Fontanelles: The posterior fontanelle is usually closed by 2 months and the anterior by 18 months. The Abnormal fontanel (AAFP)

Vision inquiry/screening: Vision screening (CPS)

• Check Red Reflex for serious ocular diseases such as retinoblastoma and cataracts.
• Corneal light reflex/cover–uncover test & inquiry for strabismus: With the child focusing on a light source, the light reflex on the cornea should be symmetrical. Each eye is then covered in turn, for 2–3 seconds, and then quickly uncovered. The test is abnormal if the uncovered eye “wanders” OR if the covered eye moves when uncovered.
• Check visual acuity at age 3–5 years.

Hearing inquiry/screening: Language delay or parental concerns about hearing acuity should prompt a rapid referral for hearing assessment. Formal audiology testing should be performed in all high-risk infants, including those with normal UNHS. Older children should be screened if clinically indicated.

Tonsil size/sleep-disordered breathing: Screen for sleep problems. Behavioural sleep problems and snoring in the presence of sleep-disordered breathing warrants assessment re obstructive sleep apnea (OSA). OSA (AAP)

Muscle tone: Assessment should be performed for abnormal tone or deep tendon reflexes, or for asymmetric movements (moving one side more than other). These may be early signs of cerebral palsy or neuromotor disorder and suggest the need for further assessment. CP Features (DM&CN)

Hips: There is insufficient evidence to recommend routine diagnostic imaging for screening for developmental dysplasia of the hips, but examination of the hips should be included until at least one year, or until the child can walk. Exam includes assessing limb length discrepancy and asymmetric thigh or buttock (gluteal) creases; performing Ortolani manoeuvre (usually negative after 3 mos); and testing for limited abduction (usually positive after 3 mos). Consider selective imaging between 6 wks and 6 mos if risk factor (i.e. breech, family history, hip instability on physical exam). DDH (AAP)

Bruising: Unexplained bruising warrants evaluation re child maltreatment or medical illness.

Jaundice: Bilirubin testing (total and conjugated) if persists beyond 2 wks of age. Neonatal Hyperbilirubinemia Guidelines (CPS) | Newborn screening for biliary atresia (AAP).

Blood pressure: Check BP at all visits for those at risk > 3 yrs old. Some risk factors: obesity, sleep-disordered breathing, prematurity, renal disease, congenital heart disease, diabetes, or on med’ns that ^ BP.
High blood pressure in children, including definitions: (NIH Working Group) (AAP)

Check palate for cleft Cleft lip/palate (AAP)

Inspect tongue mobility for ankyloglossia if breastfeeding problems. Ankyloglossia and breastfeeding (CPS)

Vision inquiry/screening: Vision screening (CPS)

• Check Red Reflex for serious ocular diseases such as retinoblastoma and cataracts.
• Check visual acuity at age 3-5 years.

Umbilicus: Gently pat dry and review S&S of infection. Preventing sepsis (Cochrane)

Dental: Examine for problems including caries, oral soft tissue infections or pathology; and for normal teeth eruption sequence. Canadian Caries Risk Assessment Tool