INITIAL HISTORY
MEASUREMENTS:
- Length/Height and Weight
- Blood Pressure
- BMI
SENSORY SCREENING
- Vision/Hearing
DEVELOPMENTAL/BEHAVIORAL HEALTH
Psychosocial/Behavioral Assessment: Pediatric Symptoms Checklist (PSC)
Developmental Surveillance: DENVER
Nutrition
Common Nutrition Concerns
- Decrease in consumption of milk and other milk products.
- Increase in consumption of sweetened beverages, especially soft drinks.
- Limited intake of fruits and vegetables.
- Higher consumption than recommended of foods high in fat, especially saturated and trans fats.
- Rise in overweight and obesity.
- Increase in body image concerns. (See Key Indicators of Nutrition Risk for Children and Adolescents.)
Nutrition Supervision
- A child’s nutrition status should be evaluated during nutrition supervision visits or as part of health supervision visits.
- Health professionals can do the following:
- Begin nutrition supervision by selectively asking interview questions or by reviewing a questionnaire filled out by parents before the visit. Continue by conducting screening and assessment and providing anticipatory guidance. Recognize that interview questions, screening and assessment, and anticipatory guidance will vary from visit to visit and from child to child.
- See Strategies for Health Professionals to Promote Healthy Eating Behaviors.
Discuss With Parents, the Child, or Both
Eating Behaviors and Food Choices
- Increasing the variety of foods the child eats and finding ways to incorporate new foods into the child’s diet.
- Making healthy foods choices based on Dietary Guidelines for Americans (fruits, vegetables, grain products [especially whole grain]; low-fat [1%] and fat-free [skim] milk products [milk, cheese, yogurt]; and lean meats, poultry, fish, beans,eggs, and nuts).
- Energy requirements are influenced by growth, physical activity level, and body composition.
- Children ages 2 to 8 need to drink 2 cups of low-fat (1%) or fat-free (skim) milk per day or consume the equivalent from other milk products (cheese, yogurt).
- Children ages 9 and older need to drink 3 cups of low-fat (1%) or fat-free (skim) milk per day or consume the equivalent from other milk products.
- Providing a vitamin D supplement of 400 IU per day for children who do not obtain 400 IU per day of vitamin D through vitamin D–fortified milk (100 IU per 8-oz serving) and vitamin D–fortified foods (fortified cereals, eggs [yolks]).
- Eating 3 meals and 1 to 2 snacks per day. Choosing healthy foods for meals and snacks rich in complex carbohydrates (whole-grain products, fresh fruits and vegetables).
- Making family mealtimes a priority.
- Providing a relaxed atmosphere for mealtimes and getting rid of distractions (television).
- Limiting foods high in calories and low in nutrients.
- Limiting foods high in fat, especially high in saturated and trans fats (chips, french fries), and foods (candy, cookies) and beverages (fruit drinks, soft drinks) high in sugar.
- Enrolling child in school breakfast and lunch programs, if needed. (See Federal Nutrition Assistance Programs.)
PHYSICAL EXAMINATION
PROCEDURES
Immunization (flu)
Influenza: This infection causes high fever, chills, severe muscle aches, headaches, pneumonia, swelling of the brain and death. There are still thousands of deaths every year in the U.S. from influenza related complications
- Anemia
- Dislipidemia
- Tuberculosis
ORAL HEALTH
ANTICIPATORY GUIDANCE
- The first priority is to attend to the concerns of the parents. In addition, the Bright Futures Middle Childhood Expert Panel has given priority to the following topics for discussion in the 9 and 10 Year Visits: Social determinants of health: Risks (neighborhood and family violence, food security, family substance use, harm from the Internet), strengths and protective factors (emotional security and self-esteem, connectedness with family and peers)
- Teach your child nonviolent conflict-resolution techniques.
- If concerns at school, ask for help from teacher/ principal; discuss bullying.
- Talk with parents/trusted adult if you are bullied.
- Contact community resources like SNAP for help with food assistance.
- Don’t use tobacco/e-cigarettes. Call 800-QUITNOW (800-784-8669) for help to quit smoking. Talk with me if you are worried about family member drug/alcohol use.
- Put family computer in easily seen place; monitor computer use; install safety filter.
- Don’t give out personal information online.
- Encourage new opportunities, activities, helping out at home/in community.
- Spend time with your child. Discuss changing responsibilities within family. Clearly communicate rules, expectations.
- Get to know child’s friends.
- Making and keeping friends is an important life skill.
- Development and mental health: Temper problems, setting reasonable limits, friends; sexuality
- (pubertal onset, personal hygiene, initiation of growth spurt, menstruation and ejaculation, loss of baby fat and accretion of muscle, sexual safety)
- Anticipate new adolescent behaviors, importance of peers.
- Reinforce values; encourage discussion of thoughts/feelings, appropriate anger management; provide personal space at home. Be a role model for positive behavior.
- Supervise activities with peers. Answer questions about puberty/sexuality; counsel to avoid sexual activity; teach rules for how to be safe with adults: (1) no adult should tell a child to keep secrets from parents; (2) no adult should express interest in private parts; (3) no adult should ask a child for help with his/her private parts.
- School: School attendance, school problems (behavior or learning), school performance and progress, transitions, co-occurrence of middle school and pubertal transitions
- Show interest in school performance/activities; if concerns, ask teacher about extra help.
- Create quiet space for homework.
Physical growth and development
- Oral health (regular visits with dentist, daily brushing and flossing, adequate fluoride, avoidance of sugar sweetened beverages and snacks), nutrition (healthy weight, disordered eating behaviors, importance of breakfast, limits on saturated fat and added sugars, healthy snacks), physical activity (60 minutes of physical activity a day, afterschool activities) Visit dentist twice a year.
- Give fluoride supplements if dentist recommends.
- Brush teeth 2 minutes, twice a day; floss once.
- Wear mouth guard during sports.
- Help child choose healthy eating (provide healthy foods, eat together as a family, be a role model).
- Eat breakfast; eat vegetables/fruits/whole grains/ low-fat or nonfat dairy/lean protein.
- Eat when you’re hungry; stop when you’re satisfied.
- Limit foods/drinks high in sugar/saturated fats/ refined grains.
- Talk with me before trying to lose weight.
- Be physically active often during the day.
- Consider making family media use plan ( www.healthychildren.org/MediaU... ), which can help balance hilds needs for physical activity, sleep, school activities, and unplugged time; decide on rules for media time in time left over after all other activities; take into account quantity, quality, location of media use.
Safety
- Car safety, safety during physical activity, water safety, sun protection, knowing child’s friends and their families, firearm safety he backseat is the safest place to ride. Switch from booster seat to seat belt in rear seat when child is ready.
- Use safety equipment (helmets, pads).
- Teach child to swim; supervise around water. Use sunscreen; wear hat; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
- Know child’s friends; make plan for personal safety.
- Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition separate. Homicide and completed suicide are more common in homes with firearms.
