15-Month Well-Child

Presents for a 15-month well-child check-up

Accompanied by: ‍both parentsmotherfather





Past medical history: ‍ ‍none

Medications: ‍ ‍none

Allergies: ‍ ‍none

Family history: ‍ ‍unremarkable

Known risk factors: ‍ ‍none



Current symptoms or caregiver concerns:

‍ ‍none



NUTRITION:

Breastfeeding: ‍yesno, ‍ feeds daily

Homogenized milk (500–750 ml or 16-24 oz): ‍ ‍mloz daily

Vitamin D 400 IU/day: ‍yesno

Vegeterian diet: ‍yesno

Appetite: ‍goodaveragepoor

Counseling:

- Avoid foods high in sugar or salt

- Avoid small, hard pieces / choking prevention

- Avoid juice

- Promote independent/self-feeding

- Promote open cup instead of bottle

- Avoid bottles in bed



EDUCATION AND ADVICE:

Sleep (11-14 hrs per day): total ‍ hrs per day

Sleep habits: ‍through the nightnight waking, ‍bedtime routine, ‍napping twice a day, ‍sleeping in crib/own bed

Daycare: ‍yesno, ‍

Living with: ‍both parentsmotherfather, ‍siblings

Parenting/bonding: ‍goodaveragepoor

Family conflict/stress: ‍yesno

Second hand smoke exposure: ‍yesno

Complementary/alternative medicine: ‍yesno

Counseling:

- Encourage reading

- Avoid screens

- Promote physical activity

- Poison prevention (poison control center)

- Car seat facing back

- Burn pervention

- Protect electric plugs/cords

- Attend during baths

- Safe sleep (avoid bed sharing, crib safety)

- Limit sun exposure / sunscreens

- Dental cleaning

- Fever advice



DEVELOPMENT:

Says 5 or more words (do not have to be clear): ‍ACHIEVEDNOT ACHIEVED

Walks sideways holding onto furniture: ‍ACHIEVEDNOT ACHIEVED

Shows fear of strange people/places: ‍ACHIEVEDNOT ACHIEVED

Crawls up a few stairs/steps: ‍ACHIEVEDNOT ACHIEVED

Tries to squat to pick up toys from the floor: ‍ACHIEVEDNOT ACHIEVED



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Measurements: length: ‍ cm - ‍ perc, weight: ‍ kg - ‍ perc, head circ: ‍ cm - ‍ perc

Head: fontanelles ‍soft, ‍normocephalic

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normalrednessexudate

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Genital: ‍normal, testicles ‍normal, penis ‍normal

Extremities: ‍normal, ‍normal pulses, cap refill ‍< 3 sec> 3 sec

Skin: ‍no rash

Musculoskeletal: joints ‍ ‍normal, ‍no limited ROM

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍, reactive to ‍

Developmental milestones: motor: ‍, communication: ‍, social/emotional: ‍, cognitive: ‍, adaptive: ‍



ASSESSMENT:

‍Normal growth and development ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC if at risk of anemia, ‍lead screening if at risk, ‍HBsAg, Anti-HBs if HBsAg positive mother

- Caregiver questions answered

- Iron supplementation if not consuming iron-rich foods or at risk

- Vitamin D supplementation if breastfeeding or premature

- Referral to dentist

- Follow-up in ‍ ‍weeksmonthsat 18 months