1
Pediatric Primary Care: Vignette 1
Marion Angotti
N588: Pediatric Health
Professor Laura Kohring
Post University
Date: 03/18/2026
, 1
Pediatric Primary Care: Vignette 1
Question 1: Top three priority items when reviewing records.
When reviewing the prior health records of the 12-month pediatric patient, the following three
areas are designated as the highest priority for evaluation of growth and development:
A. Growth Chart Measurements, (Weight, Height, And Height Circumference).
One of the single most important steps when evaluating the trajectory of a child's growth is
the assessment of the serial growth measurements that are plotted on the standardized growth
chart such as the ones offered by the CDC or WHO. Growth charts are designed to allow
providers to determine, not only where the child currently plots in relation to empirical growth
but also whether her growth velocity is congruent with predetermined growth milestones. The
current patient presents with parlor, sunken eyes, and visible thinness. Evaluation of her prior
weight and height measurements is integral in revealing whether she has experienced acute
weight loss, chronic failure to thrive, or has simply always plotted at a lower percentile. The head
circumference is also vital at this age because it's a reflection of brain growth and neurological
development. Shur et al. (2023) states that prior records are often used to demonstrate a pattern
of crossing percentile lines downwards, which are indicative of malnutrition or underlying
pathology.
B) Developmental milestone documentation.
The developmental screening results or documented milestone attainment in the previous
records are important. These results often give benchmarks that are used to determine whether a
child is growing in accordance with empirical models or is facing developmental challenges.
According to these models, by the 12th month, a child should be able to cruise or walk, use one
, 2
or two words with meaning, point at things or objects, wave goodbye, feed themselves finger
foods and demonstrate joint attention (Lozanović et al., 2021). Any lapses in these
developmental milestones could be indicative of neurological issues, nutritional deficiencies
such as iron deficiency that affect cognitive development; and/or neglect. Common standardized
developmental tools such as the Ages and Stages Questionnaire (ASQ-3) or the Survey of
Wellbeing of Young Children Should have been administered at previous well child visits
(Agarwal et al. 2020). An assessment and review of these results from the prior records will
allow the provider to identify whether delays are new or long standing.
C) Prior Laboratory Results.
Any previous laboratory work conducted on the child, including a complete blood count
(CBC), lead level and metabolic panel, should be reviewed. According to Wolf et al. (2025), at 9
and 12 months, a hemoglobin or hematocrit screen is recommended for infants at risk of iron
deficiency anemia. This is particularly relevant for this infant’s vegetarian and breastfeeding diet.
Iron deficiency is one of the most common micronutrient deficiencies in infants and can impair
cognitive and motor development (Kennady et al., 2024). Furthermore, if the family has travelled
internationally or lived in an older home, prior LED screening results are integral. These
laboratory results would contextualize the current clinical picture, particularly the pallor and
oxygen saturation of 93% that was noted on the visit.
Question 2: List of problems
Based on the history and general assessment findings, the following problems were identified:
# PROBLEM CLINICAL BASIS QUESTION FOR PARENTS
Pediatric Primary Care: Vignette 1
Marion Angotti
N588: Pediatric Health
Professor Laura Kohring
Post University
Date: 03/18/2026
, 1
Pediatric Primary Care: Vignette 1
Question 1: Top three priority items when reviewing records.
When reviewing the prior health records of the 12-month pediatric patient, the following three
areas are designated as the highest priority for evaluation of growth and development:
A. Growth Chart Measurements, (Weight, Height, And Height Circumference).
One of the single most important steps when evaluating the trajectory of a child's growth is
the assessment of the serial growth measurements that are plotted on the standardized growth
chart such as the ones offered by the CDC or WHO. Growth charts are designed to allow
providers to determine, not only where the child currently plots in relation to empirical growth
but also whether her growth velocity is congruent with predetermined growth milestones. The
current patient presents with parlor, sunken eyes, and visible thinness. Evaluation of her prior
weight and height measurements is integral in revealing whether she has experienced acute
weight loss, chronic failure to thrive, or has simply always plotted at a lower percentile. The head
circumference is also vital at this age because it's a reflection of brain growth and neurological
development. Shur et al. (2023) states that prior records are often used to demonstrate a pattern
of crossing percentile lines downwards, which are indicative of malnutrition or underlying
pathology.
B) Developmental milestone documentation.
The developmental screening results or documented milestone attainment in the previous
records are important. These results often give benchmarks that are used to determine whether a
child is growing in accordance with empirical models or is facing developmental challenges.
According to these models, by the 12th month, a child should be able to cruise or walk, use one
, 2
or two words with meaning, point at things or objects, wave goodbye, feed themselves finger
foods and demonstrate joint attention (Lozanović et al., 2021). Any lapses in these
developmental milestones could be indicative of neurological issues, nutritional deficiencies
such as iron deficiency that affect cognitive development; and/or neglect. Common standardized
developmental tools such as the Ages and Stages Questionnaire (ASQ-3) or the Survey of
Wellbeing of Young Children Should have been administered at previous well child visits
(Agarwal et al. 2020). An assessment and review of these results from the prior records will
allow the provider to identify whether delays are new or long standing.
C) Prior Laboratory Results.
Any previous laboratory work conducted on the child, including a complete blood count
(CBC), lead level and metabolic panel, should be reviewed. According to Wolf et al. (2025), at 9
and 12 months, a hemoglobin or hematocrit screen is recommended for infants at risk of iron
deficiency anemia. This is particularly relevant for this infant’s vegetarian and breastfeeding diet.
Iron deficiency is one of the most common micronutrient deficiencies in infants and can impair
cognitive and motor development (Kennady et al., 2024). Furthermore, if the family has travelled
internationally or lived in an older home, prior LED screening results are integral. These
laboratory results would contextualize the current clinical picture, particularly the pallor and
oxygen saturation of 93% that was noted on the visit.
Question 2: List of problems
Based on the history and general assessment findings, the following problems were identified:
# PROBLEM CLINICAL BASIS QUESTION FOR PARENTS
