Bright Future – 2.5 Year Visit
Health supervision
Surveillance of development
- Social language and self-help
- Urinates in a potty or toilet
- Spears food with fork
- Washes and dries hands
- Increasingly engages in imaginary play
- Tries to get parent to watch by saying, “Look at me!”
- Verbal language (Expressive and receptive)
- Uses pronouns correctly
- Gross Motor
- Walks up steps, alternating feet
- Runs well without falling
- Fine Motor
- Copies a vertical line; grasps crayon with thumb and fingers instead of fist
- Catches large balls
Observation of Parent-Child interaction
How actively do parent and child communicate? Does child speak at appropriate age level? Do child and parent look at book together, discuss it, and interact? How well does the parent calm the child?
Complete Physical Examination, including
Measure and plot: Standing height (preferred) or recumbent length, weight, and BMI (if standing height) or weight-for-length (if recumbent length)
Assess/observe for: Ocular motility, pupil opaci- fication, red reflexes, visual acuity; abdominal masses; nevi, café-au-lait spots, birthmarks, bruis- ing; coordination, language acquisition/clarity, socialization, vocalization
Screening (www.aap.org/periodicityschedule) universal: Development; Oral Health (in absence of dental home)
selective: Anemia; Blood Pressure; Hearing; Oral Health; 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:
Family routines: Day and evening routines, enjoy- able family activities, parental activities outside the family, consistency in the child’s environment
- Maintain regular family routines (meals, quiet bedtime).
- Encourage family exercise; take advantages of museums, zoos.
Tell me how you have fun with your family. - Maintain social contacts; do things outside the
- Reach agreement with all family members on how best to support child’s emerging independence while maintaining consistent limits. How well do you and your family agree on limits and discipline for your child?
Language promotion and communication: Use of simple words and reading together
- Read together every day; go to the library.
- Listen when child speaks; repeat, using correct grammar.
Is your child speaking in sentences? How frustrated does he become when others cannot understand what he is saying?
Promoting social development: Play with other children, giving choices, limits on TV and media use
- Encourage play with other children, but supervise because child not ready yet to share/play cooperatively.
- Build independence by offering choices between 2 acceptable alternatives.
Does your child enjoy making independent decisions? What are some of the new things your child is doing? - Limit TV and digital media to no more than 1 hour a day; monitor what child watches.
Preschool considerations: Readiness for early childhood programs and playgroups, toilet training
- Consider group child care, preschool program, organized playdates or playgroups.
What are your plans for child care or preschool in the year ahead? - Encourage toilet training success by dressing child in easy-to-remove clothes; establish daily routine; place on potty every 1 to 2 hours; praise; provide relaxed environment by reading/singing.
Safety: Car safety seats, outdoor safety, water safety, sun protection, fires and burns
- Be sure car safety seat is installed properly in Harness straps should be snug.
- Make sure everyone else uses seat belt.
- Supervise child outside, especially around cars, machinery, dogs.
- Provide “touch supervision” near water, bathtubs, pools, toilet.
- Use hat/sun protection clothing, sunscreen; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
- Install smoke detectors on every level; test monthly; change batteries annually; fire escape plan; keep matches/hot objects out of sight/away from child.
When did you last change the batteries in your smoke detectors?