Bright Future -9 and 10 Year Visits
Health supervision
Surveillance of development
- Demonstrates social and emotional competence (including self-regulation)
- Engages in healthy nutrition and physical activity behaviors
- Uses independent decision-making skills (including problem-solving skills)
- Forms caring and supportive relationships with family members, other adults, and peers
- Displays a sense of self-confidence and hopefulness
Observation of Parent-Child interaction
How do parent and child interact with each other? How do parent and child interact with health care professional?
Complete Physical Examination, including
Measure: Blood pressure and compare with norms
Measure and plot: Height, weight, and BMI
Assess/observe for: Signs of self-injury, SMR
Examine: Back
Screening (www.aap.org/periodicityschedule)
9 year Visit
universal: Dyslipidemia (once between 9 Year and 11 Year Visits)
selective: Anemia; Hearing; Oral Health; Tuberculosis; Vision
10 year Visit
universal: Dyslipidemia (once between 9 Year and 11 Year Visits); Hearing; Vision
selective: Anemia; Oral Health; Tuberculosis
Immunization
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 (neighbor- hood 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
- 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.
- Put family computer in easily seen place; monitor computer use; install safety filter.
How much do you know about your child’s Internet use? - Don’t give out personal information online.
What would you do if you went on a site that scared you? - Encourage new opportunities, activities, helping out at home/in community.
- Spend time with your 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 manage- ment; provide personal space at Be a role model for positive behavior.
- Supervise activities with peers.
What do you and your friends like to do together? What do you do when your friends pressure you to do things you don’t want to do? - 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.
How well do you and your partner agree on how to talk with your child about sexual development and sexuality? How would you respond if your child asked you about homosexuality?
What questions do you have about the way your body is developing?
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.
What are some things you are good at? - 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, after-school 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).
What concerns do you have about your weight?
How do you feel about how you look? - 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 (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.
Safety: Car safety, safety during physical activity, water safety, sun protection, knowing child’s friends and their families, firearm safety
- The backseat is the safest place to 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.
What would you do if you felt unsafe at a friend’s house? - Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition Homicide and completed suicide are more common in homes with firearms.
Have you considered not owning a firearm because it poses a danger to the family?
What have your parents taught you about firearms and firearm safety?