Amber is a 20-week-old female that presents to your office for a well-child check and immunizations. The history is obtained from the father as the mother is working on this day. Amber is the couple`s third child. The father states that he has a couple of concerns about Amber`s current health. He states that his wife is worried about occasional constipation with Amber. He also states that Amber still wakes up at night three times a week and wants to know if this is normal.

PMH: Normal spontaneous vaginal delivery at term; following an uncomplicated pregnancy. Her birth weight was 6 lbs. 14 oz, and she was discharged home at 48 hours of age after an uneventful stay in the newborn nursery. Amber`s weight gain and developmental milestones are all within normal limits on her previous clinic visit. Amber`s past immunizations include the Hepatitis B vaccine at 2 days. At 2 months, the following vaccines: DTap, Hib, PCV, IPV. Breastfed until three weeks ago; started on Similac and then switched to low-iron Similac. Taking 4-5 ounces of Similac every 5 hours, no solid foods.

Social history: Amber lives with both parents and 2 siblings, ages 5 and 3. Both mother and father work full time. The father, 36 years old, is employed as a product analyst and works from home. The mother, 34 years old, works as an immigration paralegal. The mother immigrated from the Philippines 10 years ago and is fluent in English. The father is American-born.

Allergies: No known drug allergies; no known food allergies.

Medications: None.

ROS: Within normal limits.

Physical examination findings: Within normal limits.

Critical Thinking Questions:

What are the normal developmental milestones of infants in Amber`s age group?

What are the appropriate screening tests based on current recommendations for Amber`s age and risk status?

What are the current recommendations for immunizations based on Amber`s age and risk status?

What is the applicable anticipatory guidance for this and the next scheduled visit during infancy?

How would you respond to the parent`s concerns?

What are areas for health maintenance, health promotion, disease prevention, and parent education