Health Supervision Visit, 3 Years

Assess

• Anthropometric measurements (growth charts).
• Physical examination.
• Screen for anemia.
• Screen for risk factors for lead and perform lead testing if positive.
• Screen for food insecurity using the validated 2-question Hunger Vital Sign tool. 
  • 1 in 7 children live in a household experiencing food insecurity.
  • Rates of food insecurity are higher in households with children younger than 6 years, single-parent households, and immigrant, Black, or Latinx families.
    • Provide resources for families experiencing food insecutiry. (Table 3) 

Discuss

• Decreasing need for caloric intake is normal.
  • Remind parents not to pressure children to eat; it is likely they are less hungry because growth velocity slows at this age. 
• Children at this age still may have immature chewing and swallowing skills. 
  • Continue to cut food into small pieces and avoid round foods such as hot dogs and grapes to reduce the risk of choking.
• Breakfast.
  • Consuming breakfast at home before preschool is not correlated with obesity. (ref)
    • Young children who skip breakfast may show a higher risk for obesity.

Calculations

Estimated energy requirements for 3 to 13.99 years (weight in kg; height in cm) 

• Males: 
  • Inactive: –447.51 + (3.68 × age) + (13.01 × height) + (13.15 × weight) + 20/15/25
  • Low active: 19.12 + (3.68 × age) + (8.62 × height) + (20.28 × weight) + 20/15/25
  • Active: –388.19 + (3.68 × age) + (12.66 × height) + (20.46 × weight) + 20/15/25
  • Very active: –671.75 + (3.68 × age) + (15.38 × height) + (23.25 × weight) + 20/15/25
• Females:
  • Inactive: 55.59 – (22.25 × age) + (8.43 × height) + (17.07 × weight) + 15/30
  • Low active: –297.54 – (22.25 × age) + (12.77 × height) + (14.73 × weight) + 15/30
  • Active: –189.55 – (22.25 × age) + (11.74 × height) + (18.34 × weight) + 15/30
  • Very active: –709.59 – (22.25 × age) + (18.22 × height) + (14.25 × weight) + 15/30
• Energy cost of growth for boys: 3 y: 20 kcal/d; 4 to 8 y: 15 kcal/d; 9 to 13 y: 25 kcal/d.
• Energy cost of growth for girls: 3 y: 15 kcal/d; 4 to 8 y: 15 kcal/d; 9 to 13 y: 30 kcal/d.