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Child Health Note (CHN) files are produced with the assistance of expert professionals in Washington State who develop and edit content specific to their practice specialty. Current topics are those developed within the past 3-4 years. CHNs are in Microsoft Word® file format.  Instructions are provided for each CHN. Please read disclaimer.

Sending a CHN for the first time? Be sure to review the suggested guideline for using CHNs.

Current CHN Topics

Tools and Resources for Office Practice

Child Health Notes
Date Created
or Updated
Decision Tree: Child with Special Needs Referral Process
Option 1
Option 2
Important:Please read Instructions 12/16
Early Intervention Services Instructions 8/10
First Steps Program  (Generic version) Instructions  10/17
Formula for Full-Term Infants  (Generic PDF version) Instructions 1/15
Growth Charts Instructions 4/13
Oral Health Fact Sheets for CSHCN Instructions 10/10
Special Education/Collaboration with Primary Health Care Providers Instructions 1/09
WithinReach and ParentHelp123 Instructions 3/12
WithinReach Resource Finder:  Help for Children with Autism Spectrum Disorders and Other Special Health Care Needs and Their Families Instructions 10/15


Screening and Anticipatory Guidance

Child Health Notes
Date Created
or Updated
Adolescent Depression: Screening and Management in Primary Care    (Generic PDF Version) Instructions NEW 5/18
Blood Lead Screening and Testing Recommendations    (Generic PDF Version) Instructions 3/17
Developmental Surveillance and Screening in Primary Care    (Generic PDF version) Instructions Updated 4/14 (11/09)
Developmental Surveillance and Screening in Primary Care: How to “Wait and See Instructions Updated 4/14 ( 6/13)
Early Brain and Child Development Instructions 7/14
Hearing Screening in Infants and Children Instructions 6/10
Oral Health for Children – Early Childhood Caries Instructions 1/09
Oral Health Tips for Parents Instructions 1/09
Postpartum Depression — more common than you may think…and more significant for the child than you may be aware! Instructions   4/16
Red Flags in Speech and Language Development Instructions  9/16
Television and Screen Time Instructions 3/11
Toilet Training for Children with Special Needs Instructions 7/12
Vision Screening for Infants, Toddlers and Preschoolers Instructions 2013


Special Health Concerns

Early Identification and Diagnosis

Child Health Notes
Date Created
or Updated
Adverse Childhood Experiences (ACEs)     (Generic PDF version)

Instructions 3/15


Asthma in Childhood Instructions 10/11
Health Management of Children with Autism Spectrum Disorder: Co-Occurring Gastrointestinal Problems and Sleep Disorders Instructions NEW 12/17
What Is Autism Now? The New DSM-5 Definition   (Generic PDF version) Instructions  7/15
What’s new in Down syndrome? Information for counseling parents     ( Generic PDF version) Instructions  7/17
Fecal Incontinence (Encopresis) In Childhood     (Generic PDF version) Instructions 7/13
Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorders (FASD) Instructions 7/11
Fragile X Syndrome and Related Disorders (FXTAS,FX-POI) – Testing for Instructions 3/14
Neonatal Abstinence Syndrome (Generic PDF version) Instructions NEW 7/18
Newborn Screening Panel Updates      (Generic PDF version) Instructions 12/13
Obesity in Children with Special Health Care Needs Instructions 5/12
Late and Moderate Preterm Infants: Best Practices for a Population at Risk  (Generic PDF version) Instructions NEW 10/18
Speech Disfluency and Stuttering in Early Childhood Instructions  rev 3/17, 12/16
Tube Feedings: Managing the Nutrition Issues Instructions 12/12

See also Archived CHN Topics for older Child Health Notes.


When customizing any CHN for use in your community, we recommend that you check the resource information to assure absolute accuracy. If you plan to make changes to didactic content, please consult the CHN Project Coordinator.

This list will be updated as additional topics are developed. Recommendations for new topics are welcome. We encourage you to email us at to share your ideas for new CHN topics, suggestions for revisions to content or updates to resource information for any CHN.

For more information about Child Health Notes, please contact:

Kate Orville, MPH,
Tel: (206) 685-1279