Well-child visits

Anticipatory guidance

• Infancy (< 12 months)
  • Nutrition: Exclusive breastfeeding to 6 mos; Vit D 400 IU/d from birth; Iron 1 mg/kg/d at 4 mos if exclusively breastfed. Early allergen intro at 4–6 mos.
  • Avoid: Honey < 12 mos (botulism); cow’s milk < 12 mos (IDA, GI bleed).
  • SIDS Prevention: Supine (“Back to sleep”), firm mattress, room-sharing without bed-sharing, no soft bedding/toys.
  • Safety: Rear-facing car seat in back seat; water heater < 120°F (49°C) (scalding prevention).
• Early Childhood (1–4 years)
  • Nutrition/Dental: Whole cow’s milk at 12 mos (limit < 24 oz/day to avoid IDA). First dental visit by 12 mos.
  • Development: Toilet training readiness at 2–3 yrs (stays dry > 2 hrs, communicates need). Screen time < 1 hr/day (ages 2–5).
  • Safety: Locked chemicals/meds; 4-sided pool isolation fence; rear-facing car seat until weight/height limit.
• Middle Childhood (5–10 years)
  • Safety: Belt-positioning booster seat until 4 ft 9 in (145 cm) (ages 8–12); back seat until age 13.
  • Lifestyle: Helmet use for bikes/scooters; guns stored unloaded and locked; screen time < 2 hrs/day.
• Adolescence (11–21 years)
  • HEADSSS Assessment: Home, Education, Activities, Drugs, Sexuality, Suicide/Depression, Safety.
  • Confidentiality: Interview alone; maintain privacy EXCEPT active suicidal/homicidal ideation, abuse, or life-threatening emergencies.
  • Counseling: Dual protection (condoms for STIs + LARC or OCPs for contraception). c
• High-Yield Screening Milestones
  • Anemia (Hb/Hct): Universal at 12 mos.
  • Lead: Universal at 12 and 24 mos (if high-risk area/Medicaid).
  • Autism (M-CHAT): Universal at 18 and 24 mos.
  • Lipids: Once at 9–11 yrs and once at 17–21 yrs.
  • Depression (PHQ-2/9): Annually starting at age 12.
  • Vision/Hearing: Vision starting at age 3; Hearing universal at birth and age 4.