Recommended Health Screenings for Infants, Children, and Adolescents: Specific Conditions

Area of Concern	Screening Method	Recommendations
Neonatal metabolic and genetic screening: Hypothyroidism Sickle cell anemia PKU	Blood Tests: Serum T₃/T₄ levels decreased Sickledex decreased Phenylalanine levels decreased	All are done in immediate neonatal period, within first few days of life. Testing for PKU must be done after infant has ingested formula or breast milk for 48-72 hours.
Lead poisoning	Blood-lead level (BLL)	Centers for Disease Control and Prevention (CDC) recommends universal or targeted screening for all children. At a minimum, all children should have BLL drawn between 1-2 years, or earlier if needed. BLL should also be done on any child between 3-6 years who has never been tested. Those children at high risk (live in older home with lead in paint and plumbing, have sibling or friend with lead poisoning) should be screened earlier and more frequently.
Hyperlipidemia	Serum cholesterol levels	Routinely at 2-4 years, 6 years, 10 years, 11-14 years, 15-17 years, and 18-21 years. May be done earlier or more frequently with risk factors such as diabetes, hypertension, parent with high cholesterol level.
Cystic fibrosis	Genetic studies, sweat test	Screen children who have sibling or other family members with CF.
Tuberculosis	Mantoux or PPD	First test done at age 12-15 months; repeated prn based on risk and exposure.
Latex allergies	Health history	During each routine visit, but especially important preoperatively or before procedures or children with ongoing catheterizations.

Pediatric Behavioral Concerns: Nursing Implications and Parental Guidance

Behavioral Concern	Nursing Implications/Parental Guidance	Behavioral Concern	Nursing Implications/Parental Guidance
Teething	Begins around age 4 months-infant may seem unusually fussy and irritable but should not run a fever. Provide relief with teething rings, acetaminophen, topical preparations.	Sibling rivalry	Fairly common, normal. Allow older child to “help.” Give each child “special” time, with individual attention.
Thumb sucking	Need to “suck” varies: may be due to hunger, frustration, loneliness. Do not stop infant from doing this-usually stops by preschool years. If behavior persists, evaluate need for attention, peer play.	Masturbation	Normal, common in preschooler. Set firm limits. Avoid overreacting.
Temper tantrums	Normal in the toddler-occurs in response to frustration. Avoid abrupt end to play or making excessive demands. Offer only allowable choices. Once a decision is verbalized, avoid sudden changes of mind. Provide diversion to achieve cooperation. If it occurs, best means to handle is to ignore the outburst.	Lying	In preschooler: not deliberate; child is often unable to differentiate between “real” and “lie," and by speaking something often feels it makes a thing real. In older child: may indicate problems and need for professional attention if persists. Serve as role model-no “white lies.”
Toilet training	Assess child for readiness: awareness of body functions, form of mutual communication, physical control over sphincters. Use child-size seat. No distractions (food, toys, books). Offer praise for success or efforts (nevershame accidents).	Cursing	Avoid overreacting. Defuse use of “the word” by simply stating “not here, not now.” Distract, change subject, substitute activity. Serve as role model by own language.
Discipline	Not for infant. Use child-size seat. No distractions (food, toys, books). Offer praise for success or efforts (nevershame accidents).	“Accidents” (enuresis)	Occasional-common and normal through preschool. If frequent-need complete physical exam to rule out pathology. “Training”: after dinner-avoid fluids; before bed-toilet (perhaps awaken once during night). Never put back into diapers or attempt to shame.
Smoking/drinking	May begin in older school-age child or adolescent. Serve as role model with own habits.