Health Supervision for the High-Risk Preschooler
Frederick P. Rivara MD, MPH1
Kathi J. Kemper MD, MPH2
1 Professor of Pediatrics and Adjunct Professor of Epidemiology, University of Washington
2 Assistant Professor of Pediatrics, University of Washington
Guidelines for the well child care of the high-risk preschooler differ from those for the average middle class patient. Such a child can be defined as one who by virtue of medical, family, or social history is at increased risk of health problems during the preschool years. Two particular, special types of high-risk children are specified in the educational objectives: the child who is a recent immigrant to the United States and the child who has repeated injuries. The focus of this article is on assessment of growth and development; immunization; screening for tuberculosis, parasitic infections, and anemia; injury prevention; and general counseling issues.
CHILDREN FROM OTHER COUNTRIES
A 3-year-old Laotian girl is brought into the clinic for her first health supervision visit. Her mother speaks little English, but indicates that she is being treated with isoniazid; her physician has recommended she bring the child to a pediatrician for a complete checkup. She says that her physician was concerned about the child's short stature and limited speech. The mother doesn't know which "shots" or tests the child has had in the past, but the child has always seemed healthy to her.
Children immigrating from other countries may have important unmet medical problems (eg, growth delay, nutritional anemia, parasitic and other infectious diseases) at the same time they are confronting the psychological upheavals of moving, learning a new language, meeting new cultural expectations and behaviors, and recovering from the horrors they left behind in their country of origin.
