18-Month Well-Child
Presents for a 18-month well-child check-up
Accompanied by:
Age: months, Gestational age: months
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 °
Metrics: length: cm - th perc, weight: kg - th perc, head circ: cm - th perc
Head: fontanelles ,
Eyes: conjunctiva/sclera , lids/lashes , , extraocular movements , red reflex , corneal light reflex , fix and follow test
Ears: tympanic membranes , auditory canal on , hearing
Nose: , , discharge ,
Throat: , ,
Neck: , , , , , c-spine
Heart: , ,
Lungs: , ,
Abdomen: , , ,
Genitourinary: external genitalia , testes , penis , Tanner stage
Extremities: , , , , Barlow , Ortolani , , cap refill sec
Skin: on
Musculoskeletal: joints ,
Neurologic: cranial nerves , overall motricity , muscle tone , gait , reflexes
Mental status: , , reactive to
Developmental milestones: motor: , communication: , social/emotional: , cognitive: , adaptive:
ASSESSMENT:
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: if at risk of anemia, if at risk
- Hearing screening if speech delay or doubt on hearing acuity
Treatments:
- Caregiver questions answered
- Iron supplementation if not consuming iron-rich foods
- Vitamin D supplementation
- Immunizations:
- DTaP-IPV-Hib vaccine
- MMR-varicella vaccine
Further care:
- Referral to dentist
- Follow-up in
EXAM: ASSESSMENT: PLAN: