What assessment, screening, and treatment are recommended for a 6-month well-child visit?

6-Month Well-Child Visit Assessment, Screening, and Treatment

At the 6-month well-child visit, developmental surveillance, physical examination, and screening for developmental milestones are essential components of care, with particular attention to gross and fine motor skills development. 1

Developmental Surveillance and Screening

Motor Development Assessment

• Gross Motor Skills to assess at 6 months:

  • Ability to roll over (both prone to supine and supine to prone)
  • Sitting with support
  • Beginning to sit without support
  • Supporting weight on legs when held in standing position

• Fine Motor Skills to assess at 6 months:

  • Hands should be unfisted
  • Ability to play with fingers in midline
  • Ability to grasp objects 1

Developmental Screening Tools

• While formal developmental screening is recommended at 9,18, and 30 months, developmental surveillance should occur at every visit including the 6-month visit 1
• Parent-completed screening tools are preferred over directly administered tools 1
• Recommended parent-completed tools:
  • Parents' Evaluation of Developmental Status (PEDS)
  • Ages and Stages Questionnaire (ASQ) 1

Physical Examination Components

Growth Assessment

• Measure and plot:
  • Weight
  • Length
  • Head circumference
  • Compare to previous measurements to assess growth trajectory

Complete Physical Examination

• Head-to-toe examination with special attention to:
  • Hip examination for developmental dysplasia of the hip (DDH)
    • DDH is more common in females (4-8 times) and firstborns 1
    • Perform Ortolani and Barlow tests (still valuable at 6 months but less sensitive than in newborns) 1
    • Check for asymmetric skin folds and limb length discrepancy
  • Vision assessment
    • External inspection of ocular structures
    • Red reflex testing
    • Assessment of fixation and following behavior 2
  • Neurological examination
    • Assessment of muscle tone
    • Symmetry of movement
    • Primitive reflexes 1

Screening Tests and Immunizations

Required Screenings

• Developmental surveillance using standardized milestones 1
• Maternal postpartum depression screening (recommended for mothers of infants up to 6 months) 3

Immunizations

• Review and update immunizations according to the recommended schedule
• Typical 6-month vaccines include:
  • DTaP (Diphtheria, Tetanus, acellular Pertussis) - 3rd dose
  • IPV (Inactivated Polio Vaccine) - 3rd dose
  • PCV13 (Pneumococcal conjugate) - 3rd dose
  • Hib (Haemophilus influenzae type b) - 3rd dose
  • Rotavirus - 3rd dose (if applicable)
  • Seasonal influenza vaccine (during flu season)

Anticipatory Guidance

Nutrition

• Continue breastfeeding until at least 12 months if possible
• If formula feeding, continue iron-fortified formula
• Begin introducing solid foods if not already started
  • Start with iron-rich foods (iron-fortified cereals, pureed meats)
  • Introduce one new food at a time, waiting 3-5 days between new foods
  • Avoid honey until after 12 months
  • Limit or avoid juice 3
• Begin transition to cup (goal is weaning from bottle by 12 months) 3

Oral Health

• Begin oral hygiene practices
• Consider fluoride supplementation if living in areas with inadequate water fluoridation (<0.6 ppm) 4

Safety

• Car seat safety: maintain rear-facing position until at least 2 years 3
• Childproofing home: cover electrical outlets, secure furniture, remove choking hazards
• Never leave infant unattended on elevated surfaces
• Water safety: constant supervision around water

Sleep

• Encourage consistent sleep routines
• Place infant on back for sleep
• Avoid co-sleeping

When to Consider Referral

• If developmental concerns are identified during surveillance
• If hip examination reveals abnormalities suggesting DDH
• If vision or hearing concerns are noted
• If growth parameters show significant deviation from expected trajectory

Common Pitfalls to Avoid

• Relying solely on clinical impression without using standardized developmental assessment tools - clinical judgment alone can miss up to 45% of children eligible for early intervention 1
• Delaying referral when developmental concerns are identified - early intervention is critical for better outcomes
• Overlooking maternal depression which can impact infant development
• Failing to provide adequate anticipatory guidance on nutrition, safety, and developmental stimulation

By following this comprehensive approach to the 6-month well-child visit, clinicians can effectively monitor development, provide preventive care, and identify concerns requiring further evaluation or intervention.