Download HAAD Standard Well Child visits

Health Authority – Abu Dhabi
Standard
Document Title:
HAAD Standard Well Child visits (0-6 years)
Document Ref. Number:
HAAD/WCVS/SD/0.9
Version
0.9
Approval Date:
04 October 2012
Effective Date:
October 2012
Last Reviewed:
N/a
Next Review:
December 2013
Document Owner:
Public Health and Research, Maternal and Child Health
Applies to:
All Licensed Healthcare Providers in the emirate of Abu Dhabi
Classification:
 Public
1. Purpose
1.1 This standard aims to ensure that all infants and children, from birth till six years of
age, receive recommended screening to assure the health and wellbeing of infants and
children and that their parents and/or guardians are provided with counseling support
appropriate for the age and healthcare needs of the infant or child. To do this, it:
1.1.1 Recommends the well child visits schedule of screening for infants and
children aged 0-6 years;
1.1.2 Mandates the data recording and reporting requirements for performed well
child visits schedule of screening.
2.
Scope
2.1 This standard applies to all Healthcare Providers (Facilities and Professionals)
licensed by HAAD in the Emirate of Abu Dhabi delivering well child screening for
infancy and early childhood services.
3
Duties for Healthcare Providers
3.1 This Standards details recommended screening and for infants and children as a
part of well child visits to healthcare providers. Where healthcare providers
engage in offering such services to parents and/or guardians of infants and
children, there are required to ensure that they:
3.1.1 Perform any of the recommended screening services consistent with
internationally recognised best practice evidence based clinical care
pathways;
3.1.2 Offer the recommended services in accordance with the defined age group as
per Section 5 (Clinical Definition) and screening tests recommended for each
as provided at Appendix 1;
3.1.3 Inform parents or guardians about the recommended screening services and
their right to consent to or refuse to consent to the screening; Obtain
Page 1 of 14
consent for screening and from the parent or guardian of the infant or child,
in accordance with the HAAD Consent Policy;
3.1.4 Where a parent or guardian refuses screening services detailed in this
Standard, information about the potential consequences of not agreeing to
any of the screening services must be given to the parent or guardian. The
parent’s or guardian’s refusal to consent must be documented on the
infant’s or child’s medical record including the parent’s or guardian‘s
signature;
3.1.5 Report and submit data to HAAD via e-claims and in accordance with the
HAAD Reporting of Health Statistics Policy and as set out in the HAAD Data
Standards and Procedures (found online at www.haad.ae/datadictionary);
and
3.1.6 Comply with HAAD policies and standards on managing patient medical
records, including developing effective recording systems, maintaining
patient records, maintaining confidentiality, privacy and security of patient
information; and educating patients on services provided and satisfying the
requirements of patients’ rights and responsibilities charter.
4.
Enforcement and Sanctions
4.1 Healthcare providers must comply with the terms and requirements of this Standard,
the HAAD Standard Contract and the HAAD Data Standards and Procedures. HAAD may
impose sanctions in relation to any breach of requirements under this standard in
accordance with the [HAAD Policy on Inspections, Complaints, Appeals and Sanctions].
5. Standard 1 - Clinical Definitions
5.1 Well child visits include:
5.1.1 Infancy well visits, defined as occurring from newborn to 11 months of age.
New born screening must be performed in accordance with the HAAD Standard
for New Born Baby Screening Requirements;
5.1.2 Early childhood well visits, defined as occurring from 1-4 years of age (early
childhood period); and
5.1.3 Middle childhood visits, defined as occurring from 5-6 years of age.
6. Standard 2 - Service Specifications
6.1 Screening Service - Where a parent or guardian consents to the screening
services, the provider must:
6.1.1 Provide infancy and childhood well visit services as detailed in Appendix
1;
6.1.2 Comply with the HAAD Patient Rights and Responsibilities Policy and
Charter and deliver culturally and socially relevant patient information
and education;
6.1.3 Provide services over a flexible range of hours throughout the day,
including evening and weekend services to ensure adequate access to
screening services;
Page 2 of 14
6.1.4 Follow up or refer infants and children with positive screening results for
further investigations (for e.g. Laboratory services, audiometry and
Radiology) as per internationally accepted best practices.
6.2 Healthcare professionals – healthcare providers must ensure that professionals
employed by them to provide such services are:
6.2.1 Licensed by HAAD;
6.2.2 Maintain their competencies and satisfy HAAD requirements for
continuing medical education and continuing professional development;
6.2.3 Limit their practice to the skills, competencies and the privileges granted
within the particular facility with which they are associated; and
6.2.4 Ensure that the multi-disciplinary teams comprises of the necessary
personnel and staff with requisite qualifications and skills.
7. Standard 4 - Payment for Well Child Visits
7.1 Eligibility for reimbursement under the Health Insurance scheme is as follows:
7.1.1 For UAE Nationals must be covered under Thiqa scheme Preventative Care;
7.1.2 For Non-Nationals (Basic and Enhanced products holders), Coverage must be
consistent with their insurance policy and policy Schedule of Benefits approved by
HAAD. If a patient is not covered by their insurance policy they can receive the
recommended screening in a SEHA facility consistent with the Government
Mandated Funds requirements.
7.2 Any subsequent encounters as a result of the infant and/or childhood Screening, and
where abnormal findings were detected (including where repeat testing is required to
validate results), such encounters must be billed and reimbursed under the insurance
plan, but as a medical condition and not a preventive service.
7.3 Reimbursement for Infancy and childhood well visits must be in accordance with
Standard Provider Contract, HAAD Mandatory Tariff and associated Claims and
Adjudication Rules, and the Claims and Adjudication Standard; all documents are available
at the HAAD website in Data Dictionary.
Page 3 of 14
Appendix 1
Age in
months/year
s
1
Newborn
1 week
History
Surveillance of
Development
Physical Examination
Screening
As per the HAAD Newborn Screening Standard
Interval history

Feeding history
Assessment of
breastfeeding

Observation of
parent-child
interaction

Social-Emotional

Communicative

Cognitive

Physical
Development
Sleeping pattern
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
General Observation:
 Assess Alertness and if in any apparent distress
 Observe for congenital anomalies
Skin
 Inspect for rashes or jaundice
Head
 Note any dysmorphic features.
Eyes
 Inspect eyes and eyelids.
 Assess ocular mobility
 Examine pupils for opacification and red reflexes
 Assess for dacryocystitis
Heart
 Auscult for murmurs.
 Palpate femoral pulses.
Abdomen
 Inspect umbilical cord and cord vessels.
Musculoskeletal
 Perform Ortolani and Barlow Maneuvers.
Neurologic
 Note posture, tone, activity level, symmetry of
movement, and state regulation.





If not Done earlier:
Metabolic and
Hemoglobinopathy
Hearing
Congenital Heart
Disease Screening
Blood Pressure (for
children with specific
risk conditions or
change in risk)
Vision
Immunizat
ion
Appendix 1
Age in
months/year
s
1
1 Month
History
Interval history
Surveillance of
Development

Observation of
parent-child
interaction
Social-Emotional

Communicative

Cognitive

Physical
Development

Observation of
parent-child
interaction

Feeding History
Sleeping Pattern
2 Months
Interval history
Feeding History
Physical Examination
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Head
 Note positional skull deformities.
Eyes
 Examine for red reflexes.
 Ensure eyes are of equivalent color, intensity, and
clarity.
 Observe for opacities or clouding of cornea.
Heart
 Auscult for heart murmurs.
 Palpate femoral pulses.
Abdomen
 Search for abdominal masses.
 Note healing of the umbilicus.
Musculoskeletal
 Perform Ortolani and Barlow Maneuvers.
Neurologic
 Assess tone and neurodevelopmental status,
including attentiveness to visual and auditory
stimuli.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Skin
Screening


If not Done earlier:
Metabolic and
Hemoglobinopathy
Hearing
Blood Pressure (for

Vision



Immunizat
ion
children with specific
risk conditions or
change in risk)
If not Done earlier:
Metabolic and
Hemoglobinopathy
Hearing

As per
HAAD
Immu
nizatio
Appendix 1
Age in
months/year
s
1
History
Sleeping Pattern
4 Months
Interval history
Surveillance of
Development

Social-Emotional

Communicative

Cognitive

Physical
Development


Observation of
parent-child
interaction
Social-Emotional

Communicative

Cognitive

Physical
Development
Feeding History
Sleeping Pattern
Physical Examination
 Inspect for rashes or bruising.
Head
 Palpate fontanelles.
Eyes
 Inspect eyes and eyelids.
 Assess ocular mobility.
 Examine pupils for opacification and red reflexes.
Heart
 Auscult for heart murmurs.
 Palpate femoral pulses.
Musculoskeletal
 Perform Ortolani and Barlow Maneuvers.
 Inspect for torticollis
Neurologic
 Evaluate tone, strength, and symmetry of
movements.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Skin
 Inspect for rashes or bruising.
Head
 Palpate for positional skull deformities.
Eyes
 Assess ocular mobility for lateral gaze.
 Examine pupils for opacification and red reflexes.
Heart
Screening



Immunizat
ion
Blood Pressure (for
n
Sched
ule
children with specific
risk conditions or
change in risk)
Vision
Blood Pressure (for
children with specific
risk conditions or
change in risk)

Vision


Hearing
Anemia

As per
HAAD
Immu
nizatio
n
Sched
ule
Appendix 1
Age in
months/year
s
1
History
Surveillance of
Development
Physical Examination


6 Months
Interval history

Observation of
parent-child
interaction
Social-Emotional

Communicative

Cognitive

Physical
Development

Feeding History
Sleeping Pattern
Screening
Immunizat
ion
Auscult for heart murmurs.
Palpate femoral pulses.
Musculoskeletal
 Assess for developmental hip dysplasia by
examining for abduction.
Neurologic
 Evaluate tone, strength, and symmetry of
movements.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Skin
 Inspect for rashes or bruising.
Eyes
 Assess ocular mobility for lateral and horizontal
gaze.
 Assess eye alignment.
 Examine pupils for opacification and red reflexes.
Heart
 Auscult for heart murmurs.
 Palpate femoral pulses.
Musculoskeletal
 Assess for developmental hip dysplasia by
examining for abduction.
Neurologic
 Evaluate tone, strength, and symmetry of

Oral health

Blood Pressure (for
children with specific
risk conditions or
change in risk)

Vision

Hearing

Lead (if +ve on risk
screening questions)

Tuberculosis (if +ve on
risk screening
questions)

As per
HAAD
Immu
nizatio
n
Sched
ule
Appendix 1
Age in
months/year
s
1
9 Months
History
Interval history
Surveillance of
Development

Observation of
parent-child
interaction
Social-Emotional

Communicative

Cognitive

Physical
Development

Observation of
parent-child
interaction
Social-Emotional
Communicative
Cognitive
Physical

Feeding History
Sleeping Pattern
12 months
Interval history




Physical Examination
movements.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Head
 Palpate for positional skull deformities.
Eyes
 Assess ocular mobility for lateral and horizontal
gaze.
 Assess eye alignment.
 Examine pupils for opacification and red reflexes.
Heart
 Auscult for heart murmurs.
 Palpate femoral pulses.
Musculoskeletal
 Assess for developmental hip dysplasia by
examining for abduction.
Neurologic
 Evaluate tone, strength, and symmetry of
movements.
 Elicit parachute reflex.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Eyes:
 examine for red-reflexes
 perform cover-uncover test for conjugate ocular
Screening

Oral health

Blood Pressure (for
Immunizat
ion
children with specific
risk conditions or
change in risk)

Vision


Hearing
Lead (if +ve on risk
screening questions-)

Anemia (haematocrit
or hemoglobin)
Lead screen(if +ve on
screening questions
Oral health
Blood Pressure (for



children with specific

As per
HAAD
Immu
nizatio
n
Sched
ule
Appendix 1
Age in
months/year
s
1
15 months
History
Interval history





18 months
Interval history





Surveillance of
Development
Physical Examination
Development
mobility
Mouth: observe for caries; plaque; demineralization (white
spots) and staining.
Neurologic: observe gait.
Genitals: determine whether testes are fully descended.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Eyes:
 examine for red-reflexes
 perform cover-uncover test for conjugate ocular
mobility
Mouth: observe for caries; plaque; demineralization (white
spots) and staining.
Neurologic: observe health care professional interaction and
stranger avoidance.
Measure: Length; weight; and head circumference
Plot: length for age, weight for age, weight for length, BMI
for age (http://www.who.int/childgrowth )
Neurologic: observe gait (walking and running), hand
control, and arm and spine movement.
Eyes:
 examine for red-reflexes
 perform cover-uncover test for conjugate ocular
mobility
Skin: observe for Nevi, Café’ au lait spots, birth marks, or
bruising.
Mouth: observe for caries; plaque; demineralization (white
Observation of
parent-child
interaction
Social-Emotional
Communicative
Cognitive
Physical
Development
Observation of
parent-child
interaction
Social-Emotional
Communicative
Cognitive
Physical
Development
Screening


risk conditions or
change in risk)
Vision
Hearing

Blood Pressure (for


Vision
Hearing

Development
(structured



Immunizat
ion
children with specific
risk conditions or
change in risk)
developmental screen)
Autism screen
(Identifying Infants and
Young Children With
Developmental
Disorders:
http://pediatrics.aapp
ublications.org/conten
t/118/1/405.full.pdf )
Oral health
Blood Pressure (for

As per
HAAD
Immu
nizatio
n
Sched
ule
Appendix 1
Age in
months/year
s
1
History
Surveillance of
Development
Physical Examination
Screening
children with specific
risk conditions or
change in risk)
spots), staining and injury.




2 years
Interval history





2 ½ years
Interval history



Observation of
parent-child
interaction
Social-Emotional
Communicative
Cognitive
Physical
Development
Observation of
parent-child
interaction
Social-Emotional
Communicative
Measure: standing height (preferred) or recumbent length,
weight, head circumference.
Calculate and Plot: Height for Age, Weight for Age, Weight
for Height, BMI for Age. (http://www.who.int/childgrowth )
Eyes:
 examine for red-reflexes
 perform cover-uncover test for conjugate ocular
mobility
Mouth: observe for caries; plaque; demineralization (white
spots), staining, injury and gingivitis.
Neurologic:
 Observe running, scribbling, socialization, and
ability to follow commands.
 Assess language acquisition and clarity.

Measure: standing height (preferred) or recumbent length,
weight, head circumference.
Calculate and Plot: Height for Age, Weight for Age, Weight
for Height, BMI for Age. (http://www.who.int/childgrowth)

Vision
Hearing
Anemia screen
Lead screen(if +ve on
screening questions)
Autism screen
(Identifying Infants and
Young Children With
Developmental
Disorders:
http://pediatrics.aapp
ublications.org/conten
t/118/1/405.full.pdf )








Oral health
Blood Pressure (for
children with specific
risk conditions or
change in risk)
Vision
Hearing
Anemia screen
Lead screen(if +ve on
screening questions-)
Development
(structured
developmental screen)
Oral health
Blood Pressure (for
Immunizat
ion
Appendix 1
Age in
months/year
s
1
History
Surveillance of
Development


3 years
Interval history





4 years
Interval history





5 years
Interval history

Cognitive
Physical
Development
Observation of
parent-child
interaction
Social-Emotional
Communicative
Cognitive
Physical
Development
Observation of
parent-child
interaction
Social-Emotional
Communicative
Cognitive
Physical
Development
Observation of
parent-child
interaction
Physical Examination
Eyes:


examine for red-reflexes
perform cover-uncover test for conjugate ocular
mobility
Neurologic:
 Observe coordination, language acquisition, and
clarity and socialization.
 Assess vocalization.
Measure: Blood pressure
Calculate and Plot: Height for Age, Weight for Age, Weight
for Height, BMI for Age. (http://www.who.int/childgrowth)
Eyes: Attempt to perform ophthalmoscopic examination of
optic nerve and retinal vessels.
Mouth: observe for caries; plaque; demineralization (white
spots), staining, injury and gingivitis.
Neuralgic:
 Observe language acquisition and speech clarity.
 Note adult-child interaction.
Measure: Blood pressure
Calculate and Plot: Height for Age, Weight for Age, Weight
for Height, BMI for Age. (http://www.who.int/childgrowth)
Neuralgic:
 Observe fine and gross motor skills.
 Assess language acquisition, speech fluency and
clarity, thought content, and abstraction.
Measure: Blood pressure
Calculate and Plot: Height for Age, Weight for Age, Weight
for Height, BMI for Age. (http://www.who.int/childgrowth)
Screening
children with specific
risk conditions or
change in risk)


Vision
Hearing

Visual Acuity (age
appropriate visual
acuity measurement)




Oral health
Hearing
Anemia screen
Lead screen(if +ve on
screening questions-)

Visual Acuity (age



Hearing
Anemia screen
Lead screen(if +ve on
screening questions-



appropriate visual
acuity measurement)
Vision
Hearing
Anemia screen
Immunizat
ion
Appendix 1
Age in
months/year
s
1
History
Surveillance of
Development

6 years
Interval history


Grade 1-12
Surveillance of
Development
(children
transitioning to
Kindergarten,
children currently
Attending school,
Development,
learning and
behavior)
Observation of
parent-child
interaction
Surveillance of
Development
(children
transitioning to
Kindergarten,
children currently
Attending school,
Development,
learning and
behavior)
As per HAAD’s School Screening Standard.
Physical Examination
Eyes:

Screening

Attempt to perform ophthalmoscopic examination
of optic nerve and retinal vessels.
Mouth:
 Observe for caries, gingival inflammation, and
malocclusion
Neuralgic:
 Observe fine and gross motor skills including gait.
 Assess language acquisition, speech fluency and
clarity, thought content, and ability to understand
abstract thinking.
Measure: Blood pressure
Calculate and Plot: Height for Age, Weight for Age, Weight
for Height, BMI for Age. (http://www.who.int/childgrowth)
Eyes:
 Attempt to perform ophthalmoscopic examination
of optic nerve and retinal vessels.
Mouth:
 Observe for caries, gingival inflammation, and
malocclusion
Neuralgic:
 Observe fine and gross motor skills including gait.
 Assess language acquisition, speech fluency and
clarity, thought content, and ability to understand
abstract thinking.








Lead screen(if +ve on
screening questions-)
Tuberculosis (if +ve on
screening questions)
Vision
Hearing
Oral health
Anemia screen
Lead screen(if +ve on
screening questions)
Tuberculosis (if +ve on
screening questions)
Dyslipidemia (if +ve on
screening questions)
Immunizat
ion
Appendix 1
Age in
months/year
s
1
References
History
1-
Surveillance of
Development
Physical Examination
Screening
Immunizat
ion
Hagan Jf, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, Third Edition. Elk Grove Village, IL: American Academy
of Pediatrics.
2- Child Growth Standards http://www.who.int/childgrowth
Appendix 2 Developmental Milestones at a Glance
Source: Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, Third Edition. Available at
http://brightfutures.aap.org/pdfs/BF3%20pocket%20guide_final.pdf