Case Background
A 6-month-old boy is seen for a routine visit. His mother inquires about transitioning to a front-facing car seat and his speech development. Born full term via uncomplicated vaginal delivery, he has shown normal growth and is up to date on vaccinations. He had a mild respiratory infection at 5 months. He was fed iron-fortified formula and started solids at 4 months.
His parents do not smoke, and there is no family history of developmental or speech issues. The boy is in good health, with normal growth percentiles. He can sit briefly unsupported, reach for objects, pick up a Cheerio, and babbles often. No abnormalities are noted.
The Child Wellness Exam
A child wellness visit is a regular meet-up with a doctor for a health assessment to prevent health problems before they escalate. The six-month-old boy requires a regular stop for both growth and development assessment. The doctors check weight, height, body mass index, hearing and visual complications, development milestone assessment, vital signs, and complete body examination to determine and stop any ailment before it jeopardizes the child’s health (Bell et al., 2019). A regular wellness visit is the antidote to ensure children are protected from preventable diseases and premature deaths.
Purpose of the Well-Child Exam
The primary purposes of the well-child visit is to offer preventive care, ensure all vaccines are administered and promote early intervention. Since the visit helps in discovering all asymptotic conditions, management and treatment is possible before the conditions becomes complicated. Further, the visit ensures that preventive care and vaccines are administered as required (Appleton et al., 2022). A child’s health in the early years depends on wellness visits because they include a holistic approach that notices any abnormality in a child’s life and offers timely intervention.
History Components and Physical Examination
The child’s health history indicates no abnormality at five months apart from the respiratory health challenge. The child’s family does not have a person who had a similar condition in the past (Appleton et al., 2022). Further, all immunizations have taken time, and the child’s history proves a healthy lifestyle. It is further prudent to note that the parents do not smoke and do not have developmental challenges. The boy is, however, the first pregnancy from the mother, but the expected vaginal delivery shows that the child is not in danger.
Although the entire physical examination (PE) showed no abnormalities, other factors must have been included to offer a holistic result on the child’s health. The PE should include the features of the child to determine symmetry (Bell et al., 2019). A healthy child’s face must be symmetrical since it tells about mental alertness, nutritional status, and hygiene.
Other essential parts of the PE include checking for body posture, movement, skin color, bruises, and hair distribution, as any of these may detect an abnormality (Appleton et al., 2022). The average BMI for healthy children ranges from the 5th to the 85th percentile. The boy is, therefore, within the correct range, and no abnormality is recorded (Bell et al., 2019). Failure to thrive is reported when a child’s weight gain or rate is below that of kids of similar age and sex. In such cases, such children appear shorter and smaller than the rest. The principal cause of failure to thrive is poor nutrition, and can be averted by ensuring a healthier lifestyle.
Development
Gross and Fine Motor Evaluation
A child must undergo a development assessment during a wellness visit to ensure that all the aspects of development are typical. The foremost factor to be evaluated the gross and fine motor. A child between three and six months must be able to raise his hands and legs when placed on the stomach and support the head (Bell et al., 2019).
The boy had healthy gross motor skills, as he could raise his hands for support after sitting on the ground for a short time. The figure-to-palm translation can evaluate fine motor skills when a child can hold objects tightly without dropping them. The boy also passed the test because he could hold Cheerio and put it in his mouth (Appleton et al., 2022). The child can also be evaluated by their ability to hold the fingers of the parent.
Language and Age to Say “Mama” /”dada.”
Language and the ability to call out to one’s parents are critical developmental stages in a child’s life. A child’s language evaluation includes the child’s ability to respond to his name with sounds and chuckles (Needlman et al., 2019). At the age of six months, children are expected to make noises to respond to positive or negative emotions. When an average child is exposed to harmful stimuli, it must make noise to confirm that the language has been developed to meet the required threshold.
Although Gravida is worried about the inability of her child to say mama, her child is too young to start calling out (Holley et al., 2019). The correct age for a child to call mama or dada is between eight and twelve months. When a child fails to call the names after twelve months, an intervention will be needed for a healthier outcome.
Social and Personal Skills
Social and personal skills are needed for a holistic child’s growth. A child can be tested using non-verbal communication to show that they are passing information. For example, the child must be able to smile and show affection when prompted. The social skills will be evaluated using raspberries because when they are blown, the children must make a sound or move (Appleton et al., 2022). Further, the child must be able to show something to the parents and caregivers through pointing.
Screening Tools and Options for a Developmental Delay
Numerous tools can be used to evaluate and determine children’s abilities. Some common ones include raspberries, Cheerio, and toys for the child to respond to by playing and making sounds. The named tools can determine whether a child’s growth is negatively affected (Morrison et al., 2019). When there are delays in any part of the growth and development, the next step is to book a therapy. When the child has delays in motor skills, a physiotherapy session will be an antidote. Occupational and behavioral therapy is critical for improving a child’s development.
Screening Tests
Screening tests are essential to ensure that a child has the correct state of health. Various screenings must be included to enhance holistic children’s health. The congenital disease is screened in the first trimester to ensure the child’s intrauterine life is unaffected. Lead levels are tested by conducting a blood test while anemia is screened using hematocrit and hemoglobin tests in the samples taken. The otoacoustic emissions technique is the best way to screen for hearing challenges before a child leaves the hospital after birth to confirm no hearing impairment (Morrison et al., 2019). At six months, a child’s test for vision is its ability to follow through a toy by rotating the eyes.
Other necessary tests that must be included in the child’s screening to ensure health and safety include Homocystinuria to evaluate the chest and inherited conditions of the child. Dental tests are conducted through oral screening, where a professional dentist examines a child’s health (Holley et al., 2019). The American academy of pediatric dentistry recommends that children must see a doctor by six months. The boy was therefore right on time for the dental checkup for healthy gums and teeth.
Anticipatory Guidance
An anticipatory guide is a critical recommendation to parents to ensure their child is protected from all forms of injury and accidents. The guidance is critical to ensure that health and wellness are promoted. Injuries can be prevented by ensuring the child plays in a safe environment without sharp objects. In the feeding domain, parents must avoid all foods likely to choke a child (Morrison et al., 2019). All sharp-edged corners and furniture must be covered so that the child does not get injuries as it starts moving around. At the age of six, a child’s development is in full gear, and the parent must start reading to familiarize him with books and materials.
Nutrition is one of the most critical aspects of a child’s growth and development. A child must constantly be exposed to a balanced diet with at least infant helping, cereal, and soft fruits with expectations of those with the tendency to choke, such as raw apples, carrots, and vegetables high in fiber. When traveling, a child under twelve months must never be allowed to be in the front seat (Needlman et al., 2019). It is essential to ensure that the parents and caregivers always talk calmly to the child to maintain positive mental health for a better outcome (Morrison et al., 2019).
Sudden infant death can be prevented when the child is always placed to sleep on his back. Further, the baby’s face must always be uncovered and placed in the foot to feet position. The child must be exposed to physical exercise and vitamin D through the sun to have holistic growth in the discourse (Holley et al., 2019). Discipline can be maintained when the child is constantly distracted by the negatives and applauded when doing the right things.
Upcoming Visits and Important Vaccines
The subsequent visit must be conducted within two months to determine whether the baby is in the proper condition. Further, essential vaccines must be taken to ensure safety, such as the flu, vitamin A, and yellow fever. Further, confirming that the child had diphtheria, tetanus, and polio is essential. If any vaccine has not been administered, it must be taken before the child leaves the hospital.
References
Appleton, J., Russell, C. G., Fowler, C., Jansen, E., Burnett, A. J., Rossiter, C., & Denney-Wilson, E. (2022). Informing infant nutrition: Timing of infant formula advice, infant formula choice and preparation in the first 6 months of life. Journal of Nutrition Education and Behavior, 54(10), 908–915. Web.
Bell, C. S., Samuel, J. P., & Samuels, J. A. (2019). Prevalence of hypertension in children: applying the new American Academy of Pediatrics clinical practice guideline. Hypertension, 73(1), 148-152. Web.
Holley, M. A., Wiley, L. A., & Marass, A. D. (2019). Watch me grow: A well-child examination protocol to improve preventive care in dominican children. Journal of Pediatric Health Care, 33(3), 263–269. Web.
Morrison, A. K., Glick, A., & Yin, H. S. (2019). Health literacy: implications for child health. Pediatrics in Review, 40(6), 263–277. Web.
Needlman, R. D., Dreyer, B. P., Klass, P., & Mendelsohn, A. L. (2019). Attendance at well-child visits after reaching out and reading. Clinical Pediatrics, 58(3), 282-287. Web.