Well Child Check: 6 month old
6 month old _ here for well child check. No parental concerns at this time.
REVIEW OF SYSTEMS:
- Diet: No concerns. Starting to try solids.
- Voiding/stooling: No concerns.
- Sleeping: Has a regular bedtime routine, and sleeps through the night without feeding.
- Behavior: No concerns.
Normal pregnancy and delivery. No surgeries, hospitalizations, or serious illnesses to date.
- Gross and fine motor: Head flexed forward when pulled to a sitting position. Is able to sit up, rolls over both ways. Reaches and grabs; raking grasps.
- Cognitive: Responds to affection. Turns towards sounds.
- Social/Emotional/Communication: Smiles, laughs, likes to talk and play.
- No smokers in the home.
- No concerns regarding postpartum depression.
- No major social stressors at home.
- No safety concerns in the home.
- Daytime child care is with _
- No TB or lead risk factors.
- Up to date.
- 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 nicely in all parameters.
* Healthy 6-month old infant
- The family was given a children’s book today (per “Reach Out and Read” program)
- Follow up at 9 months of age, or sooner PRN.
- ER/return precautions discussed.
* Vaccines today:
- Pediarix #3 (DTaP, IPV, HepB #4), PCV #3, Rota #3, Hib #3, Influenza
- Pentacel #3 (DTaP, IPV, Hib), PCV #3, Rota #3, HepB #4, Influenza
- PCV #3, Rota #3, DTaP #3, IPV #3, Influenza (Hib, HepB to be given at 12-month visit)
* Anticipatory guidance (discussed or covered in a handout given to the family)
- Common immunization SE’s
- Avoiding use of walkers and door swings/jumpers.
- Child proofing the home: Gates for stairs, burn prevention, kitchen safety, water safety
- Poison Control number (800-222-1222)
- Car seat facing backward until 2 years of age and 20 pounds
- Teething and fluoride (first tooth at 3-12 months, average 7 months)
- How and when to introduce solids: Iron-fortified foods, delaying sweet foods and fruits, no honey/corn syrup/cow’s milk until one year old, finger foods
- Choking hazards
- No juice from bottle; no bottle in bed; early use of sippy cup
- Speech development (importance of reading and talking)
- Sleep: Separation anxiety, night awakening, sleep training, lower crib mattress, side rales up
- Warning signs for postpartum depression versus baby blues