PROTECTING YOUR CHILD S HEALTH TODAY CAN LEAD TO HEALTHY TOMORROWS: Right from the very start

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1 Knowing What You Need and When to Get It PROTECTING YOUR CHILD S HEALTH TODAY CAN LEAD TO HEALTHY TOMORROWS: Right from the very start WHAT TO KNOW ABOUT INFANTS (NEWBORN TO 9 MONTHS) As a parent, you will do anything you can to protect your baby s health. Help your child get off to a healthy start and build a relationship with their health care provider by scheduling them for their well child visits. The WELL CHILD EXAM goes beyond the traditional history and physical exam, screening and immunizations; it provides a time for your child s health care provider to review developmental milestones, safety issues and offer other guidance. Babies and children grow and change very quickly. Early detection is important at all stages of life. Normal development happens very fast, and unfortunately, problems can occur just as quickly. It s important to identify any concerns or problems early to resolve them as soon as possible. Your baby s health care provider will need to see him/her two to 14 days after birth, followed by routine well child visits to monitor the baby s growth and development. KNOW YOUR PROVIDER Your baby s health care provider is your partner in your infant s health care. Work to build a positive relationship. Discuss your expectations, and let him/her know that you want to play an integral role in your child s health care and decision making. Be an active participant at each appointment. Listen carefully to what the health care provider says. If you do not understand a diagnosis or treatment, ask questions. STOP CALL SCHEDULE 1

2 What to Know About Infants (Newborn to 9 Months) ANTICIPATORY GUIDANCE AND SAFETY During each well child visit, your child s health care provider will offer age-appropriate guidance and safety information that may present problems or concerns prior to the next visit. For the INFANCY YEAR, the discussion may include, but will be not limited to: Safe sleep environment Car seat safety Secondhand smoke exposure Breast-feeding counseling Burn prevention Fire prevention Sun protection Iron supplementation INFANT DEVELOPMENTAL MILESTONES While children grow and develop at different rates, most pass a set of predictable milestones along the way. Your child s health care provider will offer examples of developmental leaps. The initial newborn visits may include discussions on how much your baby will grow and when to expect them to roll over, babble their first words and try to crawl. These are examples of developmental milestones and exciting times in the life of your baby. NEWBORN SCREENINGS Prior to leaving the hospital, your baby will have blood samples drawn for their newborn screening tests. These special screenings can provide early identification of several serious conditions and facilitate early disease management. HEMATOCRIT/HEMOGLOBIN A blood test typically recommended at the 12-month well child visit to make sure your child is getting enough iron in their diet (i.e. breast milk/formula). LEAD SCREENING Lead screening blood tests measure the amount of lead in the blood. This screening is recommended at nine months of age or older, based on risk factors and state-specific recommendations. Lead is a poisonous (toxic) metal that can damage the brain and other parts of the body. A child can be exposed to lead by: Eating or drinking lead-contaminated foods, water or other materials (like paint chips) Breathing dust or smoke containing lead Skin contact with lead Your child s health care provider is always your best source of information about childhood immunizations not the Internet, print media, TV, radio, your neighbor or family members. 2

3 What Infants Need During each well child visit, your baby s height, weight and head circumference (head size) will be measured by the clinical staff, followed by a complete physical exam performed by your baby s health care provider. This is your chance to ask any questions or discuss any concerns you have regarding your child. If there are any issues identified, it is important to initiate the appropriate care and treatment as early as possible. In addition to physical exams, there are several screening test(s) that will be performed during the infancy stage. Follow the At-A-Glance guide below for an overview of the recommendations for exams and screenings during infancy. AT-A-GLANCE RECOMMENDED EXAMS AND SCREENINGS FOR INFANTS BIRTH 1 MONTH 2 MONTH 4 MONTH 6 MONTH 9 MONTH Wellness Exam Height Weight Head Circumference Newborn Screenings Lead Screening Hearing Screening Developmental Behavioral Assessment Anticipatory Guidance and Safety Immunizations/ Vaccines Flu Vaccine PREVENTION 101 TIP A good time to schedule your child s annual well child appointment is around their birthday. It s a new year, along with new developments and challenges. Always bring a copy of your child s immunization record to each well child appointment to keep it updated. 3

4 What to Know About Early Childhood/ Toddlers (12 Months to 4 Years) Your child has reached their first birthday and will now begin amazing changes and reaching new milestones, like talking, walking and remembering. Your child s transition from infancy to early childhood is known as the TODDLER YEARS. To ensure your child remains on track, it s vital they continue with their well child examinations, plus continue with the recommended immunizations and screenings. ANTICIPATORY GUIDANCE AND SAFETY During each well child visit, your child s health care provider will discuss age-appropriate guidance and safety information that may present problems or concerns prior to the next visit. For the TODDLER YEARS, the discussion may include, but will be not limited to: Safe sleep environment Car seat safety Child-proofing the home Secondhand smoke exposure Burn and fire prevention Drowning prevention Sun protection Fall and choking prevention Oral fluoride supplementation to run, increasing independence and talking in simple phrases are just a few of the milestones that can occur during the toddler years. AUTISM SCREENING Behavioral questionnaires are commonly used to help identify autistic behaviors and to evaluate their severity. This screening is recommended at ages 18 and 24 months. TUBERCULIN TEST Tuberculin test screens for tuberculosis and often includes a skin test (called the Mantoux test) in which a small amount of purified protein derivative (PPD) is injected just under the skin of the forearm, then checked by your health care provider or nursing staff after 48 to 72 hours. This tuberculosis screening is recommended based on community and personal risk factors. TODDLER DEVELOPMENTAL MILESTONES While children grow and develop at different rates, most pass a set of predictable milestones along the way. Your child s health care provider will offer examples of developmental leaps. Beginning g OTHER SCREENINGS Other screenings include blood pressure and vision screenings (beginning at age three) and hearing screening (beginning at age four). 4

5 What to Know About Early Childhood/ Toddlers (12 Months to 4 Years) BMI BODY MASS INDEX (BMI) is a number calculated from a child s weight and height. BMI is used as a screening tool to identify possible weight problems. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend the use of BMI to screen for overweight and obesity in children beginning at two years of age. WEIGHT BMI CLASSIFICATION FOR CHILDREN (STARTING AT 24 MONTHS) AND TEENS PERCENTILE Underweight Less than the 5th percentile Healthy weight 5th percentile to less than the 85th percentile Overweight 85th to less than the 95th percentile Obese Equal to or greater than the 95th percentile After BMI is calculated for children and teens, the BMI number is plotted on the BMI-for-Age growth charts (for either girls or boys) to obtain a percentile ranking. Log onto the CDC s Web site at for a BMI percentile calculator for children and teens. OBESITY SCREENING Obesity is a major health risk for all ages. We are seeing alarming evidence that our children are at greater risk than any other generation for chronic disease, because of unhealthy lifestyle behaviors. Some experts believe that the current generation of children will be the first in medical history to die younger and live sicker than the previous generation. Children who are obese are at greater risk for bone and joint problems, sleep apnea and social and psychological problems, such as stigmatization and poor self-esteem. 1,2 Obese young people are more likely than children of normal weight to become overweight or obese Preventive Screenings for Children with a BMI In the 95th Percentile: Lipid profile Hemoglobin A1C Liver function tests Fasting glucose (sugar) adults, and therefore more at risk for associated adult health problems, including heart disease, type 2 diabetes, stroke, several types of cancer and osteoarthritis. 2 Immunization has been called the most important public health intervention in history, after safe drinking water. It has saved millions of lives over the years and prevented hundreds of millions of cases of disease. Centers for Disease Control and Prevention 5

6 What Toddlers Need During each well child visit, your child s height, weight, and (only through the 24-month visit) head circumference will be measured by the clinical staff, followed by a complete physical exam performed by your child s health care provider. Along with the routine physical examination, several additional screening tests will be initiated at certain times during early childhood. Follow the At-A-Glance guide below for an overview of the recommendations for exams and screenings during early childhood or toddler stage. AT-A-GLANCE RECOMMENDED EXAMS AND SCREENINGS FOR EARLY CHILDHOOD/TODDLERS 12 MONTHS 15 MONTH 18 MONTH 24 MONTH 30 MONTH AGE 3 AGE 4 Wellness Exam Height Weight BMI Head Circumference Blood Pressure Hearing Screening Vision Screening Hematocrit/ Hemoglobin Autism Screening Tuberculin Test Based on community and personal risk factors Developmental Behavioral Assessment Anticipatory Guidance and Safety Immunizations/ Vaccines Flu Vaccine 6

7 What to Know About Middle Childhood (Ages 5-10 Years) Children between ages five and 10 are more independent and physically active than they were in the pre-school years. They are more involved with friends and are learning to think in more complex ways. The progress noted in the major areas of development physical, intellectual, emotional and social is gradual, but the changes you will see in your child from one year to the next can be dramatic. ANTICIPATORY GUIDANCE AND SAFETY During each well child visit, your child s health care provider will discuss age-appropriate guidance and safety information that may present problems or concerns prior to the next visit. The discussion may include, but will be not limited to: Safety belt/booster seat safety Helmet safety Secondhand smoke exposure Tobacco use Substance abuse Burn and fire prevention Drowning prevention Sun protection Fall and choking prevention When Do You Use a Booster Seat? Children who have outgrown child safety seats should be properly restrained in booster seats until they are at least 8 years old, unless they are 4 9 tall. National Highway Traffic Safety Administration 1 3 REAR FACING SEATS in the back seat from birth to at least 1 year old and at least 20 pounds. 2 4 FORWARD FACING SEATS in the back seat from age 1 and 20 pounds to about age 4 and 40 pounds. BOOSTER SEATS in the back seat from about age 4 to at least age 8, unless 4 9 tall. SAFETY BELTS at age 8 and older or taller than 4 9. All children age 12 and under should ride in the back seat. 7

8 What Middle Childhood Children Need During each well child visit, your child s height, weight, BMI and blood pressure will be measured by the clinical staff, followed by a complete physical exam performed by your child s health care provider. The childhood immunizations and the recommended screenings continue to be vital parts of the well child visit. Follow the At-A-Glance guide below for an overview of the recommendations for exams and screenings during middle childhood. AT-A-GLANCE RECOMMENDED EXAMS AND SCREENINGS FOR MIDDLE CHILDHOOD AGE 5 AGE 6 AGE 7 AGE 8 AGE 9 AGE 10 Wellness Exam Height Weight BMI Blood Pressure Hearing Screening Vision Screening Lead Screening Refer to your State-specific recommendations. Tuberculin Test Based on community and personal risk factors Cholesterol Test Based on child s family history and risk factors Developmental Behavioral Assessment Anticipatory Guidance and Safety Immunizations/Vaccines Flu Vaccine PREVENTION 101 TIP You do not need to delay immunizations, because your child has a cold or other minor illness. If you have concerns, speak with your child s health care provider. 8

9 What to Know About Pre-Teen & Adolescent (Ages 11-18) As children grow into their teenage years and become more independent, it s natural for parents to have mixed emotions. Understanding the changes and challenges during the preteen and adolescent years can be difficult. It s important for the adolescent to continue to have an annual exam to keep track of changes in physical, mental and sexual development, along with providing advice against drinking, smoking and other unhealthy behaviors. Check with your adolescent s school and/or health care provider if there are any tests or requirements. (There may be requirements in your school district, especially regarding sports.) WHAT PRE-TEENS & ADOLESCENTS NEED During the annual exam, your child s height, weight, BMI and blood pressure will continue to be measured by the office staff, followed by a complete examination performed by your adolescent s health care provider. Immunizations remain an integral part of the well child visit. AT-A-GLANCE RECOMMENDED EXAMS AND SCREENINGS FOR PRE-TEENS & ADOLESCENTS AGE 11 AGE 12 AGE 13 AGE 14 AGE 15 AGE 16 AGE 17 AGE 18 Wellness Exam Height Weight BMI Blood Pressure Hearing Screening Vision Screening Hematocrit/Hemoglobin Annually for females during adolescence Cholesterol Screening Based on child s family history and risk factors Tuberculin Test Sexually Transmitted Disease Screening Based on community and personal risk factors Routine screening for sexually-active females and males, as recommended by health care provider Pelvic Exam Routine screening for sexually-active females, as recommended by health care provider Developmental Behavioral Assessment Immunizations/Vaccines Flu Vaccine 9

10 What Else You Should Know The adolescent years can be a very difficult time for both you and your child. During this transitional time between innocence and maturity, your adolescent faces both physical and emotional changes. This is a time full of choices. As a parent, you can play an important role in helping them choose behaviors and lifestyles that can shape their health. When appropriate, consider discussing the following issues with your adolescent: Dangers of sexually transmitted diseases (STD) and teen pregnancy Safe dating, including a discussion about dating violence and date rape Emotional, physical and sexual abuse Use of alcohol, drugs and other substances, including anabolic steroids Use of tobacco products, including cigarettes and smokeless tobacco Use of safety devices, seat belts, helmets and protective sports gear How to resolve conflicts without violence, including how to avoid the use of weapons Internet and social networking safety TEEN DRIVING TIPS Inexperience, speeding, cell phone talking and texting and alcohol are some of the leading factors that raise young drivers risks of motor vehicle and traffic accidents. Here are a few tips to help make your teen a safe driver: Require that your teen wears a seat belt. Seat belt use is the single best injury prevention measure a driver can take. Be a role model and wear your seat belt 100 percent of the time. Seat belt laws are enforced in most states. Eliminate distractions while driving, such as cell phone talking and texting and driving with more than one friend. Hands-free cell phones are not safer they are still a distraction. Spend time with your teen behind the wheel. Experience is a skill-builder. Set a zero-tolerance policy for alcohol and drug use. Set a curfew. Teenagers driving at night with passengers are one to five more times likely to crash than when driving alone during the day. Curfews for teen drivers are enforced in most states.? WHAT IS THE HPV VACCINE? The HPV vaccine protects females from the most common types of HPV that cause cervical cancer and genital warts. The vaccine is currently recommended for girls and women ages 9 through 26 who have not been vaccinated. Ask your health care provider about the HPV vaccine for your child. 10

11 What to Track Recommended immunizations begin at birth and continue throughout life. Infants, children and adolescents need these immunizations to stay healthy. IT IS CRITICAL THAT CHILDREN RECEIVE ALL VACCINES ACCORD- ING TO THE RECOMMENDED SCHEDULE. The childhood diseases for which children receive vaccines have NOT been eradicated. The risk of measles, whooping cough, polio, diphtheria, tetanus and bacterial meningitis still exists and a delay in getting any one of these immunizations can result in serious illness or worse. Your child s health care provider can discuss the recommended immunizations and their importance at each Well Child Visit. Keep immunizations and exams/screenings information in one convenient location by creating a Personal Health Record for your child(ren). PERSONAL HEALTH RECORD: CHILDHOOD IMMUNIZATIONS AND VACCINES IMMUNIZATION TYPE TOTAL REQUIRED DOSES RECORD DATES HERE: Tetanus, Diphtheria & Pertussis Vaccine (Tdap) Diphtheria, Tetanus, Pertussis (DTaP) Vaccine Polio (IPV) Vaccine 1-2 dose series 5-dose series 4-dose series Haemophilus Influenzae Type B (Hib) Vaccine Rotavirus Vaccine 4-dose series 2-3 oral doses Human Papillomavirus Vaccine (HPV) Measles, Mumps & Rubella Vaccine (MMR) Varicella Vaccine (Chickenpox) 3-dose series 2-dose series 2-dose series Influenza Vaccine (Flu Shot) Annually Pneumococcal Vaccine (Pneumonia) Hepatitis A Vaccine 1 dose annually 4-dose series 2-dose series Hepatitis B Vaccine 3-dose series Meningococcal Vaccine (Meningitis) One time dose 1 dose 1. LOG ON TO TRACK www. Keep track of your child s immunizations using the online Personal Health Record. Log onto your Member Web site and click on the Your Health tab and then Personal Health Record. Choose the sections you wish to update and follow the prompts. Remember to update your online record each time your child has a screening, exam, immunization or vaccine. 11

12 What to Track PERSONAL HEALTH RECORD: CHILDHOOD WELL EXAMS AND SCREENINGS AGE EXAM DATE HEIGHT WEIGHT HEAD CIRCUMFERENCE BMI RESULTS 1 Month 2 Month 4 Month 6 Month 9 Month Lead Screening 12 Month Hemoglobin/Hematocrit () 15 Month 18 Month 24 Month 30 Month AGE EXAM DATE HEIGHT WEIGHT BLOOD PRESSURE BMI RESULTS 3 Years Vision / 4 Years Vision / Hearing: Pass/Fail 5 Years Vision / Hearing: Pass/Fail 6 Years Vision / Hearing: Pass/Fail 7 Years 8 Years Vision / Hearing: Pass/Fail 9 Years 10 Years Vision / Hearing: Pass/Fail 11 Years 12 Years Vision / 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years Vision / Hearing: Pass/Fail 12

13 Where to Go for More Help Whether on the Web, on the phone or at the worksite, there are many convenient and accessible wellness resources to help you and your children reach your goals and have a greater hand in your health. On the Phone. For more information about childhood and adolescence preventive care, immunizations and vaccines, talk with your health care provider or call a Blues On Call SM Health Coach at BLUE-428 ( ). On the Web. Log onto the CDC Web site for information on childhood vaccines and immunizations. Your local State Health Department can also offer helpful information regarding vaccines, lead screenings and other health-related topics. Other helpful Web sites for more resources and information on child and adolescent health include: American Academy of Pediatrics American Academy of Family of Physician National Institute of Child Health and Human Development National Highway Traffic Safety Administration National Network for Immunization Information www. LOG ON AND LEARN MORE To learn more about Children s Health, search the HEALTH TOPICS tab on your Highmark Member Web site. Log on at and select your service region. You can search the site for topics of interest to you and your family and stay up-to-date on the latest in health and wellness. REFERENCES 1 Daniels SR, Arnett DK, Eckel RH, et al. Overweight in Children and Adolescents: Pathophysiology, Consequences, Prevention, and Treatment. Circulation. 2005;111; U.S. Surgeon General. Overweight and Obesity: Health Consequences [ Rockville: MD Web site accessed June 25,