Bright Future – 15 Month Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 15 Month Visit

Health supervision

Surveillance of development

  • Social language and self-help
    • Imitates scribbling
    • Drinks from cup with little spilling
    • Points to ask for something, get help
    • Looks around after hearing things like “Where’s your ball?” or “Where’s your blanket?”
  • Verbal language (Expressive and receptive)
    • Uses 3 words other than names
    • Speaks in sounds like an unknown language
    • Follows directions that do not include a gesture
  • Gross Motor
    • Squats to pick up objects
    • Crawls up a few steps
    • Runs
  • Fine Motor
    • Makes marks with crayon
    • Drops object in, takes object out from container

Observation of Parent-Child interaction

What is the emotional tone between parent and child? How does parent support toddler’s need for safety and reassurance? Does toddler check back with parent? How do the parent and toddler play with toys? How does parent react to praise of self or child? Does parent notice/acknowledge child’s positive behaviors? How do siblings interact with toddler?

Complete Physical Examination, including

Measure and plot: Recumbent length, weight, head circumference, and weight-for-length

Assess/observe for: Ocular motility, pupil opaci- fication, red reflexes, visual acuity; dental caries/ plaque/demineralization/staining; abdominal masses; nevi, café-au-lait spots, birthmarks, bruising; stranger avoidance; walking and moving around the room

Screening (www.aap.org/periodicityschedule) universal: Oral Health (in absence of dental home)

Selective: Anemia; Blood Pressure; Hearing; Vision

Immunization

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:

Communication and social development: Individuation, separation, finding support, attention to how child communicates wants and interests

  • When possible, allow child to choose between 2 options acceptable to you.
  • Stranger anxiety and separation anxiety reflect new cognitive gains; speak reassuringly.
  • Take time for self, Seek support from other parents.
  • Use simple, clear words and phrases to promote language development and improve communication.
    How does your child communicate what she wants? Does she point to something she wants and then watch to see if you see what she’s doing?

Sleep routines and issues: Regular bedtime routine, night waking, no bottle in bed

  • Maintain consistent bedtime and nighttime routine; tuck in when drowsy but still awake.
  • If night waking occurs, reassure briefly; give stuffed animal or blanket for self-consolation.
  • Don’t give bottle in Don’t put TV/computer/ digital device in child’s bedroom.

Temperament, development, behavior, and discipline: Conflict predictors and distraction, discipline and behavior management

  • Modify child’s environment to avoid conflict/ Use distractions; accept messiness; allow child to choose (when appropriate). What kinds of things do you find yourself saying no about?
  • Praise good behavior and accomplishments.
  • Use discipline for teaching/protecting, not punishing. Use time-outs to avoid negative attention.
    How are you and your partner managing your child’s behavior? What do you do when you disagree?
  • Teach child not to hit, bite, use aggressive Model this yourself.

Healthy teeth: Brushing teeth, reducing caries

  • Schedule first dental visit if child hasn’t seen dentist yet.
  • Brush teeth twice a day with small smear of fluoridated toothpaste, soft toothbrush.
  • Prevent tooth decay by good family oral health habits (brushing, flossing), not sharing utensils or cup.
  • If child uses nighttime bottle, use water only.

Safety: Car safety seats and parental use of seat belts, safe home environment: poisoning, falls, and fire safety

  • Use rear-facing car safety seat until child is highest weight or height allowed by manufacturer; make necessary changes when switching seat to forward facing; never place vehicle safety seat in front seat of car with passenger air bag; backseat safest.
  • Make sure everyone uses a seat belt.
  • Remove poisons/toxic household products; keep Poison Help number (800-222-1222) at every phone, including cell; use stair gates; keep furniture away from windows; install window guards.
  • When did you last examine your home to make sure it is safe? What emergency numbers do you have posted near your phones?
  • Install smoke detector on every level; test monthly/change batteries annually; make fire escape plan; set home hot water less than 120°F.

BÀI LIÊN QUAN