Contents
Physical Examination
Always plot the weight, height, and BMI on a growth chart. Measure blood pressure. You are looking for trends. Do not just look at the numbers obtained during the visit. How do they compare to the last well visit? Last well visit the weight was at the 25th percentile but this time it is at the 75th percentile….what happened?
Click to view the Individual Growth Charts website
Bright Futures emphasizes the following elements of the PE as priorities for this age group.
| Eyes | Mouth | Neurologic |
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Screening [5-6 Years]
Screening – 5 Year |
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| Universal Screening | Action | |
| Hearing | Audiometry | |
| Oral Health (in the absence of a dental home) | Apply fluoride varnish every 6 months. | |
| Vision | Objective measure with age-appropriate visual acuity measurement using HOTV or LEA symbols. Instrument-based measurement may be used for children who are unable to perform acuity testing. | |
| Selective Screening | Risk Assessment | Action if Risk Assessment Positive (+) |
| Anemia | + on risk screening questions | Hematocrit or hemoglobin |
| Lead | If no previous screen and + on risk screening questions or change in risk | Lead blood test |
| Oral Health | Does not have a dental home | Referral to dental home |
| Primary water source is deficient in fluoride. | Oral fluoride supplementation | |
| Tuberculosis | + on risk screening questions | Tuberculin skin test |
*See the Evidence and Rationale chapter for the criteria on which risk screening questions are based.
Screening — 6 Year
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| Universal Screening | Action | |
| Hearing | Audiometry | |
| Vision | Objective measure with age-appropriate visual-acuity measurement using HOTV or LEA symbols, Sloan letters, or Snellen letters | |
| Selective Screening | Risk Assessment | Action if Risk Assessment Positive (+) |
| Anemia | + on risk screening questions | Hematocrit or hemoglobin |
| Dyslipidemia | + on risk screening questions and not previously screened with normal results | Lipid profile |
| Lead | If no previous screen and + on risk screening questions or change in risk | Lead blood test |
| Oral Health | Does not have a dental home | Referral to dental home |
| Primary water source is deficient in fluoride. | Oral fluoride supplementation | |
| Tuberculosis | + on risk screening questions | Tuberculin skin test |
Table Retrieved from: https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_MiddleChildhoodVisits.pdf
IMMUNIZATIONS [5-6 Years]
4-6 Years
- DTaP #5
- IPV #4
- MMR #2
- Varicella #2
- Influenza annually
From CDC National Immunization Program: www.cdc.gov/vaccines
ANTICIPATORY GUIDANCE [5-6 Years]
Review the priorities listed in the beginning of the module. These questions will vary from family to family and visit to visit. You can modify the questions to match your communication style.
Neighborhood and family violence
- Discuss bullying.
- Ask about violence in the community and neighborhood.
- Ask if child has been in any fights.
Food Security
- Do you ever worry about having enough money to buy food?
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Have you ever run out of food and not had any money to buy more?
Family Substance Use
- Ask about tobacco, e-cigarettes, alcohol, and drugs in the household.
- Does the parent have any concerns?
- Provide national hotline and any local resources for smoking cessation. 800-QUIT-NOW
Emotional Security and Self-esteem
- Ask about child’s self-confidence.
- Ask child about accomplishments, offer praise.
Family
- Ask about family activities.
- Encourage reading and playing together.
- Limit media.
- Establish family rules and remain consistent in enforcement.
- Avoid corporal punishment for breaking rules.
- Encourage responsibility for age-appropriate chores.
- Encourage socialization with peer groups in organized and nonorganized activities.
Physical Activity, Nutrition, & Oral Health
- Encourage a variety of fruits and vegetables.
- Ask about sweetened beverages (juice, sports drinks, fruit drinks, soda, etc.).
- Encourage breakfast!
- Ask about physical activity.
- Encourage 60 minutes of play daily.
- Ask about brushing and flossing.
- Dental visits should occur every 6 months.
- Ask if any teeth have been lost.
School Readiness, Attendance, Friends
- Encourage parents to teach/model moral behavior and good citizenship.
- Ask if child attends a preschool program.
- Ask child if he is excited for school.
- Ask about school friends.
Safety
- Ask about car seat or booster seat.
- Backseat is the safest place until 13 years of age.
- Discuss importance of safety equipment when riding bikes, skating, and playing sports.
- Encourage swimming lessons.
- Emphasize sunscreen, and reapply every 2 hours.
