Health balances, what they are and when to do them

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Marie-Ange Demory
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Health balances

Health balances: this is the name of the routine checks provided by the National Health Service. The basic plan of the National Child Health Project includes at least six: three within the year and another three between two and six years.
However, it is the individual regions (sometimes the individual local health authorities) that determine exactly how many and when, even in the six-14-year range. The Marche, for example, insures eight, while in Abruzzo it reaches 12.

Let's see what the health balances month after month and year after year.


The "health balances" from the first month to the 14 years: this is what they consist of

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Health balances are a series of checks that the doctor carries out to evaluate the psychophysical development of the child. It is the individual regions (sometimes the individual Asl) that establish exactly ...

In this article

  • What do health balances consist of
  • First month of the newborn 
  • 2-3 months of the newborn
  • 6 months of the newborn
  • 8-9 months of the newborn 
  • 12 months of the newborn
  • 18 months
  • 24 months
  • 36 months
  • 5 6-years
  • 8 10-years
  • 10 12-years
  • 12 14-years 
Read also: The "health reports" from the first month to 14 years: this is what they consist of

What do health balances consist of?

"Basically there is always a general physical examination, with the collection of data on weight, height and head circumference and between 0 and 6 years the psychomotor and sensory evaluation"says Adima Lamborghini, family pediatrician and member of the Study Center of the Paesena Federation of pediatricians." Depending on the age and region, specific investigations and tests are added ".

"In the first years of life we ​​concentrate above all on neurological development, motor skills, language and sight and hearing"explains the pediatrician Luigi Greco, vice president of the Paesena Society of paediatrics." Around the age of six, attention shifts to any skeletal and postural problems or learning disabilities and with the approach of adolescence we can work on prevention of risky behaviors and sex education ".

Yes, because i health balances are also an opportunity for information, explaining to parents how to prevent accidents, what they can expect in the weeks or months following each checkup and how to intervene in case of minor problems.

However, it must be said that, in the case of particular situations, such as for example a baby who has growth anomalies and must be kept under control, the checks provided by the pediatrician can be even more frequent and closer.


The development of the child from one to two years

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From one to two years: how much progress! The child learns to walk, to say the first words, to make speeches .... also to establish the first friendships. He becomes a little adventurer to discover ...

First month of the newborn

In most regions, the first visit takes place within 45 days of life. The following are checked: growth (weight, length, head circumference), fontanel, hips (Ortolani-Barlow maneuver), eyes (red reflex test), neurological development, the presence of any malformations that may not be visible at birth (some heart defects, clubfoot), the genitals. 

The management of the child is discussed with the parents, responding to concerns and providing breastfeeding support if needed. Vitamin D and, as needed, vitamin K and fluoride for the teeth are prescribed. We begin to talk about vaccinations, illustrating which and at what time they should be done and the possible side effects. We offer indications for transport by car and for the prevention of SIDS (cot death) and complications from passive smoking.

In some regions, questionnaires are given to parents for the assessment of sight and hearing. Some local health authorities provide for the execution of an electrocardiogram at 4-5 weeks, to identify any (rare) anomalies that could be linked to the risk of SIDS. The exam is not currently offered to everyone at a national level because there is no evidence of its real usefulness as a mass screening. 

2-3 months of the newborn

If this is the first visit, everything is done as described for the first month. Otherwise, the basic checks are repeated (physical examination, growth, psychomotor evaluation, cardiovascular status) and the status of vaccinations is checked. It is time for an ultrasound of the hips, to identify any dysplasias. But beware: this is not a screening intended for everyone (also because there is no scientific evidence of its usefulness in this sense). Some pediatricians recommend it to everyone, others only in the presence of risk factors (female sex, breech position at birth, abnormalities during the visit, clubfoot).

Read also: The newborn is two months old: the well-being of the new mother

6 months of the newborn

Physical examination, psychomotor and sensory evaluation, evaluation of vaccinations. We begin to talk about weaning (never before 4 months, better from 6 months) and we provide information on the prevention of domestic accidents.

8-9 months of the newborn

Physical examination and psychomotor and sensory evaluation. For example, it is assessed if the child sits correctly, if and how he stumbles, if he has begun the lallation, if he is interested in the surrounding environment. In many cases, the Boel test is provided, which allows you to evaluate hearing (if at birth, in the hospital, the acoustic emission screening was performed, there should be no surprises, but it is always better to check), but also the attention skills and relationship of the child.

12 months of the newborn

Physical examination and psychomotor and sensory evaluation. The feeding of the child is evaluated and the vaccination against measles-mumps-rubella is illustrated, to be done around 13-15 months. Back to the indications for the prevention of accidents (including the risk of inhalation of foreign bodies).

18 months

Physical examination. Control of vaccinations. Motor Activity Assessment: The child should have started walking. Speech Assessment: Does he say a few words besides mom and dad? Does he follow the speech and understand what is being asked of him? Some regions require testing for early detection of autism (based on observation of the child and questionnaire for parents)

24 months

Physical exam, psychomotor (does the child walk, jump, run?) And sensory assessment. Language assessment: around the age of 2, the child should pronounce at least 50 words and be able to put two or more together to express concepts. Vision assessment: Lang's test is performed for amblyopia (stereoscopic vision ability). In some regions, a test for color blindness is carried out (which in others is carried out at the control of 5/6 years).

Dental occlusion is evaluated (the child should have abandoned the pacifier, or have begun to do so). The basic rules of oral hygiene are explained (or the pediatrician can suggest a visit to a dentist to clarify these aspects). 

Read also: The stages of the child's development, from birth to 6 years

36 months

Physical examinations and motor, sensory and language assessments continue. If not done before, Lang's test is performed.

5 6-years

Physical examination, psychomotor, sensory and language assessment. Control of vaccinations. Assessment of visual acuity (whether the child sees well or not). Teeth evaluation: It may be time to send your child to the dentist for an initial checkup, especially if the teeth are crooked. Evaluation of the skeleton and postural attitude, to identify any anomalies such as scoliosis, flat foot, lordosis, kyphosis. Assessment of any learning disabilities (such as dyslexia) that may emerge with the start of school. Information on the prevention of obesity and eating disorders. 

8 10-years

Physical and skeletal exam, eye exam, teeth evaluation

Read also: The development of the child between six and eight years

10 12-years

Physical and skeletal exam, eye exam, teeth evaluation. Information on HPV vaccination for girls is provided. 

12 14-years

Physical and skeletal exam, eye exam, teeth evaluation. In males, control of the genitals, to identify any cases of varicocele. Indication for the prevention of risks related to the consumption of alcohol, smoking and drugs. Willingness to discuss aspects of sex education and the prevention of sexually transmitted diseases. Indications for the prevention of accidents, especially road accidents (for example, on the use of a helmet on a motorcycle).

PLEASE NOTE: the time indications in which to do the "health assessments" must be considered flexible: 6 months, for example, does not mean exactly 180 days, but an interval between 5 and 7 months.

Sources for this article:

Childhood health project (National collective agreement for the regulation of relations with free choice pediatricians)

Consulting of Luigi Greco, family pediatrician in the city and vice president of the Del Paesena Society of Pediatrics

Consulting of Adima Lamborghini, family pediatrician in Silvi (Teramo) and member of the Study Center of the Federation of Paesena pediatricians. 

Read also: The development of the child between 12 and 14 years

Questions and answers

What is the health report?

The health assessment is the ideal time to carry out a complete examination, evaluate the child's growth, psychomotor development and the achievement of the cognitive and sensory stages appropriate for each age.

How to choose the pediatrician for your child?

From a bureaucratic point of view, choosing a pediatrician is a very simple operation: just go to the relevant office of your local health authority with:

  • an identity document (from mom or dad)
  • the child's tax code
  • and the birth certificate,
  • and indicate which pediatrician you want from those available

What to check before choosing a pediatrician?

Before choosing the pediatrician, pay attention to these elements:

  • Do the outpatient clinic and the waiting room appear clean, comfortable, child-friendly?
  • Does the doctor and possibly his staff appear courteous, attentive, ready to listen, or hasty and rude?
  • How are health assessments carried out?

  • pediatrician
  • pediatrician checks
  • 1-2 children years
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