| Course | NUR 636 Primary Care of Infants, Children and Adolescents |
|---|---|
| Module | Module 3 |
| Paper type | Milestone: well-child visit case study |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 636 Module 3
Milestone One: The 12-Month Well-Child Visit for a Newly Walking Toddler
[Student Name]
Southern New Hampshire University
NUR 636: Primary Care of Infants, Children and Adolescents
Milestone One
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone One: The 12-Month Well-Child Visit for a Newly Walking Toddler
The 12-month visit is one of the busiest in the well-child schedule. In a single appointment the clinician reviews a year of growth, checks development at a point where delays begin to show, screens for iron deficiency and, in many children, lead exposure, gives several vaccines and prepares parents for a toddler who is suddenly mobile. Each task has its own guideline. This milestone documents a 12-month visit and argues that organizing it around the child's specific risks, rather than working through a generic checklist, makes it both more efficient and more useful to the family.
History
Mia is 12 months old and comes with her mother and father. She was born at 38 weeks weighing 3.1 kg and has had no hospitalizations. Her parents report no concerns. She drinks whole milk from a bottle, about 30 ounces a day, and eats small amounts of table food; she refuses most vegetables. She took three independent steps last week, pulls to stand, says "mama" and "dada" to the right parent, waves bye-bye and looks for a toy hidden under a blanket. She sleeps through the night in her own crib. The family lives in a rented house built in 1942 where the landlord recently sanded and repainted window frames. Her father smokes outside. She attends a home daycare three days a week. Her immunizations are complete through six months, including three doses of hepatitis B and influenza vaccine last fall.
Growth and Examination
Weight is 9.4 kg, near the 55th percentile on the WHO growth chart; length is 75 cm, near the 60th percentile; head circumference is 45.5 cm, near the 50th percentile. All three follow their previous percentile lines. On examination Mia is alert, social and wary of the examiner as expected at this age. Anterior fontanelle is open and small. Red reflexes are present and symmetric, and the cover test shows no deviation. Tympanic membranes are normal. She has six teeth without visible decay. Heart, lungs and abdomen are normal. Hips abduct fully, and she walks with a wide-based gait while holding a hand. Skin shows no bruising or pallor. Genitalia are normal.
Developmental Surveillance
In 2022, a working group revised the CDC developmental milestones so that each one represents a skill that most children, about 75% or more, show by that age, rather than the average age, so that a missed milestone more clearly signals the need for further evaluation (Zubler et al., 2022). At 12 months, the revised milestones include waving bye-bye, calling a parent mama or dada or another special name, understanding no, pulling up to stand, walking holding on to furniture, picking up small objects with thumb and forefinger and looking for things she sees hidden. Mia shows all of these. Her parents were given the checklist for 15 months, and a standardized developmental screening tool will be completed at the 18-month visit, along with autism-specific screening, as recommended.
Iron and Lead Screening
The AAP recommends universal screening for anemia with a hemoglobin measurement at about 12 months, along with assessment of risk factors for iron deficiency, among which high cow's milk intake is prominent (Baker et al., 2010). Mia's intake of 30 ounces a day exceeds the recommended 16 to 24 ounces and can displace iron-rich foods and cause intestinal blood loss. A point-of-care hemoglobin is 10.8 g/dL, just below the 11 g/dL threshold. A serum ferritin will be sent, and the plan below addresses both iron and milk.
Blood lead testing is recommended at 12 and 24 months for children at risk, and children living in housing built before 1978, especially with recent renovation, are at particular risk. The CDC lowered its reference value in 2021, and a child now counts as having more lead than most peers at 3.5 micrograms per deciliter or above (Ruckart et al., 2021). A venous blood lead level was drawn today. If it is at or above the reference value, the family will be connected with the health department for an environmental inspection, and the landlord's renovation practices will be reviewed.
Immunizations and Oral Health
Vaccines due at this visit, following the routine schedule, are measles, mumps and rubella; varicella; hepatitis A, first dose; and the pneumococcal conjugate and Haemophilus influenzae type b boosters, which may be given between 12 and 15 months. The parents consented to all five, given in both thighs with the mother holding Mia. They were told that a fever or a mild rash one to two weeks after the measles and varicella vaccines can occur. Fluoride varnish was applied to her six teeth, and the parents were advised to brush twice daily with a rice-grain smear of fluoride toothpaste and to establish a dental home.
Anticipatory Guidance
Guidance focused on Mia's specific risks. For nutrition, the parents will move her from the bottle to an open cup, cap whole milk at roughly two to three cups daily and offer iron-rich foods such as beans, meat and fortified cereal with a source of vitamin C. For safety, now that she walks, they will install gates at the stairs, anchor furniture, keep cleaning products and medicines locked and keep her car seat rear-facing. For lead, they will wet-mop floors and windowsills rather than sweep, wash her hands before meals and keep her away from the repainted windows. For tobacco, her father was offered cessation support, since smoke on clothing still exposes her. Follow-up: results by phone within a week and the 15-month visit. If ferritin confirms iron deficiency, she will start oral iron at 3 mg/kg of elemental iron daily and have her hemoglobin rechecked after about a month, as the iron deficiency guidance suggests; if the lead level is high, the environmental steps will begin immediately rather than waiting for the next visit.
Conclusion
Mia is growing and developing well, but her high milk intake, borderline hemoglobin, older home with recent renovation and household smoking create specific risks. Organizing the 12-month visit around those risks produced targeted iron and lead testing, concrete dietary and environmental changes and safety guidance for a newly walking toddler, alongside the five vaccines due.
References
Baker, R. D., Greer, F. R., & Committee on Nutrition. (2010). Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 126(5), 1040-1050. https://doi.org/10.1542/peds.2010-2576
Ruckart, P. Z., Jones, R. L., Courtney, J. G., LeBlanc, T. T., Jackson, W., Karwowski, M. P., Cheng, P.-Y., Allwood, P., Svendsen, E. R., & Breysse, P. N. (2021). Update of the blood lead reference value: United States, 2021. MMWR Morbidity and Mortality Weekly Report, 70(43), 1509-1512. https://doi.org/10.15585/mmwr.mm7043a4
Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics, 149(3), Article e2021052138. https://doi.org/10.1542/peds.2021-052138
What the NUR 636 Module 3 instructions ask for
Milestone One in NUR 636 usually asks for a well-child case study at a specific age: history from the parents, growth with percentiles, a focused examination, developmental surveillance or screening, age-appropriate screening tests, immunizations due and anticipatory guidance. The age is sometimes assigned and sometimes chosen, and three to five pages in APA 7 is typical for this NUR 636 milestone. Use the current schedule and guidelines for each element, document growth trajectories as well as single percentiles, apply the revised milestones correctly, justify screening tests with the child's risk factors and tailor guidance to the family's actual situation, since graders in this pediatric course reward visits organized around the child rather than a checklist.
How this NUR 636 Module 3 milestone one example is built
This case study documents a composite one-year-old who drinks 30 ounces of milk a day, lives in a 1942 rental with recently repainted windows and has a father who smokes outside. Growth follows her percentile lines, and the examination includes red reflexes, cover test, hips and gait. The Zubler revision of the CDC milestones is explained and applied. Hemoglobin screening follows Baker and Greer, with a borderline result linked to milk intake, and a venous lead level is read against the 2021 reference value described by Ruckart and colleagues. Five vaccines, fluoride varnish and tailored guidance on milk, iron, stairs, lead dust and smoking complete the whole visit.
Where the NUR 636 Module 3 rubric puts the points
For the NUR 636 well-child milestone, graders commonly look at history, growth with percentiles and trajectory, an age-appropriate examination, developmental surveillance, screening decisions, immunizations, anticipatory guidance and APA 7 writing. The best submissions cite current recommendations for each element of the visit, such as the revised milestones, the AAP iron guidance and the current lead reference value, and connect screening to specific risks found in the history. Graders reward guidance tailored to the family rather than generic lists and plans for following up abnormal results. Correct, complete immunization plans with consent and expected reactions are frequently checked point by point against the current schedule.
NUR 636 Module 3 help: the mistakes that cost points
Well-child milestones lose points when growth is reported without percentiles or trends, when outdated milestone lists or lead thresholds are used, when screening is done or skipped without reference to risk factors or when anticipatory guidance is a generic list unrelated to the family. A common gap is failing to plan follow-up for a borderline result. Use current charts and milestones, justify each screening test, name every vaccine due, tailor guidance to the child's diet, home and development and state how and when results will be communicated to the family. If your assigned age is newborn, four months or adolescence, send the prompt and template for a case study built for that visit.
Get NUR 636 Module 3 written to your instructions
Tell us the well-child age you are assigned and share your template and rubric. The case study you receive will document growth trends, apply the revised milestones, justify each screening test by risk, list the vaccines due and tailor guidance to the family, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
More NUR 636 papers and related MSN samples
- NUR 636 Module 1 Discussion: A Hesitant Parent at Two Months
- NUR 636 Module 2 SOAP Note: Bronchiolitis in a Six-Month-Old
- NUR 550 Module 5 Evidence Synthesis: What the Evidence on Multicomponent Delirium Prevention Says Together
- NUR 557 Module 2 Case Paper: Hypertension, a Thiazide and an ACE Inhibitor in a 68-Year-Old
- NUR 560 Module 8 Focused Assessment: Acute Monoarthritis: Gout or Septic Arthritis
- NUR 635 Module 5 Milestone Two: Retrieval, Spacing and a Real Near-Miss
NUR 636 Module 3 questions, answered
Where can I find a free NUR 636 Module 3 Milestone One sample?
A complete 12-month well-child case study is on this page, covering growth, revised CDC milestones, iron and lead screening, vaccines and tailored anticipatory guidance.
What changed in the 2022 CDC developmental milestones?
Milestones were revised to reflect skills that most children, about 75% or more, show by each age, so a missed milestone more clearly signals the need for evaluation.
When should children be screened for anemia?
The AAP recommends universal hemoglobin screening at about 12 months, along with assessment of risk factors such as high cow's milk intake.
What is the current blood lead reference value?
Since 2021, CDC uses 3.5 micrograms per deciliter to identify children with blood lead levels higher than most children their age.
Which vaccines are due at the 12-month visit?
Typically measles, mumps and rubella; varicella; the first dose of hepatitis A; and pneumococcal conjugate and Hib boosters, which can be given between 12 and 15 months.