Well Child Check: 4 month old
4-month old infant here for a well child check. No parental concerns/questions today.
- Eating well: _
- Hasn’t tried solids yet.
- No concerns about stooling or voiding.
- Bedtime routine: _
Normal pregnancy and delivery. No surgeries, hospitalizations, or serious illnesses to date.
- Gross motor: Good head control, including when prone. Good head control when pulled to a sitting position.
- Fine motor: Able to roll from front to back. Reaches for objects, and holds them briefly.
- Cognitive: Responds to affection. Indicates pleasure and displeasure.
- Social/Emotional: Laughs, squeals. Can self-calm.
- Communication: Babbles, smiles.
- No smokers in the home.
- No postpartum depression in mother.
- No major social stressors at home.
- Daytime child care is with _
- No TB risk factors.
- VITALS: _
- GEN: Normal general appearance. NAD.
- HEAD: NCAT. AFOSF.
- EYES: Red reflex present bilaterally. Light reflex symmetric. EOMI, with no strabismus.
- ENMT: TMs, nares, and OP normal. MMM. No abnormal oral lesions.
- NECK: Supple, with no masses.
- CV: RRR, no m/r/g. Normal femoral pulses.
- LUNGS: CTAB, no w/r/c.
- ABD: Soft, NT/ND, NBS, no masses or organomegaly.
- GU: Normal _male genitalia. Testes descended bilaterally.
- SKIN: WWP. No skin rashes or abnormal lesions.
- MSK: Normal extremities & spine. No hip clicks or clunks.
- NEURO: MAE symmetrically. Normal muscle strength and tone.
GROWTH CHART: Following growth curve well in all parameters.
* Healthy 4-month old infant
- Follow up at 6 months of age, or sooner PRN.
- ER/return precautions discussed.
* Vaccines today:
- Pediarix #2 (DTaP, IPV, HepB #3), PCV #2, Rota #2, Hib #2
- Pentacel #2 (DTaP, IPV, Hib), PCV #2, Rota #2, HepB #3
- Comvax (Hib #2, HepB #3), PCV #2, Rota #2, DTaP #2, IPV #2
* Premature (< 37 weeks) or < 5.5 lbs
- Consider hemoglobin
* Anticipatory guidance (discussed or covered in a handout given to the family)
- Common immunization SE’s
- How and when to introduce solids
- Normal sleep patterns (decreased nighttime feeds, more regular sleep patterns)
- Infant should always sleep on back to prevent SIDS (first 6 months, at least)
- Teething (first tooth at 3-12 months, average 7 months)
- Tummy time; prevention of plagiocephaly
- Range of normal bowel habits
- Warning signs for postpartum depression versus baby blues
- No smoking in home: risk for SIDS and asthma
- Safest to sleep in crib or bassinet
- Car seat facing backward until 2 years of age and 20 pounds
- Working smoke alarms and carbon dioxide monitors in home
- Hot water heater to less than 120 degrees
- Fall prevention
- Normal crying versus colic, and what to expect
- No honey, corn syrup, cows milk until 1 year
- Poly-Vi-Sol supplement with iron if mostly breast feeding (< 32 oz/day of formula)
- How and when to contact us