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18-Month Well-Child

Presents for a 18-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
Homogenized milk (500–750 ml or 16-24 oz):   daily
Vitamin D 400 IU/day: 
Vegeterian diet: 
Appetite: 
Food insecurity: 
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: , 
Parenting/bonding: 
Family conflict/stress: 
Second hand smoke exposure: 
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: 
Usually casy to soothe: 
Child's behaviour is usually manageable: 
Comes for comfort when distressed: 
Points to several different body parts: 
Tries to get your attention to show you something: 
Turns/responds when name is called: 
Points to what helshe wants: 
Looks for toy when asked or pointed in direction: 
Imitates speech sounds and gestures: 
Says 15 or more words (do not have to be clear): 
Produces 4 consonants (e.g. BDGHNW): 
Feeds self with spoon with little spilling: 
Walks alone: 
Removes hat/socks without help: 

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: , 
Ears: -R: , -L: 
Nose: , , discharge , 
Throat: 
Neck: 
Heart: , 
Lungs: , 
Abdomen: , , , 
Genital: , testicles , penis 
Extremities: , , cap refill 
Skin: 
Musculoskeletal: joints  , 
Neurologic: cranial nerves , strength , sensation , reflexes , cerebellar function , gait 
Mental status: , , reactive to 
Developmental milestones: motor: , communication: , social/emotional: , cognitive: , adaptive: 

ASSESSMENT:
 
DDx: 

PLAN:
- Blood work:  if at risk of anemia,  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