Well-Child Visit (30 mo - 4 yr)

Subjective:
Chief Complaint:
Nasal issues and low appetite

BF4 - Accompanied By:
Ethan is accompanied by his father.

BF4 - Concerns and Questions:
The caregiver expresses concerns regarding Ethan's persistent selective eating habits, specifically his avoidance of rice, meats, and most vegetables, and inquires about his ongoing low appetite. There are no additional questions documented.

BF4 - Recent Illness:
No mention of recent illnesses since the last visit in November.

Interval History:
Since the previous visit in November, Ethan's nasal symptoms have improved with the use of the prescribed nasal spray, with only occasional nighttime nasal congestion persisting. His appetite remains selective, favoring fruit and sweets while avoiding rice, meats, and most vegetables. The family has implemented more balanced and varied meal options, resulting in a weight gain of approximately 1.5 kilograms over one month. No acute medical events or urgent care visits are reported.

BF4 - Nutrition:
- Appetite: Selective, with preference for fruit and sweets
- Variety: Limited, avoids rice, meats, and most vegetables
- Iron: No specific sources reported
- Fruits/Vegetables: Consumes fruit, avoids most vegetables
- Calcium: No specific sources reported
- Water: Not specified
- Juice: Not specified

BF4 - Dental Home:
No mention of dental issues or dental home concerns.

BF4 - Elimination:
No mention of issues with elimination.

BF4 - Sleep:
No significant concerns about sleep apart from occasional nighttime nasal stuffiness.

BF4 - Behavior:
No mention of behavioral concerns.

BF4 - Physical Activity:
No mention of physical activity concerns.

Objective:
Vitals:
- Weight: 29.1 kilograms (approximately 15th percentile)
- Height: Above average percentile
- No mention of abnormal vitals

Lab:
No lab tests discussed or ordered.

Physical Exam:
No physical exam findings discussed.

Assessment and Plan:
Anticipatory Guidance:
Guidance is provided to continue offering nutritious and varied food options without forcing intake. The importance of limiting sugar intake is emphasized, particularly in light of Ethan's preference for sweets. The family is encouraged to maintain balanced meals and to monitor growth. No additional anticipatory guidance topics are discussed.

- Chronic nasal congestion (J31.0): Ethan's nasal symptoms have improved with the use of prescribed nasal spray, with residual nocturnal nasal congestion. No urgent need to come in for a visit as the child is doing well overall.
Plan:
• Continue current intranasal corticosteroid therapy as previously prescribed.
• Monitor for any worsening of symptoms or new signs of infection.
• Reassessment recommended during the summer (July or August) to evaluate ongoing progress.

- Selective eating with low appetite (R63.3): Ethan continues to exhibit selective eating behaviors, preferring fruits and sweets while avoiding rice, meats, and most vegetables. Despite this, he has demonstrated a healthy weight gain of approximately 1.5 kilograms over one month, with weight tracking at the 15th percentile and height above average. No urgent need to come in for a visit as the child is doing well overall.
Plan:
• Encourage continued offering of a variety of nutritious and balanced foods without force-feeding.
• Advise limiting intake of sugary foods and sweets.
• Reinforce positive mealtime strategies and parental efforts to diversify diet.
• Schedule follow-up in summer (July or August) to reassess growth and dietary progress.
• Care coordinator will contact family to arrange next appointment.

Surgery Discussion:

• Purpose of the Surgery: No surgery discussion needed
• Risks and Complications: No surgery discussion needed
• Anesthesia: No surgery discussion needed
• Alternatives: No surgery discussion needed

Nutrition and Exercise counseling:
- nutrition counseling: Discussion focuses on providing a variety of nutritious foods and limiting sugar intake.
- 5,2,1 and almost none: Not discussed.
- keeping screentime under 2 hours per day: Not discussed.
- One hour of exercise: Not discussed.