Teachable moments

Patient History

Jack Olson, an established patient to your practice, presents for his 18-month-old, well-child visit with his 32-year-old mother, Carlie Olson.

Prior to going into the exam room, you briefly review Jack's chart. Well-child visits and immunizations are up to date.

Family Social History:

• Ms. Olson has been married for 3 years to husband, Rick. Jack is their first child.
• Both parents work outside the home; Jack is cared for by Carlie's mother, Nancy in the Olson's home while both parents are at work.
• Rick Olson, Jack's father, is an avid hunter.
• Remaining social history review reveals that the family in a rural area in Missouri with no surrounding industries, home built in mid 1970s.
• Parents do not smoke.

You enter the exam room and find Ms. Olson sitting while Jack is playing on the floor. Interim past medical history is unremarkable.

Development:

You find that Jack is sleeping throughout the night and taking a 2 hour nap in the afternoon and eating well. She states that he is very active and curious and frequently protests going to bed at night. Ms. Olson buckles Jack up in the back seat in an appropriately sized, front facing car seat on every trip. She locks all medications and cleaning supplies up. Ms. Olson states that everything is going well. You proceed with Jack's exam.

Physical Exam:

• Well-nourished, well-developed 15 month-old male child
• Afebrile
• Weight: 12 kg (26.4 pounds), 75th percentile
• Length: 80 cm (32 inches), 75th percentile
• Head circumference: 48 cm (19 in), 50th percentile
• Normal physical exam
• Developmentally appropriate: runs, explores drawers, containers
• Social: identifies parts of the body, feeds self

You complete your exam and discuss your findings with Ms. Olson. You explain that Jack's curiosity and exploration is normal at this age. You continue with routine age-appropriate anticipatory guidance counseling.