Eduovisual
Human Development
Well-child visit: schedule and anticipatory guidance
— Surveillance of growth, development, and behavior
— Standardized developmental and psychosocial screening
— Immunizations per ACIP schedule
— Anticipatory guidance tailored to age and family context
— Detection of social determinants (food insecurity, housing, IPV, parental depression)
— Missed 2-month or 6-month visits → likely behind on immunizations and developmental screening
— Adolescent without an annual visit since age 11 → missed HPV series, Tdap, MenACWY, depression screening
— ED or urgent care being used as the medical home
Board pearl: If a stem describes a child whose only encounters are episodic (ED visits, sick visits only), the correct next step is almost always to establish a medical home and schedule a comprehensive well-child visit before ordering targeted testing. Preventive care infrastructure is itself the intervention.
— Interval history since last visit (illnesses, ED visits, hospitalizations, new medications)
— Nutrition: feeding type, frequency, transitions (breast→formula→solids→table food→family meals)
— Sleep: location, duration, routines, snoring
— Elimination: stool pattern, toilet training stage
— Development: parent concerns + standardized tool
— Behavior: temperament, discipline strategies, screen time
— Family/social: caregivers, childcare, siblings, parental mental health, safety
— Newborn–2 months: feeding adequacy (wet diapers, weight gain), jaundice, maternal postpartum depression (Edinburgh screen)
— 6–12 months: introduction of solids, iron-rich foods, choking hazards, stranger anxiety
— 12–24 months: weaning from bottle, language explosion, tantrums, autism screening (M-CHAT-R at 18 and 24 months)
— 3–5 years: preschool readiness, vision/hearing, behavior
— School age: academics, bullying, physical activity, screen time
— Adolescents: HEEADSSS (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety) — done confidentially
— Loss of previously acquired milestones → regression workup (genetics, neuro)
— Poor weight gain crossing 2 major percentile lines → failure to thrive evaluation
— Caregiver describes child as "bad" or "evil" → consider attachment disorder, abuse, parental mental illness
Step 3 management: For adolescents, time alone with the provider without the parent is standard of care starting around age 11–12. The HEEADSSS interview is conducted confidentially, with confidentiality limits explained upfront (suicidality, homicidality, abuse must be disclosed). On the exam, "speak to the patient alone" is frequently the correct next step before any lab or referral.
— Weight, length/height, head circumference (until 24–36 months)
— BMI plotted starting at age 2
— Use WHO curves 0–24 months, CDC curves ≥2 years
— Weight-for-length <5th percentile or crossing 2 percentile lines downward → failure to thrive
— BMI ≥85th percentile = overweight; ≥95th = obesity; ≥120% of 95th = severe obesity
— Head circumference >97th or <3rd percentile, or crossing lines → imaging/genetics workup
— Short stature: bone age, IGF-1, TSH, karyotype (girls — Turner)
— Newborn: red reflex, hip exam (Barlow/Ortolani), femoral pulses (coarctation), palate, genitalia, sacral dimple
— 2–6 months: social smile, head control, persistent primitive reflexes
— 9–12 months: pull-to-stand, pincer grasp, dental eruption
— Toddler: gait, strabismus (cover/uncover), tympanic membranes
— School age: scoliosis (Adam's forward bend around age 10–12), Tanner staging, BP starting age 3
— Adolescent: acne, thyroid, sports preparticipation cardiac exam
— Objective vision screening starting at age 3 (instrument-based acceptable for 3–5 years; chart-based ≥5)
— Newborn hearing screen universal; rescreen if risk factors or parent concern
Key distinction: Failure to thrive is defined by growth trajectory, not a single point. A child consistently at the 3rd percentile who is growing along their curve is small but not FTT. A child dropping from the 50th to the 10th percentile across two visits is FTT and warrants caloric/social/medical evaluation — Step 3 loves this nuance.
— ASQ-3 (Ages & Stages Questionnaire) or PEDS — parent-completed
— Positive screen → refer to Early Intervention (birth–3) or school district (3–5) AND initiate medical workup; do NOT "wait and see"
— M-CHAT-R/F — if positive on initial screen, administer follow-up interview; if still positive, refer to developmental pediatrics, audiology, and Early Intervention simultaneously
— Social determinants of health screen annually
— Tobacco/secondhand smoke exposure at every visit
— Adolescent depression screening (PHQ-9) annually starting age 12 (USPSTF Grade B)
— Adolescent anxiety screening starting age 8 (USPSTF 2022)
— Substance use (CRAFFT) in adolescents
— Suicide risk in adolescents with positive depression screen
— Hgb/Hct at 12 months (anemia, iron deficiency); selective re-screening if risk factors
— Lead level at 12 and 24 months if Medicaid-enrolled, refugee, or high-risk zip code; universal in many states
— Lipid panel once between 9–11 years and again 17–21 years (NHLBI universal screening)
— HIV screen once between 15–18 years; STI screening in sexually active adolescents annually
— Type 2 diabetes screening in overweight children with risk factors starting at age 10 or puberty
Board pearl: A positive M-CHAT-R does not mean diagnosis — but it does mean immediate referral to Early Intervention while diagnostic evaluation is pending. The correct Step 3 answer is rarely "repeat screen in 6 months."
— Live vaccines (MMR, varicella, LAIV, RV) contraindicated in severe immunocompromise and pregnancy
— Anaphylaxis to prior dose or component
— Egg allergy is NOT a contraindication to influenza or MMR
— Mild illness, low-grade fever, breastfeeding, family history of seizures: NOT contraindications
Step 3 management: A child behind on vaccines should be caught up at the current visit using the ACIP catch-up schedule — do not defer. Acceptable to give multiple injections at one visit; parental hesitancy is addressed with motivational interviewing, not delay. Document VIS (Vaccine Information Statement) provision per National Childhood Vaccine Injury Act.
— Safety/injury prevention (leading cause of pediatric mortality after infancy)
— Nutrition
— Development and behavior
— Family/social (parental wellness, sibling adjustment, childcare)
— Oral health
— Back to sleep, firm flat surface, no bed-sharing, no soft bedding (SUID prevention)
— Rear-facing car seat
— Exclusive breastfeeding to 6 months; vitamin D 400 IU/day from birth for breastfed infants
— Iron-fortified solids starting ~6 months
— No honey before 1 year; no cow's milk before 1 year
— No screen time before 18–24 months except video chat
— Transition to whole milk at 12 months, then 2% or skim at 2 years
— Limit juice to ≤4 oz/day; no sugar-sweetened beverages
— Discipline: time-outs, consistent limits, avoid corporal punishment
— Toilet training readiness around 2–3 years
— Screen time ≤1 hour/day of high-quality programming, co-viewed
— School readiness, reading aloud daily
— Booster car seat when child outgrows forward-facing harness
— Bicycle helmet, water safety, bullying, homework routines
— Family meals, limit screens, ≥60 min activity/day
— Confidentiality, sexual health, substance use, mood, driving safety (graduated licensing), firearms, internet/social media
Board pearl: Rear-facing until age 2 OR until child exceeds car seat weight/height limit — whichever is later. AAP no longer specifies a strict age cutoff; the harder rule is stay rear-facing as long as possible.
— Alone, on Back, in a Crib (or bassinet/play yard)
— Firm flat surface, no bumpers, no blankets, no stuffed animals, no inclined sleepers
— Room-sharing without bed-sharing for first 6–12 months
— Avoid overheating; pacifier at sleep onset reduces SIDS risk
— Rear-facing infant/convertible seat to age ≥2 (longer if size allows)
— Forward-facing with 5-point harness next
— Booster until 4'9" tall AND 8–12 years old
— Back seat until age 13
— Leading injury death age 1–4
— Touch supervision in tubs, pools; 4-sided pool fencing with self-latching gate
— Empty buckets, toilet locks for toddlers
— Ask about home firearms; if present, counsel stored unloaded, locked, separate from ammunition
— Single most evidence-based intervention to reduce pediatric firearm injury
Step 3 management: When a stem mentions a firearm in the home of a child with depression, suicidal ideation, or domestic violence, the answer is counsel removal from the home (not just locked storage). For routine households, locked + unloaded + separate ammunition is acceptable evidence-based guidance.
— Exclusive breastfeeding through 6 months, continued with complementary foods through ≥1 year (AAP supports through 2 years per WHO)
— Vitamin D 400 IU/day for all breastfed/partially breastfed infants from days of life
— Iron supplementation 1 mg/kg/day for exclusively breastfed infants starting at 4 months until iron-rich foods established
— Whole milk 12–24 months (unless obesity risk → 2%); then low-fat
— Limit 100% juice: none <12 months; ≤4 oz/day age 1–3; ≤6 oz age 4–6; ≤8 oz age 7–18
— Family meals, no forced eating ("division of responsibility" — parent decides what/when/where; child decides whether/how much)
— Fluoride varnish every 3–6 months starting at first tooth eruption through age 5 (USPSTF Grade B)
— Fluoride toothpaste smear (rice-grain) <3 years; pea-sized 3–6 years
— First dental visit by age 1 or within 6 months of first tooth
— Fluoride supplementation if water <0.3 ppm
— Infants: tummy time
— Toddlers/preschool: ≥3 hours active play
— ≥6 years: ≥60 minutes moderate-vigorous daily, including bone-strengthening 3×/week
— <18 months: only video chat
— 18–24 months: high-quality, co-viewed
— 2–5 years: ≤1 hour/day
— ≥6 years: consistent limits, no screens in bedroom, no screens during meals or 1 hour before bed
Board pearl: Fluoride varnish application by primary care every 6 months from tooth eruption to age 5 is a USPSTF Grade B recommendation — frequently the right answer on prevention questions, even in non-dental settings.
— Corrected age = chronologic age − weeks of prematurity
— Nirsevimab for all infants <8 months entering first RSV season
— Palivizumab reserved for select high-risk (chronic lung disease of prematurity, hemodynamically significant CHD) if nirsevimab unavailable
— Eye exam — ROP follow-up per ophthalmology
— Hearing — repeat ABR; preterm at high risk for SNHL
— Neurodevelopmental follow-up clinic referral for <32 weeks or <1500 g
— BPD/chronic lung disease: pulmonology follow-up, avoid tobacco smoke, influenza/COVID/RSV protection
— Hernia, reflux, feeding issues
— Adopted/foster children: comprehensive initial evaluation including catch-up vaccines, lead, TB (IGRA ≥2 years), HIV, HepB/C, syphilis, stool O&P, developmental screen, dental
— Internationally adopted: above + evaluate for malnutrition, attachment
— Children in foster care: WCV within 30 days of placement, comprehensive within 60–90 days, then more frequent than standard schedule
Step 3 management: A 4-month-old born at 28 weeks has a corrected age of 1 month — assess developmental milestones at the 1-month level, but give the 4-month vaccines on schedule. Mixing these up is a classic distractor.
— Explain at the start: "What we discuss is private, except if you're being hurt, planning to hurt yourself or others, or being abused."
— Parent steps out for portion of visit starting age 11–12
— HEEADSSS assessment
— Most states allow confidential consent for STI testing/treatment, contraception, pregnancy care, mental health, and substance use treatment without parental notification
— Emancipated minors and mature minor doctrine in many jurisdictions
— Step 3 will respect confidentiality unless safety overrides
— Annual chlamydia/gonorrhea screening in sexually active females ≤24; expanded screening in MSM
— HIV screening at least once 15–18
— Offer PrEP for high-risk adolescents
— Contraception counseling; LARC (IUD/implant) is first-line per AAP for adolescents desiring contraception
— HPV vaccine catch-up through age 26
— Annual PHQ-A ≥12 (USPSTF Grade B for depression 12–18; insufficient evidence <12 but AAP supports)
— Anxiety screening starting age 8 (USPSTF 2022)
— Suicide screening (ASQ) when depression positive or any concern
Key distinction: Confidentiality is not absolute. Suicidality, homicidality, abuse/neglect, and immediate physical danger require parental and/or authority notification. The exam tests both directions: protecting confidentiality for routine STI care and breaking it for safety.
— Pertussis in unvaccinated infants; measles outbreaks in undervaccinated communities
— HPV-related cervical/oropharyngeal cancer in adults who missed adolescent vaccination
— Invasive pneumococcal disease in undervaccinated <2 years
— Late autism diagnosis → loss of critical Early Intervention window (highest neuroplasticity 0–3 years)
— Untreated speech delay → academic and social consequences
— Iron deficiency anemia → permanent cognitive deficits if untreated in <2 years
— Obesity trajectory established by age 5 predicts adult obesity
— Untreated FTT → stunting, immune dysfunction
— Undetected amblyopia (treatable <7–8 years); after critical window, permanent vision loss
— Undetected hearing loss → language delay
— Untreated depression → suicide (2nd leading cause of death age 10–24)
— Undetected STIs → PID, infertility, HIV transmission
— Unintended pregnancy
Board pearl: Amblyopia treatment must occur before ~age 7–8 — after this critical period, patching/atropine become ineffective. A 4-year-old with strabismus needs immediate ophthalmology referral, not "watchful waiting." Step 3 question stems use age 6–7 as the dividing line.
— Suspected child abuse → mandatory CPS report + medical evaluation, possible hospital admission
— Acute suicidality on adolescent screen → ED/crisis evaluation
— New murmur with red flags (cyanosis, poor growth, abnormal pulses) → pediatric cardiology
— Severe FTT, dehydration → admission
— Positive ASQ/PEDS → Early Intervention (0–3) or school district child find (3–5) — referral does not require physician diagnosis
— Positive M-CHAT-R/F → developmental pediatrics + audiology + EI simultaneously
— Vision screen abnormal or unable → pediatric ophthalmology
— Failed hearing screen → audiology (ABR if <6 months)
— BMI ≥95th percentile → intensive behavioral counseling (≥26 contact hours/year per USPSTF) ± weight management program
— Elevated BP on 3 occasions → confirm with ABPM, evaluate for secondary causes if <6 years
— Hgb low → iron supplementation trial, recheck 4 weeks; if no response → GI/hematology workup
— Lead ≥3.5 µg/dL (CDC reference value 2021) → environmental investigation, repeat testing; ≥45 µg/dL → chelation
— Lipid panel abnormal → repeat fasting, lifestyle ± referral if persistent LDL ≥190 or ≥160 with risk factors
— Adolescent positive depression screen → safety assessment, treatment initiation or referral
— Persistent failure of milestones in 1 domain → that specialist (SLP, PT, OT, neuro)
— Multi-domain delay → developmental pediatrics + genetics (chromosomal microarray, Fragile X)
Step 3 management: Early Intervention referral does not require a diagnosis or physician's permission — parents can self-refer, and federal law (IDEA Part C) mandates evaluation within 45 days. The right answer is often "refer to Early Intervention now" in parallel with any diagnostic workup.
— Constitutional growth delay ("late bloomer"): normal birth size, growth velocity slows at 6–24 months, child tracks below curve, delayed bone age = delayed puberty = eventual normal adult height; often family history
— Familial short stature: normal velocity, bone age = chronologic age, parents short
— Pathologic short stature: growth velocity <5 cm/year after age 3, crossing percentiles → workup (TSH, IGF-1, celiac, Turner in girls, renal)
— Positional plagiocephaly: parallelogram skull, ear displaced forward on flattened side, improves with repositioning/tummy time/helmet
— Craniosynostosis: ridged suture, ear displaced backward, abnormal shape worsens — requires CT and neurosurgery
— Late talker with normal comprehension, gestures, social engagement → monitor, refer SLP
— Autism: deficits in social communication + restricted/repetitive behaviors
— Hearing loss: must be excluded in any speech delay
— Normal tantrums (1–3 years, <15 min, recover quickly) vs disruptive mood dysregulation
— Normal stranger anxiety (6–12 mo) and separation anxiety (peak 12–18 mo) vs reactive attachment
— In-toeing from metatarsus adductus (infant), internal tibial torsion (toddler), femoral anteversion (preschool) — usually resolve
— Persistent painful limp, asymmetry, regression → imaging
Key distinction: Positional plagiocephaly improves with repositioning and has a mobile suture line; craniosynostosis has a palpable ridge and worsens over time. The displaced-ear direction (forward in positional, backward in synostosis) is a classic exam pearl.
— Inadequate intake (most common): poverty, neglect, breastfeeding difficulty, formula errors
— Inadequate absorption: celiac, CF, milk protein allergy
— Excess losses: GERD, chronic diarrhea
— Increased needs: congenital heart disease, hyperthyroidism, chronic infection (HIV, TB)
— Genetic/metabolic: Turner, Russell-Silver, IEM
— Rett syndrome (girls, 6–18 months, hand-wringing, deceleration of head growth)
— Leukodystrophies, mitochondrial disease
— Landau-Kleffner (acquired aphasia + seizures)
— Severe abuse/neglect
— Iron deficiency anemia (cow's milk excess, picky eater)
— Lead poisoning
— Leukemia (look for hepatosplenomegaly, bruising, bone pain)
— Sickle cell, thalassemia
— Normal frequency: 6–8 URIs/year in daycare child
— Red flags: ≥2 serious bacterial infections, FTT, opportunistic organisms → immunodeficiency workup
— Mongolian spots vs bruises (blue-gray, sacral, birth)
— Bullous impetigo vs cigarette burns
— Osteogenesis imperfecta vs fracture from abuse
Board pearl: Any bruise in a non-cruising infant (<6 months, or any pre-mobile child) is concerning for abuse — "those who don't cruise rarely bruise." The correct Step 3 action is skeletal survey + ophtho + CPS report, not reassurance.
— Up-to-date problem list, medication list, allergy list, immunization record (registry-linked)
— Growth charts maintained continuously
— Developmental milestone tracking
— Family/social context document (caregivers, custody, languages, insurance, school)
— Require enhanced care coordination, written care plan shared with school/specialists
— Identify a care coordinator within the practice
— Plan for transition to adult care starting age 12–14
— Use emergency information forms for specialists
— Forms for school entry (vaccines, physicals)
— IEP (Individualized Education Program) for children with disabilities affecting learning (IDEA)
— 504 plans for accommodations (asthma, diabetes, ADHD without academic impairment)
— Sports preparticipation forms
— Medicaid EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) mandates comprehensive WCVs and follow-up of any identified condition
— CHIP coverage for working families
— Practice should have automated reminders for vaccines due, screening due, missed visits
— No-show outreach especially for high-risk families
Step 3 management: When a child with chronic disease (asthma, T1DM, sickle cell) is transitioning to middle/high school, proactively initiate a 504 plan or update IEP, provide written action plans for emergencies (e.g., asthma action plan, glucagon training), and coordinate with the school nurse. This is a frequent ambulatory-management scenario on Step 3.
— Newborn: 3–5 days after discharge (especially breastfed for weight/jaundice), then 1, 2, 4, 6, 9, 12, 15, 18, 24, 30 months
— Annual from age 3 through 21
— Preterm/NICU graduate: more frequent first year
— FTT: weekly to monthly weight checks until trajectory restored
— Obesity: 3-month follow-ups with intensive behavioral counseling
— Newly diagnosed chronic disease
— Foster care: within 30 days of placement, then every 3–6 months
— Maternal postpartum depression positive: closer follow-up of infant
— Newborn screen abnormal: same-day callback per state newborn screening program
— Hgb low: iron trial × 1 month, recheck CBC; if no response, ferritin, reticulocyte, GI eval
— Lead 3.5–19: repeat per CDC schedule (1–3 months), environmental assessment
— Lead 20–44: confirm venous, nutrition counseling, possible chelation
— Lead ≥45: chelation (succimer); ≥70 or symptomatic: admit, dimercaprol + EDTA
— Elevated BP: confirm on 3 separate visits before diagnosing HTN
— BMI ≥85: 3-month follow-up with lifestyle plan
— Every WCV note should include: growth plotted, milestones, screening results, immunizations given, anticipatory guidance topics, follow-up plan, parent concerns addressed
Board pearl: Newborn hyperbilirubinemia is the most common reason an early 3–5 day follow-up after discharge matters on the exam. A breastfed newborn discharged at 48 hours must be seen within 48–72 hours of discharge for weight, jaundice, and feeding assessment — earlier if risk factors (near-term, ABO incompatibility, bruising).
— Consent is from a parent/legal guardian
— Assent is sought from children ~7+ years, mandatory in research
— Adolescents may consent independently for sensitive services (state-dependent): STI, contraception, mental health, substance use
— Use presumptive language ("Today she's due for her 12-month shots"); motivational interviewing for hesitant families
— Document refusal with AAP Refusal to Vaccinate form, including risks discussed
— Vaccine refusal is not sufficient grounds to dismiss from practice in most states — AAP allows but discourages; ethics generally favor continued engagement
— Mandatory reporting of vaccine adverse events to VAERS
— All pediatric providers are mandated reporters of suspected child abuse/neglect to CPS — based on reasonable suspicion, not certainty
— Good-faith reporting carries legal immunity
— Failure to report = criminal liability
— Foster parents generally cannot consent for non-emergency invasive procedures without state agency authorization
— Divorced/separated parents: either may consent for routine care unless court order restricts
— Step-parents have no inherent consent authority
— Newborn discharge: ensure scheduled follow-up, car seat, feeding established, screening complete
— School transitions: medication coverage gaps, mental health continuity
— Adolescent → adult: avoid loss to follow-up of chronic disease patients
Board pearl: A parent refusing the HepB birth dose or vitamin K is a common stem. Counsel risks (hemorrhagic disease of the newborn for vitamin K refusal), document refusal with informed-refusal form, do not coerce, do not report as abuse for these alone — but do not document the child as having received the vaccine.
— 2 mo: social smile, lifts head 45°
— 4 mo: rolls front to back, laughs, reaches
— 6 mo: sits with support, transfers objects, babbles
— 9 mo: sits unsupported, pulls to stand, stranger anxiety, pincer emerging
— 12 mo: walks with one hand, 1–3 words, mature pincer, waves bye
— 15 mo: walks independently, 3–5 words
— 18 mo: runs, 10–25 words, points to body parts, parallel play
— 24 mo: 2-word phrases, kicks ball, half speech intelligible to strangers
— 3 yr: tricycle, 3-word sentences, 75% intelligible, copies circle, knows age/sex
— 4 yr: hops, copies cross, fully intelligible, cooperative play
— 5 yr: skips, copies triangle, ties knot (not bow)
— No social smile by 3 months
— No babbling by 9 months
— No words by 16 months
— No 2-word phrases by 24 months
— Any loss of skills at any age
— Newborn hearing, hypothyroidism, PKU screening
— Vision screening 3–5 years
— Obesity screening ≥6 years with intensive behavioral counseling for BMI ≥95th
— Depression 12–18, anxiety 8–18
— Fluoride varnish from tooth eruption
— HIV 15–18 (once)
— Vitamin D 400 IU breastfed from birth
— Whole milk 12–24 mo; switch to 2%/skim at 2
— Juice limits by age
— Screen time AAP guidelines
— Car seat transitions
Key distinction: Bright Futures = the schedule. ACIP = the vaccines. USPSTF = adult-style screening recommendations applied to pediatrics. AAP = the overarching authority publishing Bright Futures. Step 3 questions cite all four; recognize which guideline body governs which recommendation.
— Stem gives age → match to Bright Futures requirement (e.g., 18 months → M-CHAT-R; 9–11 years → lipid panel; 12 months → Hgb + lead)
— Memorize the schedule; common at 2, 6, 12, and 11–12 years; remember HPV at 11–12
— Mild illness, egg allergy, breastfeeding, family seizure history are NOT contraindications
— Severe immunocompromise and pregnancy ARE contraindications to live vaccines
— Choose the age-appropriate counseling (e.g., 9-month-old → choking hazards, stair gates; not yet bicycle helmet)
— Positive M-CHAT-R → refer to EI + audiology + developmental peds; not "repeat in 6 months"
— Positive PHQ-A in adolescent → safety assessment first, then treatment
— Elevated BMI → intensive behavioral counseling, not labs first
— "How should you proceed?" → speak alone; protect confidentiality except for safety
— Tracking along curve = reassurance; crossing 2 percentile lines = workup
— Delayed bone age + family history of late puberty = constitutional → reassure
— Mobile suture + parallelogram = positional; ridged suture = synostosis → CT + neurosurgery
— Bruise in non-mobile infant → skeletal survey + CPS report
— Discharged at 48 hr → see in 48–72 hr for jaundice/feeding/weight
— Give at chronologic age (except HepB if <2 kg)
Step 3 management: The most common WRONG answer on WCV questions is "reassure and follow up at next routine visit" when a positive screen demands action. When in doubt between reassurance and referral after a positive standardized screening test, refer/intervene.
The well-child visit is a longitudinal, schedule-driven encounter — following the AAP Bright Futures periodicity (newborn, 1, 2, 4, 6, 9, 12, 15, 18, 24, 30 months, then annually through 21 years) — that integrates growth surveillance, standardized developmental and psychosocial screening, ACIP-aligned immunizations, and age-tailored anticipatory guidance to detect problems early and prevent the leading causes of pediatric morbidity and mortality.
Board pearl: When a Step 3 stem gives an age and a chief concern of "routine visit," ask three questions in order: (1) What is due on the Bright Futures schedule at this age? (2) Are there positive screens or red flags requiring action today? (3) What is the single most age-appropriate piece of anticipatory guidance? The right answer almost always falls in one of these three buckets — and rarely is it "return in a year."