From the Guidelines
During a 30-month child check, the physical exam should focus on assessing key developmental milestones, including gross motor skills such as walking up steps with hand held, running, and kicking a ball forward, as well as fine motor skills like building a tower of at least 3 blocks, scribbling spontaneously, and picking up small objects with a 2-finger pincer grasp 1. The child's language development should be assessed by checking if they can speak in 2-3 word sentences, follow two-step commands, and use at least 50 words. Some key points to consider during the physical exam include:
- Assessing the child's ability to walk backward, run, and walk up steps with hand held
- Evaluating fine motor skills such as building a tower of at least 3 blocks, scribbling spontaneously, and picking up small objects with a 2-finger pincer grasp
- Checking for any delays in speech or motor development, as early intervention is most effective
- Plotting standard measurements of height, weight, and head circumference on growth charts
- Assessing vision, hearing, heart, lungs, abdomen, and neurological function The exam provides an opportunity to address parental concerns about behavior, sleep, and nutrition while offering anticipatory guidance about safety, discipline, and cognitive stimulation appropriate for this developmental stage, as recommended by the American Academy of Pediatrics 1. Particular attention should be paid to any regression of skills, as this could be a sign of a progressive disorder, and the child's posture, play, and spontaneous motor function should be observed without the stressful demands of performance under deliberate observation 1.
From the Research
Expected Physical Exam Milestones for a 30-month-old Child
The physical exam for a 30-month-old child during a well-child check should include:
- A head-to-toe examination, including a review of growth 2
- Developmental surveillance, with formal developmental screening at 30 months 2
- Autism-specific screening at 24 months, but this may be reviewed at 30 months 2
- Screening for iron deficiency anemia, as recommended by the American Academy of Pediatrics 3, 4
- Lead screening, if the child is at risk 3
- Vision and hearing assessment, although the American Academy of Pediatrics recommends a one-time vision screening between three and five years of age 2
- Assessment of dietary habits, including fluoride use and limitation of juice and sugar-sweetened beverages 2, 5
- Review of immunizations and updating as appropriate 2, 5
Physical Examination Approach
The approach to physical examination should consider the child's age and developmental level 6. It is essential to make the child comfortable with pleasant surroundings and playful behavior to yield maximum information from the examination 6. The examination should also involve identification of malnutrition, immunization status, level of development, and screening for defects, deficiencies, diseases, and developmental delays 6.
Additional Considerations
Additional considerations during the well-child visit include:
- Screening for postpartum depression in mothers of infants up to six months of age, although this may not be directly relevant for a 30-month-old child 2
- Providing age-appropriate guidance and answering parents' or caregivers' questions 2
- Discussing car seat safety, dental health, and screen time limits 2