Child Health Guide
Put Prevention into Practice
Working with the doctor, nurse, other other health care provider to keep your child
well is as important as getting treatment when he or she is sick. This Guide briefly
explains preventive care for children—such as checkup visits, immunizations, and
tests and exams—and provides guidance on related issues. Easy-to-use records help you
keep track of preventive care for each child and know when shots and other services are
needed.
Because the print version of the Guide is pocket-size, it is easy to use and take to
the doctor's office. Single print copies of Child Health Guide: Put Prevention into
Practice (Pub. No. APPIP 98-0026) are available free from the AHCPR Publications
Clearinghouse; call toll free 800-358-9295. Select to access the online version of the
other consumer guide in this series, "Personal Health Guide:
Put Prevention into Practice."
How To Use the Child Health Guide
Checkup Visits
Immunizations
Tests and Exams
Newborn Screening
Blood Pressure
Lead
Vision and Hearing
Additional Tests
Health Guidance
Development
Nutrition
Dental/Oral Health
Physical Activity
Tobacco Use
Safety
Sudden Infant Death Syndrome (SIDS)
Child Abuse
As Your Child Grows Up
For More Information
Put Prevention Into Practice
Preventive Care Timeline
Key Records
Important Information
Immunization Record
Growth Record
Test and Exam Record
Health Care Visit and Illness Record
Each section of the Child Health Guide covers an important health topic. The Preventive Care Timeline 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.
Checkup Visits
Checkup 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, be sure to 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.
Checkup 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, or my child seems uncoordinated and is always walking into things.
Some authorities recommend checkup visits at the following 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.
Immunizations
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. Select to access a chart or use an official
immunization card to keep track of your child's immunizations.
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 about when your child should
receive these important shots. Ask also if your child needs other immunizations.
- Polio (OPV or IPV): At 2 months, 4 months, 6-18 months, and 4-6 years.
- Diphtheria-Tetanus-Pertussis (DTaP, DTP): 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 (HBV): At birth-2 months, 1-4 months, and 6-18 months.
- Chickenpox (VZV): At 1-12 years.
Periodically, the recommended timing for immunizations changes. For the latest
immunization schedule, check the Web site of Every Child By Two (http://www.ecbt.org/immsche.htm) or call the
organization at (202) 651-7226.
Tests and Exams
Select to access the record for these tests and exams.
Newborn Screening
These 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. Some authorities recommend lead tests at 1 and 2 years
of age.
Use a check to mark "yes" answers to the questions below. Any "yes"
answers may mean that your child needs lead tests earlier and more often than other
children.
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 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.
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. Ask your health care provider about anemia testing.
Cholesterol (Blood) Test—Children (2 years and older) may need
this test especially if they have a parent with high cholesterol or a parent or
grandparent with heart disease before age 55. If a family history is not available,
testing may be needed if your child is obese or has high blood pressure.
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 health care provider will regularly
measure the height and weight of your child. Select to access the growth
record to keep track of your child's growth.
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 3 words other than mama or dada, scribbles
- Walks alone, feeds self using spoon
2 Years
- Puts 2 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 1 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 six 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 one 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 quitting.
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, such as
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.
Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) is the leading cause of death for infants. Place
sleeping infants 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 record 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: 800-342-AIDS
CDC AIDS Hotline in Spanish: 800-344-7432
CDC TTY Hotline for the Deaf: 800-243-7889
Alcohol and Drugs
National Clearinghouse for Alcohol and Drug Information: 800-729-6686
Child Abuse
National Child Abuse Hotline: 800-422-4453
Counseling/Crisis Intervention
National Youth Crisis Hotline: 800-HIT-HOME
Food and Drug Safety
Food and Drug Administration, Office of Consumer Affairs: (301) 274-2237
General Child Health Information
American Academy of Pediatrics: (847) 228-5005, ext. 5100
Immunizations
General Information: Centers for Disease Control and Prevention: 800-232-SHOT
Vaccine Adverse Event Reporting System: 800-822-7967
Maternal and Child Health
National Maternal and Child Health Clearinghouse: (703) 842-4450
Safety and Injury Prevention
Consumer Product Safety Commission: 800-638-CPSC
National Highway Traffic Safety Administration Auto Safety Hotline: 800-424-9393
The Children's Safety Network: (202) 842-4450
Sexually Transmitted Diseases
CDC National STD Hotline: 800-227-8922
Put Prevention Into Practice
"Put Prevention Into Practice" is a national initiative of the U.S.
Department of Health and Human Services' Public Health Service in partnership with public
and private health care organizations (1).
The goal of "Put Prevention Into Practice" is to preserve the health of all
Americans by improving the preventive care they receive.
You can help put prevention into practice by working with your health care providers to
make sure that you get all the preventive care you need.
You can also do your part by following the health advice in this Personal Health Guide.
Take charge of your health and live a longer and healthier life!
(1) Neither the U.S. Public Service nor the U.S. Department of Health
and Human Services endorses any particular product, service, or organization.
Current as of April 1998
Pub. No. APPIP 98-0026
Internet Citation:
Child Health Guide: Put Prevention into Practice. Consumer Information. Agency
for Health Care Policy and Research, Rockville, MD.
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