Components of a 1-Year-Old Physical Examination
A comprehensive 1-year-old physical examination should include growth measurements, developmental assessment, complete physical examination, screening tests, immunizations, and anticipatory guidance to ensure optimal health outcomes and early identification of potential concerns.
Growth Assessment
- Measure and plot height, weight, and head circumference on appropriate growth charts
- Compare with previous measurements to assess growth trajectory
- For premature infants, use corrected age for the first 24 months of life 1
Complete Physical Examination
General Assessment
- Overall appearance, alertness, and responsiveness
- Skin examination for color, texture, lesions, or bruising
- Vital signs (temperature, heart rate, respiratory rate, blood pressure)
Head and Neck
- Head shape and fontanelles (anterior fontanelle typically closes between 9-18 months)
- Eye examination: pupillary response, extraocular movements, red reflex
- Ear examination: tympanic membranes
- Nose and mouth: dentition (typically 6-8 teeth by 12 months), oral mucosa
- Neck mobility and lymph nodes
Cardiopulmonary
- Heart auscultation for rate, rhythm, and murmurs
- Lung auscultation for breath sounds and respiratory effort
Abdomen
- Palpation for organomegaly, masses, or tenderness
- Assessment of umbilicus
Genitourinary
- External genitalia examination
- Testes descent in males
Musculoskeletal
- Joint range of motion
- Spine examination for abnormalities
- Extremity examination for symmetry and deformities
Neurological Assessment
- Primitive reflexes (should be disappearing by this age)
- Muscle tone and strength
- Symmetry of movement 2
- Cranial nerve function assessment through observation of facial movements, eye tracking, and response to sounds 2
Developmental Assessment
- Gross motor: Typically pulling to stand, cruising, or beginning to walk
- Fine motor: Pincer grasp, transfers objects between hands
- Language: Typically says 1-3 words with meaning, follows simple commands
- Social: Plays interactive games (peek-a-boo), shows separation anxiety
- Use standardized developmental screening tool (e.g., Ages and Stages Questionnaire) 3
Screening Tests
- Vision and hearing screening
- Anemia screening with hemoglobin/hematocrit
- Lead screening (if risk factors present)
- Tuberculosis risk assessment
- Oral health assessment
Immunizations
- Review and update immunizations according to the recommended schedule
- Typically includes MMR, Varicella, Hepatitis A, and PCV13 at 12-15 months
Anticipatory Guidance
Nutrition
- Transition from formula to whole milk (after 12 months)
- Introduction of cup drinking (weaning from bottle by 12-18 months)
- Continued introduction of solid foods with variety
- Avoid juice and sugar-sweetened beverages 3
Safety
- Car seat safety (remain rear-facing until at least age 2) 3
- Childproofing the home
- Water safety and supervision
- Fall prevention
Sleep
- Typical sleep patterns (12-14 hours total, including 1-2 naps)
- Safe sleep practices
Dental Health
- Brushing teeth twice daily with small amount of fluoride toothpaste
- First dental visit by 12 months 3
Behavior and Discipline
- Setting consistent limits
- Managing separation anxiety and stranger anxiety
Parental Assessment
- Screen for postpartum depression (recommended through 6 months of age) 4
- Assess family functioning and support systems
- Screen for social determinants of health 4
Documentation and Follow-up
- Document all findings and discussions
- Address any parental concerns
- Schedule next well-child visit (typically at 15 months)
By following this comprehensive approach to the 1-year-old physical examination, healthcare providers can effectively monitor growth and development, identify concerns early, and provide appropriate guidance to promote optimal health outcomes.