Carle Foundation Hospital, Urbana, IL, USA.
Am Fam Physician. 2018 Sep 15;98(6):347-353.
The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.
定期健康检查可全面评估儿童健康状况,一旦发现异常,可及时进行进一步评估。定期健康检查时,应详细询问儿童的出生史、既往筛查情况、饮食、睡眠、口腔保健及医疗、手术、家庭和社会等方面的信息。应进行从头到脚的全面体格检查,包括生长发育评估。应检查和更新疫苗接种情况。建议对 6 月龄内婴儿的母亲进行产后抑郁筛查。根据专家意见,美国儿科学会建议每次就诊时进行发育监测,9 月龄、18 月龄和 30 月龄时进行正式发育筛查,18 月龄和 24 月龄时进行自闭症特定筛查;美国预防服务工作组认为目前的证据不足以做出推荐。定期健康检查可以为家长或看护人提供答疑解惑和适宜的指导,同时帮助其了解儿童的生长发育情况。应让儿童一直保持面向后坐的乘车姿势,直至 2 岁或达到座椅的身高或体重限制为止。使用氟化物、限制或避免果汁摄入、12 月龄时用杯子取代奶瓶可改善儿童的口腔健康。美国预防服务工作组建议,3 至 5 岁儿童单次视力筛查有助于及早发现弱视。根据专家意见,美国儿科学会制定的指南建议 18 月龄以下儿童应避免使用任何屏幕,18 月龄以上儿童每天屏幕使用时间应限制在 1 小时以内。6 月龄前停止母乳喂养和 6 月龄前添加固体食物与儿童肥胖有关。1 岁前应避免儿童饮用果汁和含糖饮料,1 岁以上儿童应限量饮用此类饮品。