Health Supervision Visit, 12 Months

Assess

• Anthropometric measurements.
• Physical examination.
• Screen for iron deficiency and iron deficiency anemia.
  • Babies who are breastfeeding beyond 1 year may need additional iron screening if iron intake is inadequate.
• Screen for food insecurity using the validated 2-question Hunger Vital Sign tool.
  • 1 in 7 children live in a household experiencing food insecurity
  • Rates of food insecurity are higher in households with children younger than 6 years, single-parent households, and immigrant, Black, or Latinx families.
    • Provide resources for families experiencing food insecurity. (Table 3)

Discuss

• Continue vitamin D at 400 IU/day.
• Breastfeeding may continue as long as mutually desired by mother and child for 2 years and beyond.
• Babies on formula should begin whole milk at this time.
  • Babies >12 months who have overweight may be given 2% milk but not skim milk.
  • Weaning from a bottle by 12 months avoids the consequences of prolonged bottle use (ie, iron deficiency, excessive weight gain, and tooth decay).
    • Transition to an open cup because a sippy cup may not reduce risks.
• Support self-feeding to encourage self-regulation of energy intake.
  • Round foods such as grapes, string cheese and hot dogs must be cut into very small pieces.
    • Children should be seated and supervised while self-feeding.

Calculations

Estimated energy requirements (kcal/d) for infants 6 months to 2.99 years (weight in kg; height in cm):

• Males: −716.45 − (1.00 × age) + (17.82 × height) + (15.06 × weight) + 20
• Females: −69.15 + (80.0 × age) + (2.65 × height) + (54.15 × weight) + 20/15
  • Energy cost of growth for girls: 6 to 11.99 months: 20 kcal/d; 12 to 35.99 months: 15 kcal/d.