Well-Baby 6 Month
Presents for a 6-month well-child check-up
Accompanied by:
Age: days, Gestational age: months
Past medical history:
Medications:
Allergies:
Family history:
Known risk factors:
Current symptoms or caregiver concerns:
NUTRITION:
Breastfeeding: , feeds daily
Vitamin D 400 IU/day (if breastfeeding):
Formula feeding/Preparation (750-1080 mL (25-36 oz)/kg/day): daily, type:
Iron supplement (if prematurity):
Vegeterian diet:
Appetite:
Counseling:
- Eat iron containing foods (iron fortified infant cereals, meat, tofu, legumes, poultry, fish, whole eggs)
- Eat allergenic foods (especially eggs and peanut products)
- Fruits, vegetables, and milk products (yogurt, cheese) to follow
- Explore textures
- Promote independent/self-feeding
- Avoid foods high in sugar or salt
- Avoid small, hard pieces / choking prevention
- Avoid juice
- Avoid mercury-containing fish
- No honey
- Water offered at meals
- Encourage transition from bottle to cup
- Avoid bottles in bed
- Respect hunger and satiety signals
EDUCATION AND ADVICE:
Sleep: total hrs per day
Sleep habits:
Living with: ,
Parenting/bonding:
Family conflict/stress:
Parental fatigue/postpartum depression:
Difficulty making ends meet or food insecurity:
High-risk infants/assess home visit need:
Second hand smoke exposure:
Complementary/alternative medicine:
Counseling:
- Encourage reading
- Avoid screens
- Promote physical activity
- Falls (stairs, change table, unstable furniture/TV, no walkers)
- Carbon monoxide/smoke detectors
- Choking/safe toys
- Protect electric plugs/cords
- Poison prevention (poison control center)
- Car seat facing back
- Burn prevention
- Hot water <49°C/bath safety
- Safe sleep (room sharing, avoid bed sharing, crib safety)
- Limit sun exposure / sunscreens / insect repellent
- Supervised tummy time while awake (minimum 30 min/day)
- Water not required if exclusive breastfeeding
- No OTC cough/cold medicine
- Temperature control and overdressing
- Fever advice
- Dental cleaning
DEVELOPMENT:
Turns head toward sounds:
Makes sounds while you talk to him/her:
Vocalizes pleasure and displeasure:
Rolls from back to side:
Sits with support (e.g. pillows):
Reaches/grasps objects with both hands equally:
No persistent closed/fisted hands:
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 premature ou birth weight < 2500g
Treatments:
- Caregiver questions answered
- Iron supplementation if premature
- Vitamin D supplementation if breastfeeding or premature
- Immunizations:
- DTaP-IPV-Hib vaccine PRN
- Pneumococcal vaccine PRN
- Influenza vaccine if at risk
- If HBsAg-positive parent/sibling Hep B vaccine #3
Further care:
- Referral to resources and support for parents if needed
- Follow-up in
EXAM: ASSESSMENT: PLAN: