Bright Future – 12 Month Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 12 Month Visit

Health supervision

Surveillance of development

  • Social language and self-help
    • Looks for hidden objects
    • Imitates new gestures
  • Verbal language (Expressive and receptive)
    • Uses Dada or Mama specifically
    • Uses 1 word other than Mama, Dada, or personal names
    • Follows directions with gestures, such as motioning and saying, “Give me (object).”
  • Gross Motor
    • Takes first independent steps
    • Stands without support
  • Fine Motor
    • Drops an object in a cup
    • Picks up small object with 2-finger pincer grasp
    • Picks up food to eat

Observation of Parent-Child interaction

How does parent interact with toddler? Does child check back with parent visually? Does child bring an object of interest to share with parent? How does parent react to praise of self or child? How do siblings interact with child? Does parent seem positive when speaking about child?

Complete Physical Examination, including Measure and plot: Recumbent length, weight, head circumference, and weight-for-length

Assess/observe for: Ocular motility, pupil opacification, red reflexes, visual acuity; dental irregularities and staining; abdominal masses; gait if walking, hand grasp and strength; testes fully descended/labia open; nevi, café-au-lait spots, birthmarks, bruising

Screening (www.aap.org/periodicityschedule) universal: Anemia; Lead (high prevalence area/ on Medicaid); Oral Health (in absence of dental home)

Selective: Blood Pressure; Hearing; Lead (low prevalence area/not on Medicaid); Oral Health; Tuberculosis; 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:

social determinants of health: Risks (living situation and food security; tobacco, alcohol, and drugs), strengths and protective factors (social connections with family, friends, child care and home visitation program staff, and others)

  • Community agencies can help you with concerns about your living situation.
    Tell me about your living situation. Do you have the resources 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.
  • Discuss with your caregiver your child’s medical needs, your feelings about diet/discipline/oral health/physical activity/media use.
  • Maintain ties with friends, community.

Establishing routines: Adjustment to the child’s developmental changes and behavior; family time; bedtime, naptime, and teeth brushing; media

  • Use positive discipline as well as time-outs and distractions; praise for good behaviors.
    When your child is troublesome, what do you do?
  • Carve out family time every day; establish  consistent daily routines.
  • Continue 1 nap a day; follow nightly bedtime routine with quiet time, reading, singing, favorite toy.
  • Establish teeth-brushing routine.
  • Avoid TV and other digital media with toddler; consider making a family media use plan (www.healthychildren.org/MediausePlan).
    How much time each day does your child spend watching TV or playing on tablet, smartphone, or other digital device? Is a TV on in the background while your child is playing in the room?

Feeding and appetite changes: Self-feeding, continued breastfeeding and transition to family meals, nutritious foods

  • Encourage self-feeding; avoid small, hard foods.
  • Provide healthy food and snacks; be sure caregivers do the same.
  • Feed 3 meals and 2 to 3 snacks a Toddlers tend to graze. Trust child to decide how much to eat.

Establishing a dental home: First dental checkup and dental hygiene

  • Visit the dentist by the time child is 12 months old or after first tooth erupts.
  • Brush child’s teeth twice a day with small smear of fluoridated toothpaste, soft toothbrush.
  • If child is still using bottle, offer only Avoid added sugars.

Safety: Car safety seats, falls, drowning prevention and water safety, sun protection, pets, safe home environment: poisoning

  • Use rear-facing car safety seat until child is high- est 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.
  • Use stair gates; keep furniture away from windows; install window guards.
  • Stay within an arm’s reach when near water (“touch supervision”); empty buckets, pools, bathtubs immediately after use.
  • Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
  • Keep child away from pet feeding area; monitor interactions between child and pet.
  • Remove/lock up poisons/toxic household products; keep Poison Help number (800-222- 1222) at each telephone, including cell.

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