Preventive Medicine
| Developmental Level | Primary Prevention | Secondary Prevention |
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Infancy (0-1 year) |
Parent education Infant safety Nutrition Breast feeding Sensory stimulation Infant massage and touch Visual stimulation Activity Colors Auditory stimulation Verbal Music Immunizations DPT TOPV at 2,4 and 6 months Hepatitis B Oral hygiene Teething biscuits Fluoride Avoid sugared food and drink |
Complete physical exam every 2-3 month Screening at birth Congenital hip PKU G-6-PD deficiency in blacks, Mediterranean, and Far Eastern origin children 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 |
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Preschool (1-5 years) |
Parent education Teething Discipline Nutrition Accident prevention Normal growth and development Child education Dental self-care Dressing Bathing with assistance Feeding self-care Immunizations DPT at 18 months TOPV 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 Hearing Vision 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 Strabismus Hearing deficit Vision deficit |
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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 Immunizations Tetanus age 10 DPT boosters between 4 and 6 years TOPV 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 Language 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) |
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Adolescence (12-19 yrs) |
Health education Proper nutrition and healthful diets Sex education Choices Risks Precautions 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 Immunizations 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 negative Screening and interventions if high risk Depression Suicide Substance abuse Pregnancy Family history of alcoholism or domestic violence |
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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 Divorce Parenting Sexual practices Parenting skills Regular exercise Environmental health choices Alcohol, drug use Dental hygiene every 6-12 months Immunizations Tetanus at 20 years and every 10 years Female: rubella, if serum negative for antibodies 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 |
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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 Grandparenting Dental hygiene every 6-12 months Immunizations 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 |
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Elderly adult (60-74 yrs) |
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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 Immunizations 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 |