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
Biannual dentist visit
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 5 and 6 Year Visits:
Growth and Physical Development
- Expected accelerated growth (for girls at ages 9–11, for boys at about age 12).
- Variation in onset of puberty among children.
- Upcoming physical changes and specific concerns. How the child compares to others on a standard growth chart.
- Healthy body weight based on genetically determined size and shape rather than on socially defined ideal weight.
- Positive body image. (People come in unique sizes and shapes, within a range of healthy body weights.) (See Tips for Fostering a ositive Body Image Among Children and Adolescents.)
- Assuring children that they are loved and accepted as they are, regardless of their size and shape.
- Eating healthy foods and being physically active to achieve or maintain a healthy weight.
- Weight loss should not occur in children with BMI below the 95th percentile; gradual weight loss of no more than 1 lb per month may be appropriate for children with BMI between the 95th and 99th percentiles. A weight loss of no more than 2 lbs per week may be appropriate for children with BMI above the 99th percentile. (But, even if they are losing weight, children need to consume sufficient calories and nutrients for growth and development.)
Social determinants of health
- Risks (neighborhood and family violence, food security, family substance use), strengths and protective factors (emotional security and self-esteem, connectedness with family)
- Teach your child nonviolent conflict-resolution techniques.
- 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.
- Encourage independence, self-responsibility; show affection; praise appropriately.
- Spend time with your child. Make time to talk.
Development and mental health
- Family rules and routines, concern for others, respect for others; patience and control over anger
- Continue family routines; assign household chores.
- Use discipline for teaching, not punishment.
- Model anger management/self-discipline.
- Solve conflict/anger by talking, going outside and playing, walking away.
School
- Readiness, established routines, school attendance, friends; after-school care and activities, parent-teacher communication
- Ensure child is ready to learn (regular bedtime routine, healthy breakfast).
- Tour school; attend back-to-school events.
- Be sure after-school care is safe, positive.
- Talk with child about school experiences.
- If child has special health care needs, be active in IEP process.
Physical growth and development
- Oral health (regular visits with dentist, daily brushing and flossing,
- adequate fluoride, limits on sugar-sweetened beverages and snacks), nutrition (healthy weight; increased vegetable, fruit, wholegrain consumption; adequate calcium and vitamin D intake; healthy foods at school), physical activity (60 minutes of physical activity a day)
- Help child with brushing teeth if needed.
- Visit dentist twice a year.
- Brush teeth twice a day; floss once.
- Help child choose healthy eating (provide healthy foods, eat together as a family, be a role model).
- Eat breakfast; eat vegetables/fruits.
- Eat when you’re hungry; stop when you’re satisfied. Drink milk 2 to 3 times a day.
- Limit sugary drinks/foods.
- Consider making family media use plan ( www.healthychildren.org/MediaU... ), which can help balance child’s 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.
- Be physically active often during the day.
Safety
- Car safety, outdoor safety, water safety, sun protection, harm from adults, home fire safety, firearm safety
- Use properly positioned belt-positioning booster seat in backseat.
- Teach safe street habits (crossing/riding school bus).
- Ensure child uses safety equipment (helmet, 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.
- 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; explain “privates.”
- Install smoke detectors and carbon monoxide detector/alarms; make fire escape plan.
- Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition locked separately.
- Oral Health
- Toothbrushing requires good fine motor control, and young children cannot clean their teeth without help. (After children acquire fine motor skills [ability to tie their shoelaces], typically by age 7 or 8, they can brush their teeth effectively.)
- Brushing teeth with fluoridated toothpaste twice a day (after breakfast and before bed).
- Drinking water when thirsty.
- Using community fluoridated water as a safe, effective way to reduce dental caries. (If bottled water is preferred, recommend a brand with fluoride added at a concentration of approximately 0.8–1.0 mg/L [ppm].)
- Limiting foods (candy, cookies) and beverages (juice, juice drinks, soft drinks) high in sugar.
Anticipatory Guidance
