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Important topics duringthe well child exams
Screening labs and exams
Wendy Hobson-Rohrer, MD, MSPH
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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
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Bright Futures GuidelinesScreening Tables
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Well Child Care
Guide visits by parents or caregivers questions
For anticipatory guidance think about what they will bedoing prior to your next visit
This presentation only focuses on testing at WCC
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At every visit
History
Weight
Height
Physical Examination
Developmental Surveillance or Screening
Psychosocial/Behavioral Assessment
Immunization
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In a newborn and/or 2 week WCCit is important to screen for or
check the results of hearingtesting, newborn metabolicscreening and red reflex?
a. All of the aboveb. All of the above and BPc. All of the above and Hb
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Newborn Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
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2 Month Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
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4 Month Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
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6 Month Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
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Fluoride
Medicaid pays for physician offices toadminister 6 months through 4 years
Apply every 3 months at WCC
Quick easy administration
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At what age(s) do we screen for
anemia?
a. 9 monthsb. 12 monthsc. 9 months and 12 monthsd. 12 months and 24 months
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History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
9 Month Visit
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CDC recommendations
Recommend screening between ages 9 months to 12months and again 6 months later (15 months-18months)
Infants and Children
From families with low incomes
Who are eligible for Special Supplemental Nutrition Programfor Women, Infants and Children (WIC)
Who are recent migrants or recently arrived refugees
Who are Mexican-American
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Anemia Risk Factors
Infancy
Prematurity
Low birth weight
Use of low-iron formula or infants not receiving iron-fortifiedformula
Early introduction of cows milk as a major source ofnutrition. If infants are not yet consuming a sufficient
alternate source of iron-rich foods, replacement of breastmilk or formula may lead to insufficient iron intake.
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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
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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
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StructuredDevelopmental
Screens
http://www.developmentalscreening.org/screening_tool
s/index.htm
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You are seeing a child who is onMedicaid, at what/which ages do
you need to screen for lead?
a. 12 monthsb. 12 months and 24 months
c. 12 months and 24 months (or any timefrom 24 to 72 months when the childhas not had the test)
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Lead Exposure Risk AssessmentQuestions
For children ages 9 months to 6 years, ask screeningquestions for lead exposure
Does your child live in or regularly visit a house or childcare facility built before 1950?
Does your child live in or regularly visit a house or childcare facility built before 1978 that is being or has recentlybeen renovated or remodeled (within the last 6 months)?
Does your child have a sibling or playmate who has or didhave lead poisoning?
For targeted families, consider exposures to potterycontaining lead, home remedies containing lead andparents workplace exposure
History Physical Exam
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History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
12 Month Visit
History Physical Exam
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15 Month Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
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The M-Chat is a means of AutismSurveillance
True or FalseWhy?
History Physical Exam
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18 Month Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
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History Physical Exam
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2 Year Visit
History, Physical ExamWeight, Height, OFCPsychosocial and Behavioral Assessment
History Physical Exam
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Official BF3 Table ImagesUse for Presentations
2 Year Visit
History, Physical ExamWeight, Height, BMIPsychosocial and Behavioral Assessment
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Tuberculosis Exposure Screening
Every 6 months until age 2 years, then annually, ask thefollowing 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 otherthan the United States, Canada, Australia, New Zealand, orWestern European countries)?
Has your child traveled to, and had contact with residentpopulations of, a high-risk country for more than 1 week?
Offi i l BF3 T bl I
History Physical Exam
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Official BF3 Table ImagesUse for Presentations
3 Year Visit
History, Physical ExamWeight, Height, BMIPsychosocial and Behavioral Assessment
Offi i l BF3 T bl I
History Physical Exam
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Official BF3 Table ImagesUse for Presentations
4 Year Visit
History, Physical ExamWeight, Height, BMIPsychosocial and Behavioral Assessment
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All 5 year olds should have aroutine UA to screen for
hematuria and proteinuria?
True or FalseWhy?
Offi i l BF3 T bl I
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
5 Year Visit
History, Physical ExamWeight, Height, BMIPsychosocial and Behavioral Assessment
Offi i l BF3 T bl I
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
6 Year Visit
History, Physical ExamWeight, Height, BMIPsychosocial and Behavioral Assessment
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Follow immunization schedule
Official BF3 Table Images
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
7 Year Visit
y, yWeight, Height, BMIPsychosocial and Behavioral Assessment
Official BF3 Table Images
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
10 Year Visit
y, yWeight, Height, BMIPsychosocial and Behavioral Assessment
Official BF3 Table Images
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
11-14 Year Visit
y, yWeight, Height, BMIPsychosocial and Behavioral Assessment
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Follow Immunization Schedule
Official BF3 Table Images
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
15 to 17 Year Visit
y, yWeight, Height, BMIPsychosocial and Behavioral Assessment
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An 18-20 year old young womanshould be screened for
dyslipidemia and cervicaldysplasia? She has been sexuallyactive for 2 years.
True or False
Why?
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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 activityor age 21 (whichever comes first)
These recommendations are per Bright Futures and AAP,
may not be the same as ACOG
Official BF3 Table Images
History, Physical Exam
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Official BF3 Table ImagesUse for Presentations
18 to 21 Year Visit
Weight, Height, BMIPsychosocial and Behavioral Assessment
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Complete the grid
Hb or Hg Lead Devscreen
Autismscreen
Lipidscreen
9 mo
12 mo
18 mo
24 mo
30 mo
18 yr
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Complete the grid
Hb or Hg Lead Devscreen
Autismscreen
Lipidscreen
9 mo X
12 mo X X
18 mo X X
24 mo X X
30 mo X
18 yr X