医学英语阅读——Health Promotion and Counseling: Evidence and Recommendations of Children 1 to 4 Years

The AAP and Bright Futures periodicity schedules for children include health supervision visits at 12, 15, 18, and 24 months followed by annual visits when the child is 3 and 4 years old. An additional visit at 30 months is also recommended to assess the child's development.

During these health supervision visits clinicians address concerns and questions from parents, evaluate the child's growth and development, perform a comprehensive physical examination, and provide anticipatory guidance about healthy habits and behaviors, social competence of caregivers, family relationships, and community interactions.

This is a critical age for preventing childhood obesity as many children begin their trajectory toward obesity between ages 3 and 4 years. It is also important to assess the child's development. Standardized developmental screening instruments are recommended to measure the different dimensions of a child's development. Similarly, it is important to differentiate normal (but potentially challenging) childhood behavior from abnormal behavioral or mental health problems.

The following box demonstrates the major components of a health supervision visit for a 3-year-old, stressing health promotion. You do not have to wait for a health supervision visit to address many of these health promotion issues; they can be addressed during other types of visits, even when the child is mildly ill.

Components of a Health Supervision Visit for a 3-Year-Old

1. Discussions with Parents

● Parental concerns8

● Providing advice

● Child care, school, social

● Major topic areas: development, nutrition, safety, oral health, family relationships, community

2. Developmental Assessment

● Assessment of milestones: gross and fine motor, personal–social, language, and cognitive; use a validated developmental screener.

3. Physical Examination

● Careful examination, including growth parameters with percentiles for age.

4. Screening Tests

● Vision and hearing (formal testing at age 4 years), hematocrit and lead (if high risk or at ages 1 to 3 years), screen for social risk factors

5. Immunizations

● See updated AAP schedule

6. Anticipatory Guidance

6.1. Healthy Habits and Behaviors

● Injury and illness prevention

Car seats, poisons, tobacco exposure, supervision

● Nutrition and exercise

Obesity assessment; healthy meals and snacks

● Oral health

Brushing teeth; dentist

6.2. Parent–Child Interaction

● Reading and fun times, child-directed play, limiting screen time

6.3. Family Relationships

● Activities, babysitters

6.4. Community Interaction

● Child care, resources

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