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Pediatric Health Maintenance 4 Year 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, language, and social skills
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Not available
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Child should be able to hop on one foot, draw a person, cut with scissors, count, and speak in full sentences. Child can now take turns, share, and play simple board games.
Tell Me More...
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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.
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Full physical exam
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Lead and tuberculosis test if child is at risk
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Excellent
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Risks for lead poisoning include living in an older house and having a sibling (brother or sister) who has had lead poisoning.
Risks for tuberculosis exposure in the childhood years includes the following: living in an area where tuberculosis is present, being homeless, being a recent immigrant, or history of exposure to family members with tuberculosis.
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Lead and tuberculosis test if child is at risk
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Blood pressure check
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Excellent
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A growing number of children have high blood pressure. While most cases are due to other medical conditions, an increasing number of children are being diagnosed with primary, or "essential" hypertension (high blood pressure without a known cause). High blood pressure in children is different than in adults. It follows different diagnosis guidelines, has different treatment options, and different measures of treatment success. Early detection is important.
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Blood pressure check
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Cholesterol blood test if there is a family history of high cholesterol and test has not been done previously
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Not available
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This can be delayed a year or so if the parent feels that drawing blood will be very traumatic for the child.
Tell Me More...
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Cholesterol blood test if there is a family history of high cholesterol and test has not been done previously
Cholesterol screening is recommended after age two, and no later than age ten for children with a family history of high cholesterol or heart disease, for children with an unknown family history, as well as for children who are obese, have high blood pressure, or diabetes.
Children who have elevated levels of cholesterol should focus on weight reduction, increased physical activity, and nutritional counseling.
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IPV, DTaP, MMR, VAR
(IVP = inactivated poliomyelitis vaccine, DTaP = diptheria/tetanus/pertussis vaccine, MMR = measles/mumps/rubella, VAR = varicella/chicken pox)
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Excellent
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Can be done either this visit or at the 5-year visit.
Tell Me More...
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IPV, DTaP, MMR, VAR
The most common side effects from these vaccines are pain around the area of 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 reaction occur once in every 2 million vaccinations.
The second of the two shot varicella (chicken pox) vaccine is given at age 4. It can be deferred to age 5, but definitely should be given before the childs 6th birthday. Possible side effects of Varivax are generally mild and include redness, stiffness, and soreness at the injection site; such localized reactions occur in about 20% of children immunized. A small percentage of persons develop a mild rash, usually around the spot where the shot was given.
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.
Tell Me More...
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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 local pain and fever. There have been rare severe side effects reported involving the nervous system. The only children who should not get a flu shot are 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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Physicians should discuss a balanced diet and annual dental check-ups. Pre-school decisions should be addressed.
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Discuss nutrition, health and sleep habits, behavior, and safety issues
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Back
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