Well and Preventative Pediatric Care
from One to Four Years Old
Twelve Month Visit
We will do measurements, discuss feeding , the change to whole milk and possible weaning from the breast. We will discuss sleep, child care, and family changes. Developmental milestones include first words, specific MaMa and DaDa, clapping, waving, walking holding on and alone, and exploration of everything.
Safety is reinforced, especially climbing hazards, window safety, car seat safety, and water safety. At this visit we do blood tests to check for iron-deficiency anemia (the hemoglobin level) and a screening test for lead exposure.
Fifteen Month Visit
We will do measurements, and discuss sleep, child care, safety, family life. Behavior issues and temper tantrums are normal parts of this age. Feeding discussion focuses on allowing children to feed themselves and avoiding cajoling or struggling with a child to eat. We recommend avoiding or limiting juices and limiting sweets. Developmental milestones including using a few words, understanding simple commands, copying household or self-care tasks, and walking and climbing.
Eighteen Month Visit
We will do measurements, and discuss sleep, behavior, child care, safety, and family life. Toddlers often become more picky in their eating habits at this age. Developmental milestones include more single words (usually around ten or more), some pretend play, interest in other children, and more motor skills, such as running. At this visits we ask parents to complete the M-CHAT (Modified Checklist for Autism in Toddlers) questionnaire.
While we are always evaluating babies’ and toddlers’ social skills, this checklist helps us to identify some children who may have developmental delays in social skills. It cannot and does not diagnose autism. It can be a starting point for discussion and possible referral for further evaluation, such as to Connecticut’s Birth to Three program.
Immunization: Second Hepatitis A
Two Year Visit
We will do measurements, and discuss sleep, diet, behavior, child care, safety, and family life. We will begin discussion of toilet training. Developmental milestones include using many single words and some short sentences and phrases, pretend play, side by side play with other children, and some self-care skills, such as brushing teeth, letting needs be known, and picking up after oneself.
We will ask parents again to complete the M-CHAT. Because the next routine visit is not until age three years, if there are any developmental concerns, often we will schedule a follow-up visit in 3-6 months to evaluate progress and concerns.
At age two, we will repeat the blood tests to screen for anemia (the hemoglobin) and for lead exposure.
No immunizations are scheduled at this visit, but we will review the immunization record to determine if any vaccines are needed.
Three Year Visit
We will measure height, weight and blood pressure. We will discuss sleep, diet, behavior, child care, and family life. We will check on toilet training. A vision screen is performed.
Developmental milestones include speaking in sentences, being able to be mostly understood by others, pretend play, play and some sharing with other children, being able to take off own clothes, jumping with both feet, drawing a full circle. If the child is in preschool or daycare, adjustment to group settings is an important achievement at this age.
No immunizations are scheduled at this visit, but will always be reviewed.
Four Year Visit
We will measure height, weight and blood pressure. We will discuss diet, digestive issues, sleep, behavior, safety, school or daycare involvement, and family life. We will do a vision screen and a hearing screen.
Developmental milestones include imaginative play, play with other children, expanding vocabulary, and dressing and undressing. We also repeat the blood test to evaluate for anemia.
Immunizations: Kinrix (a booster vaccine to protect against diphtheria, tetanus, pertussis, and polio), the secondMMR (measles, mumps, and rubella vaccine) and the second Varivax (chickenpox vaccine).