Bright Future – 4 Year Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 4 Year Visit

Health supervision

Surveillance of development

■ Social language and self-help

– Enters bathroom and has bowel movement by himself

– Brushes teeth

– Dresses and undresses without much help

– Engages in well-developed imaginative play

■ Verbal language (Expressive and receptive)

– Answers questions like “What do you do when you are cold?” or “…when you are sleepy?”

– Uses 4-word sentences

– Speaks in words that are 100% understandable to strangers

– Draws recognizable pictures

– Follows simple rules when playing board/ card games

– Tells parent a story from book

■  Gross Motor

  • Skips on 1 foot
  • Climbs stairs, alternating feet without support

■  Fine Motor

  • Draws a person with at least 3 body parts
  • Draws simple cross
  • Unbuttons and buttons medium-sized buttons
  • Grasps pencil with thumb and fingers instead of fist

Observation of Parent-Child interaction

How do parent and child communicate?

Does parent allow child to answer questions?

Does child separate from parent during the examination? Does the child dress and undress self?

How do parent, child, siblings interact? If offered books, does parent let child choose?

Complete Physical Examination, including

Measure: Blood pressure and compare with norms

Measure and plot: Height, weight, and BMI

Assess/observe for: Condition of gums and teeth; nasal stuffiness; rashes, bruises; ocular motility, pupil opacification, red reflexes; abdominal masses; fine/gross motor skills; language acqui- sition, speech fluency/clarity, thought content/ abstraction, articulation difficulties

Perform: Formal motor assessment

Screening (www.aap.org/periodicityschedule)

universal: Hearing; Oral Health (in absence of dental home); Vision

selective: Anemia; Dyslipidemia; Lead; Oral Health; Tuberculosis

Immunization

CDC: www.cdc.gov/vaccines

AAP: http://redbook.solutions.aap.org

Anticipatory Guidance

The first priority is to attend to the concerns of the parents. In addition, the Bright Futures Early Childhood Expert Panel has given priority to the following topics for discussion in this visit:

Social determinants of health: Risks (living situation and food security; tobacco, alcohol, and drugs; intimate partner violence; safety in the community), strengths and protective factors (engagement in the community)

  • Community agencies can help you with concerns about your living situation.
    Tell me about your living situation. Do you have the things you need to care for your child?
  • Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
    Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more?
  • Don’t use tobacco/e-cigarettes/alcohol/drugs. Call 800-Quit-NoW (800-784-8669) for help to quit smoking.
  • Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
    Do you always feel safe in your home? Has your partner ever hit, kicked, or shoved you, or physically hurt you or your child? Would you like information on where to go or who to contact if you ever need help?
  • You can also call the National domestic  Violence Hotline toll-free at 800-799-sAFE (7233).
  • Teach your child rules for how to be safe with adults: (1) no adult should tell a child to keep secrets from parents; (2) no adult should express interest in private parts; (3) no adult should ask a child for help with his/her private parts.
  • Maintain or expand participation in community parts.
    What activities do you participate in outside the home? What help do you need in finding other community resources, such as a faith-based group, recreational centers, or volunteer opportunities?

School readiness: Language understanding and fluency, feelings, opportunities to socialize with other children, readiness for structured learning experiences, early childhood programs and preschool

  • Give child time to finish sentences; encourage speaking skills by reading/talking together. Keep answers short and simple.
    How does your child communicate what she wants and knows?
  • Read together daily; ask child questions about the stories.
  • Children are very sensitive, either easily encouraged or hurt; model respectful behavior and apologize if wrong; praise when demonstrates sensitivity to feelings of others.
  • Provide opportunities for your child to play with other children.
    How interested is your child in other children?
    How confident is she socially and emotionally?
  • Visit your child’s preschool/child care program; become actively involved; talk with your child about what she’s learning.
    How happy are you with your preschool or child care arrangements? On most days, does she seem happy to go?

Developing healthy nutrition and personal habits: Water, milk, and juice; nutritious foods; daily routines that promote health

  • Always have cool water available.
  • Provide 16 to 24 oz low-fat/fat-free milk daily.
  • Juice is not a necessary If you choose to give juice, limit to 4 oz daily and always serve it with a meal.
  • Offer variety of healthy foods/snacks, especially vegetables, fruits, lean protein.
  • Trust child to decide how much to eat.
  • Create calm bedtime ritual; enjoy mealtimes without TV; ensure child brushes teeth twice a day with pea-sized fluoridated toothpaste.

Media use: Limits on use, promoting physical activity and safe play

  • Limit TV and video to no more than 1 hour a day; no TV in bedroom; supervise any Internet use; consider making a family media use plan (healthychildren.org/MediausePlan).
    What digital and Internet-connected devices does your child use (eg, handheld devices, video games, digital toys, TV, computers)?
  • Make opportunities for daily play; be physically active as a family.

Safety: Belt-positioning car booster seats, outdoor safety, water safety, sun protection, pets, firearm safety

  • Continue to use a size-appropriate forward- facing car safety seat installed in backseat.
    Where do you sit when you ride in the car?
    Do you have a special seat?
  • Supervise all outdoor play; never leave child  alone; don’t allow to cross street alone.
  • Be sure swimming pools are fenced; use life jacket; teach child to swim.
  • Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
  • Teach child about safety around pets.
  • Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked Ask if firearms in other homes where child plays; if so, ensure same safety precautions before letting child play there.

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