U.S. Department of Health and Human Services
Public Health Service, June 1994
Child Health Guide
PUT PREVENTION INTO
PRACTICE
Important Information
Child's Name:_________________________________________
Date of Birth:________________________________________
Parent/Guardian Name(s):______________________________
Home Telephone:_______________________________________
Work Telephone(s):____________________________________
Address:______________________________________________
Important Health Problems/Allergies:__________________
Health Care Provider Name(s) and Phone Number(s):
______________________________________________________
______________________________________________________
Health Insurance Number(s):___________________________
______________________________________________________
______________________________________________________
Poison Control Center Phone Number:___________________
______________________________________________________
A Message About Your Child's Health
Preventive care is as important for your child's health as
treatment is when he or she is sick This care includes
immunizations, tests, and health guidance. Your child receives
preventive care from the doctor or other health care provider
at check-up visits and at other times. Proper preventive care
helps keep your child healthy.
As a parent, you should know what preventive care your
child needs. Work with your child's doctor or other health care
provider to assure that he or she gets proper care.
The Child Health Guide has information on needed
preventive care and on good health habits. Use it as a
permanent record to help you keep track of your child's health
and care through the years. This guide can help your child get
a healthy start on life.
M. Joycelyn Elders, M.D.
Surgeon General
U.S. Public Health Service
How to Use The Child Health Guide
Each page of the Child Health Guide covers an important
health care topic.
* Read each page carefully and ask your child's doctor or
other health care provider to answer any questions that
you may have.
* The Preventive Care Timeline in the center of this booklet
gives an overview of care your child may need at each
age.
* 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 gets. Use these
records to remind you when your child needs to be seen
next.
* Take the Child Health Guide home and keep it in a safe
place. Check it often to make sure that your child is
getting the preventive care that he or she needs. Keep the
Child Health Guide up-to-date.
* Bring the Child Health Guide every time your child goes to
a doctor or other health care provider-such as a nurse,
nurse practitioner, or physician assistant.
Table of Contents
Check-Up Visits
Immunizations
Immunization Record
Tests and Exams
Growth
Blood Pressure
Anemia
Lead
Vision and Hearing
Additional Tests
Test and Exam Record
Preventive Care Timeline
Health Guidance
Development
Nutrition
Dental/Oral Health
Physical Activity
Smoking
Safety
A Special Message About SIDS
Child Abuse
As Your Child Grows Up
For More Information
Visit and Illness Record
Put Prevention Into Practice
Check-Up Visits
Your child's doctor or other health care provider may want
to see your child for check-up visits even when shots or test
are not due. Some authorities recommend check-up visits at the
following ages: 2-4 weeks; 2, 4, 6, 9, 12, 15 and 18 months;
and 2, 3, 4, 5, 6, 8, 10, 12, 14, 16 and 18 years. Your child's
doctor or other health cam provider will discuss with you
increasing or decreasing the number of these visits to meet the
individual needs of your child.
My Child's Check-Up Schedule:
(Record age and/or date)
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
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. Immunizations should be given at the recommended
ages--even if your child has a cold or minor illness at the
time. Ask your health care provider about when your child
should receive these important shots. Ask also if your child
needs additional immunizations.
* Polio (OPV): At 2 months, 4 months, 6 months, and 4-6
years.
* Diphtheria-Tetanus-Pertussis (DTP, DTP): At 2 months, 4
months, 6 months, 15 months, and 4-6 years.
Tetanus-Diphtheria (Td) at 14-16 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, 1-2 months and 6-18 months;
OR 1-2 months, 4 months, and 618 months.
* Chickenpox (VZV): At 12-18 months.
Immunization Record
Use this chart or an official immunization card to keep
track of your child's immunizations. Significant reactions
should be recorded and reported to your Health care provider
immediately.
Growth Record
Your child's doctor or other health care provider will
measure your child's height and weight regularly. Your child's
head size will also be measured during the first 2 years of
life. These measurements will help you and your health care
provider know if your child is growing properly. Use this
record or the growth charts on pages 10-13 to keep track of
your child's growth. If you need help using these charts, ask
your doctor or other health care provider.
Birth Date/Age Weight Height Head Size
Growth Record Date/Age Weight Height
GROWTH CHART
(Boys, birth to 3 years of age)
GROWTH CHART
(Boys, 3 to 18 years of age)
GROWTH CHART
(Girls, birth to 3 years of age )
GROWTH CHART
(Girls, 3 to 18 years of age)
High 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 doctor or health care provider
about blood pressure measurements.
Anemia
Your child should be tested for anemia ("low blood") when
he or she is still a baby (usually around the first birthday)
and also may need anemia tests as he or she gets older. Anemia
may cause your child to grow slowly, tire easily, and get
infections more often. Anemia in children is usually caused by
too little iron in the diet. Your child needs to eat iron-rich
foods such as meats, green leafy, vegetables, and
iron-fortified cereals.
Check with your child's doctor or health care provider
about anemia testing.
Record test results on pages 18-19.
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 (+) 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 with peeling or
chipped paint built before 1960? (This could include a day
care center, preschool, the home of a babysitter, etc.)
* Lived in or regularly visited a house built before 1960
with recent, ongoing, or planned renovation or
remodeling?
* Had a brother or sister, housemate, or playmate with lead
poisoning?
* Lived with an adult whose job or hobby involves exposure
to lead (such as refinishing furniture, making pottery or
stained glass, or working in any of the industries listed
in the next question)?
* Lived near a lead smelter, battery plant, car repair shop,
glass or pipe factory, or other industry likely to release
lead?
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 doctor or
other 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 pages 18-19.
Additional Tests
Your child may need other tests to prevent health
problems. Check this list with your child's doctor or other
health care provider.
Newborn Screening (for PKU, thyroid and other
inherited/metabolic diseases)--If your child did not receive
this blood test before coming home from the hospital, or
received it before 24 hours of age. Some states require a
repeat test during the first month of life.
Sickle Cell or Thalassemia Test--If your child has an
African-American, Mediterranean, Asian, or Middle Eastern
family background.
Tuberculosis (TB) Skin Test--If your child has had close
contact with a person having TB, lives in an area where TB is
more common than average (such as a Native American
reservation, a homeless shelter, or an institution), or has
recently moved from Asia, Africa, Central America, South
America, the Caribbean, or the Pacific Islands.
Cholesterol Test--If your child has a parent with high
cholesterol or a parent or grandparent with heart disease
before age 55.
Urinalysis Test--If your child is less than 5 years of
age, particularly if your child has had a bladder or kidney
infection.
Record test results on pages 18-19.
Test and Exam Record
Child Preventive Care Timeline
Check-up visits are important for your child's health.
Some authorities recommend these visits at the following ages:
2-4 weeks; 2, 4, 6, 9, 12, 15 and 18 months; and 2, 3, 4, 5, 6,
8, 10, 12, 14, 16 and 18 years. Your child's doctor or other
health care provider will discuss with you the individual needs
of your child. At check-up visits, your child may receive a
physical examination and the types of preventive care shown
below.
Development
Children grow and develop at different rates. This table
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 doctor or other 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 sew up to standing
1 YEAR
* Waves bye-bye, says mama or dada
* Walks when holding on, picks up small 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 in buttoning clothing, washes and dries
hands
* Throws ball overhand, rides tricycle
4 YEARS
* Knows first and last name, tells a story, counts 4
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 darkskinned, 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 ironenriched 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 meats, ironenriched cereals,
and other grains.
* Do not give honey to infants during the first 6-12 months
of life.
* Do not limit fat during the first 2 years of life.
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.
* Using dental floss can 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 and don't smoke yourself.
* If a permanent tooth is knocked out, rinse it gently and
put it back into the socket or into 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 exercise 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.
Set a good example for your child-get regular physical
exercise yourself.
Physical Activity Tips for Children
* Encourage your child to walk or ride a bicycle to school
and to visit friends.
* 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 a playground,
park, gym, or swimming pool instead.
* Encourage your child to be actively involved in sports,
rather than only being an observer.
* Find out about exercise or sports programs at your child's
school and in your community.
* Encourage children with disabilities to participate in
physical activities as much as possible.
* Exercise should be fun. Don't make winning the only
goal.
Smoking
Smoking is very harmful to your health (causing lung
cancer, heart disease, and other serious illnesses) and to your
child's health. If you smoke, your child is 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.
Do not permit your child to smoke. Set a good example and
don't smoke yourself. If you do smoke, talk with your doctor or
other health care provider about getting help with quitting.
Quit Date: I will stop smoking on: (fill in) ________
_________________________________________________________
The three reasons that I should stop smoking are: (fill in)
1._______________________________________________________
2._______________________________________________________
3._______________________________________________________
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 doctor or other health
care provider about ways to protect your child from injuries.
Fill out this safety checklist.
Safety Guidelines Checklist
Read the list below and check off (+) each guideline that
your family already follows. Work on those you don't.
FOR ALL AGES:
* Use smoke detectors in your home. Change the batteries
every year and check to see that they work once a month.
* Keeping a gun in your home can be dangerous. If you do,
make sure that the gun and ammunition are locked up
separately and kept out of reach.
* Never drive after drinking alcohol.
* Teach your child traffic safety. Children under 9 years of
age need supervision when crossing streets.
* 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 Poison Control Center number near your
telephone and write it in the space provided on the inside
front cover.
INFANTS AND YOUNG CHILDREN:
* Use a car safety seat at all times until your child weighs
at least 40 pounds. When possible, secure it in the center
of the back seat.
* Keep medicines, cleaning solutions, and other dangerous
substances in childproof containers, locked up and out of
reach.
* Use safety gates across stairways (top and bottom) and
guards on windows above the first floor.
* Keep hot water heater temperatures below 120 F.
* Keep unused electrical outlets covered with plastic
guards.
* Baby walkers can be dangerous. Children using them should
be closely supervised. Access should be blocked 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.
A SPECIAL MESSAGE ABOUT SIDS
Sudden Infant Death Syndrome (SIDS) is the leading cause
of death for infants. Some authorities believe that placing
sleeping infants on the side or back, instead of the stomach,
decreases the risk of SIDS.
FOR OLDER CHILDREN:
* Use car safety belts at all times. Use with a booster seat
if your child weighs less than 70 lbs. The lap belt should
be snug and low on the hips. The shoulder belt should
cross the chest, not the face, neck, or stomach. If it
does not fit properly, tuck it behind the shoulders
instead.
* Make sure your child uses a safety helmet while riding on
a bicycle or motorcycle.
* Make sure your child uses protective equipment (such as
mouth guards, pads, sports goggles, and helmets) when
playing contact sports, rollerskating, or skateboarding.
* Don't let your child use alcohol or illegal drugs. Many
driving, sports, and violence-related injuries are
caused by the use of alcohol or drugs.
* Read all instructions for safe handling of household
tools, such as saws and lawn mowers. Teach your child to
use these tools safely.
* Don't allow your child to ride on or drive heavy farm
equipment, such as tractors, without special training.
* Teach your child to deal with anger and conflict without
using violence. Set a good example for your child.
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, or your health care professional.
Take time for yourself. Share child care between parents,
trade baby-sitting with friends, or use day care.
As Your Child Grows Up
As your child grows up, he or she will have to begin
dealing with many important health issues not included in the
Child Health Guide. Some examples of these issues are:
* Alcohol
* Drugs
* Tobacco
* Sexuality
* AIDS
* Birth Control
Talk to your child's doctor or other health care provider
about these important issues even while your child is still
young. You may also get assistance from authorities listed on
the next two pages.
Start early to teach your child to make responsible
choices--not mistakes that can have a lifelong effect. Take the
time to "be there for your child--listening, advising, and
supporting. The rewards will be well worth the effort.
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
heath care provider. You can also get information by calling
your local health department (look in the phone book) or the
authorities listed below, many of which have toll-free
numbers.
AIDS
* CDC National AIDS Hotline (800) 342-AIDS
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) 443-3170
General Child Health Information
* American Academy of Family Physicians (800) 274-2237
* American Academy of Pediatrics (800) 433-9016
Immunizations
* General Information: Centers for Disease Control and
Prevention (404) 3324553
* Vaccine Adverse Event Reporting System (800) 822-7967
Maternal and Child Health
* National Maternal and Child Health Clearinghouse
(703) 821-8955 ext. 254
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 (703) 524-7802
Sexually Transmitted Diseases
* CDC National STD Hotline (800) 227-8922
Health Care Visit and Illness Record
Use this chart to keep track of your child's visits to
doctors or other health care providers. Also use this chart to
keep track of your child's illnesses (such as chicken pox,
measles, or mumps) and injuries (such as broken bones). A
record of childhood illnesses and injuries will be useful even
when your child is an adult.
Health Care Visit and Illness Record
Date of illness/ Reason for Visit
Treatment/Medication
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.*
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 to put prevention into practice by working
with your health care providers to make sure 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!
For more information about the "Put Prevention Into
Practice" campaign, write: Put Prevention Into Practice,
National Health Information Center, P.O. Box 1133, Washington,
DC 20013-1133.
* Neither the Public Health Service nor the U.S. Department
of Health and Human Services endorses any particular product,
service or organization.
This publication was developed by the U.S. Federal
Government and is in the public domain. Duplication is
encouraged subject to the following conditions: The material
must appear in its entirety and it must be identified as
developed by the U.S. Department of Health and Human Services.
If your organization is identified on copies and/or
supplemental information is incorporated, then all supplemental
pages must be labeled "(Your organization) Supplement" and the
following disclaimer must appear within the publication:
"Neither the Public Health Service nor the U.S. Department of
Health and Human Services endorses any particular organization,
product, or service."
For more information about the Put Prevention Into
Practice campaign, write:
Put Prevention Into Practice
National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
For sale by the U.S. Government Printing Office
Superintendent of Documents, Mail Stop: SSOP, Washington, DC
20402-9328
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