15-Month Well-Child

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

Accompanied by: ‍both parentsmotherfather



Age: ‍ months, Gestational age: ‍ months



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): ‍✓NOT ACHIEVED

Walks sideways holding onto furniture: ‍✓NOT ACHIEVED

Shows fear of strange people/places: ‍✓NOT ACHIEVED

Crawls up a few stairs/steps: ‍✓NOT ACHIEVED

Tries to squat to pick up toys from the floor: ‍✓NOT ACHIEVED





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Metrics: length: ‍ cm - ‍th perc, weight: ‍ kg - ‍th perc, head circ: ‍ cm - ‍th perc

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Genitourinary: external genitalia ‍normal, testes ‍descended, penis ‍normal, Tanner stage ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍

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





ASSESSMENT:

‍Normal growth and development ‍likelysuspectedpossible

DDx: developmental delay, autism spectrum disorder, hearing impairment, vision impairment, speech and language delay, motor skill delay, cognitive impairment, growth disorders, nutritional deficiencies, anemia, lead poisoning, genetic disorders, metabolic disorders, environmental exposure concerns, attachment issues, behavioral issues





PLAN:

Investigations:

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

Treatments:

- Caregiver questions answered

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

- Vitamin D supplementation if breastfeeding or premature

Further care:

- Referral to dentist

- Follow-up in ‍ ‍weeksmonthsat 18 months