Infant to Child Assessment
INFANT TO CHILD EXAM
| NEWBORN | 3-6 MONTHS | 6-12MONTHS | > 3 YEARS OLD | |
|---|---|---|---|---|
| EYE EVALUATION & VISION SCREENING | Red Reflex (Red Reflex must be present; if absent, may be congenital cataracts) -Newborns are nearsighted (myopia) w/ vision of 30/400 -Infants can focus at distance of 8-10 inches | Red Reflex Fix & Follow -Infants > 3 months-assess ability to fixate on objects & social response to parents face -2-4 months of age, eye alignment should occur -Infant will hold hands close to face to observe them; at 6 months able to make eye contact | Red Reflex Corneal Light Reflex Cover/Uncover Test Fix & Follow -Corneal Light Reflex & Cover/Uncover Test are used to assess strabismus | Red Reflex Corneal Light Reflex Cover/Uncover Test Visual Acuity Ophthalmology -Preschool children: Tumbling E or Allen Cards -Vision at 3 years 20/50 -Vision at 4 years 20/40 -Vision at 5 years 20/30 -Vision at 6 years 20/20 |
| EAR EVALUATION | Startle (Moro Reflex) | Able to stop & listen to new sounds; stops crying when hearing parents voice -Peak incidence for OM is 6 months-36 months of age; commonly seen following URI -Approx. 80% of OM cases resolve spontaneously | Responds to name -12-18 months-follows directions without cues -18-24 months-50% of speech intelligible to strangers | |
| MOUTH EVALUATION | First teeth will come in about 6 - 10 months (primary dentition) -Oral health risk assessment starts at 6 months -Fluoride supplementation at 6 months | 2 1/2 years of age: has complete set of primary teeth (20 teeth) | ||
| HEART EVALUATION | Normal HR 120-160 with marked sinus arrhythmia -The purpose of assessing B/P in all 4 extremities is to assess for coarctation -Suspect coarctation of the aorta if pulses are unequal & weak &/or high B/P in upper extremity with low B/P in lower extremity -Murmurs are common: 10% are significant | HR 80-120 at 3 years of age -HR 70-110 at 6 years of age -B/P screening should begin in children at 3 years of age; dyslipidemia risk assessment at 2,4,6,8,10 years of age (assess by their diet) -FLP usually done at 18-21 years of age |
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| GI EVALUATION | Bilirubin is a normal component of RBC's -> 5mg/dL is termed hyperbilirubinemia -If full-term newborn, bilirubin peaks on 3rd or 4th day -In premature neonates, bilirubin peaks on 5th to 7th day -Hyperbilireubin is treated by phototherapy -Neonates loose up to 7% of body weight but should regain it by 2 weeks of age -Meconium; infants should pass within 24 hours of birth (if not-may be intestinal obstruction) | Birth weight doubles at 6 months and triples at 12 months | Avoid cows milk for 1st year of life; cows milk is most common cause of iron deficiency anemia in babies < 12 months -can start solid foods 4-6 months; start with iron fortified rice cereal -Introduce 1 food at a time for 4-5 days -Anemia screening is done at 9-12 months | |
| MUSCULOSKELETAL EVALUATION | Assess for hip dysplasia: Barlow's & Ortolani's maneuvers -Galeazzi Test- unequal knee height -Assess for club foot: Talipes equinovarus is the most common (urgent referral) -Assess for club foot: metatarsus adductus |
Diagnostic Tests
Federally mandated testing
- TSH
- PKU
- Universal screening for hearing loss is done in nursery
Other Common Diagnostic Tests
Testing varies from state to state
- Sickle Cell Disease (can detect 4 types of hemoglobin: hemoglobin F, S, A, and C)
- H & H (done in late infancy 9-12 months)
- Lead Screening (high-risk children at age 1-2 years)
CDC Recommended Childhood Immunizations
Recommended Childhood Immunizations
| AGE | BIRTH | 1 MONTH | 2 MONTHS | 4 MONTHS | 6 MONTHS | 12 MONTHS | 15 MONTHS | 18 MONTHS |
|---|---|---|---|---|---|---|---|---|
| VACCINE | ||||||||
| HEPATITIS B | HEP B #1 | HEB B #2 | HEP B #3 | |||||
| DIPHTHERIA, TETANUS, PERTUSSIS (DTaP) | DTaP | DTaP | DTaP | DTaP | ||||
| HEMOPHILUS INFLUENZA TYPE B | Hib | Hib | Hib | Hib | ||||
| INACTIVATED POLIOVIRUS (IPV) | IPV | IPV | IPV *can administer 6-18 months) | |||||
| MEASLES, MUMPS, RUBELLA (MMR) | MMR #1 | |||||||
| VARICELLA | VARICELLA | |||||||
| PNEUMOCOCCAL (PCV) | PCV | PCV | PCV | PCV |
*CDC Recommended Childhood Immunizations with Catch-Up Schedule
*Must Have CDC Immunization App for Health Care Providers
*More Information on Prenatal & newborn visit
References
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2010). Pathophysiology: The biologic basis for disease in adults and children (6th ed.).
Dunphy, L.M., Winland-Brown, J. E. (2011). Primary Care: The Art and Science of
Advanced Practice Nursing. Philadelphia, PA. F.A. Davis.
Uphold, C.R., & Graham, M.V. (2013). Clinical guidelines in family practice. (5th ed.) Gainesville, Fl.: Barmarrae Books, Inc.
Boynton, R., Dunn, E.S., & Stephens, G.R. (2009). 6th edition. Manual of Ambulatory
Pediatrics. Philadelphia: Lippincott.
Youngkin, E.Q., & Davis, M.S. (2012). Women’s health: A primary care clinical guide
(4th. ed ). Norwalk, CT: Appleton and Lange.