A well-child visit note records a preventive checkup: growth, development, screening, immunizations, and guidance for the child’s age. Copy the free template, see a 12-month and a 5-year example, and check what each part needs.
Blank well-child visit template
FreeWELL-CHILD VISIT Patient: [Name] Date of birth and age: [Date; age in months or years] Date of visit: [Date] Visit: [Scheduled well-child visit, such as 12-month or 5-year] Accompanied by: [Caregiver and relationship to the child] Clinician: [Name, credentials] INTERVAL HISTORY Since the last visit: [Illnesses, emergency visits, hospital stays, new diagnoses, medication changes] Caregiver concerns: [Questions and worries raised today] Family and social changes: [New sibling, move, childcare or school change, stressors, supports] GROWTH Weight: [kg and lb, percentile] Length or height: [cm and in, percentile; length lying down under age 2] Head circumference: [cm and in, percentile; to age 2] Weight-for-length or BMI: [Weight-for-length percentile under age 2; BMI and BMI percentile from age 2] Trend: [Following the curve, or crossing percentile lines] Vital signs: [Temperature, HR, RR; BP from age 3, or earlier if at risk] NUTRITION AND DAILY HABITS Feeding: [Breast milk, formula, or milk with amount per day; solids, textures, cup use, self-feeding] Diet: [Fruits and vegetables, juice and sweet drinks, water, picky eating] Supplements: [Vitamin D, iron, fluoride, or none] Sleep: [Hours and naps, bedtime routine, night waking, sleep position and place for infants, snoring] Elimination: [Stool pattern, constipation, voiding, toilet training, bedwetting] Activity and screens: [Active play, daily screen time] DEVELOPMENT Screening tool: [Standardized tool and age form used, and the result; or not due at this visit] Gross motor: [Milestones seen or reported] Fine motor: [Milestones seen or reported] Language: [Words or sentences, understanding, speech clarity] Social and emotional: [Play, interaction, behavior] Autism screening: [Tool and result, if due at this age per local schedule] School or childcare: [Setting, readiness, progress, teacher concerns] SCREENING Vision: [Method and result, such as red reflex, instrument-based screening, or acuity in each eye] Hearing: [Newborn hearing result, or method and result today] Oral health: [Teeth, brushing with fluoride toothpaste, dental visits, fluoride varnish] Other screening: [Hemoglobin, lead exposure risk, or other tests due at this age per local practice] Caregiver and family: [Caregiver mood, family stress, food security] IMMUNIZATIONS Status: [Up to date per local schedule, or doses due] Given today: [Vaccines given; or declined, with the discussion recorded] Next due: [Vaccines and the age they are due] SAFETY AND ANTICIPATORY GUIDANCE Topics discussed: [Car seat or booster, water, fire, falls, poisons and medicines, safe storage, sun, helmets] Age-specific guidance: [What to expect before the next visit] PHYSICAL EXAMINATION General: [Appearance, interaction with caregiver and clinician] Findings: [Skin, head and fontanelle, eyes, ears, mouth and teeth, neck, heart, lungs, abdomen, genitalia, hips and spine, neurological and tone] ASSESSMENT AND PLAN Assessment: [Healthy child with normal growth and development, or the concerns found] Concerns: [Each concern, with its plan] Referrals: [Early intervention, audiology, eye care, dental, or other services] Forms: [School, childcare, or activity forms completed] Next visit: [Age of the next well-child visit, and reasons to come sooner] Signed: [Clinician name, credentials, date and time]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Pediatric clinic, scheduled well visit
12-month-old girl, seen with her mother. One cold since the 9-month visit; no emergency visits or hospital stays. No medicines. Her mother asks when to stop the bedtime breastfeed and whether her daughter should be walking yet. Mother back at work part-time; grandmother cares for her 3 days a week.
Weight 9.2 kg (20.3 lb), 60th percentile. Length 74 cm (29.1 in), 50th percentile. Head circumference 45 cm (17.7 in), 50th percentile. Weight-for-length 60th percentile. All following their curves. T 36.7 °C (98.1 °F), HR 118, RR 30.
Breastfeeds in the morning and at bedtime. Whole cow’s milk about 480 mL (16 oz) a day from an open cup; no bottle. Eats chopped soft family foods and feeds herself with her fingers. No juice. Vitamin D 400 IU daily. Sleeps 11 hours at night, wakes once, naps twice. Soft stool daily; 6 wet diapers a day. Plays on the floor most of the day; no screens.
ASQ-3, 12-month questionnaire, completed by her mother: above the cutoff in all five areas. Gross motor: pulls to stand, cruises, took 3 steps alone last week. Fine motor: pincer grasp, bangs two blocks together. Language: says “mama” and “dada” for her parents and one other word; follows a simple request with a gesture. Social: waves bye-bye, plays peekaboo, shy with strangers.
Vision: red reflex present and equal in both eyes, symmetric corneal light reflex, fixes and follows. Hearing: passed the newborn screen in both ears; turns to voices. Oral health: 6 teeth, no visible decay; teeth brushed twice a day with a smear of fluoride toothpaste; fluoride varnish applied. Hemoglobin, per local screening practice: 11.8 g/dL (118 g/L). Lead exposure questions: no risk factors. Family stress and food security: no concerns.
Up to date per the local schedule. Given today, after discussion with her mother: the 12-month vaccines on the local schedule, including MMR. Observed for 15 minutes; no reaction. Next vaccines due at the 15- to 18-month visit.
Rear-facing car seat for as long as the seat allows. Stair gates, window guards, and furniture anchored now that she is cruising. Medicines and cleaning products locked away; poison center number saved. Constant supervision in the bath and near water. Smoke and carbon monoxide alarms. Cow’s milk kept under 720 mL (24 oz) a day. Tantrums and clinginess are common at this age; consistent routines help.
Happy and interactive; cruising around the room. Anterior fontanelle small and soft. Ear drums normal. Heart regular, no murmur. Lungs clear. Abdomen soft, no masses. Normal female genitalia. Hips: full, equal abduction; legs equal in length. Spine straight. Tone and strength normal, moves all limbs equally. Skin: no rashes or unexplained bruises.
Healthy 12-month-old with normal growth and development. Most children walk alone by about 15 months; review if she is not walking by 18 months. Breastfeeding can continue for as long as mother and child wish; clean her teeth after the bedtime feed. First dental visit advised now. Next well-child visit at 15 months, sooner if any concerns.
Pediatric clinic, school-entry well visit
5-year-old boy, seen with his father, starting kindergarten in 2 months. Two colds this year; no emergency visits. No medicines or allergies. His father asks about bedwetting and needs the school health form. Lives with both parents and a 2-year-old sister.
Weight 19 kg (41.9 lb), 60th percentile. Height 110 cm (43.3 in), 50th percentile. BMI 15.7, 60th percentile. Following his curves. BP 98/58, normal for age and height. HR 92, RR 20.
Three meals and two snacks a day; picky with vegetables, eats fruit daily. Milk 2 cups (about 500 mL) a day, water otherwise; juice about once a week. Sleeps 10.5 hours a night; no snoring. Dry by day; wets the bed about once a week; no daytime accidents or constipation. About 1 hour of screens a day; plays outside after preschool.
PEDS completed by his father: no concerns. Gross motor: hops on one foot, catches a large ball. Fine motor: draws a person with several body parts, copies a triangle, writes some letters of his name. Language: speaks in full sentences, understood by strangers, tells a story with a beginning and an end. Social: takes turns, follows game rules, dresses himself. His preschool teacher reports no concerns.
Vision: 20/25 in each eye on a LEA Symbols chart; passed. Hearing: pure-tone screen passed in both ears. Oral health: no visible decay; brushes twice a day with fluoride toothpaste; dental checkups twice a year. No other screening due. Family: no concerns about food or housing.
Up to date per the local schedule. Given today, after discussion with his father: the 4- to 6-year booster vaccines on the local schedule, and the seasonal influenza vaccine. Next routine vaccines due in the preteen years per the local schedule.
Booster seat in the back seat until the seat belt fits properly. Helmet for bikes and scooters. Swimming lessons, and supervision near water. Crossing streets with an adult. Sun protection. Safe storage of medicines and any firearms in the home. Body safety: naming private parts and telling a trusted adult. A steady sleep and morning routine before school starts.
Well, chatty, and cooperative. Ear drums and throat normal. Teeth: no visible decay. Heart regular, no murmur. Lungs clear. Abdomen soft, no masses. Normal male genitalia, both testes descended. Spine straight. Gait and coordination normal. Skin normal.
Healthy 5-year-old, ready for school, with normal growth, development, vision, and hearing. Bedwetting once a week is common at this age: reassured; no treatment needed now; review at the next visit, or sooner if it bothers him or daytime symptoms start. School health form completed. Next well-child visit in 1 year.
Measured and plotted at every visit. The trend matters more than any single percentile.
Avoid: A percentile without the trend. A child who has always tracked the 10th percentile is different from one who has dropped from the 50th.
What and how the child eats, sleeps, and plays, in enough detail to guide your advice.
Avoid: Writing “eats well”. The volume of milk and the kinds of food are what your advice depends on.
Each domain, plus the result of any standardized screen: surveillance at every visit, and formal screens at the ages your local schedule sets.
Avoid: “Development normal” with nothing behind it. Name the milestones or the tool, so a change shows at the next visit.
Vision, hearing, oral health, and the other checks due at this age.
Avoid: Marking a screen “normal” without the method. “20/25 in each eye on a LEA Symbols chart” can be compared next year.
What was due, what was given, and what comes next.
Avoid: Leaving out a declined vaccine. Record what was offered, the information given, and the caregiver’s decision.
The topics you covered for this age, so the next clinician can pick up the rest.
Avoid: A stock paragraph pasted in at every age. List the topics you actually discussed.
Measure and plot it at every visit until age 2. A head crossing percentile lines can be the first sign of a problem that a single value misses.
Weigh infants undressed and measure length lying down until age 2. Poor technique creates false drops across percentiles.
A failed vision or hearing screen, or a development score below the cutoff, needs a referral or a rescreen date in the plan.
Parents often notice changes in development and behavior before the exam shows them. Ask first, and write down what they say.
Note the teeth, brushing with fluoride toothpaste, and a dental home from the first tooth. Tooth decay is common in young children, and preventable.
Vero Scribe writes the well-child note in your template from the visit conversation, with the caregiver’s consent, or from your dictation. You review and edit it, then copy it into your chart or EHR. It works in more than 60 languages.
Interval history and the family’s concerns, growth with percentiles, nutrition, sleep, and elimination, development by domain with any screening tool used, vision and hearing, immunizations, safety guidance, a full exam, and the plan with the next visit.
Common validated tools include the ASQ-3 and PEDS for general development, and the M-CHAT-R/F for autism. Record the tool, the age form used, and the result, and follow your local schedule for which visits need a formal screen.
The WHO charts are widely recommended from birth to age 2. After that, use the charts your organization follows, and record the percentile and the trend for each measure.
Usually at age 2. Keep measuring after that if there is a concern, such as a head that is large or small for age, or a developmental delay.
Record it under Concerns with its own assessment and plan, or book a separate visit if it needs more time. Keep the preventive parts of the visit complete.
Yes. Copy it, or download it as a Word or text file. No account needed.
The sick-visit SOAP note for children, with caregiver history, hydration, and weight-based doses.
Birth history, feeding and weight change, the full newborn exam, jaundice, and newborn screens.
The full pediatric history and exam for an admission or a new patient, from birth history to plan.
The adolescent psychosocial interview, from confidentiality and home life to safety online.
Well-child and sick-visit notes from child and caregiver conversations.
Notes, family instructions, and follow-up for pediatric practices.
The diagnosis codes used most in pediatric visits.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
No credit card required. 10 free actions every month.