Health Maintenance in School-Aged Children: Part I. History, Physical Examination, Screening, and Immunizations

 

Am Fam Physician. 2019 Aug 15;100(4):213-218.

This is part I of a two-part article on health maintenance in school-aged children. Part II, “Counseling Recommendations,” appears in this issue of AFP.

The goals of the health maintenance visit in school-aged children (five to 12 years) are promoting health, detecting disease, and counseling to prevent injury and future health problems. During the visit, the physician should address patient and parent/caregiver concerns and ask about emergency department or hospital care since the last visit; lifestyle habits (diet, physical activity, daily screen time, secondhand smoke exposure, hours of sleep per night, dental care, safety habits); and school performance. Poor school performance may indicate problems such as learning disabilities, attention-deficit/hyperactivity disorder, or bullying. Previsit questionnaires and psychosocial screening questionnaires are also useful. When performing a physical examination, the physician should be alert for signs of abuse. Children should be screened for obesity (defined as body mass index at or above the 95th percentile for age and sex), and obese children should be referred for intensive behavioral interventions. Although its recommendations are primarily based on expert opinion, the American Academy of Pediatrics recommends screening for hypertension annually, vision and hearing problems approximately every two years, and dyslipidemia once between nine and 11 years of age; regular screening for risk factors related to social determinants of health is also recommended. There is insufficient evidence to recommend routine screening for depression before 12 years of age, but depression should be considered in children younger than 12 years presenting with unexplained somatic symptoms, restlessness, separation anxiety, phobias, or hallucinations. Children living in areas with inadequate levels of fluoride in the water supply (0.6 ppm or less) should receive daily fluoride supplements. Age-appropriate immunizations should be given, as well as any catch-up immunizations.

The goals of the health maintenance visit in school-aged children (five to 12 years) are promoting health, detecting disease, and counseling to prevent injury and future health problems. It is also an opportunity for family physicians to stay connected with children and their families. Health maintenance visits should focus on evidence-based screening and counseling interventions that have a beneficial effect on children's health. This article, part I of a two-part series, discusses history, physical examination, screening, and immunization recommendations for health maintenance in school-aged children. Part II, in this issue of American Family Physician (AFP), focuses on counseling recommendations.1

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

School-aged children should be screened for obesity by measuring body mass index. Those with obesity (i.e., body mass index at or above the 95th percentile) should be offered resources and referral for comprehensive, intensive behavioral interventions.13,14,18

B

Based on studies showing that intensive (more than 26 contact hours) behavioral interventions can result in reduced weight; evidence for less-intensive interventions is inconclusive

The American Academy of Pediatrics recommends annual blood pressure measurements in school-aged children, or at every health care encounter in those who have risk factors.12,17

C

Based on expert opinion from the American Academy of Pediatrics; the U.S. Preventive Services Task Force, however, found insufficient evidence to assess the benefits and risks of universal blood pressure screening in children and adolescents15

Children living in areas with inadequate fluoride in the water supply (0.6 ppm or less) should take a daily fluoride supplement.27,28

B

Based on expert opinion and a small number of placebo-controlled trials

School-aged children should receive age-appropriate immunizations, as well as catch-up immunizations if needed.29,30

A

Based on consistent evidence from randomized controlled trials showing reduced incidence of disease and complications when children receive immunizations


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

School-aged children should be screened for obesity by measuring body mass index. Those with obesity (i.e., body mass index at or above the 95th percentile) should be offered resources and referral for comprehensive, intensive behavioral interventions.13,14,18

B

Based on studies showing that intensive (more than 26 contact hours) behavioral interventions can result in reduced weight; evidence for less-intensive interventions is inconclusive

The American Academy of Pediatrics recommends annual blood

The Authors

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MARGARET RILEY, MD, FAAFP, is an associate professor in the Department of Family Medicine at the University of Michigan Medical School and medical director for Michigan Medicine's Regional Alliance for Healthy Schools, Ann Arbor....

LEIGH MORRISON, MD, is an academic fellow and clinical lecturer in the Department of Family Medicine at the University of Michigan Medical School.

ANNA McEVOY, MD, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School.

Author disclosure: No relevant financial affiliations.

Address correspondence to Margaret Riley, MD, FAAFP, Chelsea Health Center, 14700 E. Old U.S. Hwy 12, Chelsea, MI 48118. Reprints are not available from the authors.

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show all references

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