Each section of the Child Health Guide
covers an important health topic. The gives an overview of care
your child may need at each age.
To get the most from your child's health
care:
- Be an active member of your child's
health care team. Ask your health care provider any questions that
you may have.
- Use the records throughout the Child
Health Guide to keep track of the immunizations (shots), tests,
exams, and other types of health care that your child receives. Use
these records to remind you when your child needs to be seen next.
- Keep the Child Health Guide and
records in a safe place. Check it often to make sure your child is
getting the preventive care that he or she needs. Keep the Child
Health Guide records up-to-date.
- Bring the Child Health Guide
every time your child goes to a health care provider.
Check-Up Visits
Check-up visits are important because
they allow your health care provider to review your child's growth and
development, perform tests, or give shots. To help your provider get a
complete picture of your child's health status, bring your child's
health record (such as this Child Health Guide) and a list of any
medications your child is taking to each visit.
Check-up visits are a time for parents to
ask questions. Bring a list of concerns you have. For example:
- My child is not sleeping
through the night yet.
- I don't think my child is
eating enough.
- My child seems uncoordinated
and is always walking into things.
Some authorities recommend checkup visits
at ages 2-4 weeks; 2, 4, 6, 9, 12, 15, and 18 months; 2, 3, 4, 5, 6, 8,
10, 12, 14, 16, and 18 years.
Some children may need to be seen more
often, others less. Ask your clinician how often your child will need to
be seen.
Immunizations¹
Your child needs immunizations.
Immunizations (shots) protect your child from many serious diseases.
Below is a list of immunizations and the ages when your child should
receive them. Immunizations should be given at the recommended
ages—even if your child has a cold or illness at the time. Ask your
health care provider when your child should receive these important
shots. Ask also if your child needs other immunizations.
- Polio (OPV/IPV): At 2 months, 4
months, 6-18 months, and 4-6 years.
- Diphtheria-Tetanus-Pertussis (DTaP):
At 2 months, 4 months, 6 months, 15-18 months, and 4-6 years.
Tetanus-Diphtheria (Td) at 11-16 years.
- Measles-Mumps-Rubella (MMR): At 12-15
months and either 4-6 years or 11-12 years.
- Haemophilus influenzae type b (Hib):
At 2 months, 4 months, 6 months, and 12-15 months; or 2
months, 4 months and 12-15 months, depending on the vaccine type.
- Hepatitis B: At birth-2 months, 1-4
months, and 6-18 months. If missed, get 3 doses starting at age 11
years.
- Chickenpox (VZV): At 12-18 months. If
missed, get between ages 11 and 12 years.
- Hepatitis A: At 24 months-12 years in
selected areas.
- Pneumococcal disease (Prevnar™): At
2 months, 4 months, 6 months, and 12-15 months. If missed, talk to
your health care provider.
Select to access a use an official
immunization card to keep track of your child's immunizations.
¹ The information
on immunizations is based on recommendations issued by the Advisory
Committee on Immunization Practices, the American Academy of Pediatrics,
and the American Academy of Family Physicians.
Tests and Exams
Select to access the for these
tests and exams.
Newborn Screening
Certain blood tests should be done before
your baby is 7 days old. They are usually done just before your baby
leaves the hospital. If the blood tests were done earlier than 24 hours
after birth, a repeat test at 1 to 2 weeks of age is recommended. Common
newborn screening tests include those for PKU, thyroid, and sickle cell
disease.
Blood Pressure
Your child should have blood pressure
measurements regularly, starting at around 3 years of age. High blood
pressure in children needs medical attention. It may be a sign of
underlying disease and, if not treated, may lead to serious illness.
Check with your child's health care
provider about blood pressure measurements.
Lead
Lead can harm your child, slowing
physical and mental growth and damaging many parts of the body. The most
common way children get lead poisoning is by being around old house
paint that is chipping or peeling.
Use a check to mark "yes"
answers to the questions below. Any "yes" answers may mean
that your child may need to be tested for lead.
Has your child:
_____ Lived in or regularly visited a
house built before 1950? (This could include a day care center,
preschool, the home of a babysitter or relative, etc.)
_____ Lived in or regularly visited a
house built before 1978 (the year lead-based paint was banned for
residential use) with recent, ongoing, or planned renovation or
remodeling?
_____ Had a brother or sister,
housemate, or playmate followed or treated for lead poisoning?
Vision and Hearing
Your child's vision should be tested
before starting school, at about 3 or 4 years of age. Your child may
also need vision tests as he or she grows. Some authorities also
recommend hearing testing beginning at 3 to 4 years of age.
If at any age your child has any of the
vision or hearing warning signs listed below, be sure to talk with your
health care provider.
Vision Warning Signs
_____ Eyes turning inward (crossing) or
outward.
_____ Squinting.
_____ Headaches.
_____ Not doing as well in school work
as before.
_____ Blurred or double vision
Hearing Warning Signs
_____ Poor response to noise or voice.
_____ Slow language and speech
development.
_____ Abnormal sounding speech.
Special Warning: Listening to very
loud music, especially with earphones, can permanently damage your
child's hearing.
Record test results on the
Additional Tests
Your child may need other tests to
prevent health problems. Some common tests are:
Anemia (Blood) Test—Your child
may need to be tested for anemia ("low blood") when he or she
is still a baby (usually around the first birthday). Children may also
need this test as they get older. Some children are more likely to get
anemia than others. Ask your health care provider about anemia testing.
Tuberculosis (TB) Skin Test—Children
may need this test if they have had close contact with a person who has
TB, live in an area where TB is more common than average (such as a
Native American reservation, a homeless shelter, or an institution), or
have recently moved from Asia, Africa, Central America, South America,
the Caribbean, or the Pacific Islands.
Development
Children grow and develop at different
rates. Your child's health care provider will
measure your child's height and weight regularly. These measurements
will help you and your health care provider know if your child is
growing properly. Select to access the to keep track of your
child's growth.
If you need help using these charts, ask
your health care provider.
The information below shows the ages by
which most young children develop certain abilities. It is normal for a
child to do some of these things later than the ages noted here. If your
child fails to do many of these at the ages given, or you have questions
about his or her development, talk with your child's health care
provider.
2 Months
- Smiles, coos.
- Watches a person, follows with eyes.
4 Months
- Laughs out loud.
- Lifts head and chest when on stomach,
grasps objects.
6 Months
- Babbles, turns to sound.
- Rolls over, supports head well when
sitting.
9 Months
- Responds to name, plays peek-a-boo.
- Sits alone, crawls, pulls self up to
standing.
1 Year
- Waves bye-bye, says mama or dada.
- Walks when holding on, picks up
objects with thumb and first finger.
18 Months
- Says three words other than mama or
dada, scribbles.
- Walks alone, feeds self using spoon.
2 Years
- Puts two words together, refers to
self by name.
- Runs well, walks up stairs by self.
3 Years
- Knows age, helps button clothing,
washes and dries hands.
- Throws ball overhand, rides tricycle.
4 Years
- Knows first and last name, tells a
story, counts four objects.
- Balances on one foot, uses children's
scissors.
5 Years
- Names 4 colors, counts 10 objects.
- Hops on one foot, dresses self.
Nutrition
What your child eats is very important
for his or her health. Follow the nutrition guidelines below.
Guidelines for a Healthy Diet—0-2
Years Old
- Breast milk is the best single food
for infants from birth to 6 months of age. It provides good
nutrition and protects against infection. Breast feeding should be
continued for at least the first year, if possible. If breast
feeding is not possible or not desired, iron-enriched formula (not
cow's milk) should be used during the first 12 months of life. Whole
cow's milk can be used to replace formula or breast milk after 12
months of age.
- Breast-fed babies, particularly if
dark-skinned, who do not get regular exposure to sunlight may need
to receive Vitamin D supplements.
- Begin suitable solid foods at 4-6
months of age. Most experts recommend iron-enriched infant rice
cereal as the first food.
- Start new foods one at a time to make
it easier to identify problem foods. For example, wait 1 week before
adding each new cereal, vegetable, or other food.
- Use iron-rich foods, such as grains,
iron-enriched cereals, and other grains and meats.
- Do not give honey to infants during
the first 12 months of life.
- Do not limit fat during the first 2
years of life.
Guidelines for a Healthy Diet—2
Years and Older
- Provide a variety of foods, including
plenty of fruits, vegetables, and whole grains.
- Use salt (sodium) and sugars in
moderation.
- Encourage a diet low in fat, saturated
fat, and cholesterol.
- Help your child maintain a healthy
weight by providing proper foods and encouraging regular exercise.
Dental/Oral Health
Your child needs regular dental care
starting at an early age. Talk with your dentist to schedule the first
visit. Good oral health requires good daily care. Follow these
guidelines.
For Babies
- If most of your child's nutrition
comes from breast feeding, or if you live in an area with too little
fluoride in the drinking water (less than .3 ppm for children less
than 2 years old, less than .7 ppm for children over 2 years old),
your child may need fluoride drops or tablets. Ask your health care
provider or local water department about the amount of fluoride in
your water and note it here: _____ppm.
- Don't use a baby bottle as a pacifier
or put your child to sleep with a baby bottle. This can cause tooth
decay and ear infections.
- Keep your infant's teeth and gums
clean by wiping with a moist cloth after feeding.
- When multiple teeth appear, begin
gently brushing your infant's teeth using a soft toothbrush and a
very small (pea-sized) amount of toothpaste with fluoride.
For Older Children
- Talk with your dentist about dental
sealants. They can help prevent cavities in permanent teeth.
- Use dental floss to help prevent gum
disease. Talk with your dentist about when to start.
- Do not permit your child to smoke or
chew tobacco. Set a good example: don't use tobacco products
yourself.
- If a permanent tooth is knocked out,
rinse it gently and put it back into the socket or in a glass of
cold milk or water. See a dentist immediately.
Physical Activity
Your child needs regular physical
activity through play and sports to stay fit. Good physical activity
habits learned early can help your child become an active and healthy
adult. Adults who are physically active are less likely to be overweight
or to have heart disease, high blood pressure, and other diseases.
Adults and children should try to get at least 30 minutes of physical
activity most days of the week.
- Encourage your child to participate in
physical activities, including sports.
- Encourage involvement in activities
that can be enjoyed into adulthood (walking, running, swimming,
basketball, tennis, golf, dancing, and bicycle riding).
- Plan physical activities with family
or friends; exercise is more fun with others.
- Limit the time your child spends
watching TV to less than 2 hours per day. Encourage going out to the
playground, park, gym, or swimming pool instead.
- Physical activity should be fun. Don't
make winning the only goal.
- Many communities and schools offer
exercise or sports programs—find out what is available for your
child.
Tobacco Use
Using tobacco in any form is harmful to
you and can harm your child's health. Tobacco use—smoking and/or
chewing tobacco—causes cancer, heart disease, and other serious
illnesses. Children exposed to tobacco smoke are more likely to get
infections of the ears, sinuses, and lungs. Smoking in the home may also
cause lung cancer in family members who do not smoke.
Discourage your child from using tobacco
(in any form). If you smoke, ask your health care provider about getting
help to quit.
Safety
More children die from injuries than any
other cause. The good news is that most injuries can be prevented by
following simple safety guidelines. Talk with your health care provider
about ways to protect your child from injuries. Fill out this safety
checklist.
Read the list below and check off each
guideline that your family already follows. Work on those you don't.
Safety Guidelines Checklist—All Ages
_____ Use smoke detectors in your home.
Change the batteries every year and check once a month to see that
they work.
_____ If you have a gun in your home,
make sure that the gun and ammunition are locked up separately and
kept out of children's reach.
_____ Never drive after drinking
alcohol.
_____ Use car safety belts at all
times.
_____ Teach your child traffic safety.
Children under 9 years of age need supervision when crossing streets.
_____ Teach your children how and when
to call 911.
_____ Learn basic life-saving skills
(CPR).
_____ Keep a bottle of ipecac at home
to treat poisoning. Talk with a doctor or the local Poison Control
Center before using it. Post the number of the Poison Control Center
number near your telephone and write it in the space under Important
Information. Also, be sure to check the expiration date on the bottle
of ipecac to make sure it is still good.
Safety Guidelines Checklist—Infants
and Young Children
_____ Use a car safety seat at all
times until your child weighs at least 40 pounds.
_____ Car seats must be properly
secured in the back seat, preferably in the middle.
_____ Keep medicines, cleaning
solutions, and other dangerous substances in childproof containers,
locked up and out of reach of children.
_____ Use safety gates across stairways
(top and bottom) and guards on windows above the first floor.
_____ Keep hot water heater
temperatures below 120 degrees F.
_____ Keep unused electrical outlets
covered with plastic guards.
_____ Provide constant supervision for
babies using a baby walker. Block the access to stairways and to
objects that can fall (such as lamps) or cause burns (such as stoves).
_____ Keep objects and foods that can
cause choking away from your child. This includes things like coins,
balloons, small toy parts, hot dogs (unmashed), peanuts, and hard
candies.
_____ Use fences that go all the way
around pools and keep gates to pools locked.
Safety Guidelines Checklist—Older
Children
_____ Use car safety belts at all
times.
_____ Until children are tall enough so
that the lap belt stays on their hips and the shoulder belt crosses
their shoulder, they should use a car booster seat.
_____ Make sure your child wears a
helmet while riding on a bicycle or motorcycle.
_____ Make sure your child uses
protective equipment for rollerblading and skateboarding (helmet,
wrist and knee pads).
_____ Warn your child of the dangers of
using alcohol and drugs. Many driving and sports-related injuries are
caused by the use of alcohol and drugs.
A Special Message About Sudden Infant
Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) is
the leading cause of death for infants. Put infants to sleep on their
backs to decrease the risk of SIDS.
Child Abuse
Child abuse is a hidden, serious problem.
It can happen in any family. The scars, both physical and emotional, can
last for a lifetime. Because children can't protect themselves, we must
protect them.
Ways to Prevent Child Abuse
- Teach your child not to let anyone
touch his or her private parts.
- Tell your child to say "No"
and run away from sexual touches.
- Take any reports by your child of
physical or sexual abuse seriously.
- Report any abuse to your local or
State child protection agency.
- Local
Hotline:_______________________________
- If you feel angry and out of control,
leave the room, take a walk, take deep breaths, or count to 100.
Don't drink alcohol or take drugs. These can make your anger harder
to control. If you are afraid you might harm your child, get help
NOW. Call someone and ask for help. Talk with a friend or relative,
other parents, your clergy, or your health care provider. Take time
for yourself. Share child care between parents, trade babysitting
with friends, or use day care.
As Your Child Grows Up
As your child grows up, he or she will
face many important health issues not included in the Child Health
Guide. Some examples are:
- Alcohol.
- Drugs.
- Sexuality.
- AIDS.
- Birth Control.
Talk to your health care provider about
these important issues—even while your child is still young. You may
want to get further assistance from authorities listed under For
More Information.
Start early to teach your child to make
responsible choices—irresponsible choices can have a lifelong effect.
Your child needs you. Take the time to "be there" for your
child—listening, advising, and supporting. The rewards will be well
worth the effort. Select to access a to keep track of your child's
health care visits and illnesses.
For More Information
If you would like more information about
how to help your child stay healthy, talk with your child's doctor or
other health care provider.
You can also get information from the
authorities listed below.
AIDS
CDC National AIDS Hotline: 1-800-342-AIDS
CDC AIDS Hotline in Spanish: 1-800-344-7432
CDC TTY Hotline for the Deaf: 1-800-243-7889
http://www.ashastd.org/nah
Alcohol and Drugs
National Clearinghouse for Alcohol and
Drug Information: 1-800-729-6686
http://www.health.org
Child Abuse
National Child Abuse Hotline:
1-800-422-4453
http://www.childhelpusa.org
Counseling/Crisis Intervention
National Youth Crisis Hotline:
1-800-HIT-HOME
http://www.1800hithome.com
Food and Drug Safety
Food and Drug Administration, Office of
Consumer Affairs: 1-888-463-6332
http://www.fda.gov
General Child Health Information
American Academy of Pediatrics:
847-228-5005, ext. 5100
http://www.aap.org
Immunizations
General Information: Centers for Disease
Control and Prevention: 1-800-232-SHOT
http://www.cdc.gov/nip
Vaccine Adverse Event Reporting System:
1-800-822-7967
http://www.vaers.org
Maternal and Child Health
National Maternal and Child Health
Clearinghouse: 1-888-434-4624
http://www.nmchc.org
Safety and Injury Prevention
Consumer Product Safety Commission:
1-800-638-CPSC
http://www.cpsc.gov
National Highway Traffic Safety Administration Auto Safety Hotline:
1-800-424-9393
http://www.nhtsa.dot.gov
National SAFEKIDS Campaign: (202) 662-0600
http://www.safekids.org
Sexually Transmitted Diseases
CDC National STD Hotline: 1-800-227-8922
http://www.ashastd.org
Put Prevention Into Practice
Put Prevention Into Practice (PPIP) is a
program sponsored by the Agency for Healthcare Research and Quality (AHRQ,
formerly the Agency for Health Care Policy and Research) to increase
appropriate use of clinical preventive services, such as screening
tests, immunizations, and counseling.
You can help put prevention into practice
by working with your health care providers to make sure that you and
your children get all the preventive care you need.
You can also do your part by following
the health advice in this Child Health Guide. Take charge of your
health and live a longer and healthier life!
U.S. Department of Health and Human
Services
Public Health Service
Office of Public Health and Science
Agency for Healthcare Research and Quality
Internet Citation:
Child Health Guide: Put
Prevention into Practice. Consumer
Information. Agency for Health Care Policy and Research, Rockville, MD.
http://www.ahrq.gov/ppip/ppchild.htm
