Health Maintenance in School-Aged Children: Part II. Counseling Recommendations
Am Fam Physician. 2019 Aug 15;100(4):219-226.
Author disclosure: No relevant financial affiliations.
School-aged children (five to 12 years) are establishing patterns of behavior that may last a lifetime; therefore, during health maintenance visits, it is important to counsel families on healthy lifestyle practices. Children should eat a diet high in fruits, vegetables, whole grains, low-fat or nonfat dairy products, beans, fish, and lean meats, while limiting sugar, fast food, and highly processed foods. Children should engage in 60 minutes of moderate to vigorous physical activity each day. A Family Media Use Plan should be used to individualize screen time limits and content for children. Nine to 12 hours of sleep per night is recommended for school-aged children. Inadequate sleep is associated with behavioral issues, difficulty concentrating at school, high blood pressure, and obesity. Children should brush their teeth twice per day with a pea-sized amount of toothpaste containing fluoride. Unintentional injury is the leading cause of death in this age group in the United States, and families should be counseled on vehicle, water, sports, firearm, home, environmental, and social safety. Because high-risk behaviors may start in early adolescence, many experts recommend discussing tobacco, alcohol, and drug use, including prescription drugs, beginning at 11 years of age. Sexually active adolescents should be counseled about the risk of sexually transmitted infections, and they should be screened for these infections if indicated.
Anticipatory guidance is appropriate at all ages, but it is particularly important in school-aged children (five to 12 years) because they are establishing patterns of behavior that may last a lifetime. This article, part II of a two-part series, discusses counseling recommendations in school-aged children. Part I, in this issue of American Family Physician, focuses on history, physical examination, screening, and immunization recommendations.1
SORT: KEY RECOMMENDATIONS FOR PRACTICE
USPSTF = U.S. Preventive Services Task Force.
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 recommendation||Evidence rating||Comments|
School-aged children should be counseled on healthy lifestyle habits, including eating a healthy diet, being active for at least 60 minutes per day, consistent screen media limits, obtaining adequate sleep, and practicing good dental hygiene.12,14–16,19–31
Based on expert consensus guidelines
Based on a Cochrane review of heterogeneous studies of home parenting interventions, mostly in socioeconomically disadvantaged populations
Adolescents 12 years and older should be screened for major depressive disorder using a validated tool such as the Patient Health Questionnaire for Adolescents and the Beck Depression Inventory for primary care.3
Based on a USPSTF recommendation
Based on a USPSTF recommendation
Sexually active females younger than 25 years should be screened for chlamydia and gonorrhea annually. Adolescents with multiple partners or high-risk sexual behavior should be screened for syphilis and HIV. All adolescents should be s
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