Health Maintenance in School-Aged Children: Part II. Counseling Recommendations

 

Am Fam Physician. 2019 Aug 15;100(4):219-226.

This is part II of a two-part article on health maintenance in school-aged children. Part I, “History, Physical Examination, Screening, and Immunizations,” appears in this issue of AFP.

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

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

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.12,1416,1931

C

Based on expert consensus guidelines

School-aged children should be taught safety precautions, and parents should be encouraged to model safe behaviors.38

B

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

B

Based on a USPSTF recommendation

Sexually active adolescents should receive intensive behavioral counseling on the prevention of sexually transmitted infections.7

B

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 screened for HIV beginning at 15 years of age.8,10,11

A

Based on USPSTF recommendations


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.

The Authors

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AMY LOCKE, MD, FAAFP, is a clinical associate professor in the Department of Family and Preventive Medicine at the University of Utah Health, Salt Lake City, and an adjunct assistant professor in the Department of Family Medicine at the University of Michigan, Ann Arbor. She is also codi-rector of the Resiliency Center in the Office of Wellness and Integrative Health at the University of Utah Health....

KIRSTEN STOESSER, MD, is the program director of the Family Medicine Residency Program and a clinical associate professor in the Department of Family and Preventive Medicine at the University of Utah Health.

KARLY PIPPITT, MD, FAAFP, is a clinical associate professor in the Department of Family and Preventive Medicine at the University of Utah Health. She is also an assistant dean of community faculty in the Office of Academic Affairs and Education at the University of Utah Health.

Address correspondence to Amy Locke, MD, FAAFP, 555 Foothill, Salt Lake City, UT 84109 (email: amy.locke@hsc.utah.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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