2025 – PAGE 200 – 202 – DEVELOPMENTAL MILESTONES & ANTICIPATORY GUIDANCE

2025 – Core Study Guide 08 – Developmental Milestones and Anticipatory Guidance 2025 – PAGE 200 – 202 – DEVELOPMENTAL MILESTONES & ANTICIPATORY GUIDANCE

FIRST DENTAL EXAM

The first visit to the dentist should be either 6 months after the eruption of the first tooth, or by 12 months of age (whichever comes first).

MOUTH GUARDS

For a child with braces, a mouth guard should be worn during play of all sports. For everyone else, one should be worn for collision sports, shot put, and discus.

CONTACT SPORTS PARTICIPATION

Contact sports participation should be avoided in children with a single kidney, those with hepatosplenomegaly, and those who have had repeated concussions. Those with a single eye or single testicle can participate given proper protection of the remaining organ. A single ovary is not a contraindication to contact sports, though the issue is somewhat controversial (thus probably won’t be tested!).

BICYCLE SAFETY

Bicycle safety recommendations are simple, but the vast majority of children do not follow proper precautions. All children riding a bicycle should wear a helmet, and they should have front and rear reflectors on their bikes. Most bicycle-related injuries are preventable. Head injuries are responsible for almost all bicycle-related deaths.

BOAT SAFETY

For proper boating safety and death prevention, all children should wear a life jacket at all times on all boats.

AGE-APPROPRIATE ANTICIPATORY GUIDANCE AND SAFETY (BRIGHT FUTURES)

  • PRENATAL VISIT
    • Review social determinants of health (living situation and food insecurity, environmental risks, pregnancy adjustment, maternal alcohol, tobacco, and drug use, partner violence).
    • Introduction to the medical home, circumcision if appropriate, newborn health risks.
    • Breastfeeding guidance and support.
  • NEWBORN
    • Social determinants of health (refer to programs such as WIC and SNAP, alcohol/drug/tobacco quit lines, and national domestic violence hotline).
    • Discuss infant supplies, skin and cord care, illness prevention and calming the baby (shaken baby syndrome).
    • If breastfeeding, goal is 9-12 feeds per day, continue prenatal vitamin and avoid alcohol.
    • If formula feeding, goal is at least 8 times per day, hold baby upright and don’t prop the bottle.
    • Car seat safety.
  • 2-WEEK WELL-CHILD CHECK
    • Social determinants of health (family support).
    • Early brain development, adjusting to home, when to call the on-call doctor, illness prevention and sun exposure.
    • Exclusive breastfeeding for 6 months, otherwise iron-fortified formula is recommended as a substitute (NOT goat milk or other whole milk types until after 1 year of age).
    • Safe sleep (back to sleep), heatstroke prevention, and safe home environment.
  • 2-MONTH WELL-CHILD CHECK
    • Post-partum depression and sibling relationships if relevant.
    • Parent-infant relationship and communication.
    • Vitamin D (400 IU) daily.
  • 4-MONTH WELL-CHILD CHECK
    • Social determinants of health (lead exposure, maintain social contacts, make time for self and partner, and other children in the household, childcare arrangement).
    • Infant self-calming, consistent daily routines, media, and playtime.
    • Good oral hygiene (no bottle in bed), teething and drooling.
  • 6-MONTH WELL-CHILD CHECK
    • Parents as teachers (communication and early literacy), infant independence (putting self to sleep and self-calming).
    • Oral hygiene with soft toothbrush and avoidance of bottle in bed.
    • Introduce solids with single ingredient foods one at a time (provide iron rich foods first and peanut butter).
    • Choking safety, poisoning, drowning, falls.
  • 9-MONTH WELL-CHILD CHECK
    • Changing sleep patterns, interactive learning and communication, developmental mobility and cognitive development.
    • Self-feeding, mealtime routine, cup drinking, increase variety of foods.
    • Use consistent, positive discipline.
    • Firearm safety.
  • 12-MONTH WELL-CHILD CHECK
    • Establishing routines (family time, bedtime, naptime, teeth brushing).
    • Provide 16-24 oz of whole milk.
    • Establish a dental home and fluoride treatments.
  • 15-MONTH WELL-CHILD CHECK
    • Attention to how the child communicates wants and interests.
    • Regular bedtime routine, night waking, no bottle in bed.
    • Conflict predictor and distraction, discipline and behavioral management (time-out).
  • 18-MONTH WELL-CHILD CHECK
    • Separation anxiety, toilet training readiness and expectations.
    • Encourage language (reading, playing, talking, singing).
  • 2-YEAR WELL-CHILD CHECK
    • Promote physical activity and safe play.
    • Promote reading.
    • Toilet training and personal hygiene.
  • 3-YEAR WELL-CHILD CHECK
    • Playing with siblings and peers (interactive games).
    • Promote literacy activities (reading, talking and singing) and language development.
  • 4-YEAR WELL-CHILD CHECK
    • School readiness (ready for structured learning, early childhood programs and preschool, socialize with other children, language fluency, expression of feelings).
  • 5-6 YEAR WELL-CHILD CHECK
    • Family rules and routines, concern and respect for others, patience, and control over anger.
    • School (attendance, friends, after-school care and activities, parent-teacher communication).
    • Drink milk 2-3 x per day.
    • Physical activity (60 minutes a day and after-school activities).
  • 7-8 YEAR WELL-CHILD CHECK
    • Independence, rules and consequences, temper and conflict resolution, puberty.
    • Adaptation to school, school performance and problems (IEP or special education services), after-school programs, parental involvement in school.
  • 9-10 YEAR WELL-CHILD CHECK
    • Temper tantrums, setting reasonable limits, friends, sexuality (puberty, personal hygiene, sexual safety).
    • Talk with parents/trusted adult if bullied.
  • EARLY ADOLESCENT WELL-CHILD CHECK (11-14 YEAR)
    • Tobacco/e-cigarettes, take responsibility for schoolwork, making friends, get enough sleep (10 hours per night).
    • 5 servings of fruits and vegetables per day and 24 oz or more of low-fat/fat-free dairy.
    • Mood regulation, mental health and sexuality.
  • MIDDLE ADOLESCENT WELL-CHILD CHECK (15-17 YEAR)
    • Manage conflict nonviolently, discuss dating, spend time with family and work with them to solve problems, find ways to deal with stress.
    • Get accurate information about physical development/puberty and sexuality and sexual feelings by talking to a trusted adult.
    • Don’t smoke/vape, drink alcohol, or use drugs (avoid situations with drugs/alcohol).
    • Don’t talk/text/use mobile device when driving.
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