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6-Month Well-Child

Presents for a 6-month well-child check-up
Accompanied by: 


Past medical history:  
Medications:  
Allergies:  
Family history:  
Known risk factors:  

Current symptoms or caregiver concerns:  

NUTRITION:
Breastfeeding: ,  feeds daily
Vitamin D 400 IU/day (if breastfeeding): 
Formula feeding/Preparation (750-1080 ml (25-36 oz)/kg/day):   daily, type: 
Iron supplement (if prematurity): 
Vegeterian diet: 
Appetite: 
Counseling:
- Eat iron containing foods (iron fortified infant cereals, meat, tofu, legumes, poultry, fish, whole eggs)
- Eat allergenic foods (especially eggs and peanut products)
- Fruits, vegetables, and milk products (yogurt, cheese) to follow
- Explore textures
- Promote independent/self-feeding
- Avoid foods high in sugar or salt
- Avoid small, hard pieces / choking prevention
- Avoid juice
- Avoid mercury-containing fish
- No honey
- Water offered at meals
- Encourage transition from bottle to cup
- Avoid bottles in bed
- Respect hunger and satiety signals

EDUCATION AND ADVICE:
Sleep: total  hrs per day
Sleep habits:  
Living with: , 
Parenting/bonding: 
Family conflict/stress: 
Parental fatigue/postpartum depression: 
Difficulty making ends meet or food insecurity: 
High-risk infants/assess home visit need: 
Second hand smoke exposure: 
Complementary/alternative medicine: 
Counseling:
- Encourage reading
- Avoid screens
- Promote physical activity
- Falls (stairs, change table, unstable furniture/TV, no walkers)
- Carbon monoxide/smoke detectors
- Choking/safe toys
- Protect electric plugs/cords
- Poison prevention (poison control center)
- Car seat facing back
- Burn prevention
- Hot water <49°C/bath safety
- Safe sleep (room sharing, avoid bed sharing, crib safety)
- Limit sun exposure / sunscreens / insect repellent
- Supervised tummy time while awake (minimum 30 min/day)
- Water not required if exclusive breastfeeding
- No OTC cough/cold medicine
- Temperature control and overdressing
- Fever advice
- Dental cleaning

DEVELOPMENT:
Turns head toward sounds: 
Makes sounds while you talk to him/her: 
Vocalizes pleasure and displeasure: 
Rolls from back to side: 
Sits with support (e.g. pillows): 
Reaches/grasps objects with both hands equally: 
No persistent closed/fisted hands: 

EXAM:
General appearance: 
Vital signs: , BP , HR , RR , SpO2  %, Temp °
Measurements: length:  cm -  perc, weight:  kg -  perc, head circ:  cm -  perc
Head: fontanelles , 
Eyes: -R: , -L: , , , red reflex , corneal light reflex , fix and follow test 
Ears: -R: , -L: 
Nose: , , discharge , 
Throat: 
Neck: 
Heart: , 
Lungs: , 
Abdomen: , , , 
Genital: , testicles , penis 
Extremities: , , cap refill , Barlow , Ortolani 
Skin: 
Musculoskeletal: joints  , 
Neurologic: cranial nerves , global motricity , muscle tone , gait 
Mental status: , , reactive to 
Developmental milestones: motor: , communication: , social/emotional: , cognitive: , adaptive: 

ASSESSMENT:
 
DDx: 

PLAN:
- Blood work:  if premature ou birth weight < 2500g
- Caregiver questions answered
- Iron supplementation if premature
- Vitamin D supplementation if breastfeeding or premature
- Immunizations:
- DTaP-IPV-Hib vaccine PRN
- Pneumococcal vaccine PRN
- Influenza vaccine if at risk
- If HBsAg-positive parent/sibling Hep B vaccine #3
- Referral to resources and support for parents if needed
- Follow-up in