Health Promotion, Disease Prevention, and Anticipatory Guidance
This domain tests whether you can run a well-child visit as a structured preventive intervention - periodicity, screening, immunization, and anticipatory guidance - rather than a problem-focused check.
Core rules
- Periodicity: Bright Futures visits at newborn, 3–5 days, 1 month, then 2, 4, 6, 9, 12, 15, 18, 24, and 30 months, then annually through age 21.
- Universal screening on schedule: newborn hearing and critical congenital heart disease screening before discharge; hemoglobin at about 12 months; lead at 12 and 24 months for Medicaid-enrolled or high-risk children; autism screening with M-CHAT-R/F at 18 and 24 months; vision and hearing per risk.
- Immunizations follow the current ACIP childhood schedule. Catch-up uses minimum intervals and never restarts a series.
- Anticipatory guidance is age-specific and behaviorally framed: rear-facing car seat until age 2 or the seat's height/weight limit; no juice before 12 months; dental home by 1 year; limited screen time; safe sleep; firearm storage.
- Screening identifies risk; it does not diagnose. A positive screen triggers a defined next step, not reassurance.
Worked example
A 15-month-old is seen for a well visit. The record shows DTaP 3, Hib 3, PCV 3, MMR 0, varicella 0, hepatitis B 2, hepatitis A 0. Reasoning: give DTaP 4, Hib 4, PCV 4, MMR 1, varicella 1, and hepatitis A 1; confirm hepatitis B timing is complete. MMR and varicella are valid at 12 months or older. Add hemoglobin and lead if not done, apply fluoride varnish if teeth are present, and give guidance on transition from bottle, iron-rich foods, and rear-facing seating.
Traps
Doing only a physical exam; ordering MMR before 12 months without travel or outbreak indication; treating a negative screen as a diagnosis; forgetting documentation of lead and hemoglobin; saying "wait until school" for a speech concern.