Two Year Well-Child Check

Normal Exam Template

• Parental concerns:

• General health

  • No new allergies, medications, health issues

  • No parental concerns regarding vision, hearing, oral health

  • Most recent dentist visit:

• Nutrition: Consumes balanced diet that includes fruits, vegetables, protein, iron rich foods, and < 20 oz 2% milk daily

• Elimination: Regular voids and no constipation; has not started toilet training

• Sleep: Regular bedtime and naps; sleeps 11 to 14 hours daily

• Social history

  • Activities/childcare during day:

  • No parental concerns about behavior, temperament

  • M-CHAT-R/F administered

• Developmental milestones

  • Uses at least 50 words and 2-word phrases

  • Imitates adults and plays pretend alongside other children

  • Follows 2-step commands

  • Draws with crayon

  • Stacks 5 or 6 blocks

  • Goes up and down stairs one step at a time

• Anticipatory guidance

  • Screen time < 2 hours daily

  • Always supervised when outside and/or near water

  • Uses rear-facing car seat

  • Firearms in household stored unloaded in firearm safe with ammunition stored separately

Assessment and Plan

General Health

• Acute health issues:

• Vision/hearing concerns: Refer to ophthalmology/audiology

• Oral health

  • Encouraged twice yearly dental visits

  • Water source does not contain fluoride: Fluoride drops 0.25 mg/day

• Nutrition concerns, low iron intake, and/or consuming > 20 oz milk daily: Obtain CBC

• Elimination

  • Functional constipation: Trial of 4 ounces diluted fruit juice daily; f/u in 2-4 weeks if symptoms persist

  • Toilet training

    • Insufficient verbal/motor skills to indicate need to void/use potty: Delay toilet training

    • Child ready for toilet training: Parents encouraged to visit https://www.healthychildren.org/English/ages-stages/toddler/toilet-training/Pages/default.aspx for more information

• Anticipatory guidance: Counseled about appropriate screen time, water safety, car safety, and gun safety

Vaccinations/Universal Screening

• Vaccinations

  • Administer hepatitis A vaccine

  • Live attenuated influenza vaccine

    • Pt has received < 2 lifetime doses: Administer first dose now followed by second dose in 4 weeks

    • Pt has received ≥ 2 lifetime doses: Administer 1 dose

• Obtain lead level

• M-CHAT-RF

  • 0-2: Normal screen; repeat at age 3 years

  • 3-7: Positive M-CHAT-R/F responses reviewed; upon clarification

    • Score < 2: Repeat at age 3 years

    • Score remains ≥ 2 with provider concern based on observation: Refer to developmental pediatrics

  • 8-20: Refer to developmental pediatrics

• Not achieving developmental milestones:

  • No previous missed milestones: Reassess in 6 months and refer to early intervention resources and/or medical specialist if issues persist

  • Persistent developmental delay: Refer to early intervention resources and/or medical specialist

Notes

• Diet

  • Iron rich foods include meat, eggs, beans, and iron-fortified cereals

  • At age 2, children should begin consuming 2% milk

• Car seat

  • Child should remain in rear facing car seat until age 2

  • May transition to forward-facing car seat when child exceeds weight limit of rear-facing seat

  • Child should remain in forward facing car seat (not booster seat) until age 5 years

• MCHAT scoring

  • 1 point for YES on items on 2, 5, and 12

  • 1 point for NO on all other items