2019-20 TOW #3: Middle Childhood Well Checks

We continue our journey through the land of well visits and review middle childhood (ages 5-10). Speaking from personal experience as a parent of kids this age, it’s a wonderful time to see children growing and developing as their personhood emerges. In primary care at this stage, we get to interact more directly with our patients and begin to develop more of a doctor-patient relationship. I’ve had the joy of attending a patients’ 5th grade graduation ceremony-just one example of the experiences that make primary care amazing!

Materials for next week:

Key take-home points:

  1. What are the priorities for well child visits in middle childhood (ages 5-10)? As always, we are addressing parent concerns first. During these years we discuss school readiness and school performance to help us assess how children are doing. Mental health becomes a bigger area to address including issues like bullying and body image; as well as limit setting and safety, as children become more independent including around strangers, using media, and walking and riding on streets.
  2. What are the Bright Futures priority areas for these ages? 1) School readiness/ school performance, 2) development and mental health, 3) nutrition and physical activity including limits/rules about screen time, 4) oral health, and 5) safety.
  3. What are the most evidence-based aspects of our care? There are not quite as many areas that are as well studied for this age group, but we do know that we should not try to cover too many topics – less is more and probably not more than 5. We know studies have shown parents value primary care and want us to discuss topics likes behavior, eating habits, and safety. Some studies have shown we can augment our verbal advice with approaches like safety-focused children’s books and parent videos and other tangible tools. One study looking at violence-prevention strategies in primary care using office-based counseling and free tools like timers and firearm locks demonstrated parent-reported changes in media use and firearm storage after the intervention.
  4. What are the recommended screenings? In addition to measuring weight, height, BMI, and BP, we should screen for vision and hearing. Anemia, TB, and dyslipidemia should be selectively screened based on risk factors.
  5. How do we establish rapport with our patients at this age? What are some clinical pearls? We can begin to interact first with the patients in these visits, then their parents. Entering the kids’ world by commenting on how much they have grown, something they are wearing, or reading or watching can be a fun starting point. For younger kids in this age range, I have found it really helpful to use the ROR books to assess school readiness/ reading/ counting, as well as their drawings of people and how they write their name. A strategy to learn about kids’ self-perception is to ask them what they like/are proud of about themselves and to ask parents what they appreciate about their kids to draw out more about their strengths and relationships.

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