the back seat of the vehicle.

  • Review automobile safety both as passenger and pedestrian.

  • Tie up window cords to avoid strangulation.

  • Use safety caps and latches.

  • Prevent falls.

  • Remove handguns from the home.

  • Closely supervise children while in or near any body of water (for example, bathtubs, pools, spas, wading pools, ponds, irrigation ditches, or any other standing water). Children 1 year of age and older should have swim lessons and should wear a life jacket while swimming and always while boating.

Some Recommendations Regarding the Use of Infant and Child and Car Seats

In addition to those in the list above, the following examples of injury prevention apply to children age 5 years and older:

  • Use a forward-facing car seat with a harness for as long as possible (until children outgrow the weight or height limits for the car seat) and then use a belt-positioning booster seat until the vehicle seat belt fits properly (typically when children have reached 4 feet 9 inches in height and are between 8 years and 12 years of age).

  • Have children under 13 years of age restrained with a seat belt in the back seat of the vehicle.

  • If the vehicle does not have a back seat, disable the air bag in the front passenger seat.

  • Have children wear a bicycle helmet and protective sports gear.

  • Instruct children about safe street crossing.

  • Closely supervise swimming and sometimes have children wear a life jacket while swimming and always while boating.

The doctor may also emphasize other safety topics, such as the importance of installing and maintaining smoke alarms and of keeping potential toxins (such as cleaners and drugs) out of the reach of children. Parents should take the opportunity to bring up topics that are most relevant to their unique family situation. As children get older, they can be active participants in these discussions.

Nutrition and exercise

Parents can help prevent obesity Obesity Obesity is excess body weight. Obesity is influenced by a combination of factors, which usually results in consuming more calories than the body needs. These factors may include physical inactivity... read more Obesity and type 2 diabetes Type 2 diabetes Diabetes mellitus is a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced... read more Type 2 diabetes by establishing healthy eating patterns and promoting regular exercise. Parents should provide children with a variety of healthy foods, including fruits and vegetables along with sources of protein. Regular meals and small nutritious snacks encourage healthy eating in even a picky preschooler. Although children may avoid some healthy foods, such as broccoli or beans, for a period of time, it is important to continue to offer healthy foods. In addition, parents should limit the child's intake of fruit juices, which, despite their seemingly healthy origin, are mainly sugar water. Some children lose their appetite for food at mealtime if they drink too much fruit juice. Parents should guide children away from frequent snacking and foods that are high in calories, salt, and sugar.

Exercising and maintaining good physical and emotional health are very beneficial for children. Playing outdoors with the family or participating on an athletic team is a good way to encourage children to exercise and prevent obesity.

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