testing in well child care without poll.pptx

7/29/2019 Testing in Well Child Care without poll.pptx

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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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9

2 Month Visit



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10

4 Month Visit



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11

6 Month Visit



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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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14


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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22


12 Month Visit



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23

15 Month Visit



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The M-Chat is a means of AutismSurveillance

True or FalseWhy?



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25

18 Month Visit



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27

2 Year Visit




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28

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



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30


3 Year Visit


Offi i l BF3 T bl I



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4 Year Visit



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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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5 Year Visit


Offi i l BF3 T bl I



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6 Year Visit



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Follow immunization schedule

Official BF3 Table Images



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7 Year Visit

y, yWeight, Height, BMIPsychosocial and Behavioral Assessment




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10 Year Visit





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11-14 Year Visit



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Follow Immunization Schedule




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15 to 17 Year Visit



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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




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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

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