Well-Baby 12 Month
Presents for a 12-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:
Counseling:
- Eat family foods
- Eat variety of textures
- 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: , , ,
Daycare: ,
Living with: ,
Parenting/bonding:
Family conflict/stress:
Second hand smoke exposure:
Complementary/alternative medicine:
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:
Responds to own name:
Understands simple requests (e.g. Where is the ball?):
Makes consonant/vowel combinations:
Says 3 or more words:
Crawls or pulls to stand:
Shows distress when separated:
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
Treatments:
- Caregiver questions answered
- Iron supplementation if not consuming iron-rich foods
- Vitamin D supplementation
- Immunizations: , , , , , ,
Further care:
- Referral to dentist
- Follow-up in
EXAM: ASSESSMENT: PLAN: