Important topics during the well child exams Screening labs and exams

Wendy Hobson-Rohrer, MD, MSPH

Objectives

At the end of this hour, participants will be able to:

Describe the difference between screening and surveillance

List the most common blood tests used in screening

Complete the grid for required screens at selected ages

Bright Futures Guidelines Screening Tables

Well Child Care

Guide visits by parents or caregivers questions For anticipatory guidance think about what they will be doing prior to your next visit This presentation only focuses on testing at WCC

At every visit

History Weight Height Physical Examination Developmental Surveillance or Screening

Psychosocial/Behavioral Assessment
Immunization

In a newborn and/or 2 week WCC it is important to screen for or check the results of hearing testing, newborn metabolic screening and red reflex?
a. All of the above b. All of the above and BP c. All of the above and Hb

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

Newborn Visit

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

2 Month Visit

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

4 Month Visit

10

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

6 Month Visit

11

Fluoride

Medicaid pays for physician offices to administer 6 months through 4 years Apply every 3 months at WCC Quick easy administration

At what age(s) do we screen for anemia?

a. b. c. d.

9 months 12 months 9 months and 12 months 12 months and 24 months

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

9 Month Visit

14

CDC recommendations
Recommend screening between ages 9 months to 12 months and again 6 months later (15 months-18 months)
Infants and Children
From families with low incomes Who are eligible for Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Who are recent migrants or recently arrived refugees Who are Mexican-American

Anemia Risk Factors

Infancy
Prematurity Low birth weight Use of low-iron formula or infants not receiving iron-fortified formula Early introduction of cows milk as a major source of nutrition. If infants are not yet consuming a sufficient alternate source of iron-rich foods, replacement of breast milk or formula may lead to insufficient iron intake.

Anemia Risk Factors

Early and Middle Childhood (ages 18 month5 years)

At risk of iron deficiency because of special health needs Low-iron diet (eg, nonmeat diet)

Environmental factors (e.g., poverty, limited access to food)

Middle Childhood (610 years)

Strict vegetarian diet and not receiving an iron supplement

Anemia Risk Factors

Adolescence (1121 years)

Extensive menstrual or other blood loss

Low iron intake

Strict vegetarian diet and not receiving an iron supplement Previously diagnosed with iron-deficiency anemia

Structured Developmental Screens

http://www.developmentals creening.org/screening_tool s/index.htm

You are seeing a child who is on Medicaid, at what/which ages do you need to screen for lead?
a. 12 months b. 12 months and 24 months c. 12 months and 24 months (or any time from 24 to 72 months when the child has not had the test)

Lead Exposure Risk Assessment Questions

For children ages 9 months to 6 years, ask screening questions for lead exposure
Does your child live in or regularly visit a house or child care facility built before 1950?
Does your child live in or regularly visit a house or child care facility built before 1978 that is being or has recently been renovated or remodeled (within the last 6 months)?

Does your child have a sibling or playmate who has or did have lead poisoning?

For targeted families, consider exposures to pottery containing lead, home remedies containing lead and parents workplace exposure

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

12 Month Visit

22

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

15 Month Visit

23

The M-Chat is a means of Autism Surveillance

True or False Why?

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

18 Month Visit

25

History, Physical Exam Weight, Height, OFC Psychosocial and Behavioral Assessment

2 Year Visit

27

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

2 Year Visit

28

Tuberculosis Exposure Screening

Every 6 months until age 2 years, then annually, ask the following screening questions:
Has a family member or contact had tuberculosis disease? Has a family member had a positive tuberculin skin test?

Was your child born in a high-risk country (countries other than the United States, Canada, Australia, New Zealand, or Western European countries)?
Has your child traveled to, and had contact with resident populations of, a high-risk country for more than 1 week?

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

3 Year Visit

30

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

4 Year Visit

31

All 5 year olds should have a routine UA to screen for hematuria and proteinuria?

True or False Why?

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

5 Year Visit

33

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

6 Year Visit

34

Follow immunization schedule

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

7 Year Visit

36

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

10 Year Visit

37

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

11-14 Year Visit

38

Follow Immunization Schedule

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

15 to 17 Year Visit

40

An 18-20 year old young woman should be screened for dyslipidemia and cervical dysplasia? She has been sexually active for 2 years.

True or False Why?

Cervical Dysplasia Screening

Risk assessment for ages 11-21 Routine papa and pelvic NOT recommended Screening for all sexually active girls as part of a pelvic examination beginning within 3 years of sexual activity or age 21 (whichever comes first) These recommendations are per Bright Futures and AAP, may not be the same as ACOG

History, Physical Exam Official BF3 Table Images Weight, Height, BMI Use for Presentations Psychosocial and Behavioral Assessment

18 to 21 Year Visit

43

Complete the grid

Hb or Hg Lead Dev screen Autism screen Lipid screen

9 mo 12 mo

18 mo
24 mo 30 mo 18 yr

Complete the grid

Hb or Hg Lead Dev screen Autism screen Lipid screen

9 mo 12 mo X X

18 mo
24 mo 30 mo 18 yr X

X
X

X X