Reading milestones
Trends → Milestones tracks developmental progress by domain, as the family records it in Heartful Baby.
What you see
Milestones are grouped by developmental domain and marked as the family observes them, so the record shows both what the child has reached and what is still outstanding for their age.
For a preterm infant, read milestones against corrected age, the same way you would growth. A baby born at 30 weeks is not late on a milestone their corrected age has not reached yet. See Reading the growth curve for how corrected age works elsewhere in the chart.
What to look for
- Completion that is falling behind in one domain while the others keep pace, which is more informative than overall lateness
- A domain with nothing recorded for a long stretch, which may mean the family stopped logging rather than the child stopped progressing
- Delays worth raising with the pediatrician. Milestones are parent-observed, so treat them as a prompt for assessment rather than as an assessment
Where this belongs in a visit
Milestones are a good pre-visit read because they are quick, and because a family who has been recording them has usually been paying close attention to something they want to discuss.
Vaccination compliance
Unlike the other records in this section, vaccinations live on the patient's Care Plan → Vaccines tab rather than Trends.
The schedule follows the AAP Recommended Childhood and Adolescent Immunization Schedule, 2026, covering 39 doses across 16 vaccines from birth through 18 years. Both you and the family can record doses, and you see the same record either way.
Reading the tab
Four tiles run across the top and answer the compliance question before you look at anything else:
| Tile | Tells you |
|---|---|
| Status | Up to date through a given age, next to the patient's current age |
| Overdue | How many doses are overdue, and the first few by name |
| Due soon | What is coming up |
| Seasonal and annual | Flu, COVID, and RSV standing separately from the routine series |
Below the tiles is an AAP-style grid: one row per vaccine, one column per age band from birth to 17–18 years, with the patient's current age column highlighted. Recurring vaccines sit in their own band at the bottom, with one marker per season rather than per dose.
By default the grid shows routine vaccines only. Filter chips switch in the other AAP categories: high risk, shared decision, and desire for protection.
Per-dose statuses
| Status | Meaning |
|---|---|
| Complete | A dose is recorded |
| Due soon | Within a month of the recommended age |
| Overdue | Past the recommended window |
| Pending | A future dose, not yet due |
| Missed | A past season for an annual vaccine. It cannot be closed retroactively |
| Out of season | A seasonal dose outside its season, currently RSV outside October to March |
| Not applicable | A high-risk dose for a patient not flagged high risk |
| Declined | The family chose not to give it. A reason is recorded |
| Contraindicated | A medical contraindication. A reason is recorded |
Click any dose to open its detail panel, which shows the AAP category, the recommended age and window, the minimum interval from the previous dose, and whether the vaccine is live, seasonal, or annual.
Recording a dose
You can record doses yourself, from the same detail panel.
- Select the dose in the grid.
- Choose a status: Given, Declined, or Contraindicated.
- Set the date, and add the provider and a note if useful.
- For declined or contraindicated, enter a reason. It is required.
Recording a dose given in error can be undone with Cancel on that dose.
Families record doses too, from Heartful Baby, and those appear here the same way. They cannot mark a dose declined or contraindicated, so those two statuses always come from a clinician.
Catch-up and preterm
For a patient behind schedule, the detail panel shows an earliest valid date, calculated from the previous dose plus the minimum interval in the AAP catch-up tables. The platform does not rebuild the rest of the schedule around it, so plan the remaining doses yourself.
Preterm infants are scheduled by chronological age, matching AAP guidance, so this tab does not apply corrected age the way growth and milestones do. A baby born at 30 weeks is due their 2-month doses 2 months after birth.
Seasonal and annual vaccines
Three vaccines do not follow the age-based series:
- Influenza is annual, from 6 months, evaluated per flu season running August through July.
- COVID-19 is annual, from 6 months, evaluated by season in the same way.
- RSV monoclonal antibody is seasonal rather than annual. It shows as out of season outside October to March.
Because these repeat, a past season that was never covered shows as missed rather than overdue. That is deliberate: you cannot give last year's flu shot now.
Where else it shows
- The snapshot panel on Summary carries a one-line vaccination status.
- The family's Clinician PDF includes the full record as of the moment they generate it, plus a line naming what is due next.
Well-child visits
Heartful Baby tracks the family's well-child visits against the AAP schedule and nudges them to book. This happens on the family's side, so it is worth knowing what they are being told and what reaches you.
What the family sees
The app shows the AAP well-child schedule as a timeline covering the first six years, with fifteen visits: newborn, then 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months, then yearly at 3, 4, 5 and 6 years.
Each entry ticks off automatically when the family logs a visit that falls in its age window. Visits that do not fall in any window are still recorded, they just sit outside the schedule.
What the app reminds them about
- Before a booked visit, at whatever notice the family has chosen.
- When the child enters a visit window and nothing is booked, a nudge follows a few days later.
- When the next window is still ahead, the reminder is scheduled for the day the child reaches that age.
The wording is a prompt to book, not clinical advice.
What reaches you
Well-child visits are recorded in the family's app, not in your patient record, so there is no next-visit-due indicator on your side.
What you get is the family's Clinician PDF, which carries a line naming their most recent visit, its type, and how long ago it was. The Well-Visit preset on that report turns on every section, including growth, milestones and the full vaccination record, which is what makes it useful to receive before a visit.
Vaccines and visits are tracked separately
The vaccine schedule and the visit schedule are independent. The app will not tell a family which vaccines are due at their upcoming visit, and ticking off a visit does not record any dose.
In practice the age bands line up, since both follow AAP, so a family arriving for their 6-month visit is usually due their 6-month doses. Confirm that against the Vaccines tab rather than assuming it.