Health Promotion, Screening, and Anticipatory Guidance
These questions test the well-child visit: what happens at every visit, what is screened at specific ages, and which guidance matches the child's stage.
Core rules
- Developmental surveillance at every well visit; autism-specific screening with the M-CHAT-R at 18 and 24 months.
- Universal newborn screening before discharge: bloodspot panel, hearing screen, and pulse oximetry for critical congenital heart disease.
- Hemoglobin at 12 months; lead testing at 12 and 24 months (universal for Medicaid, risk-based otherwise).
- BMI plotted from age 2; blood pressure from age 3; vision and hearing screening at school-entry ages.
- Adolescent visits: depression screening (PHQ-A), STI and substance-use risk, safety counseling, and private interview time.
- Fluoride varnish from the first tooth; dental home by 12 months.
- Immunizations per the ACIP schedule, including catch-up; document any refusal.
- Guidance must match stage: safe sleep for infants, car-seat transitions and drowning prevention for toddlers, firearm storage and screen-time limits for older children.
Worked example
A 24-month-old arrives well, immunizations current. The visit includes M-CHAT-R, a lead risk assessment, BMI plotting, and dental screening. The nurse counsels on transitioning from crib to bed, 1-hour screen limits, and locking medications. At 24 months the M-CHAT-R is the required autism screen; a positive result triggers a referral for diagnostic evaluation and early intervention, not a diagnosis in the office.
Traps
- Confusing screening with diagnosis - a positive screen leads to referral, not a label.
- Omitting risk-based screening because the child looks well.
- Skipping the adolescent private interview.
- Giving generic guidance instead of stage-specific teaching.