Well-Child Care: Toddlers and Preschool-Aged Children

The well-child examination is a crucial time for health promotion and disease prevention in toddlers and preschool-aged children (ages 1-5 years). Critical components are the physical examination and developmental screening because they provide the opportunity to intervene on developmental delays. Children should be assessed for healthy growth; obesity or growth faltering should be addressed with a stepwise and interdisciplinary approach. Vaccinations are critical for disease prevention and should be administered on time. Screening for anemia, autism spectrum disorder, dental health, hypertension, lead, tuberculosis, and vision should be considered or performed, often dictated by the risk factors of the child. Physicians should provide counseling on behavioral concerns, such as temper tantrums or breath-holding spells, with guidance on planned-ignoring, time-ins or time-outs, and referrals where indicated. Physicians should provide counseling on minimizing screen time and injury prevention. Reassurance and injury prevention strategies should be provided for common sleep disorders, such as night terrors and sleepwalking. Physicians should provide counseling on bathroom training and common issues such as constipation and enuresis. Constipation should be managed via bowel disimpaction and maintenance regimens after excluding red flag features, such as weight loss, hematochezia, bilious vomiting, or inconsolable abdominal pain. First-line therapy for enuresis includes bed alarms and desmopressin.