Bright Future – 3 Year Visit

Dec 6, 2019 admin NHI KHOA 0

Bright Future – 3 Year Visit

Health supervision

Surveillance of development

■  Social language and self-help

  • Enters bathroom and urinates by herself
  • Puts on coat, jacket, or shirt by herself
  • Eats independently
  • Engages in imaginative play
  • Plays in cooperation and shares

■  Verbal language (Expressive and receptive)

  • Uses 3-word sentences
  • Speaks in words that are 75% understandable to strangers
  • Tells you a story from a book or TV
  • Compares things using words like bigger or shorter
  • Understands simple prepositions, such as on or under

■  Gross Motor

  • Pedals a tricycle
  • Climbs on and off couch or chair
  • Jumps forward

■  Fine Motor

  • Draws a single circle
  • Draws a person with head and 1 other body part
  • Cuts with child scissors

Observation of Parent-Child interaction

  • How do parent and child communicate?
    Does parent give the child choices? Does parent encourage child’s cooperation? Does parent notice and acknowledge child’s positive behaviors?
  • Does unacceptable behavior elicit appropriate limit setting from parents?

Complete Physical Examination, including

Measure: Blood pressure and compare with norms

Measure and plot: Height, weight, and BMI

Assess/observe for: Ocular motility, pupil opacification/red reflexes, visual acuity; condition of gums and teeth; abdominal masses; nevi, café-au-lait spots, birthmarks, bruising; language acquisition and clarity

Screening (www.aap.org/periodicityschedule)

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

Selective: Anemia; Hearing; Lead; Oral Health; Tuberculosis

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 situa- tion and food security; tobacco, alcohol, and drugs), strengths and protective factors (positive family interactions, work-life balance)

  • 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?
KEy = Guidance for parents, questions; Guidance for child, questions
  • 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.
  • Show affection in family; handle anger constructively; give child opportunities to make choices.
    Who loves you? How do you know?
  • Take time for self, partner; create opportunities for family to spend time with the child.

Playing with siblings and peers: Play opportunities and interactive games, sibling relationships

  • Encourage play with appropriate toys and safe exploration; expect fantasy play.
    Tell me about your child’s typical play.
  • Encourage interactive games with peers; explain importance of taking turns.
  • Help your children develop good relations with each other.

Encouraging literacy activities: Reading, talking,   and singing together; language development

  • Read, sing, play rhyme games together; let child “tell” story; practice reading wherever you go.
  • Encourage child to talk about friends, experiences.
    How does your child tell you what he wants? How well does the family understand his speech?

Promoting healthy nutrition and physical activity: Water, milk, and juice; nutritious foods; competence in motor skills and limits on inactivity

  • 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.
  • Encourage opportunities for physical activity for child, family.
  • Limit TV and other digital media to no more than 1 hour a day; monitor what child watches; consider making a family media use plan (healthychildren.org/MediausePlan).

Safety: Car safety seats, choking prevention, pedestrian safety and falls from windows, water safety, pets, firearm safety

■ Continue to use properly installed, size- appropriate rear-facing or forward-facing car safety seat with 5-point Keep car safety seat in the backseat.

■ Prevent choking by cutting food into small pieces.

■ Supervise all play near streets/driveways; don’t allow child to cross street alone.

■ Move furniture away from windows; install operable window guards.

■ Provide “touch supervision” near water, bathtubs, pools, toilet.

■ Teach child about safety around pets.

■ Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately; ask if firearms in other homes where child plays; if so, ensure same safety precautions are used before letting child play there.

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