2025 – PAGE 199 – DEVELOPMENTAL MILESTONES & ANTICIPATORY GUIDANCE

ANTICIPATORY GUIDANCE & SAFETY

PREVENTATIVE MEDICINE TERMINOLOGY

Preventative medicine includes primary, secondary, and tertiary prevention. Primary prevention refers to preventing a disease from ever happening (vaccinations). Secondary prevention involves catching a new disease early so that it can be treated (screen tools, pap smears). Tertiary prevention aims to reduce the negative impact of an active disease in order to get a patient back to their previous state, or to reduce the complications of it (like giving insulin to a diabetic).

FLUORIDE SUPPLEMENTATION

If the local water supply contains less than 0.6 parts per million of fluoride, oral supplementation is recommended. Pediatricians should focus on one source of ingested fluoride, such as drinking water supplemented with fluoride, fluoride toothpaste, fluoride mouth rinses, professionally applied topical fluoride or infant formula containing fluoride.

PEARL: Fluoride toothpaste is an effective method of preventing dental caries in children. Use of fluoride toothpaste should begin with the eruption of the first tooth. In children < 3 years of age, a smear or grain-of-rice-sized amount of toothpaste should be used. In children 3 years or older, a pea-sized amount of toothpaste should be used.

HOT WATER HEATER

Temperature of a hot water heater should be set to no more than 120 degrees.

MNEMONIC: Imagine boiling a dozen (12) EGGS on top of a HOT WATER HEATER. 12 should remind you of 120.

HEARING SCREENING (AUDIOMETRY)

Hearing screening (audiometry) is an important part of well-child care given that proper hearing is critically important for language development. Always consider hearing problems in a child with language issues.

• SCREENING IN INFANTS < 6 MONTHS OLD: Use the ABR or OAE.
  • AUTOMATED AUDITORY BRAINSTEM RESPONSE: Measures brainstem response to sounds. This is better than the OAE test. It can check for unilateral, bilateral, conductive and/or sensory hearing loss. The infant should be sleeping for best results; therefore, it is difficult to administer in children > 6-months of age.
  • OTOACOUSTIC EMISSIONS TESTING: This measures sound that is made by the normally functioning cochlea in response to external sound. There is much more room for error in a noisy environment. Cost is similar, but false positives result in frequent audiology referrals. The infant should be sleeping for best results; therefore, it is difficult to administer in children > 6-months of age.
• SCREENING CHILDREN 6 MONTHS TO 2 YEARS OLD: For these preschoolers, use VISUAL REINFORCED AUDIOMETRY. This checks for bilateral hearing loss.
• SCREENING CHILDREN OF SCHOOL AGE: Use PURE TONE AUDIOMETRY. At this age, children can wear headphones and let the examiner know which side the sound is coming from.

LEAD SCREENING

Screen everyone at around 9-12 months and then again at 24 months. If no screening was done prior to 36-72 months, screen at that time. How you screen varies and can range from a simple questionnaire to a blood lead test. If the lead exposure is widespread in a community, universal blood lead testing is recommended at ages 1 and 2. If exposure is not widespread, use questionnaires to guide “targeted” blood lead screening. If a parent or guardian can’t answer the questionnaire, do blood lead screening.