The goals of the well-child visit for school-aged children (ages 6-12 years) are health promotion, disease prevention, disease detection, and anticipatory guidance. Critical components include the physical examination and developmental surveillance. Vaccines remain a cornerstone of disease prevention and should be administered on time. Screening for dental care, dyslipidemia, hearing, hypertension, mental health, overweight and obesity, scoliosis, social determinants of health, and vision should be considered or performed, and is often dictated by risk factors. Healthy lifestyle should be discussed at every well-child visit, including recommending 60 minutes/day of physical activity, adequate nutritional intake, 9 to 12 hours/night of sleep without disturbance, and routine dental care, including fluoride supplementation if not in the primary water supply. Social history should be reviewed, including media use and substance use and exposure. Children and families should be counseled on safety, including the leading cause of death in this age group: unintentional injury.
Case 3. RK is a 10-year-old child who is brought to your office by her mother for a well-child visit. The history and physical examination results are normal. The mother asks for your help in talking to RK about social media because she feels RK is too young for it. RK says that all her friends are using social media, and she feels left out because her mother will not let her create an account.
Well-Child Visit Goals
Well-child visits provide an opportunity to lay the foundation for current and future health within families. The goals of the well-child visit for school-aged children (ages 6-12 years) are health promotion, disease prevention, disease detection, and anticipatory guidance. For children and youth with special health care needs, this is also an opportunity to address existing needs, identify additional health care needs, and introduce individualized screening and anticipatory guidance.1 Table 1 summarizes age-specific developmental surveillance markers and physical examination recommendations for infants, children, and adolescents developed by the American Academy of Pediatrics (AAP).1
Table 1 Age-Specific Developmental Surveillance and Physical Examination Recommendations
| Age (years) | Developmental surveillance | Physical examination |
|---|---|---|
| 5-6 | Speech Has good articulation Tells a simple story using full sentences Uses appropriate tenses and pronouns Gross motor function Balances on 1 foot, hops, skips Fine motor function Ties a knot Has mature pencil grasp Draws a person with ≥ 6 body parts Prints some letters and numbers Copies squares and triangles General Counts to 10 Names at least 4 colors Follows simple directions Listens and attends Undresses and dresses with minimal assistance | Ocular motility assessment Observe the mouth for caries, gingivitis, and malocclusion Assess neurodevelopment through fine and gross motor skills and gait |
| 7-8 | Demonstrates social and emotional competence, including self-regulation Engages in healthy nutrition and physical activity behaviors Forms caring, supporting relationships with family members, other adults, and peers | Observe the mouth for caries, gingivitis, and malocclusion Assess the breasts and genitalia for a sexual maturity rating Assess the hip, knee, and ankle joints for function and gait |
| 9-10 | Demonstrates social and emotional competence, including self-regulation Engages in healthy nutrition and physical activity behaviors Forms caring and supportive relationships with family members, other adults, and peers Uses independent decision-making skills, including problem solving skills Displays a sense of self-confidence and hopefulness | Observe for signs of self-injury on the skin Assess the breasts and genitalia for a sexual maturity rating Examine the back |
| 11-14 | Engages in healthy nutrition and physical activity behaviors Forms caring and supportive relationships with family members, other adults, and peers Engages in a positive way with the life of the community Engages in behaviors that optimize wellness and contribute to a healthy lifestyle Chooses safety by wearing bike helmets, using seat belts, and avoiding alcohol and drugs Demonstrates physical, cognitive, emotional, social, and moral competencies, including self-regulation Exhibits compassion and empathy Exhibits resiliency when confronted with life stressors Uses independent decision-making skills, including problem-solving skills Displays a sense of self-confidence, hopefulness, and well-being | Inspect the skin for acne, acanthosis nigricans, atypical nevi, piercings, and signs of harm Examine the back and spine for deformities Assess breasts for a sexual maturity rating in females, and for gynecomastia in males |
Information from reference 1.
Read the full edition
Get immediate access, anytime, anywhere.
Choose a single edition, 1-year or 2-year full-access subscription.
Earn 4 CME credits for this edition.
