Preventive Health Care Visits in Children

At each visit, several measurements are taken, screening procedures are done, and vaccinations Childhood Vaccination Schedules Vaccination protects children against many infectious diseases. Vaccines contain either noninfectious components of bacteria or viruses or whole forms of these organisms that have been weakened... read more are given depending on the schedule.

Height Length and Height 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 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 Physical Growth of Infants and Children 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 ). 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 has been completed. Incontinence may be present During the day... 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 address any issues.

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.

Preventive visits should include a check of vision and hearing. Vision screening may begin at 3 years of age, if children are cooperative, but is recommended at 4 and 5 years of age. 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.

Some children may need to have their blood checked for anemia Diagnosis Anemia is a disorder in which there are too few red blood cells in the blood. Anemia can occur when red blood cells are broken down too rapidly, too much blood is lost, or the bone marrow does... read more or an increased level of lead Diagnosis Lead poisoning affects many parts of the body, including the brain, nerves, kidneys, liver, and blood. Children are particularly susceptible because their nervous system is still developing... read more .

Children who are at risk of having high cholesterol should have a blood test between the ages of 2 years and 10 years. Children at risk include those who have a family history of high cholesterol levels, heart attack, or stroke or have risk factors for heart disease (for example, diabetes, obesity, or high blood pressure). 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 with a questionnaire 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, but almost any organ can be involved. Tuberculosis... read more done.

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

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:

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

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) and firearms (guns) 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.

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 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 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.

Screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time) may result in inactivity and obesity. Limits on the time a child spends using devices with screens should start at birth and be maintained throughout adolescence.