The increasing independence among school-aged children is a difficult issue for some parents, and may raise concerns such as the real or perceived safety of the neighborhood. However, the major developmental task at this age is the beginning of independent lives, as children spend more time away from home and establish stronger peer relationships. In addition, rules become very important to children in kindergarten and first grade, who often will spend time during recess working out the rules of the games they play. Focus groups with teenagers stressed the importance of beginning parent/child communication about peer relationships well before adolescence; this age is the perfect time to begin these discussions.

Communication is the central theme in this brochure. This is an opportunity for clinicians to model healthy communication by asking questions about the child?s life and engaging the child as much as possible during the examination. It also reinforces the importance of appropriate routines and limits. The section "Teach Simple Rules About Safety With Adults" raises the issue of sexual abuse prevention. In addition, as children begin to explore new friendships, parents are given tips on how to help their child understand situations of conflict or unhappiness.

How to Use This Tool

• Help parents understand that independence begins with small steps at a young age. This is a time when parents' fears about children's safety in the outside world come to the forefront. Use this as an opportunity to address these fears. Some of these fears may be based on the reality of the neighborhood they live in, but others may reflect current media coverage rather than the true situation in their own immediate environment.
• Ask how the child is doing in school or preschool, with specific attention to social, behavioral, or emotional issues.
  

• Use the history and physical as an opportunity to model communication with the child. Many clinicians find that a discussion about child sexual abuse is most naturally conducted during or after the examination of the child?s genitals. For example, you might ask, "What would you do if someone else who wasn't a doctor wanted to look at you here? What would you say?" It is important to reinforce to children that no one, other than a doctor or nurse (with their parents) should look at their genitals, and that adults never need help with their genitals.
• Let the child know that secrets are not okay. "I'm here with your mother so it's okay. No adult should ever tell you to keep a secret from your parents. Is that a rule in your family?" This also provides a clinical opportunity to talk with the parents about those behaviors of which a child needs to be aware.
  

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