Teachable moments

Patient History

Robin Wilson, an established patient to your practice, presents for her 6-year-old, well-child visit with her 42-year-old mother, Jennifer Robinson.

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

Family Social History:

• Ms. Robinson has been married for 10 years to husband, Rufus. Robin is their only child.
• Both parents work outside the home; Robin is cared for by a full-time nanny. Ms. Robinson is a stockbroker and Mr. Wilson is a bank vice president. Both work long hours.
• Remaining social history review reveals that the family lives in a new house in an area of Chicago undergoing gentrification. In the neighborhood, there still many vacant lots and boarded up buildings; gunfire is occasionally heard at night.
• Parents do not smoke cigarettes. Mr. Wilson occasionally smokes cigars, but only outside the home or on the back porch.

You enter the exam room and find Ms. Robinson checking her voice mail messages while Robin is reading a book. Interim past medical history is unremarkable.

Development:

On review of systems, you find that Robin is getting about 10 hours of sleep. She is a picky eater, prefers pasta and milk, but does seem to get some fruit and vegetable each day. Four or five meals a week are fast food or take out. Mom states that Robin is finishing up first grade and is doing well. She seems to make friends easily and has a good friend who lives on the next block. Robin spends a few hours there each week on the days her nanny needs to leave early and her parents are running late. She enjoys a variety of activities, including ballet and soccer. Robin is learning to ride a bike and on Sundays after church the family likes to take a bike ride together along the lakefront. Recently, Robin has been resisting using her booster seat because many of her friends do not use them. Ms. Robinson would like to know if they could stop using them too because Robin is tall for her age. You proceed with Robin’s exam.

Physical Exam:

• Well-nourished, well-developed 6yo female child
• Afebrile
• Weight: 22kg (48.4 pounds), 75th percentile
• Length:115 cm (45 ¹/₄ inches), 50th percentile
• BMI: 16.6
• Normal physical exam
• Developmentally appropriate: can jump on one foot, tie shoes, reads well for age
• Social: is reserved, but will answer your questions and interact appropriately

You complete your exam and discuss your findings with Ms. Robinson. You explain that Robin is developing appropriately for age. You continue with routine age-appropriate anticipatory guidance counseling.

Proceed to the Anticipatory Guidance Counseling. It is open in another window.