Caring for the Healthy Child
Your schedule is booked for the morning but the first visit looks easy peasy – a three year old Well Child Check (WCC). What can be easier than seeing a healthy kid?
When I first started in Pediatrics, I did almost exclusively WCCs. The idea was to become accustomed to healthy children, and then I could more readily recognize pathology. What I soon learned was that a quality WCC was not easy and can actually be some of your most complex encounters. You have to cover everything from head to toe – from eating to growing to social concerns, and you have to address and educate on any problems you find.
If the child has chronic health issues like asthma or diabetes, those are on the table too, with any accompanying school forms or notes to the school nurse for good continuity of care.
But soon Well Child Checks (WCCs) were my favorite visits. Wellness visits really allow you to connect with patients and their families.
Tips for a stellar WCC
- Make (or borrow) a good Template
- Be familiar with your state requirements
- Know your healthy development
- Pick your battles
- Don’t tackle everything
- Be an authority of vaccination
- Give parents tools
- Make (or borrow) a good Template
Normal child development is a fairly complex topic. “Is this normal?” “Is this okay?” are questions you will constantly need to address. A good WCC template will have the questions you should ask and hints to help you along for seamless documentation.
A word of caution – try not to just stare at the computer! Be sure to address your patient and look the parent in the eye when they are talking. WHen you turn to type, use a lot of Mmmhmmms and back checking;
2. Be familiar with your state requirements
If you accept Medicaid (and even if you don’t), you’ll want to be aware of state requirements. Texas has a pretty comprehensive guide here. You’ll want to know when you need to check blood work and what you are looking for. It’s also a good idea to look ahead and give parents and kids a heads up about what to expect with the next visit.
3. Know your healthy development
Anxiety is the name of the game for new parents. You are a source of authority and need to be well-versed in healthy development, variations, and when to refer.
4. Pick your battles
There might some things you do not agree are good choices for the health of your patient. Maybe you get the sense the parent is over-managing behavior with screen-time. Maybe the child is heading toward serious obesity. Maybe the parents are anti-vaccine or think car seat laws and helmet laws are over-reach.
Don’t tackle everything
It can get overwhelming for you, the child, and the parent if you tackle everything. Move through the systems but if there are multiple red flags or concerns (body weight, mood issues, behavior problems), start tabling items and planning for follow-up visits.
Be an authority of vaccination
Vaccination saves lives. One of my favorite nuggest of research is that views on vaccination can change over time. Keep recommending. Keep talkijng about it.
5. Give parents tools
I am the queen of handouts. I really like to give parents concrete tools to try to implement.
Healthy Eating
This, this, and this are good resources. Otra en espanol
Iron Rich Foods
This, this, and this are good resources
Screen Time
Medication Dosing
Musculoskeletal Exercises
Ages and Stages – I love this system but you need a subscription.
I also think it is important to know the local school district where you work. I would keep the Sports Physical forms for the local districts on my laptop, along with their specific Asthma Action Plans and school medication forms. If there is a school that many of your patients attend, send the school nurse an email and say hello.
Diane Wagner
