Health Supervision Visit, 24 Months

Assess

• Anthropometric measurements (growth charts)
• Physical examination
• Screen for iron deficiency and iron deficiency anemia
• Screen for risk factors for dyslipidemia 
  • Lipid profile, if positive on screening
• Screen for risk factors for lead 

Discuss

• Encourage foods, whether home or commercially prepared, with no added salt or sugar; particularly important for commercial foods marketed for toddlers. 
• Encourage mono- and polyunsaturated fatty acids (eg, avocado, ground nuts or nut butters, olive and canola oils). 
  • Commercially fried foods (eg, chicken nuggets, fries, onion rings, corn dogs, doughnuts) are discouraged because heated oil converts to trans fats, particularly when heated repeatedly. The FDA designates trans fats as not “generally safe for human consumption.”
• Sugar-sweetened beverages, beverages with low-calorie sweeteners, and caffeinated beverages are not recommended. Avoid formulas designed for older children unless medically indicated.
  • Plant-based milks should be used only when medically indicated or to meet specific preferences for plant-based milks.
  • Children 1 to 3 years of age should consume no more than 4 oz (120 mL) of 100% fruit juice.
  • 66% of children and teens 2 to 19 years of age consume SSBs daily. 
• Remind parents they are responsible for providing nutritious foods and their child’s responsibility is to decide how much to eat.
  • Explain the 2 domains of encouraging healthy eating: structure and autonomy. Tips for families regarding each domain are listed here.
  • Encourage a variety of food with sufficient calories to support growth without contributing to obesity.
    • Saturated fatty acids, <10% of total energy intake.
      • Total fat, averaged over several days, no less than 25% of total calories and no more than 30% of calories. 
      • 47% of preschool-aged children 24 to 47 months consume less fat than recommended.
    • Dietary cholesterol, <300 mg/day. 
    • Carbohydrate content of the diet should be 55% to 60% of the calories, of which the majority should be complex carbohydrates. 
      • Fiber is important and can improve blood cholesterol levels.
    • Protein should provide 10% to 15% of dietary calories. 

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.