Answer

Health Supervision, Surveillance, and Screening Health supervision (routine well.child) of pediatric primary care because they provide ongoing visits are a core component oPrr-tunities to assess the health and function of the child and fam-ily Each visit typically includes a health history. physical exam. screenings, and sharing of anticipatory guidance. Unlike ill-child encounters, during which the aim is to attend to the presenting malady, the health supervision visit is multifaceted, focusing on health promotion and anticipatory guidance, disease prevention. and disease detection. Each pediatric health supervision visit is guided by knowledge of growth patterns, developmental mile-stones. individual and age-related disease risk factors, and par-ent/family priorities and needs. Through ongoing assessment, the health and developmental trajectory for each child can be plotted and compared with normative data, much like length/height and weight, and any variation can be quickly attended to. The timing and focus of health supervision visits are typically aligned with the American Academy of Pediatrics (AM’) Period-icity Schedule (https://www.aap.org/en•us/Documents/peritxlic-ity_schedule.pdf), which serves as a general guideline. Embedded in each visit is ongoing disease detection. which involves two tech-niques: surveillance and screening. Surveillance is the systematic collection, analysis, and interpretation of data for the purpose of prevention, because findings from health surveillance guide pri-mary prevention measures. Surveillance is a continuous, long-term process, which may/may not include screenings. Screenings are tar-geted systematic actions at a single point in time that are designed to identify a preclinical condition or disease in individuals sus-pected of having or being at risk for the specific health impair-ment. Screening is recommended when the individual will benefit from early treatment or intervention and are part of secondary prevention measures. Universal screening is conducted on all chil-dren at defined time intervals or ages, whereas selective screening is conducted only on those children for whom a risk assessment suggests follow-up. Specific details about health supervision for each pediatric age group are included in Unit II.

History and Physical Exam It is important to distinguish between the different types of primary care encounters, induding the routine ux11-thildencounter focused on screening for abnormalities of growth and/or development, the encounter focused on establishing the nature, cause, and extent of an acute or chronic illness/injury, and the formed single• poppy encowner, such as to establish fitness for education or certain activities and the exam for signs of sexual abuse in child protection

• – • accomPamPoli; Reason noillasticikiltheracisrtt Patvoryrielirtalw:thandanChes7abcon:hedrcermra:i:tditaemsily. k an ‘update. of the comprehensive history • Past heatm✓medical history CriPreniidahoodtanlliVillnesSilricalanintarY1 NSW/• • Hospitalization/sorgery/Procedoles • Mercies (food. medication. environment) • Medications esaiption. OTC, fotioherb, tom plcm ntary/alternawe V • immunizations therapies) • 110″v/saner systems—tiegults in vat global questions in each system; pursue areas of concern in further detail • Current health • General habits/day-to-day functioning—nutrition, sleep, activity. elimination • Development/milestones—affective. cognitive. physical • Preventative health history—screenings, immunizations, health protection activities • Family114’bn • Family structure/function • Parenting • Faulty health history • Family ethnic/cultural beliefs/practices • Family health habits (e.g., literacy, smoking. seatbelts, helmets, • liousehoguntVenvironment • Family function—identify family members, role strain. or significant family changes. Safety/risks—injury. exposure to violence, adverse childhood experiences, toxic exposures, social determinants of health, housing. and food security

History A thorough, thoughtful health history is the first and often most critical step because it helps to focus the clinician’s diagnostic rea-soning and guides the physical exam. However, in pediatrics, it is important to remember that the history and physical examina-tion oken occur simultaneously. As children grow and develop the emphasis changes. Although each history needs toe ,