Preventive Medicine

Developmental Level Primary Prevention Secondary Prevention

    (0-1 year)

Parent education
     Infant safety
     Breast feeding
Sensory stimulation
         Infant massage and touch
     Visual stimulation
     Auditory stimulation
     TOPV          at 2,4 and 6 months
     Hepatitis B
Oral hygiene
     Teething biscuits
     Avoid sugared food and drink

Complete physical exam every 2-3 month
Screening at birth
    Congenital hip
    G-6-PD deficiency in blacks, Mediterranean, and Far Eastern origin
    Sickle cell
    Hemoglobin or hematocrit (for anemia)
    Cystic fibrosis
    Vision (startle reflex)
    Hearing (response to and localization of sounds)
    TB test at 12 months
    Developmental assessments
Screen and intervene for high risk
    Low birth weight
    Material substance abuse during pregnancy
        Alcohol: fetal alcohol syndrome
        Cigarettes: SIDS
        Drugs: addicted neonate, AIDS
    Maternal infections during pregnancy

   (1-5 years)

Parent education
     Accident prevention
     Normal growth and development
Child education
     Dental self-care
     Bathing with assistance
     Feeding self-care
     DPT            at 18 months
     MMR at 15 months
     Hib at 24 months
Dental/oral hygiene
     Fluoride treatments
     Fluoridated water
     Dietary counsel

Complete physical exam between 2 and 3 years and preschool (U/A, CBC)
TB test at 3 years
Development assessments (annual)
    Speech development
Screen and intervene
    Lead poisoning
    Developmental lag
    Neglect or abuse
    Strong family history of arteriosclerotic diseases (e.g., ML, CVA, peripheral vascular
        disease),diabetes, hypertension, gout or hyperlipidemia - fasting serum cholesterol at
        age 2 years, then every 3-5 years if normal
    Hearing deficit
    Vision deficit

School age
   (6-11 years)

Health education of child
     "Basic 4" nutrition
     Accident prevention
     Outdoor safety
     Substance abuse counsel
     Anticipatory guidance for physical changes
         at puberty
     Tetanus age 10
     DPT  boosters between 4 and 6 years
Dental hygiene every 6-12 months
     Continue fluoridation
Complete physical exam

Complete physical exam
TB test every 3 years (at ages 6 and 9)
Developmental assessments
    Vision: Snellen charts at school
        6-8 years, use "E" chart
        Over 8 years, use alphabet chart
    Hearing: audiogram
Cholesterol profile, if high risk, every 3-5 years
Serum cholesterol one time (not high risk)

   (12-19 yrs)

Health education
     Proper nutrition and healthful diets
     Sex education
     Sexually transmitted diseases
Safe driving skills
Adult challenges
     Seeking employment and career choices
     Dating and marriage
     Confrontation with substance abuse
Safety in athletics, water
Skin care
Dental hygiene every 6-12 months
     Tetanus without trauma
     TOPV booster at 12-14 years

Complete physical exam (prepuberty or age 13)
     Blood pressure
     Cholesterol profile
     TB test at 12 years
     VDRL, CBC, U/A
     Female: breast self-exam (BSE)
     Male: testicular self-exam (TSE)
     Female, if sexually active: Pap and pelvic exam twice, 1 year apart
         (cervical gonorrhea culture with pelvic); then every 3 years if both are
Screening and interventions if high risk
     Substance abuse
Family history of alcoholism or domestic violence

Young adult
   (20-39 yrs)

Health education
     Weight management with good nutrition as
          BMR changes
     Low cholesterol diet
Life-style counseling
     Stress management skills
     Safe driving
     Family planning
     Sexual practices
     Parenting skills
     Regular exercise
     Environmental health choices
     Alcohol, drug use
Dental hygiene every 6-12 months
     Tetanus at 20 years and every 10 years
     Female: rubella, if serum negative for
     Hepatitis-B for high-risk persons

Complete physical exam at about 20 years, then every 5-6 years
Cancer checkup every 3 years
Female: BSE monthly
Male: TSE monthly
All females: baseline mammography between ages 35 and 40
Parents-to-be: high-risk screening for Down syndrome, Tay-Sachs
Female pregnant: screen for VD, rubella titer, Rh factor, amniocentesis for
    women 35 years or older (if desired)
Screening and interventions if high risk
     Female with previous breast cancer: annual mammography at 35 years
    and after
     Female with mother or sister who has had breast cancer, same as above
     Family history colorectal cancer or high risk: annual stool guaiac, digital
    rectal, and sigmoidoscopy
     PPD if exposed to TB
     Glaucoma screening at 35 years and along with routine physical exams
     Cholesterol profile every 5 years, if normal
     Cholesterol profile every 1-2 years if borderline

Middle-aged adult
   (40-59 yrs)

Health education: continue with young adult
Midlife changes, male and female counseling
     "Empty nest syndrome"
     Anticipatory guidance for retirement
Dental hygiene every 6-12 months
     Tetanus every 10 years
     Influenza - annual if high risk (i.e. major
        chronic disease /COPD, CAD/)
Pheumococcal - single dose

Complete physical exam every 5-6 years with complete laboratory 
   evaluation (serum/urine tests, x-ray, ECG)
Cancer checkup every year
Female: BSE monthly
Male: TSE monthly
Al females: mammogram every 1-2 years (40-49 years) then annual
    mammography 50 years and over
Schiotz's tonometry (glaucoma) every 3-5 years
Sigmoidoscopy at 50 and 51, then every 4 years if negative
Stool guaiac annually at 50 and thereafter
Screening and intervention if high risk
     Endometrial cancer: have endometrial sampling at menopause
     Oral cancer: screen more often if substance abuser

Elderly adult
   (60-74 yrs)

Health education: continue with previous
     Home safety
     Loss of spouse, relatives, friends
     Special health needs
         Nutritional changes
         Changes in hearing or vision
     Dental/oral hygiene every 6-12 months
     Tetanus every 10 years
     Influenza - annual if high risk
     Pneumococcal - (one time only)

Complete physical exam every 2 years with laboratory assessments
Annual cancer chekup
Blood pressure annually
Female: BSE monthly
Male: TSE monthly
Female: annual mammogram
Annual stool guaiac
Sigmoidoscopy every 4 years
Schiotz's tonometry every 3-5 years
Podiatric evaluation with foot care PRN
Screen for high risk
     Alcohol/drug abuse
     "Elder abuse"

Old-age adult
   (75 years and over)

Health education: continue counsel
Anticipatory guidance
     Dying and death
     Loss of spouse, relatives, friends
     Increasing dependency upon others
Dental/oral hygiene every 6-12 months
     Tetanus every 10 years
     Influenza - annual
     Pneumococcal - if not already received

Complete physical exam annually
     Laboratory assessments
     Cancer checkup
     Blood pressure
     Stool guaiac
Female: annual mammogram, sigmoidoscopy every 4 years
Schiotz's tonometry every 3-5 years
Podiatrist PRN