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A Health and Wellness Program for Children

What to Expect during your Child’s Wellness Checkups Quick Reference Guide
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Updating the Medical History When performed
A child’s medical history is a complete set of notes from all doctor visits. It also includes a family health  history. Started at first visit and updated every visit after that for all children.

The Head-to-Toe Physical Exam and Important Measurements

Exam, screen or action When performed
Physical exam Every visit for every child.
Measure Length/Height and Weight Every visit for every child.
Body Mass Index (BMI): This measurement is calculated from a child’s height and weight. A very high BMI  (over 30) suggests that a child may have too much body fat. Starting at age 2 for all children, then every wellness visit.
Measure Head circumference: Shows if a child’s skull is growing along with his or her growing brain. Every visit up to and including the 2 year visit.
Measure Blood pressure (BP): If BP is high, it means the heart is working extra hard to pump blood. This could be a sign of possible health problems
  • Up to age 3 years, only at-risk children are screened.
  • At age 3 and at all wellness visits through age 20, all children are screened.

Checking the Senses

Exam, screen or action When performed
Vision screen:A child identifies pictures or reads letters on an eye chart with one eye at a time while the other eye is covered.
  • At ages 3 to 6 years old, then at wellness visits at 8, 10, 12 and 15 year old
  • At other wellness checks, only at-risk children.
Hearing Screen: Low volume tones are made by a handheld device or earphones. The child will identify which he/she can hear by raising his/her hand.
  • At birth or soon after.
  • At ages 4, 5, 6, 8 and 10 years old.
  • At other wellness checks, only children at-risk

Assessing Behavior, Psychosocial Development, and Mood

Exam, screen or action When performed
Developmental screen: The doctor asks parents to answer a series of written questions that can indicate whether their child is on track for development, or possibly behind (“developmentally delayed”).
  • Standardized testing at ages 9, 18 and 30 months for all children
  • At other wellness checks, at parents’ request or per physician’s judgment
Developmental surveillance:The doctor tracks a child's physical, mental, emotional, social, and behavioral growth by asking parents questions and by observing how the child moves, behaves and interacts with his/her parents and him/herself during the visit. At every visit for all children unless a scheduled               screening questionnaire is administered (see above)
Autism screen: Helps identify any issues a child may have with unusual behavior, language delays, and  problems interacting with others. These can be signs of autism.
  • At 18 and 24 months for all children
  • At other visits, only children at risk.
Psychosocial/behavioral assessment: A doctor may ask a child questions about how he/she feels about  him/herself, hopes, fears, friends, mentors, or moods. The doctor may also check for developmental  milestones or use screening questions to identify risk. Every visit for every child.
Alcohol/drug use assessment: A doctor will ask your child questions about alcohol use when they are middle-school aged. For at-risk youth, every wellness visit from age 11 through age 20
Depression screens are most often questionnaires for children and/or parents to complete. Depression is an  illness, not a phase. For at risk youth, every wellness visit from age 11 through age 20; any wellness visit at parent’s request or   per physician’s judgment

Various screens from birth through adolescence

Exam, screen or action When performed
The newborn blood screening tests for several genetic issues and syndromes. Newborns should be screened before they leave the hospital; at the latest, 2 months old
Critical congenital heart defect screening:measures oxygen levels in a newborn’s blood. Low numbers can mean there may be a heart problem. At birth for all newborns.
Screens for anemia–Anemia is a disorder that causes a child to feel tired because her body’s cells are not getting enough oxygen. This is often caused by not having enough red blood cells or not enough iron. Blood tests are given: A hematocrit measures number of red blood cell in blood; hemoglobin measures iron
  • At the 12 month wellness check for all children
  • At other visits, for children at risk, for those who complain of constantly feeling tired, or when a physician or parents have a concern
Screening for lead poisoning –with a blood sample. Just a tiny amount of lead in the blood can cause damage to the brain, heart and immune systems. In New Jersey,
  • All children have a blood test for lead between ages 1 and 2 years.
  • If at risk, at 6, 9, or 18 months; between 3 and 6 years old inclusive if no previous screening
The tuberculin skin test screens for exposure to (not necessarily infection with) to tuberculosis (TB), a very dangerous bacterial disease that damages lungs and makes it hard to breathe.
  • At 1 month, 6 months, 1 year and 2 years old for children at risk
  • Annually after children have screened positive for exposure or for other children who are at-risk
Dyslipidemia screening includes blood tests for cholesterol, triglycerides and other substances that cause hardening of the arteries in the heart.
  • All children should be screened once between ages 9 through 11 years and again between ages 18 through 20.
  • At ages 2 years, 4 years, 6 years, 8 years, and possibly each year from ages 12 through 17 for youth at risk.
Screening for Sexually Transmitted Infection (STI) and/or Human Immunodeficiency Virus (HIV): The doctor will ask the patient about sexual activity, number of partners and any symptoms. Based on the child’s responses, the doctor will screen for disease by testing the child’s urine, swabbing and testing any sores in the genitalia, or ordering a blood test. STI screening
  • At least during one wellness visit for all youth from age 16 through 18 years
  • At wellness visits for at- risk youth from age 11 through age 20 years
  • HIV screening for at risk youth after counseling
Cervical dysplasia screening: This is known as a Pap test. A doctor will take a tiny sample of tissue from the patient’s cervix to test for precancerous cells. (May be done by a gynecologist instead of a child’s primary doctor). For young women who are sexually active, within 3 years of onset of sexual activity
Oral health: Doctors should refer children to a dentist when the child’s first tooth comes through. Sometimes patients cannot get to a dentist regularly. The doctor should check these patients for oral/dental health and administer a fluoride treatment
  • Referral to dentist between ages 6 and 12 months.
  • For youth at risk, fluoride treatments at age 12 months and sometime between ages 2 and 3 years, inclusive