4-5 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
Elimination: Regular voids and no constipation; toilet training complete
Sleep: Regular bedtime; sleeps 10 to 13 hours daily
Activity: Plays for ≥ 60 minutes daily
Social history
School (plans):
No parent or teacher concerns about behavior, temperament, attention, performance
Developmental milestones
4 Year: Speech usually understandable, engages in fantasy play with peers, knows name/age/gender, names 4 colors, dresses self and brushes own teeth, draws person with 3 body parts, hops on 1 foot
5 Year: Good articulation/language skills, counts to 10, names 4 colors, copies squares/triangles, prints some letters, draws person with 6 body parts, hops on 1 foot
Anticipatory guidance
Screen time < 2 hours daily
Always supervised when outside and/or near water
Always wears helmet
Firearms in household stored unloaded in firearm safe with ammunition stored separately
Assessment and Plan
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 0.5 mg/day
Educated about appropriate nutrition and physical activity
Concerns about attention/school performance: Consider administering Vanderbilt Assessment Scales for ADHD in cases of severe dysfunction
Anticipatory guidance: Counseled about appropriate screen time, water safety, helmet use, car safety, and gun safety
Vaccinations
Administer 4th Polio, 5th DTaP, 2nd MMR, and 2nd varicella if not yet completed
Live attenuated influenza vaccine
Pt has received < 2 lifetime doses: Administer first dose now followed by 2nd dose in 4 weeks
Pt has received ≥ 2 lifetime doses: Administer 1 dose
Not achieving developmental milestones
Has not started school: Refer to early intervention resources and/or medical specialist
Notify school about concerns
Notes
Child 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
ADHD can be diagnosed and treated as young as four years, but there is little evidence to support this practice