18-Month Well-Child

Presents for a 18-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

Food insecurity: ‍yesno

Counseling:

- Avoid foods high in sugar or salt

- Avoid small, hard pieces / choking prevention

- Avoid juice

- Promote independent/self-feeding

- No bottles



EDUCATION AND ADVICE:

Daycare: ‍yesno, ‍

Parenting/bonding: ‍goodaveragepoor

Family conflict/stress: ‍yesno

Second hand smoke exposure: ‍yesno

Counseling:

- Healthy sleep habits (11-14 hrs per day)

- Encourage reading

- Avoid screens

- Promote physical activity

- Wean from pacifier

- Choking / safe toys

- Fall prevention (stairs, change table, unstable furniture/TV)

- Poison prevention (poison control center)

- Car seat (child/booster)

- Burn pervention

- Protect electric plugs/cords

- Attend during baths

- Limit sun exposure / sunscreens

- Dental cleaning twice a day



DEVELOPMENT:

Interested in other children: ‍ACHIEVEDNOT ACHIEVED

Usually casy to soothe: ‍ACHIEVEDNOT ACHIEVED

Child's behaviour is usually manageable: ‍ACHIEVEDNOT ACHIEVED

Comes for comfort when distressed: ‍ACHIEVEDNOT ACHIEVED

Points to several different body parts: ‍ACHIEVEDNOT ACHIEVED

Tries to get your attention to show you something: ‍ACHIEVEDNOT ACHIEVED

Turns/responds when name is called: ‍ACHIEVEDNOT ACHIEVED

Points to what helshe wants: ‍ACHIEVEDNOT ACHIEVED

Looks for toy when asked or pointed in direction: ‍ACHIEVEDNOT ACHIEVED

Imitates speech sounds and gestures: ‍ACHIEVEDNOT ACHIEVED

Says 15 or more words (do not have to be clear): ‍ACHIEVEDNOT ACHIEVED

Produces 4 consonants (e.g. BDGHNW): ‍ACHIEVEDNOT ACHIEVED

Feeds self with spoon with little spilling: ‍ACHIEVEDNOT ACHIEVED

Walks alone: ‍ACHIEVEDNOT ACHIEVED

Removes hat/socks without help: ‍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

- Hearing screening if speech delay or doubt on hearing acuity

- Caregiver questions answered

- Iron supplementation if not consuming iron-rich foods

- Vitamin D supplementation

- Immunizations:

- DTaP-IPV-Hib vaccine

- MMR-varicella vaccine

- Referral to dentist

- Follow-up in ‍ ‍weeksmonthsat 2 years