5-Year-Old Routine Check-Up
Presents for a 5-year well-child check-up
Accompanied by:
Age: years, months
Past medical history:
Medications:
Allergies:
Family history:
Known risk factors:
Current symptoms or caregiver concerns:
NUTRITION:
Milk (500 mL or 16 oz): daily
Vitamin D 400 IU/day:
Appetite:
Vegeterian diet:
Food insecurity:
Counseling:
- Avoid foods high in sugar or salt
- Avoid juice
- Healthy diet
EDUCATION AND ADVICE:
Daycare: ,
Parenting/bonding:
Family conflict/stress:
Second hand smoke exposure:
Counseling:
- Healthy sleep habits (>10 hrs per day)
- Encourage reading
- Limit screen time
- Promote physical activity
- Car seat (child/booster)
- Burn pervention / matches
- Poison prevention (poison control center)
- Bike helmet
- No pacifier
- Limit sun exposure / sunscreens
- Dental cleaning
- Dentist visit
- Visual screening
DEVELOPMENT:
Counts out loud or on fingers to answer ("How many are there?"):
Speaks clearly in adult-like sentences most of the time:
Throws and catches a ball:
Hops on 1 foot several times:
Dresses and undresses with little help:
Cooperates with adult requests most of the time:
Retells the sequence of a story:
Separates casily from parent/caregiver:
EXAM:
General appearance: ,
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Metrics: length: cm - th perc, weight: kg - th perc, BMI: - 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, ADHD, hearing impairment, vision impairment, speech and language delay, motor skill delay, cognitive impairment, learning disabilities, growth disorders, nutritional deficiencies, anemia, lead poisoning, genetic disorders, metabolic disorders, environmental exposure concerns, behavioral issues, psychosocial issues, school difficulties
PLAN:
Investigations:
- Blood work: if at risk of anemia, if at risk, if at risk and not done yet
- Hearing screening if speech delay or doubt on hearing acuity
- Vision screening
Treatments:
- Caregiver questions answered
- Iron supplementation if not consuming iron-rich foods
- Vitamin D supplementation
- Immunizations:
- Tdap-IPV (preschool booster at 4-6 years of age) if not yet received
- 2nd dose of varicella vaccine if not yet received
- Meningococcal vaccine booster PRN if not yet received
Further care:
- Referral to dentist
- Follow-up in
EXAM: ASSESSMENT: PLAN: