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Pediatric Health Maintenance 15 Months quick look
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This chart rates treatment options according to general effectiveness, ease of use,
side effects and safety.
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Check coordination and muscle strength, and language, social skills
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Not available
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Toddler should walk alone, begin to use a spoon, and scribble with a crayon. He/she should say 5-15 single words. He/she should play games and understand how objects work (such as a phone).
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Full physical exam
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Not available
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Physician compares height to a growth chart to see if growth is normal. Physician will also focus on the skin to look for rashes and bruises that may suggest abuse or inadequate supervision.
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Full physical exam
The 15-month visit is a good time for physicians to observe the parent-child interaction in terms of setting limits on behavior and to discuss behavioral issues/problems.
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Blood test for "complete blood count"; blood lead level if at risk; and tuberculosis test (if these were not done at the 9- or 12-month visits)
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Excellent
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Many physicians delay the blood count until this visit because iron deficiency may only appear after the child switches over to cow's milk at 12 months. The complete blood count is a check for anemia, and should include tests called "the mean corpuscular volume" (MCV) and the "red cell distribution width" (RDW). Infants at risk for anemia are those who were exclusively breast fed (mother's milk is low in iron), infants who are on a low iron formula, as well as infants who develop a distaste for iron-rich foods.
Iron supplements, either in the diet or separately, can easily treat as well as help to prevent anemia. Children at risk for lead poisoning include those in older homes or those with siblings (brother or sister) who have had lead poisoning.
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Blood test for "complete blood count"; blood lead level if at risk; and tuberculosis test (if these were not done at the 9- or 12-month visits)
Most formulas are iron-fortified while cow's milk is not.Children are at risk for tuberculosis if they are exposed to someone who has it, are institutionalized, or are recent immigrants from areas where tuberculosis is widespread.
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Immunizations include: DTaP booster, HIB booster, VAR, MMR, PCV booster, IPV booster, Hepatitis A (first dose) if these were not given at the 12-month visit
(DTaP=Diphtheria/Tetanus/Pertussis, HIB=Hemophila Influenza B; Varicella (chicken pox), MMR=Measles/Mumps/Rubella, PVC=Pneumoccal pneumonia, IPV=Inactivated Polio, Hepatitis A)
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Excellent
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These vaccines should only be given if the child is over 12 months of age at the time of the visit. DTaP (diptheria/tetanus/pertussis) booster is only given at the 12 month visit if it has been at least 6 months since the third DTaP dose in the series.
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Immunizations include: DTaP booster, HIB booster, VAR, MMR, PCV booster, IPV booster, Hepatitis A (first dose) if these were not given at the 12-month visit
The recommended age ranges for administering these vaccines are: - VAR (Varicella-Chicken Pox) 12-18 months,
- MMR (Measles/Mumps/Rubella) 12-15 months,
- HIB (Hemophilus Influenza Type B) 12-15 months,
- PCV (Pneumococcal Pneumonia) 12-15 months,
- DTaP (Diphtheria/Tetanus/Pertussis) 15-18 months.
Hepatitis A vaccination #1 (of a two part series) is now recommended for all children, with the first vaccination between 12 and 18 months.
The decision about when to give these vaccines depends on several factors including whether previous doses have been given on schedule, whether the particular vaccine is available at the time of the visit, cost, and preference of the parents. The most common side effects from these vaccines are pain at the area of the injection and fever. MMR causes fever in about 5% of children. The fever can be very high, and can trigger seizures in children who tend to seize with high fevers. The fever starts 7-12 days after the vaccine and can last 1-2 days. Sometimes children can also get a rash from MMR. Severe reactions are rare and most of these are due to allergic reactions. DTaP can rarely cause a nerve problem called brachial neuritis. MMR can rarely cause a problem with low blood counts and a serious brain problem called encephalopathy. These rare reactions occur once in every 2 million vaccinations. Physicians must give parents vaccine information statements to inform them of the risks of any vaccine. These statements are available at: http://www.immunize.org/vis/). The only babies who should not get one of these vaccines are those who have had a severe reaction or who are allergic to an ingredient in the vaccine. (See vaccine information statement at http://www.immunize.org/vis/).
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Influenza Vaccine
(flu shot)
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Good
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Children over 6 months of age should get the flu shot every year. The best time to get the shot is from October to mid-November.
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Influenza Vaccine
If a child has never had a flu shot he/she will need two doses (about a month apart) the first year the vaccine is given. After the first year only one dose is needed per year.
The major side effects are pain around the area of injection and fever. There have been rare severe side effects reported involving the nervous system. Experts recommend flu shots for all children, except for those with a severe allergic reaction to eggs.
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Discuss nutrition, health and sleep habits, behavior, and safety issues
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Not available
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The toddler should be weaned to milk rather than breast milk or formula by now. Teeth should be cleaned daily (still no toothpaste). Physicians should discuss behavioral issues such as tantrums and bedtime rituals. Dangers of putting small objects in the mouth should be stressed.
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Discuss nutrition, health and sleep habits, behavior, and safety issues
Toilet training should be delayed until at least age 2. Fluoride supplements are needed if the drinking water contains less than 0.3 ppm
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