Bright Future – 5 and 6 Year Visits
Health supervision
Surveillance of development
- Balances on one foot; hops; skips
- Is able to tie a knot; can draw person with at least 6 body parts; prints some letters/numbers; is able to copy squares and triangles
- Has good articulation/language skills; can count to 10; names 4 or more colors
- Follows simple directions; dresses with minimal assistance
Observation of Parent-Child interaction
How do parent and child interact? Is parent positive and supportive of child? How do parent and child interact with health care professional? Does parent engage child in an age-appropriate manner?
Complete Physical Examination, including
Measure: Blood pressure and compare with norms
Measure and plot: Height, weight, and BMI
Assess/observe for: Ocular motility; caries, gingival inflammation, malocclusion; fine/gross motor skills, gait
Screening (www.aap.org/periodicityschedule)
5 Year Visit
universal: Hearing; Oral Health (in absence of dental home); Vision
selective: Anemia; Lead; Oral Health; Tuberculosis
6 Year Visit
universal: Hearing; Vision
selective: Anemia; Dyslipidemia; Lead; Oral Health; Tuberculosis
Immunization
CDC: www.cdc.gov/vaccines
AAP: http://redbook.solutions.aap.org
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:
social determinants of health: Risks (neighbor- hood 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
- Talk with parents/trusted adult if you are bullied.
- Contact community resources, like SNAP, for help with food assistance.
Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more? - Don’t use tobacco/e-cigarettes. Call 800-Quit- NoW (800-784-8669) for help to quit 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 Make time to talk. How are you getting along as a family? What do you do together?
Development and mental health: Family rules and routines, concern for others, respect for others; patience and control over anger
- Continue family routines; assign household
- Use discipline for teaching, not
- Model anger management/self-discipline.
- Solve conflict/anger by talking, going outside and playing, walking away.
What makes you sad/angry? How do you handle it?
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.
What concerns do you have about your child’s ability to do well in school? - 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 floss- ing, adequate fluoride, limits on sugar-sweetened beverages and snacks), nutrition (healthy weight; increased vegetable, fruit, whole-grain 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 ( healthychildren.org/MediaUsePlan), 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.”
Have you talked with your child about ways to avoid sexual abuse? - What would you do if a grown-up made you scared? Who could you tell? Who would help you?
- 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.