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PERIODIC HEALTH
EXAMINATION- CHILDREN
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Learning Objectives
 To list the different preventive services that need to be
provided to children and adolescents.
 To advise children and adolescents on healthy behavior.
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DEFINITION
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Definition
 The periodic health examination in children & adolescents
aims at:
o Detecting and managing health problems at an early stage
o Preventing diseases
o Promoting healthy behavior and lifestyles
 The periodic health examination in children & adolescents
includes the following :
o Monitoring physical growth, motor and psychological
development
o Counseling
o Anticipatory guidance
o Screening and immunizing
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ASSESSMENT
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History
 Interval history
 Prenatal history: medical condition of the mother during pregnancy
 Delivery: mode of delivery, any complications and Apgar score
 Growth history
 Nutritional history: breast/formula, diet, history of vomiting
 Developmental history: speech, fine motor, gross motor, social
interaction
 Medical & surgical history
 Family history of genetic diseases
 Immunization history
 Psychological history
 Safety habits
 Sleep patterns
 Dental care practices
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Physical Examination
 Growth: height, weight, and head circumference parameters
(WHO growth charts)
 Vital signs (temperature, pulse, respiratory rate, blood
pressure)
 Head (including fontanels in babies), ENT exam
 Heart, lungs, abdomen
 Genitalia
 Neurologic examination: level of alertness, motor function,
cranial nerves and reflexes
 Vision &Hearing
 Developmental milestones (Denver’s chart)
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Diagnostic Considerations-
Failure to Thrive
 Attained growth
o Weight < 3rd percentile on NCHS growth chart
o Weight for height < 5th percentile on NCHS growth chart
o Weight 20% or more below ideal weight for height
o Triceps skin fold thickness < 5mm
 Rate of growth
o Depressed rate of weight gain
o < 20 g/d from 0-3 months of age
o < 15 g/d from 3-6 months of age
o Fall off from previously established growth curve
o Downward crossing of > 2 major percentiles on NCHS growths
chart
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Diagnostic Considerations-
Developmental Milestones
• Using Denver charts
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SCREENING
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Screening at Birth
 Neonatal screening for metabolic and genetic disorders
includes congenital hypothyroidism, phenylketonuria,
galactosemia and hemoglobinopathies.
 Glucose screening for infants at risk (premature, diabetic
mothers….).
 Bilurbin measurement when jaundice is present during
the first 24 hours.
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Vision Screening
At birth through 12 years of age
 External eye examination (position and spacing of the eyes,
symmetry, pupillary size, eye movement ..).
 Corneal light reflex to check ocular alignment.
 Pupillary light reflex assessing pupils shapes and reaction to
light.
 Red reflex to rule out retinoblastoma, cataract.
 Extraocular muscle movement ( >6 months).
 Vision acuity testing: Monocular visual acuity ( > 2-3 years of
age), Snellen chart or other starting at 4 to 5 years, at 6, 10 and
12 years of age.
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Hearing Screening
 Screening tests: the auditory brainstem responses and otoacoustic
emissions.
o It could be done at birth or before one month of age.
o Earlier detection (< 10 months of age) improves language development.
 Newborns at risk:
o Family history of hereditary of sensorineural hearing loss
o History of congenital infection (cytomegalovirus, toxoplasmosis, rubella..)
o History of exposure to prenatal medications (aminoglycosides)
o Craniofacial malformations
o Low birth weight (<1500 g)
o Severe hyperbilirubinemia
o APGAR 0-4 at 1 minute or 0-6 at 5 minutes
o History of meningitis (bacterial or fungal)
o Mechanical ventilation > 5 days
o Cerebrovascular ischemia
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Blood Pressure
 Routinely at least once a year for children aged 3 years
and older (American Academy of Pediatrics)
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Cholesterol and Lipids

The AAP/Bright Futures guidelines recommend
dyslipidemia risk assessment at 2, 4, 6, 8, and 10 years, and
annually thereafter.
They recommend dyslipidemia screening (a fasting lipid
profile) between 9 and 11 years and between 18 and 21
years of age.
The AAFP and the USPSTF do not support routine
screening for dyslipidemia in children.
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Iron Deficiency Anemia

 Risk assessment for iron deficiency anemia at four months
of age and measurement of hemoglobin or hematocrit at
12 months of age (AAP).
 Conditions associated with increasing the risk of iron
deficiency anemia during the first three to six months of
age include:
o Prematurity
o Maternal iron deficiency
o Fetal-maternal hemorrhage
o Low birth weight
o Dietary factors (Introduction of unmodified cow’s milk before 12
months of age, Insufficient dietary intake of iron
o Low income level
o Psychological problems
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Vitamin D & fluoride supplementation

 Vitamin D
o The AAP recommends 400 IU of vitamin D daily for all
children
 Fluoride
o Children six months to 16 years of age living in areas with
inadequate fluoride in the water supply (0.6 ppm or less)
should be counseled on fluoride supplementation to prevent
dental caries.
o Doses vary between 0.25 mg and 1 mg according to age and
water supplementation in fluoride
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Tuberculosis
 There is no lower age limit for screening.
 The American Academy of Pediatrics advises that risk
assessment (through a questionnaire) for Tuberculosis
should be performed at first contact with a child and every
six months thereafter for the first year of life (at 2 weeks,
6 months, and 12 months of age) and annually thereafter,
if possible.
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PARENT EDUCATION
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Parent Education
 Parent education is a part of every visit.
 Counseling about injury prevention and nutrition is of
particular importance.
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Injury Prevention
 Safe baby furniture
 Car safety: age-appropriate child restraint seats , seat belt
 Water safety (temperature) and bath safety
 Sun exposure
 Fall prevention Avoid the use of infant walkers, gates for
stairways …
 Small objects
 Electrical outlets, smoke detector
 Poisoning : child resistant packaging
 Playground safety
 Appropriate sports-specific safety equipment : protective
equipment for skating, and skateboarding, bicycle helmets
 Firearm to be kept in locked places
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Nutrition
 Beverages: water is the preferred beverage
 Fruits and vegetables: to offer daily, whole fruits are preferred
to fruits juice
 Meat: to choose meat with little fat
 Fat: limit the use of saturated fat, it should not exceed 35% of
total daily energy intake
 Milk: encourage the use of low- fat or fat- free milk
 Grains: whole grain is preferable
 Foods should be prepared with little added salt or sugar
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IMMUNIZATION
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Types of Vaccines
 Inactivated Vaccines
 Live-attenuated Vaccines
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Inactivated Vaccines
Tetanus, Diphteria & Pertusis
 Polio
 Pneumococcus
 Hemophilus influenza
 Influenza
 Hepatitis B
 Hepatitis A
 Meningococcus
 Human papilloma virus
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Live Attenuated Vaccines

 Measles, mumps & rubella
 Varicella
 Rotavirus
 Yellow fever
 Varicella-zoster vaccine
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The following are NOT contraindications to immunization:

• Current or recent mild illness, with or without low grade

fever
• Current or recent antibiotic therapy
• Previous mild to moderate local tenderness, redness,
swelling, or fever less than 40.5ºC after any vaccination
• Personal history of allergies
• Family history of adverse reactions to immunization
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Vaccine-specific reportable events include:

• Tetanus – Brachial neuritis within 28 days
• Pertussis – Encephalopathy or encephalitis within seven days
• Measles, mumps, and/or rubella – Encephalopathy or encephalitis
within 15 days
• Rubella – Chronic arthritis within six weeks
• Measles – Thrombocytopenic purpura within 7 to 30 days; vaccine-
strain measles infection in an immunodeficient recipient within six
months of measles vaccination
• Oral polio – Paralytic polio or vaccine-strain polio within 30 days to 6
months (this vaccine is no longer used for routine childhood
immunization)
• Rotavirus – Intussusception within 30 days of rotavirus immunization
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References
1- AAFP
- Health Maintenance in School-aged Children. Part I. History,
Physical Examination, Screening, and Immunizations
http://www.aafp.org/afp/2011/0315/p683.html
- Health Maintenance in School-aged Children: Part II.
Counseling Recommendations
http://www.aafp.org/afp/2011/0315/p689.html
2- USPTSF: www.uspreventiveservicestaskforce.org
3- AAP: www.aap.org
3- UpToDate:
Standard immunizations for children and adolescents.
Assessment of the newborn infant
Overview of the routine management of the healthy newborn
infant