Bright Future – 2 Year Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 2 Year Visit

Health supervision

Surveillance of development

  • Social language and self-help
    • – Plays alongside other children (ie, parallel play)
    • – Takes off some clothing
    • – Scoops well with spoon
  • Verbal language (Expressive and receptive)
    • – Uses 50 words; combines 2 words into short phrase or sentence
    • – Follows 2-step command
    • – Names at least 5 body parts
    • – Speaks in words that are 50% understandable to strangers
  • Gross Motor
    • – Kicks a ball
    • – Jumps off the ground with 2 feet
    • – Runs with coordination
    • – Climbs up a ladder at a playground
  • Fine Motor
    • – Stacks objects; turns book pages
    • – Uses hands to turn objects like knobs, toys, lids
    • – Draws lines

Observation of Parent-Child interaction

How do parent and child communicate? What is tone, feeling of parent-child interactions? Does child feel free to explore the room? How does parent set limits? Does parent seem positive when speaking about 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; condition of gums and teeth; abdominal masses; nevi, café- au-lait spots, birthmarks, or bruising; running, scribbling, socialization, ability to follow commands; language acquisition and clarity

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

Selective: Anemia; Blood Pressure; Dyslipidemia; 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 (intimate partner violence; living situation and food security; tobacco, alcohol, and drugs), strengths and protective factors (parental well-being)

  • 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).
  • Community agencies can help you with concerns about your living situation.
    Tell me about your living situation. What are your resources for caring for the 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.
  • Take care of self; maintain social contacts.
  • Create opportunities for family time.
  • Spend time with each child; resolve sibling  conflict without taking sides.
  • Do not allow hitting, biting, aggressive Model this yourself.

temperament and behavior: Development, temperament, promotion of physical activity and safe play, limits on media use

  • Praise good behavior and accomplishments; listen to and respect your child.
    What are some of the new things your child is doing?
  • Help child express feelings like joy, anger, sadness, frustration.
  • Encourage self-expression.
  • Learn child’s way of reacting to people/situations.
    How does your child act around family members?
  • Encourage free play for up to 60 minutes per day; give child age-appropriate play equipment.
  • Make time for learning through reading, talking, singing, exploring environment, not screens.
    How much time each day does your child spend watching TV or playing on tablet, smartphone, or other digital device?
  • Limit TV and other digital media to no more than 1 hour of quality programming per day; avoid TV during meals.

Assessment of language development: How child communicates and expectations for language, promotion of reading

  • Model appropriate language.
  • Should be able to follow simple 1- or 2-step commands.
    What do you think your child understands?
  • Read/look at books together every day; child may want same story over and over.

Toilet training: Techniques, personal hygiene

  • Begin when child is ready (dry for periods of 2 hours, knows wet and dry, can pull pants up/down, can indicate bowel movement).
  • Plan for frequent toilet breaks (up to 10 times a day).
  • Teach to wash hands.

Safety: Car safety seats, outdoor safety, firearm safety

  • Be sure car safety seat is installed properly in Harness straps should be snug.
  • Make sure everyone else uses a seat belt.
  • Supervise child outside, especially around cars, around machinery, in streets.
  • Use bike helmet.
  • Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.

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