Practice Guidelines 2009 Pediatric Well Child Care Flow Sheets Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company and Keystone Health Plan Central. Independent licensees of the Blue Cross and Blue Shield Association. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies.
PHYSICIAN GUIDELINES FOR PREVENTIVE SERVICES Capital BlueCross Physician Guidelines for Preventive Services should serve as a useful component of your delivery of preventive services. We urge you to refer to them frequently and aim for the highest compliance possible. Additional suggestions follow: Make preventive services one of your practice s highest priorities. Consider every visit as an opportunity to promote wellness services. If time and resources are especially scarce, try devoting attention to at least a few key areas on a seasonal basis. Post a copy of the Guidelines in each consultation/exam room. Reinforce our efforts to educate Members about the importance of health maintenance interventions. Use office reminder systems, including wall posters and chart alerts. Involve non-physician staff in the process, including the delegation of specific responsibilities. The Guidelines include: Adult Health Maintenance Guidelines (Commercial) Adult Health Maintenance Guidelines (SeniorBlue and SeniorBlue PPO) Child Health Maintenance Guidelines Pediatric Well Child Care Flow Sheets 2009 Provider Manual Practice Guidelines - 36
2-4 Weeks Equal movements Palmar grasp Raises head when prone Regards face Follows to midline Responds to sound Fem. Art. Head Fontanelle Umbilic Eyes Red reflex Testes ENT Hips Car restraints Crib safety Sleep position Babysitters Pet control Secondary tobacco smoke Tap water not to exceed 120 F for bathing Smoke detectors Urine Stools 1 Month Equal movements Palmar grasp Raises head when prone Regards face Follows to midline Responds to sound Fem. Art. Head Fontanelle Umbilic Eyes Red reflex Testes ENT Hips Car restraints Crib safety Sleep position Babysitters Pet control Secondary tobacco smoke Tap water not to exceed 120 F for bathing Smoke detectors Urine Stools 2 Months Lifts head temp. erect when held upright Regards face in direct line of vision Grasps rattle placed in hand Social smile Coos Responds to loud sounds Fem. Art. Head Fontanelle Eyes Testes ENT Hips Sleep patterns Daycare/babysitters Sleep position Fall prevention Vitamins (breast-fed babies) Urine Stools NF-116 (6/2008) This information is provided as an educational resource and the entities listed below assume no liability associated with either its contents or use. Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company and Keystone Health Plan Central. Independent licensees of the Blue Cross and Blue Shield Association.
4 Months Holds head high Raises body on hands when prone Rolls prone to supine Plays with hands Follows parent with eyes Smiles, coos, laughs, squeals, gurgles Eyes Fem. Art. Head Fontanelle ENT Hips Cereal Sleep position Reinforce falls prevention Avoid small objects 6 Months Sits with support Passes hand to hand Rolls over Reaches for toys Bears weight Raking hand pattern Babbles, laughs Turns to voice Head Fontanelle Fem. Art. EOM ENT Eyes Hips Stools Puréed foods (including iron sources) Check home for hazards; hot liquids, electrical outlets, poisons, medicines, dangling cords or table covers Provide Poison Control phone # Sleep position Sun Exposure Crib safety Car restraints 9 Months Sits well Crawls, creeps Pulls to stand Assisted walking Inferior pincer grasps - pokes Bangs two toys together Pat-a-cake Peek-a-boo Imitates speech sounds Dada, Mama Head Fontanelle ENT Eyes Hips Table food Self-feeding Toast ing bisc. Wean to cup Home safety Avoid popcorn, nuts, raw carrot or celery sticks, raw apple, raisins, or tiny pieces of toys Family/social dynamics Tooth care Car restraints Stools
12 Months Pulls to stand Walks w/support or few steps alone Precise pincer grasp Points Has 1-3 new words plus Dada, Mama Looks for dropped or hidden objects Head Fontanelle ENT Eyes Hips Milk (whole milk) Table foods Continue weaning to cup SAFETY poison-proofing; stair safety, water safety, auto seat restraints; fences and gates Tooth care 15 Months Walks alone Crawls up stairs Puts raisin in bottle Points to 1-2 body parts Gestures Understands simple commands Uses cup Fem. Art. Eyes Head Fontanelle Testes ENT Gait Milk Toothcare No bottle in bed Finger foods REEMPHASIZE: Home/environment safety Socialization Tantrums/behavior 18 Months Walks up stairs with help Sits in a chair 3-4 Cube tower Uses spoon Imitates a crayon stroke 4-10 words May tell 2 or more wants Knows body parts Autism screening Head Fontanelle Testes Eyes ENT Gait Mealtime not to be a battle Discourage Toothcare STRESS FIRMLY: Stairs and window safety Avoid playing in street or driveway Don t leave alone in car or home Guard against falls, electrical injuries, drowning Sleep patterns and night fears Tooth brushing
24 Months Walks up steps Jumps in place Sits in a chair 5-6 Cube tower Makes horizontal or circular strokes 50+ words Knows name What s that? Parents understand child s speech Autism screening Ht. Wt. HC Eyes Head ENT Hearing Vision Avoid fights Over eating No STRESS DANGERS: Burns, falls from windows, cabinets, furniture; eat and drink when sitting; poison danger; avoid machinery, plastic bags Read to child Toilet training Poison control information 30 Months Walks up steps Jumps in place Sits in a chair 5-6 Cube tower Makes horizontal or circular strokes 50+ words Knows name What s that? Parents understand child s speech Able to pedal Eyes Head ENT Hearing Vision Avoid fights Over eating No STRESS DANGERS: Burns, falls from windows, cabinets, furniture; eat and drink when sitting; poison danger; avoid machinery, plastic bags Read to child Toilet training Poison control information 3 Years Kicks ball Pedals tricycle Opens door 9 Cube tower Copies circle Does some dressing Feeds self Knows full name, age, sex Counts to three Comprehends tired, cold, hungry Head Eyes ENT EOM Avoid junk drinks and food Feeds self entirely Car seat Knives out of reach Stay out of street Water safety Read to child Speech or language evaluation
4 Years Hops, jumps forward Climbs ladder Can cut & paste Knows 3 or 4 colors Dresses and undresses w/supervision Counts to 10 Gender ID Draws person 3 parts Copies cross, circle, and maybe square Head Eyes EOM ENT Family talk mealtimes Offer small portions Seconds available REEMPHASIZE: Water safety; street crossing and/or play; booster seat, and/or appropriate seat belt ; avoid strangers; home fire safety; sleep in own bed Marble and card games; bed time ritual; nursery school, daycare, babysitting Car Booster Seat Bike helmet 5 Years Hops on one foot Dresses and undresses self Can throw and catch a bean bag Gallops, begins skipping, alternating feet Prints some letters and numbers Head Eyes EOM ENT Hearing test Seat belts Street sense School experiences/readiness Separates from parents Bike helmet Car booster seat 6 Years Rides bicycle Laces and ties shoes Growing capacity for selfregulation of behavior Can answer phone, take simple messages School experiences Head Eyes EOM ENT Hearing test Bike/traffic safety School environment Car booster seat
7 Years Rides bicycle Laces and ties shoes Growing capacity for selfregulation of behavior Can answer the phone, take simple messages School experiences Head Eyes EOM ENT Hearing test Abdom Bike/traffic safety School environment Car booster seat Excercise 8 Years HEENT Nodes 9 Years HEENT Nodes
10 Years HEENT Nodes 11 Years HEENT Nodes 12 Years HEENT Nodes
13 Years HEENT Nodes 14 Years Education Social relationships HEENT Nodes Pelvic exam Pap Cholesterol evaluation Injury prevention; firearms Pregnancy prevention Sexually transmitted diseases TSE/BSE Chlamydia/STD screening 15 Years Education Social relationships HEENT Nodes Pelvic exam Pap Cholesterol evaluation Injury prevention; firearms Pregnancy prevention Sexually transmitted diseases TSE/BSE Chlamydia/STD screening
16 Years Education Social relationships HEENT Nodes Pelvic exam Pap Cholesterol evaluation Injury prevention; firearms Pregnancy prevention Sexually transmitted diseases TSE/BSE Chlamydia/STD screening 17 Years Education Social relationships HEENT Nodes Pelvic exam Pap Cholesterol evaluation Injury prevention; firearms Pregnancy prevention Sexually transmitted diseases TSE/BSE Chlamydia/STD screening 18 Years Education Social relationships HEENT Nodes Pelvic exam Pap Cholesterol evaluation Injury prevention; firearms Pregnancy prevention Sexually transmitted diseases TSE/BSE Chlamydia/STD screening