5 year old well child visit soap note

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• Sep 8, 2021

Well Child Check: 5 year old

SUBJECTIVE:

5 yo _ here for well child check. No parental concerns at this time.

REVIEW OF SYSTEMS:

- Diet: No concerns.

- Fast food, soda, juice intake: _

- Calcium intake: _

- Voiding/stooling: No concerns. + toilet trained (in the day at least).

- Sleeping: No concerns. Has regular bedtime routine.

- Dental: + brushes teeth. Sees the dentist regularly.

- Behavior: No concerns.

- Activity: Screen/TV time is limited to < 2 hrs/day, gets time outside every day.

Normal pregnancy and delivery. No surgeries, hospitalizations, or serious illnesses to date.

DEVELOPMENT:

- Gross and fine motor: Hops and skips, holds crayon or pencil well, rides a bike, able to tie a knot; copies squares and triangles.

- Cognitive: Draws a person with head, body, and limbs (6+ body parts); knows at least 4 colors; counts to 5 or 10; can explain the use of a ball or shoe.

- Social/Emotional: Plays cooperatively, plays board/card games, plays make-believe, listens and attends.

- Communication: Can speak in full sentences and tell a story, recognizes most letters, prints some letters and numbers.

- In kindergarten

- After-school activities:

- No smokers in the home.

- No major social stressors at home.

- No safety concerns in the home.

- No TB or lead risk factors.

IMMUNIZATIONS:

- Up to date.

- VITALS: _

- GEN: Normal general appearance. NAD.

- HEAD: NCAT.

- EYES: PERRL, red reflex present bilaterally. Light reflex symmetric. EOMI, with no strabismus.

- ENMT: TMs and nares normal. MMM. Normal gums, mucosa, palate, OP. Good dentition.

- NECK: Supple, with no masses.

- CV: RRR, no m/r/g.

- LUNGS: CTAB, no w/r/c.

- ABD: Soft, NT/ND, NBS, no masses or organomegaly.

- GU: Normal _male genitalia. Testes descended bilaterally.

- SKIN: WWP. No skin rashes or abnormal lesions.

- MSK: No deformities. Normal gait. No clubbing, cyanosis, or edema.

- NEURO: Normal muscle strength and tone. No focal deficits.

GROWTH CHART: Following growth curve well in all parameters. BMI at _ percentile.

LABS/STUDIES:

- Urine dip normal.

- Hearing screen normal.

- Snellen testing: _

ASSESSMENT/PLAN:

* Healthy 5 yo child

- The family was given a children’s book today (per “Reach Out and Read” program).

- CBC ordered. No indication for a lipid panel or DM screening.

- Follow up at 6 years of age, or sooner PRN.

- ER/return precautions discussed.

* Vaccines today:

- Influenza

* Anticipatory guidance (discussed or covered in a handout given to the family)

- Safety: Street/car safety, strangers, gun safety, helmets and safety equipment.

- Booster seat required by law until 8 yrs old or 4’9”

- Food and exercise: Limiting juice and junk/fast food, exercise.

- Memorize name, address, and phone number.

- Speech: Importance of reading, limiting screen time.

- Dental care and fluoride; dental visits

- Hazards of second hand smoke

• Encounter Notes

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Home > Blog > Pediatric SOAP Notes (With Examples and Template)

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Pediatric SOAP Notes (With Examples and Template)

Courtney Gardner, MSW

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You won't believe the transformation your SOAP notes will undergo when you start working with kids! It's time to take your pediatric SOAP notes to the next level. Get ready to learn how to make your notes to fit the needs of your little clients, including what to include, examples, templates, and expert tips. We'll also explore pediatric documentation's unique benefits and challenges and why it demands a specialized approach. Let's explore pediatric documentation's distinct benefits and challenges so you can improve your notes for little ones, regardless of your experience level.

What Are SOAP Notes and Why Use Them for Pediatric Clients?

When working with children, it's essential to use SOAP notes.  SOAP notes are a type of progress note used by mental health providers to document patient encounters. SOAP notes are valuable for tracking a child's progress , communicating with other providers, and justifying medical necessity for insurance purposes.

The acronym stands for:

• S ubjective - The client's chief complaint and history in their own words
• O bjective - Your observations and measurements
• A ssessment - Your analysis and impressions
• P lan - Your plan for treatment, follow-up, and goals

For pediatric clients, SOAP notes offer a structured and consistent way to document developmental milestones, behavioral changes, responses to treatment, and more. This comprehensive record can help monitor growth and skills and assess the effectiveness of interventions .

Adapting SOAP Notes for Pediatric Behavioral Health

When documenting pediatric behavioral health care, it's essential to adapt SOAP notes to the unique needs of young patients. This involves asking creative questions to understand their thoughts and feelings,  observing behaviors and emotions, and considering developmental stages and family dynamics in assessments. Plans may also involve parental involvement or community resources.

Pediatric SOAP notes require modifications to accommodate the needs of child patients and their families. Here are the key adaptations:

• Shorter, more straightforward sentences and words.  Sentence length should aim for 8-12 words to match a child's attention span. Avoid complex medical terminology.
• More spacing and bullet points.  Extra spacing between each section and bullet points within sections make the notes easier for children and caregivers to follow.
• Pictures and drawings . Illustrations and simple diagrams can supplement written notes, especially for younger patients.
• Focus on function, not just symptoms . Note how the child's condition impacts their ability to function at school and home.
• Provide take-home summaries.  Give families a brief overview of diagnoses, recommendations, and follow-up to assist with home care.

These adaptations help create functional, informative, and family-centered pediatric SOAP notes. They communicate your recommendations so that children and caregivers can easily understand and use them to improve the patient's health and well-being.

When writing your pediatric SOAP notes, remember:

• Children are still developing and have different needs than adults, which should be reflected in your documentation.
• Children's behaviors and symptoms may have different root causes than in adults, requiring different interventions and strategies. This should be evident in the documentation.
• Pediatric patients have caregivers involved in their treatment, so documentation must also consider the family's needs.

The Benefits and Challenges of Pediatric SOAP Notes

The advantages of using pediatric SOAP notes are extensive. They help improve the quality of care by promoting a systematic and thoughtful approach. They also aid in better communication among healthcare providers. Detailed notes can also be crucial in addressing concerns about a child's safety or progress. Moreover, pediatric SOAP notes enable early intervention, particularly important for children with developmental delays or learning differences. By promptly identifying issues and needs, healthcare professionals can collaborate with parents to provide the necessary support for children at a young age, leading to better outcomes.

However, documenting for pediatric clients does present some challenges. These include the need to keep notes concise yet comprehensive and to maintain client confidentiality. Concentrating on behaviors and conversations rather than personal interpretations and  using the child's words  and objective observations is vital.

Children typically have shorter attention spans, and communicating with nonverbal or minimally verbal children requires creativity. In such cases, it's essential to interpret behaviors and cues rather than relying on self-report. Building rapport with children also takes time, affecting the frequency of follow-up visits. Despite these challenges, the benefits of creating thorough, personalized pediatric SOAP notes far outweigh any difficulties.

Best Practices for Writing Pediatric SOAP Notes

Adhering to these best practices will make your pediatric SOAP notes a more effective tool for assessment and treatment.

Emphasize Behavior and Development

Carefully observe the child's behavior, moods, social abilities, interests, personality, and development. Note any delays or difficulties and track their progress. Give specific examples of the child's social interactions and skills compared to typical development at that age. This information will help inform future treatment plans.

Include Information from Caregivers and Teachers

When documenting a child's progress , ask open-ended questions to obtain perspectives from the child's parents, guardians, teachers, and other caregivers. Inquire about their observations of the child's symptoms, progress, challenges, strengths, environment, support systems, and needs. Also, ask them to voice any specific concerns. Note their insights in your SOAP notes to understand the child's functioning comprehensively. This context will help you provide appropriate treatment.

Discuss Treatment Approach and Response

Describe your therapeutic approach with the child, including how you use play, workbooks, and conversations to engage them. Discuss the child's responses and progress in treatment, noting any difficulties or resistance encountered and how your methods help them develop skills and overcome challenges.

Focus on Strengths

Rather than focusing solely on a child's problems and symptoms, which can dishearten families, note their strengths, talents, interests, and sources of joy. Identify protective factors in their lives, such as supportive friends, activities they excel in, and caring adults. Building on these strengths provides growth opportunities.

Recommend Practical Strategies

To empower and encourage families, offer practical advice on helping children, such as allowing extra response time, establishing routines, presenting choices, and rewarding good behavior. Specific, actionable strategies make families feel more capable and hopeful.

Provide a Safe Space

Take a compassionate, understanding approach so the child and family feel your office is a secure environment where they are listened to, valued, and cared for. Foster trust by showing empathy, encouraging, and focusing on their strengths. This will make children and caregivers more open to sharing freely and engaging actively in therapy.

Set Achievable Goals .

When setting goals for a child, aim for ones that are realistic yet challenging for their age, and break down any larger goals into smaller, measurable steps.

Review notes Regularly.

Review your notes periodically to monitor progress and watch for warning signs, ensuring your documentation remains up-to-date and effective.

Template for Pediatric SOAP Notes

The following template covers the core areas to address for each section of the SOAP note while allowing flexibility for each pediatric patient's unique needs, developmental level, and concerns. Using this framework can help ensure consistent and complete documentation of mental health concerns in children and adolescents.

SOAP notes for pediatric patients with mental and behavioral health concerns will include the following sections:

Subjective (S)

• A chief complaint or reason for visit, reported by the child or caregiver
• Pertinent developmental, medical, family, and social histories
• Symptoms and concerns, using child's words when possible

Objective (O)

Provide factual observations of the client's:

• Appearance and behavior
• Speech and language skills
• Mood and affect
• Thought processes
• Perception, cognition, and memory
• Relevant physical exam findings

Assessment (A)

• DSM (or ICD) diagnoses in order of importance
• Any relevant differential diagnoses
• Medication changes
• Therapy or behavioral recommendations tailored to the child's age and needs
• Safety planning as needed
• Follow-up instructions and timing

Examples of Pediatric SOAP Notes for Common Clinical Situations

These examples show how a clinician would document common issues in children and teens: generalized anxiety, separation anxiety, depression, and ADHD. Following the standard SOAP format, the notes use age-appropriate language, suggest initial evaluations and referrals, and outline the next steps. Keeping detailed records of your work with young clients enables the best care and continuity if other providers are involved.

Generalized Anxiety  in an 8-year-old

S : B.T. reports feeling "worried all the time" and having trouble sleeping. His mother says he seems anxious and has frequent stomachaches.

O : B.T. presented as tense but cooperative. He reported worries about school, friends, and family health. His speech was rapid, and eye contact was fleeting. Billy said his stomach "hurts a lot."

A : Generalized Anxiety Disorder, Adjustment Disorder with Anxiety

P : Recommended coping strategies like deep breathing, limiting screen time before bed, and journaling worries. Referred to a child psychologist for assessment and potential therapy. Follow-up in two weeks.

Separation Anxiety in a 7-year-old

S : L.Q. is a 7-year-old girl who has had difficulty separating from her parents, especially her mother, in the past few months. Her mother reports that L.Q cries and clings whenever she tries to leave for school or other activities.

O : L.Q was shy but cooperative during the interview. She became tearful when discussing being separated from her mother and reported frequent worries that something bad would happen if her mother were not with her.

A : Separation Anxiety Disorder

P : Recommended gradual exposure exercises for L.Q and her mother to practice separating for short periods. Referred L.Q to a child psychologist for cognitive behavioral therapy to address her anxiety. Provided a handout on separation anxiety for parents. Follow-up in four weeks to monitor progress and adherence to treatment plan .

Depression  in a 15-year-old

S : M.C.'s parents have brought him in due to changes in behavior and mood over the past three months. They report that M.C. has lost interest in activities, sleeps excessively, and gained weight. His grades have declined significantly.

O : During the interview, M.C. appeared lethargic and discouraged. He reported a lack of motivation, sadness, hopelessness, and poor concentration. He has also withdrawn from friends and hobbies.

A : Major Depressive Disorder

P : Recommended monitoring of mood, sleep, and appetite. Referred M.C. to a psychiatrist for medication evaluation and a psychologist for cognitive behavioral therapy. Provided handout on depression management strategies for adolescents—follow-up in two weeks to discuss a treatment plan and monitor for suicidal thoughts .

ADHD  in a 12-year-old

S : J.P. was brought in by her parents due to problems focusing in school and at home. Teachers report that J.P. is distractible, impulsive, and struggles to finish tasks.

O : J.P. was talkative and energetic. She had trouble sitting still during the interview and was easily distracted by noises outside the office. She reported difficulty paying attention in class and frequent interruptions.

A : Predominantly Inattentive Presentation of ADHD.

P : Recommended parent/teacher-completed behavior rating scales. Referred to a psychiatrist to consider medication for symptoms and a counselor for behavioral strategies. Scheduled a follow-up in three to four weeks to review recommendations and next steps.

You now have an overview of pediatric SOAP notes and how to adapt them for children and teens. Preparing and approaching SOAP note writing with intentionality is essential to ensure a clear and comprehensive clinical picture. Mastering SOAP notes takes practice, but having SOAP notes templates and examples can assist clinicians in this process. When documenting pediatric behavioral health concerns, it is crucial to consider their unique considerations. Remember that perfecting SOAP notes may require practice, but the benefits for children are worth the effort. Start with a basic template and then personalize it to meet your requirements. Additionally, you can request to view examples from colleagues and seek feedback from a supervisor to refine your notes. With regular use, documenting pediatric SOAP notes will become second nature; we believe in you!

Sign up for Mentalyc today , a HIPPA-compliant AI notes software designed to assist you in generating your SOAP notes , increase efficiency, and automate your notes with additional templates so you can spend more time doing what you love—helping kids!

FAQs About Pediatric SOAP Notes for Mental and Behavioral Health

How detailed do pediatric soap notes need to be.

SOAP notes for children and teens should provide a high-level overview of the session rather than an exhaustive account of everything discussed. Focus on the key highlights, events, and takeaways. Be concise yet capture the essential details another clinician would need to get up to speed on the client's care. Provide enough context around discussions and the client's mental/emotional state, but avoid verbatim transcripts.

Should parents or guardians review and sign the SOAP notes?

Whether parents should review and sign a child's SOAP notes depends on the child's age, the clinician's discretion, and local laws. For young children who are not yet able to consent to treatment themselves, it is typically required for parents to review and sign the notes. However, for teenagers who are mature enough to consent to treatment confidentially, some clinicians may share general overviews of sessions and treatment progress with parents while keeping specific details private. Other clinicians may assess whether the teen can consent to treatment autonomously. Nevertheless, clinicians must always follow their state laws regarding confidentiality and informed consent for minors.

Should goals and treatment plans be designed for each child's age?

Yes, the treatment goals and plans in SOAP notes should always be designed specifically to the child's unique needs, issues, and stages of development. Goals and interventions appropriate for a teenager will differ significantly from those for a young child. An individualized approach is essential for effective pediatric behavioral health treatment.

At what age do children's SOAP notes no longer require parental consent?

The age at which parental consent is no longer required for children's mental health SOAP notes varies by state and clinician discretion. Generally, once a child reaches the age of maturity defined by law in their state (around age 14 to 17), parental consent may no longer be legally required. However, clinicians should consider the child's cognitive and emotional development to determine the capacity for autonomous consent.

Should I write SOAP notes for each problem or diagnosis?

The level of documentation required depends on the case's complexity and the client's needs. For clients with multiple diagnoses or issues, separate SOAP notes can be written for each problem or diagnosis. This approach ensures that each condition receives the necessary attention and documentation. However, a single comprehensive SOAP note may suffice for more straightforward cases with only one or two main issues. The important thing is to document all critical details to support the client's treatment.

How often should I update my pediatric client's SOAP notes?

Updating your client's SOAP notes after every session or critical interaction is best. This will ensure that the notes accurately reflect your client's mental health status, treatment progress, and changes over time. For ongoing clients, reviewing the previous SOAP notes before each session can also help guide the discussion and remind you of important details. Writing a new SOAP note after each session is ideal for clients you see weekly or bi-weekly.

What should I include in the subjective section for kids?

The subjective section of a pediatric SOAP note should include observations about the client's mood, behavior, sleep, and appetite. It's important to note any changes in functioning at home or school. Summarize any concerns the parents mention regarding their child. You can also include quotes from the client or their caregivers that provide insight into their mental state. The goal is to capture a holistic picture of how the client is doing from a subjective perspective.

All examples of mental health documentation are fictional and for informational purposes only.

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KATHERINE TURNER, MD

Am Fam Physician. 2018;98(6):347-353

Related letter: Well-Child Visits Provide Physicians Opportunity to Deliver Interconception Care to Mothers

Author disclosure: No relevant financial affiliations.

The well-child visit allows for comprehensive assessment of a child and the opportunity for further evaluation if abnormalities are detected. A complete history during the well-child visit includes information about birth history; prior screenings; diet; sleep; dental care; and medical, surgical, family, and social histories. A head-to-toe examination should be performed, including a review of growth. Immunizations should be reviewed and updated as appropriate. Screening for postpartum depression in mothers of infants up to six months of age is recommended. Based on expert opinion, the American Academy of Pediatrics recommends developmental surveillance at each visit, with formal developmental screening at nine, 18, and 30 months and autism-specific screening at 18 and 24 months; the U.S. Preventive Services Task Force found insufficient evidence to make a recommendation. Well-child visits provide the opportunity to answer parents' or caregivers' questions and to provide age-appropriate guidance. Car seats should remain rear facing until two years of age or until the height or weight limit for the seat is reached. Fluoride use, limiting or avoiding juice, and weaning to a cup by 12 months of age may improve dental health. A one-time vision screening between three and five years of age is recommended by the U.S. Preventive Services Task Force to detect amblyopia. The American Academy of Pediatrics guideline based on expert opinion recommends that screen time be avoided, with the exception of video chatting, in children younger than 18 months and limited to one hour per day for children two to five years of age. Cessation of breastfeeding before six months and transition to solid foods before six months are associated with childhood obesity. Juice and sugar-sweetened beverages should be avoided before one year of age and provided only in limited quantities for children older than one year.

Well-child visits for infants and young children (up to five years) provide opportunities for physicians to screen for medical problems (including psychosocial concerns), to provide anticipatory guidance, and to promote good health. The visits also allow the family physician to establish a relationship with the parents or caregivers. This article reviews the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Pediatrics (AAP) guidelines for screenings and recommendations for infants and young children. Family physicians should prioritize interventions with the strongest evidence for patient-oriented outcomes, such as immunizations, postpartum depression screening, and vision screening.

Clinical Examination

The history should include a brief review of birth history; prematurity can be associated with complex medical conditions. 1 Evaluate breastfed infants for any feeding problems, 2 and assess formula-fed infants for type and quantity of iron-fortified formula being given. 3 For children eating solid foods, feeding history should include everything the child eats and drinks. Sleep, urination, defecation, nutrition, dental care, and child safety should be reviewed. Medical, surgical, family, and social histories should be reviewed and updated. For newborns, review the results of all newborn screening tests ( Table 1 4 – 7 ) and schedule follow-up visits as necessary. 2

PHYSICAL EXAMINATION

A comprehensive head-to-toe examination should be completed at each well-child visit. Interval growth should be reviewed by using appropriate age, sex, and gestational age growth charts for height, weight, head circumference, and body mass index if 24 months or older. The Centers for Disease Control and Prevention (CDC)-recommended growth charts can be found at https://www.cdc.gov/growthcharts/who_charts.htm#The%20WHO%20Growth%20Charts . Percentiles and observations of changes along the chart's curve should be assessed at every visit. Include assessment of parent/caregiver-child interactions and potential signs of abuse such as bruises on uncommonly injured areas, burns, human bite marks, bruises on nonmobile infants, or multiple injuries at different healing stages. 8

The USPSTF and AAP screening recommendations are outlined in Table 2 . 3 , 9 – 27 A summary of AAP recommendations can be found at https://www.aap.org/en-us/Documents/periodicity_schedule.pdf . The American Academy of Family Physicians (AAFP) generally adheres to USPSTF recommendations. 28

MATERNAL DEPRESSION

Prevalence of postpartum depression is around 12%, 22 and its presence can impair infant development. The USPSTF and AAP recommend using the Edinburgh Postnatal Depression Scale (available at https://www.aafp.org/afp/2010/1015/p926.html#afp20101015p926-f1 ) or the Patient Health Questionnaire-2 (available at https://www.aafp.org/afp/2012/0115/p139.html#afp20120115p139-t3 ) to screen for maternal depression. The USPSTF does not specify a screening schedule; however, based on expert opinion, the AAP recommends screening mothers at the one-, two-, four-, and six-month well-child visits, with further evaluation for positive results. 23 There are no recommendations to screen other caregivers if the mother is not present at the well-child visit.

PSYCHOSOCIAL

With nearly one-half of children in the United States living at or near the poverty level, assessing home safety, food security, and access to safe drinking water can improve awareness of psychosocial problems, with referrals to appropriate agencies for those with positive results. 29 The prevalence of mental health disorders (i.e., primarily anxiety, depression, behavioral disorders, attention-deficit/hyperactivity disorder) in preschool-aged children is around 6%. 30 Risk factors for these disorders include having a lower socioeconomic status, being a member of an ethnic minority, and having a non–English-speaking parent or primary caregiver. 25 The USPSTF found insufficient evidence regarding screening for depression in children up to 11 years of age. 24 Based on expert opinion, the AAP recommends that physicians consider screening, although screening in young children has not been validated or standardized. 25

DEVELOPMENT AND SURVEILLANCE

Based on expert opinion, the AAP recommends early identification of developmental delays 14 and autism 10 ; however, the USPSTF found insufficient evidence to recommend formal developmental screening 13 or autism-specific screening 9 if the parents/caregivers or physician have no concerns. If physicians choose to screen, developmental surveillance of language, communication, gross and fine movements, social/emotional development, and cognitive/problem-solving skills should occur at each visit by eliciting parental or caregiver concerns, obtaining interval developmental history, and observing the child. Any area of concern should be evaluated with a formal developmental screening tool, such as Ages and Stages Questionnaire, Parents' Evaluation of Developmental Status, Parents' Evaluation of Developmental Status-Developmental Milestones, or Survey of Well-Being of Young Children. These tools can be found at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx . If results are abnormal, consider intervention or referral to early intervention services. The AAP recommends completing the previously mentioned formal screening tools at nine-, 18-, and 30-month well-child visits. 14

The AAP also recommends autism-specific screening at 18 and 24 months. 10 The USPSTF recommends using the two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening tool (available at https://m-chat.org/ ) if a physician chooses to screen a patient for autism. 10 The M-CHAT can be incorporated into the electronic medical record, with the possibility of the parent or caregiver completing the questionnaire through the patient portal before the office visit.

IRON DEFICIENCY

Multiple reports have associated iron deficiency with impaired neurodevelopment. Therefore, it is essential to ensure adequate iron intake. Based on expert opinion, the AAP recommends supplements for preterm infants beginning at one month of age and exclusively breastfed term infants at six months of age. 3 The USPSTF found insufficient evidence to recommend screening for iron deficiency in infants. 19 Based on expert opinion, the AAP recommends measuring a child's hemoglobin level at 12 months of age. 3

Lead poisoning and elevated lead blood levels are prevalent in young children. The AAP and CDC recommend a targeted screening approach. The AAP recommends screening for serum lead levels between six months and six years in high-risk children; high-risk children are identified by location-specific risk recommendations, enrollment in Medicaid, being foreign born, or personal screening. 21 The USPSTF does not recommend screening for lead poisoning in children at average risk who are asymptomatic. 20

The USPSTF recommends at least one vision screening to detect amblyopia between three and five years of age. Testing options include visual acuity, ocular alignment test, stereoacuity test, photoscreening, and autorefractors. The USPSTF found insufficient evidence to recommend screening before three years of age. 26 The AAP, American Academy of Ophthalmology, and the American Academy of Pediatric Ophthalmology and Strabismus recommend the use of an instrument-based screening (photoscreening or autorefractors) between 12 months and three years of age and annual visual acuity screening beginning at four years of age. 31

IMMUNIZATIONS

The AAFP recommends that all children be immunized. 32 Recommended vaccination schedules, endorsed by the AAP, the AAFP, and the Advisory Committee on Immunization Practices, are found at https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Immunizations are usually administered at the two-, four-, six-, 12-, and 15- to 18-month well-child visits; the four- to six-year well-child visit; and annually during influenza season. Additional vaccinations may be necessary based on medical history. 33 Immunization history should be reviewed at each wellness visit.

Anticipatory Guidance

Injuries remain the leading cause of death among children, 34 and the AAP has made several recommendations to decrease the risk of injuries. 35 – 42 Appropriate use of child restraints minimizes morbidity and mortality associated with motor vehicle collisions. Infants need a rear-facing car safety seat until two years of age or until they reach the height or weight limit for the specific car seat. Children should then switch to a forward-facing car seat for as long as the seat allows, usually 65 to 80 lb (30 to 36 kg). 35 Children should never be unsupervised around cars, driveways, and streets. Young children should wear bicycle helmets while riding tricycles or bicycles. 37

Having functioning smoke detectors and an escape plan decreases the risk of fire- and smoke-related deaths. 36 Water heaters should be set to a maximum of 120°F (49°C) to prevent scald burns. 37 Infants and young children should be watched closely around any body of water, including water in bathtubs and toilets, to prevent drowning. Swimming pools and spas should be completely fenced with a self-closing, self-latching gate. 38

Infants should not be left alone on any high surface, and stairs should be secured by gates. 43 Infant walkers should be discouraged because they provide no benefit and they increase falls down stairs, even if stair gates are installed. 39 Window locks, screens, or limited-opening windows decrease injury and death from falling. 40 Parents or caregivers should also anchor furniture to a wall to prevent heavy pieces from toppling over. Firearms should be kept unloaded and locked. 41

Young children should be closely supervised at all times. Small objects are a choking hazard, especially for children younger than three years. Latex balloons, round objects, and food can cause life-threatening airway obstruction. 42 Long strings and cords can strangle children. 37

DENTAL CARE

Infants should never have a bottle in bed, and babies should be weaned to a cup by 12 months of age. 44 Juices should be avoided in infants younger than 12 months. 45 Fluoride use inhibits tooth demineralization and bacterial enzymes and also enhances remineralization. 11 The AAP and USPSTF recommend fluoride supplementation and the application of fluoride varnish for teeth if the water supply is insufficient. 11 , 12 Begin brushing teeth at tooth eruption with parents or caregivers supervising brushing until mastery. Children should visit a dentist regularly, and an assessment of dental health should occur at well-child visits. 44

SCREEN TIME

Hands-on exploration of their environment is essential to development in children younger than two years. Video chatting is acceptable for children younger than 18 months; otherwise digital media should be avoided. Parents and caregivers may use educational programs and applications with children 18 to 24 months of age. If screen time is used for children two to five years of age, the AAP recommends a maximum of one hour per day that occurs at least one hour before bedtime. Longer usage can cause sleep problems and increases the risk of obesity and social-emotional delays. 46

To decrease the risk of sudden infant death syndrome (SIDS), the AAP recommends that infants sleep on their backs on a firm mattress for the first year of life with no blankets or other soft objects in the crib. 45 Breastfeeding, pacifier use, and room sharing without bed sharing protect against SIDS; infant exposure to tobacco, alcohol, drugs, and sleeping in bed with parents or caregivers increases the risk of SIDS. 47

DIET AND ACTIVITY

The USPSTF, AAFP, and AAP all recommend breastfeeding until at least six months of age and ideally for the first 12 months. 48 Vitamin D 400 IU supplementation for the first year of life in exclusively breastfed infants is recommended to prevent vitamin D deficiency and rickets. 49 Based on expert opinion, the AAP recommends the introduction of certain foods at specific ages. Early transition to solid foods before six months is associated with higher consumption of fatty and sugary foods 50 and an increased risk of atopic disease. 51 Delayed transition to cow's milk until 12 months of age decreases the incidence of iron deficiency. 52 Introduction of highly allergenic foods, such as peanut-based foods and eggs, before one year decreases the likelihood that a child will develop food allergies. 53

With approximately 17% of children being obese, many strategies for obesity prevention have been proposed. 54 The USPSTF does not have a recommendation for screening or interventions to prevent obesity in children younger than six years. 54 The AAP has made several recommendations based on expert opinion to prevent obesity. Cessation of breastfeeding before six months and introduction of solid foods before six months are associated with childhood obesity and are not recommended. 55 Drinking juice should be avoided before one year of age, and, if given to older children, only 100% fruit juice should be provided in limited quantities: 4 ounces per day from one to three years of age and 4 to 6 ounces per day from four to six years of age. Intake of other sugar-sweetened beverages should be discouraged to help prevent obesity. 45 The AAFP and AAP recommend that children participate in at least 60 minutes of active free play per day. 55 , 56

Data Sources: Literature search was performed using the USPSTF published recommendations ( https://www.uspreventiveservicestaskforce.org/BrowseRec/Index/browse-recommendations ) and the AAP Periodicity table ( https://www.aap.org/en-us/Documents/periodicity_schedule.pdf ). PubMed searches were completed using the key terms pediatric, obesity prevention, and allergy prevention with search limits of infant less than 23 months or pediatric less than 18 years. The searches included systematic reviews, randomized controlled trials, clinical trials, and position statements. Essential Evidence Plus was also reviewed. Search dates: May through October 2017.

Gauer RL, Burket J, Horowitz E. Common questions about outpatient care of premature infants. Am Fam Physician. 2014;90(4):244-251.

American Academy of Pediatrics; Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics. 2010;125(2):405-409.

Baker RD, Greer FR Committee on Nutrition, American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics. 2010;126(5):1040-1050.

Mahle WT, Martin GR, Beekman RH, Morrow WR Section on Cardiology and Cardiac Surgery Executive Committee. Endorsement of Health and Human Services recommendation for pulse oximetry screening for critical congenital heart disease. Pediatrics. 2012;129(1):190-192.

American Academy of Pediatrics Newborn Screening Authoring Committee. Newborn screening expands: recommendations for pediatricians and medical homes—implications for the system. Pediatrics. 2008;121(1):192-217.

American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.

Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or = 35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-1198.

Christian CW Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse [published correction appears in Pediatrics . 2015;136(3):583]. Pediatrics. 2015;135(5):e1337-e1354.

Siu AL, Bibbins-Domingo K, Grossman DC, et al. Screening for autism spectrum disorder in young children: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(7):691-696.

Johnson CP, Myers SM American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-1215.

Moyer VA. Prevention of dental caries in children from birth through age 5 years: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2014;133(6):1102-1111.

Clark MB, Slayton RL American Academy of Pediatrics Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626-633.

Siu AL. Screening for speech and language delay and disorders in children aged 5 years and younger: U.S. Preventive Services Task Force recommendation statement. Pediatrics. 2015;136(2):e474-e481.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening [published correction appears in Pediatrics . 2006;118(4):1808–1809]. Pediatrics. 2006;118(1):405-420.

Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633.

National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents. October 2012. https://www.nhlbi.nih.gov/sites/default/files/media/docs/peds_guidelines_full.pdf . Accessed May 9, 2018.

Moyer VA. Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(9):613-619.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents [published correction appears in Pediatrics . 2017;140(6):e20173035]. Pediatrics. 2017;140(3):e20171904.

Siu AL. Screening for iron deficiency anemia in young children: USPSTF recommendation statement. Pediatrics. 2015;136(4):746-752.

U.S. Preventive Services Task Force. Screening for elevated blood lead levels in children and pregnant women. Pediatrics. 2006;118(6):2514-2518.

Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials . Atlanta, Ga.: U.S. Public Health Service; Centers for Disease Control and Prevention; National Center for Environmental Health; 1997.

O'Connor E, Rossom RC, Henninger M, Groom HC, Burda BU. Primary care screening for and treatment of depression in pregnant and post-partum women: evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA. 2016;315(4):388-406.

Earls MF Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010;126(5):1032-1039.

Siu AL. Screening for depression in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(5):360-366.

Weitzman C, Wegner L American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics; Committee on Psychosocial Aspects of Child and Family Health; Council on Early Childhood; Society for Developmental and Behavioral Pediatrics; American Academy of Pediatrics. Promoting optimal development: screening for behavioral and emotional problems [published correction appears in Pediatrics . 2015;135(5):946]. Pediatrics. 2015;135(2):384-395.

Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children aged 6 months to 5 years: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;318(9):836-844.

Donahue SP, Nixon CN Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Academy of Pediatrics; American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

Lin KW. What to do at well-child visits: the AAFP's perspective. Am Fam Physician. 2015;91(6):362-364.

American Academy of Pediatrics Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.

Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ. The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol. 2009;38(3):315-328.

American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment of infants, children, and young adults by pediatricians. Pediatrics. 2016;137(1):28-30.

American Academy of Family Physicians. Clinical preventive service recommendation. Immunizations. http://www.aafp.org/patient-care/clinical-recommendations/all/immunizations.html . Accessed October 5, 2017.

Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html . Accessed May 9, 2018.

National Center for Injury Prevention and Control. 10 leading causes of death by age group, United States—2015. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2015_1050w740h.gif . Accessed April 24, 2017.

Durbin DR American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Child passenger safety. Pediatrics. 2011;127(4):788-793.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Reducing the number of deaths and injuries from residential fires. Pediatrics. 2000;105(6):1355-1357.

Gardner HG American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Office-based counseling for unintentional injury prevention. Pediatrics. 2007;119(1):202-206.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of drowning in infants, children, and adolescents. Pediatrics. 2003;112(2):437-439.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Injuries associated with infant walkers. Pediatrics. 2001;108(3):790-792.

American Academy of Pediatrics Committee on Injury and Poison Prevention. Falls from heights: windows, roofs, and balconies. Pediatrics. 2001;107(5):1188-1191.

Dowd MD, Sege RD Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-e1423.

American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Prevention of choking among children. Pediatrics. 2010;125(3):601-607.

Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention (review). Evid Based Child Health. 2013;8(3):761-939.

American Academy of Pediatrics Section on Oral Health. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-1229.

Heyman MB, Abrams SA American Academy of Pediatrics Section on Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 2017;139(6):e20170967.

Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591.

Moon RY Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940.

American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

Wagner CL, Greer FR American Academy of Pediatrics Section on Breastfeeding; Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents [published correction appears in Pediatrics . 2009;123(1):197]. Pediatrics. 2008;122(5):1142-1152.

Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics. 2011;127(3):e544-e551.

Greer FR, Sicherer SH, Burks AW American Academy of Pediatrics Committee on Nutrition; Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.

American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk in infancy. Pediatrics. 1992;89(6 pt 1):1105-1109.

Fleischer DM, Spergel JM, Assa'ad AH, Pongracic JA. Primary prevention of allergic disease through nutritional interventions. J Allergy Clin Immunol Pract. 2013;1(1):29-36.

Grossman DC, Bibbins-Domingo K, Curry SJ, et al. Screening for obesity in children and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426.

Daniels SR, Hassink SG Committee on Nutrition. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1):e275-e292.

American Academy of Family Physicians. Physical activity in children. https://www.aafp.org/about/policies/all/physical-activity.html . Accessed January 1, 2018.

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5-Year-Old Well Child Check

Although the five-year-olds world seems smooth on the surface, it can be stormy underneath, and it can be more turbulent as your child begins school..

The world of a five-year-old is still a mysterious place, but one in which she has some control. Instead of the impulsiveness she showed at four, she is able to gauge a situation before she reacts, to "stop and think" first. She may be slower to get into situations, and seems to have a serious air about her. She likes the familiar territory at home, the tried and true, and rules. 

At five, your child still believes in magic; it rains because of something he did, or because the clouds were angry. He still thinks he is the center of the universe, and has trouble telling the difference between fantasy and reality. He may believe in the Tooth Fairy, Santa Claus the Easter Bunny, ghosts, and monsters.

At this stage, he knows that words stand for ideas and objects, and likes to guess about cause and effect. Although he lives in the "now," he knows the difference between past and future. The five-year-old is on a quest for knowledge, and when he asks questions, he really wants to know the answers. The more experiences he has this year and the more you explain things, the broader his horizons will be.

Except for certain sounds, "s," "v," "f," and "th," your five-year-old is quite the little speaker. His sentences are nicely made, with plurals, pronouns, and correct verb tenses. He knows his name, age, address, phone number, his birthday, and over 2,000 words. It's this use of language that helps him clarify ideas and express himself. It will help him succeed in school and the world. 

Five is a truly creative age. The world is fresh and exciting, and your five-year-old can use his new skills in language, painting, and music to combine ideas in uniquely interesting ways.Your five-year-old can now invent stories, music, dances, and excels at innovative drama alone and with other children. Because creativity is using the mind more than it is using many materials, simple things like art supplies, books, and musical instruments are the tools which help them grow.

Development

• Stands on one foot for 10 seconds or longer
• Hops, swings, climbs, can do somersaults
• May be able to skip

Hand And Finger Skills

• Copies a triangle and other geometric patterns
• Draws person with body
• Prints some letters
• Dresses and undresses without assistance
• Recalls part of a story
• Uses future tense
• Tells longer stories
• Likes to argue and reason; use words like "because"
• Able to memorize address and phone number
• Is project minded and loves to learn
• Organizes other children and toys for pretend play
• More likely to agree to rules
• Likes to sing, dance and act
• Sometimes demanding, sometimes eagerly cooperative

Growth And Nutrition

Daily nutritional guide for the 4 to 6 year old.

Grains -  6 -11 servings/day

• Bread, ½ slice
• Cereal, rice, pasta cooked, 1/3 cup
• Cereal, dry ½ cup
• Crackers, 3 to 4

Vegetables - 2-3 servings/day

• Vegetables, cooked or canned ¼ cup
• Salad, ½ cup

Fruits - 2-3 servings/day

• Fruit, cooked or canned, ¼ cup
• Fruit, fresh, ½ piece
• Juice, 1/3 cup

Dairy - 2-3 servings/day

• Milk (does not have to be whole) ½ cup
• Cheese, 1 ounce
• Yogurt, ½ cup

Meats and Proteins - 2 servings/day

• Meat, fish, poultry, tofu, 1 ounce (2 1 inch cubes)
• Beans, dried, cooked, 1/3 cup

Calcium 1000 mg/day

Keep snacks healthy, encourage drinking water and keep juice to a minimum.

Common Issues And Concerns

The parents who have trouble with discipline are often more permissive, because they don't want their children to resent them or because they feel guilty about not being "superparents."  As a parent you may want to take a look at the ways you are being too permissive and make an effort to firm up your discipline in those areas. Make the punishment "fit the crime." Keep your discipline simple, short, and consistent. Be loving but firm.

Map out rules that help your child learn to control impulsiveness and expected behavior without impairing their independence. Keep your child's developmental level in mind when you set limits and don't expect more than he is capable of achieving. Remember that you are a key role model for your child. The more even-handed and controlled your behavior, the more likely your child will be to pattern himself after you.

It is important to read to you child. Children not only love to be read to, but the story and fairy tales assist kids in working through their own fantasies, conflicts, and experimentation with roles. If children are read to at home, they will do better in school, have more complex vocabularies, and ask more complex questions.

Even though your child is older now, it's important to realize that until age seven, television and movies are risky business. Because your child still can't differentiate between reality and fantasy, certain scenes, even in classic family entertainment movies, can terrify her and cause nightmares. Studies have shown that although children can learn from imitating television, they do not learn to think or solve problems. It's been proven that children who watch hours of television every day lag behind their peers in development. Remember, children can't set their own limits.

Sibling Rivalry

Jealousy toward brothers and sisters, and occasionally angry feelings with parents are natural, and nothing for your child to be ashamed of. The basic struggle in sibling rivalry is that a child must learn to share her parents with others, a hard fact to accept. The more dependent the child is on the parent, the harder the struggle is. Often the displays of jealousy are a way to get more love. The line has to be drawn when rivalry moves into destructive behavior, whether it is physical or verbal. No matter how your child feels, she will have to find a civilized solution for it. She will have to accept the fact that neither child will have the exclusive love of the parent.

Thumb-sucking

Many children resort to old habits, like thumb-sucking, at five, especially when they're tired, hungry, watching T.V., or listening to a story. These habits are ways to calm down from pressure, help them concentrate, and make the transition from a hectic stage to a quiet one. By five, your child doesn't usually resort to his habits in public, because he cares too much about what his friends think. The habits will probably stop this year or next year unless you make a big deal about them.

Kindergarten

When children are ready, kindergarten is wonderful for them. Brightness is not necessarily the guideline for readiness, behavior traits are a better guide. A child who is ready is healthy, independent, cooperative, and can follow directions.

For age-specific safety tips please visit Healthychildren.org .

Next Well Child Visit

The next routine physical examination is at six years of life.

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Well-Child Visits: Parent and Patient Education

The Bright Futures Parent and Patient Educational Handouts help guide anticipatory guidance and reinforce key messages (organized around the 5 priorities in each visit) for the family. Each educational handout is written in plain language to ensure the information is clear, concise, relevant, and easy to understand. Each educational handout is available in English and Spanish (in HTML and PDF format). Beginning at the 7 year visit , there is both a Parent and Patient education handout (in English and Spanish).

For the Bright Futures Parent Handouts for well-child visits up to 2 years of age , translations of 12 additional languages (PDF format) are made possible thanks to the generous support of members, staff, and businesses who donate to the AAP Friends of Children Fund . The 12 additional languages are Arabic, Bengali, Chinese, French, Haitian Creole, Hmong, Korean, Polish, Portuguese, Russian, Somali, and Vietnamese.

Reminder for Health Care Professionals:  The  Bright Futures Tool and Resource Kit, 2nd Edition ​ is available as an online access product. For more detailed information about the Toolkit, visit  shop.aap.org . To license the Toolkit to use the forms in practice and/or incorporate them into an Electronic Medical Record System, please contact  AAP Sales .

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American Academy of Pediatrics

Family Life

AAP Schedule of Well-Child Care Visits

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children.

The Bright Futures /American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care, known as the " periodicity schedule ." It is a schedule of screenings and assessments recommended at each well-child visit from infancy through adolescence.

Schedule of well-child visits

• The first week visit (3 to 5 days old)
• 1 month old
• 2 months old
• 4 months old
• 6 months old
• 9 months old
• 12 months old
• 15 months old
• 18 months old
• 2 years old (24 months)
• 2 ½ years old (30 months)
• 3 years old
• 4 years old
• 5 years old
• 6 years old
• 7 years old
• 8 years old
• 9 years old
• 10 years old
• 11 years old
• 12 years old
• 13 years old
• 14 years old
• 15 years old
• 16 years old
• 17 years old
• 18 years old
• 19 years old
• 20 years old
• 21 years old

The benefits of well-child visits

Prevention . Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

Tracking growth & development . See how much your child has grown in the time since your last visit, and talk with your doctor about your child's development. You can discuss your child's milestones, social behaviors and learning.

Raising any concerns . Make a list of topics you want to talk about with your child's pediatrician such as development, behavior, sleep, eating or getting along with other family members. Bring your top three to five questions or concerns with you to talk with your pediatrician at the start of the visit.

Team approach . Regular visits create strong, trustworthy relationships among pediatrician, parent and child. The AAP recommends well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental and social health of a child.

More information

Back to School, Back to Doctor

Recommended Immunization Schedules

Milestones Matter: 10 to Watch for by Age 5

Your Child's Checkups

• Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (periodicity schedule)

Well Child Visit at 5 to 6 Years

Medically reviewed by Drugs.com. Last updated on Apr 2, 2024.

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What is a well child visit?

A well child visit is when your child sees a healthcare provider to prevent health problems. Well child visits are used to track your child's growth and development. It is also a time for you to ask questions and to get information on how to keep your child safe. Write down your questions so you remember to ask them. Your child should have regular well child visits from birth to 17 years.

What development milestones may my child reach between 5 and 6 years?

Each child develops at his or her own pace. Your child might have already reached the following milestones, or he or she may reach them later:

• Balance on one foot, hop, and skip
• Hold a pencil correctly
• Draw a person with at least 6 body parts
• Print some letters and numbers, copy squares and triangles
• Tell simple stories using full sentences, and use appropriate tenses and pronouns
• Count to 10, and name at least 4 colors
• Listen and follow simple directions
• Dress and undress with minimal help
• Say his or her address and phone number
• Print his or her first name
• Start to lose baby teeth
• Ride a bicycle with training wheels or other help

How can I prepare my child for school?

• Talk to your child about going to school. Talk about meeting new friends and having new activities at school. Take time to tour the school with your child and meet the teacher.
• Begin to establish routines. Have your child go to bed at the same time every night.
• Read with your child. Read books to your child. Point to the words as you read so your child begins to recognize words.

What can I do to help my child who is already in school?

• Engage with your child if he or she watches TV. Do not let your child watch TV alone, if possible. You or another adult should watch with your child. Talk with your child about what he or she is watching. When TV time is done, try to apply what you and your child saw. For example, if your child saw someone print words, have your child print those same words. TV time should never replace active playtime. Turn the TV off when your child plays. Do not let your child watch TV during meals or within 1 hour of bedtime.
• Limit your child's screen time. Screen time is the amount of television, computer, smart phone, and video game time your child has each day. It is important to limit screen time. This helps your child get enough sleep, physical activity, and social interaction each day. Your child's pediatrician can help you create a screen time plan. The daily limit is usually 1 hour for children 2 to 5 years. The daily limit is usually 2 hours for children 6 years or older. You can also set limits on the kinds of devices your child can use, and where he or she can use them. Keep the plan where your child and anyone who takes care of him or her can see it. Create a plan for each child in your family. You can also go to https://www.healthychildren.org/English/media/Pages/default.aspx#planview for more help creating a plan.
• Encourage your child to talk about school every day. Talk to your child about the good and bad things that happened during the school day. Encourage your child to tell you or a teacher if someone is being mean to him or her.

What else can I do to support my child?

• Teach your child behaviors that are acceptable. This is the goal of discipline. Set clear limits that your child cannot ignore. Be consistent, and make sure everyone who cares for your child disciplines him or her the same way.
• Help your child to be responsible. Give your child routine chores to do. Expect your child to do them.
• Talk to your child about anger. Help manage anger without hitting, biting, or other violence. Show him or her positive ways you handle anger. Praise your child for self-control.
• Encourage your child to have friendships. Meet your child's friends and their parents. Remember to set limits to encourage safety.

What can I do to help my child stay healthy?

• Teach your child to care for his or her teeth and gums. Have your child brush his or her teeth at least 2 times every day, and floss 1 time every day. Have your child see the dentist 2 times each year.
• Make sure your child has a healthy breakfast every day. Breakfast can help your child learn and behave better in school.
• Teach your child how to make healthy food choices at school. A healthy lunch may include a sandwich with lean meat, cheese, or peanut butter. It could also include a fruit, vegetable, and milk. Pack healthy foods if your child takes his or her own lunch. Pack baby carrots or pretzels instead of potato chips in your child's lunch box. You can also add fruit or low-fat yogurt instead of cookies. Keep his or her lunch cold with an ice pack so that it does not spoil.

What can I do to help my child get the right nutrition?

Offer your child a variety of foods from all the food groups. The number and size of servings that your child needs from each food group depends on his or her age and activity level. Ask your dietitian how much your child should eat from each food group.

• Half of your child's plate should contain fruits and vegetables. Offer fresh, canned, or dried fruit instead of fruit juice as often as possible. Limit juice to 4 to 6 ounces each day. Offer more dark green, red, and orange vegetables. Dark green vegetables include broccoli, spinach, romaine lettuce, and collard greens. Examples of orange and red vegetables are carrots, sweet potatoes, winter squash, and red peppers.
• Offer whole grains to your child each day. Half of the grains your child eats each day should be whole grains. Whole grains include brown rice, whole-wheat pasta, and whole-grain cereals and breads.
• Offer lean meats, poultry, fish, and other protein foods. Other sources of protein include legumes (such as beans), soy foods (such as tofu), and peanut butter. Bake, broil, and grill meat instead of frying it to reduce the amount of fat.
• Offer healthy fats in place of unhealthy fats. A healthy fat is unsaturated fat. It is found in foods such as soybean, canola, olive, and sunflower oils. It is also found in soft tub margarine that is made with liquid vegetable oil. Limit unhealthy fats such as saturated fat, trans fat, and cholesterol. These are found in shortening, butter, stick margarine, and animal fat.
• Limit foods that contain sugar and are low in nutrition. Limit candy, soda, and fruit juice. Do not give your child fruit drinks. Limit fast food and salty snacks.

What can I do to keep my child safe?

• Children aged 4 to 8 years should ride in a booster car seat in the back seat.
• Booster seats come with and without a seat back. Your child will be secured in the booster seat with the regular seatbelt in your car.
• Your child must stay in the booster car seat until he or she is between 8 and 12 years old and 4 foot 9 inches (57 inches) tall. This is when a regular seatbelt should fit your child properly without the booster seat.
• Teach your child how to cross the street safely. Teach your child to stop at the curb, look left, then look right, and left again. Tell your child never to cross the street without an adult. Teach your child where the school bus will pick him or her up and drop him or her off. Always have adult supervision at your child's bus stop.
• Teach your child how to swim if he or she does not know how. Even if your child knows how to swim, do not let him or her play around water alone. An adult needs to be present and watching at all times. Make sure your child wears a safety vest when he or she is on a boat.
• Put sunscreen on your child before he or she goes outside to play or swim. Use sunscreen with a SPF 15 or higher. Use as directed. Apply sunscreen at least 15 minutes before your child goes outside. Reapply sunscreen every 2 hours when outside.
• Talk to your child about personal safety without making him or her anxious. Explain to him or her that no one has the right to touch his or her private parts. Also explain that no one should ask your child to touch their private parts. Let your child know that he or she should tell you even if he or she is told not to.

What do I need to know about my child's next well child visit?

Your child's healthcare provider will tell you when to bring him or her in again. The next well child visit is usually at 7 to 8 years. Contact your child's healthcare provider if you have questions or concerns about his or her health or care before the next visit. All children aged 3 to 5 years should have at least one vision screening. Your child may need vaccines at the next well child visit. Your provider will tell you which vaccines your child needs and when your child should get them.

Care Agreement

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Learn more about Well Child Visit at 5 to 6 Years

Care guides.

• Body Image in Adolescents
• Gender Identity in Adolescents
• Gender Identity in your Adolescent
• Hemoglobin A1c
• Hepatitis B in Children
• Hepatitis B Vaccine
• How to Childproof your Home

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Well Child Check Presentation Note

6 Mo pt, the product of a SVD @ term comes in for WCC. Pt on schedule with vaccinations. Eating pureed foods three times per day, Drinking 7 oz of infamil q 3hrs; BMs 2-3  per day Voids more than 5 times per day. No incidences of diaper rashes.Sleep: Sleeps all night Developmentally, patient says dada & baba; sits up without support, grabs things, picks objects, is beginning to crawl, recognizes mom, seems happy. Behaviorally, Patient is consolable when he cries.

Patient has one brother at home. Is taken care of at home and doesn’t go to day care. Grand parents live at home and help with care. Mum doesn’t feel stressed.

ROS is negative.

Physical Examination

Head Circumference =  __% ; Wt = ___ %; Ht = __ %.  NB % = percentile General: Patient is alert and playful.

HEENT Head – NC/AT; Posterior fontanel closed, AF is flat Eyes – PERRL, red reflex present. (Note infants may not be able to accomodate) Ears – TMs normal Nose – Normal mucous membranes, no rhinorhea Throat & Mouth – Sucking and rooting reflex present, palate normal. Neck – Supple Lungs – CTA Heart – RRR, no murmurs Abd – Normal BS, no tenderness, umbilicus healed. Genital area:Both testicles palpated in scrotum, no diaper rash present. Back – No excessive hairs or abnormality in the sacral area Hips: Ortolani and Barlow negative.

7 mo old   healthy male,  the product of term SVD with adequate prenatal and postnatal care. No prenatal, perinatal or postnatal complications. No past medical problems. Has been uptodate with immunizations. Mom is not depressed and has adequate support at home to care for the baby.

Anticipatory guidance discussed. Education on child safety provided. Counseling provided on nutrition and food introduction done. Patient will call clinic or go to ED if child becomes sick or if she has concerns. Immunizations given today: Patient will get: Pentacel #3 Heb B #3 PCV #3 Rota #3 Follow up in 3 months for 9 month well child check.

This patient was seen and presented to attending physician, ______ who agrees with this plan. print

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ROUTINE WELLNESS/FOLLOW-UP Visit. ​​The SOAPnote Project. https://www.soapnote.org/complete/episodic-visit/. Published August 29, 2021. Updated September 14, 2021. Accessed May 2, 2024.

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