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Paeds Topicspreventive-and-community-paediatrics

Paeds · preventive-and-community-paediatrics

Toddler health supervision: 1 to 3 years

Also known as Toddler well-child visit · 1 to 3 year health supervision · 12 to 36 month preventive care · Toddler Bright Futures visit · Toddler health check

Fellowship approach to toddler (12–36 months) health supervision: growth trajectories, developmental surveillance and autism screening, injury and oral-health anticipatory guidance, feeding and sleep, iron and lead risk assessment, positive discipline, equity and safeguarding, with regional schedule differences.

high22 referencesUpdated 11 July 202613 min readVerification in progress

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Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

  • Toddler booked for well care who is lethargic, mottled, working hard to breathe or poorly responsive
  • Developmental regression or loss of social engagement or language
  • Crossing down major weight or length/height centiles with poor intake or illness signs
  • Positive autism or developmental screen without a closed-loop referral plan
  • Unexplained injuries, inconsistent history, delayed care or fearfulness with caregivers
  • Severe food insecurity, formula or food rationing, or inability to feed safely

Life stages

toddlerpreschool

Care settings

preventive-medical-homecommunity-schooloutpatienttelehealthrural-remote

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-developmentmrcpch-history-managementmrcpch-communicationrcpsc-structured-oral

Board mappings

  • General and Community Paediatrics
  • Growth and Development
  • Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
  • Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Management – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 9: Clinical assessment and management – child safety and maltreatment
  • Clinical Applications
  • Long Cases
  • Short Cases
  • 5. Professional skills and knowledge: Health promotion and illness prevention
  • 4. Professional skills and knowledge: Patient management
  • 2. Professional skills and knowledge: Communication
  • 9. Safeguarding vulnerable children
  • Foundation of Practice (FOP)
  • Applied Knowledge in Practice (AKP)
  • History
  • Communication
  • Clinical
  • Development
  • General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
  • General Pediatrics Content Outline — Domain 2: Growth and Development
  • General Pediatrics EPA 1: Provide a Medical Home for Well Children of All Ages
  • General Pediatrics EPA 3: Provide Well-Child Care and Anticipatory Guidance
  • Patient Care 1: History
  • Patient Care 5: Patient Management
  • Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
  • Systems-Based Practice 3: System Navigation for Patient-Centered Care
  • Health Advocate
  • Communicator
  • Pediatrics: Foundations EPA #1 — Assessing, diagnosing, and managing patients with common acute and chronic pediatric presentations
  • Pediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and/or families
  • Pediatrics: Core EPA #8 — Recognizing and managing suspected child maltreatment and/or neglect
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Study tools

Your progress

Saved on this device.

Practise this topic

  • Short-answer question1
  • Viva station1
  • Clinical case1

Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

  • Toddler booked for well care who is lethargic, mottled, working hard to breathe or poorly responsive
  • Developmental regression or loss of social engagement or language
  • Crossing down major weight or length/height centiles with poor intake or illness signs
  • Positive autism or developmental screen without a closed-loop referral plan
  • Unexplained injuries, inconsistent history, delayed care or fearfulness with caregivers
  • Severe food insecurity, formula or food rationing, or inability to feed safely

Life stages

toddlerpreschool

Care settings

preventive-medical-homecommunity-schooloutpatienttelehealthrural-remote

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-developmentmrcpch-history-managementmrcpch-communicationrcpsc-structured-oral

Board mappings

  • General and Community Paediatrics
  • Growth and Development
  • Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
  • Current 2026 PREP curriculum — Learning Objective 1.2.2: Communicate with parents or carers
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Management – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 9: Clinical assessment and management – child safety and maltreatment
  • Clinical Applications
  • Long Cases
  • Short Cases
  • 5. Professional skills and knowledge: Health promotion and illness prevention
  • 4. Professional skills and knowledge: Patient management
  • 2. Professional skills and knowledge: Communication
  • 9. Safeguarding vulnerable children
  • Foundation of Practice (FOP)
  • Applied Knowledge in Practice (AKP)
  • History
  • Communication
  • Clinical
  • Development
  • General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
  • General Pediatrics Content Outline — Domain 2: Growth and Development
  • General Pediatrics EPA 1: Provide a Medical Home for Well Children of All Ages
  • General Pediatrics EPA 3: Provide Well-Child Care and Anticipatory Guidance
  • Patient Care 1: History
  • Patient Care 5: Patient Management
  • Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
  • Systems-Based Practice 3: System Navigation for Patient-Centered Care
  • Health Advocate
  • Communicator
  • Pediatrics: Foundations EPA #1 — Assessing, diagnosing, and managing patients with common acute and chronic pediatric presentations
  • Pediatrics: Foundations EPA #8 — Communicating assessment findings and management plans to patients and/or families
  • Pediatrics: Core EPA #8 — Recognizing and managing suspected child maltreatment and/or neglect
The fellowship answer

A toddler visit is a growth, development, safety and family-context package — not vaccines alone. From 12 to 36 months you plot WHO growth trajectories, run developmental surveillance and autism-specific screening at the ages your schedule supports, look in the mouth, prioritise injury prevention for new motor skills, counsel iron-rich diet and bottle weaning, assess lead and food-security risk, promote play and positive discipline without corporal punishment, and leave a closed-loop plan for every positive screen. Caregiver concern and a failed screen change plan same day. [1] [2] [4]

Two jobs that get mixed up

Toddler health supervision

    Acute toddler sick visit

      T.O.D.D.L.E.R. visit

      Trajectory growth (plot it) · Observe development and autism screen · Dental/lift-the-lip · Diet iron and bottle limits · Lead and social risk · Environment and injury safety · Refer closed-loop and teach-back. [1] [2] [12]

      Overview & Definition

      Picture an 18-month-old climbing off the parent’s lap while you try to open the chart. The parent wants “the needles done.” Your real job is broader. Toddler health supervision is structured preventive care for children from about 12 to 36 months. It combines measurement, developmental surveillance, autism-specific screening at recommended ages, oral health, injury prevention, feeding and sleep guidance, iron and lead risk assessment, immunisation reconciliation, and family psychosocial care. [1] [2]

      AAP preventive periodicity recommendations organise these visits as a repeating package across 12, 15, 18, 24, 30 and 36 months rather than a single birthday ritual. Local child-health books in Australia and Aotearoa New Zealand, UK Healthy Child Programme contacts, and Canadian tools such as the Rourke Baby Record use different forms but the same idea: find problems while early services still change trajectories. [1]

      This page owns the toddler package. Cross-link dedicated leaves for full immunisation schedules, deep developmental assessment tools, growth charting mechanics, and full child-protection workups rather than hiding whole second chapters here. [1] [2]

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      References22ShowHide
      1. [1]Committee on Practice and Ambulatory Medicine 2025 Recommendations for Preventive Pediatric Health Care: Policy Statement. Pediatrics, 2025.PMID 39914362
      2. [2]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
      3. [3]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
      4. [4]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
      5. [5]Baker RD Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 2010.PMID 20923825
      6. [6]COUNCIL ON ENVIRONMENTAL HEALTH Prevention of Childhood Lead Toxicity. Pediatrics, 2016.PMID 27325637
      7. [7]Clark MB Fluoride Use in Caries Prevention in the Primary Care Setting. Pediatrics, 2020.PMID 33257404
      8. [8]Krol DM Maintaining and Improving the Oral Health of Young Children. Pediatrics, 2023.PMID 36530159
      9. [9]Durbin DR Child Passenger Safety. Pediatrics, 2018.PMID 30166367
      10. [10]Sege RD Effective Discipline to Raise Healthy Children. Pediatrics, 2018.PMID 30397164
      11. [11]COUNCIL ON COMMUNICATIONS AND MEDIA Media and Young Minds. Pediatrics, 2016.PMID 27940793
      12. [12]Gardner HG Office-based counseling for unintentional injury prevention. Pediatrics, 2007.PMID 17200289
      13. [13]Christian CW The evaluation of suspected child physical abuse. Pediatrics, 2015.PMID 25917988
      14. [14]Yogman M The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics, 2018.PMID 30126932
      15. [15]Peltz A Food Insecurity and Health Care Use. Pediatrics, 2019.PMID 31501238
      16. [16]Holve S Early Childhood Caries in Indigenous Communities. Pediatrics, 2021.PMID 34001640
      17. [17]WHO Multicentre Growth Reference Study Group WHO Child Growth Standards based on length/height, weight and age. Acta paediatrica (Oslo, Norway : 1992). Supplement, 2006.PMID 16817681
      18. [18]Aishworiya R Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening. Pediatrics, 2023.PMID 37203373
      19. [19]Dubowitz H The safe environment for every kid model: impact on pediatric primary care professionals. Pediatrics, 2011.PMID 21444590
      20. [20]Hampl SE Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 2023.PMID 36622135
      21. [21]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428
      22. [22]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387

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