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1. For newborns discharged in less than 48 hours after delivery

2. By history and appropriate physical examination: if suspicious, by specific objective development testing

3. At each visit, a complete physical examination is essential, with infant totally unclothed, older child undressed and suitably draped

Key: • = to be performed S = subjective, by history O = objective, by a standard testing method

Adapted from Recommendations For Preventive Pediatric Health Care promulgated by the American Academy of Pediatrics Committee on Practice and Ambulatory Medicine. Pediatrics 96:373, 1995. Additional recommendations made by the Committee regarding screening for metabolic disorders, tuberculosis, anemia, and urinary tract diseases, administration of immunizations, provision of anticipatory guidance, and initial dental referral are not included in the above summation.

An important and unique aspect of examining younger children is that parents are usually watching and taking part in the interaction, providing you the opportunity to observe the parent-child interaction. Note whether the child displays age-appropriate behaviors. Assess the "goodness of fit" between parents and child. While some abnormal interactions may be due to the unnatural setting of the examination room, others may be due to interactional problems. Careful observation of the child's interactions with parents and the child's unstructured play in the examination room can reveal abnormalities in physical, cognitive, and social development.

Normal toddlers are occasionally terrified, more commonly angry at the examiner, and often completely uncooperative. Most eventually warm up. If this behavior continues and is not developmentally appropriate (e.g., stranger anxiety of the infant or shyness of the early adolescent), there may be an underlying behavioral or developmental abnormality.

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