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