Health Supervision Visit, 4 Years

Assess

• Anthropometric measurements (growth charts).
• Physical examination.
• Screen for anemia.
• Screen for dyslipidemia risk factors.
• Perform lead testing if no previous screen or risk factors are present. 
• 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

• Avoid sugar-sweetened beverages. No more than 4 to 6 oz of 100% fruit juice per day.
• Breakfast for children in preschool or formal child care.
  • Consuming breakfast at home before preschool or child care is not correlated with obesity.
    • Young children who skip breakfast may show a higher risk for obesity. 

Remind parents

• To offer a variety of healthy foods to their child, especially vegetables and fruits, and include meat or deboned fish at least twice a week.
• That children this age seldom eat 3 meals a day but more likely 1 good meal and multiple smaller meals and snacks.
• That if their child refuses something, it usually means they are not hungry. It doesn’t mean they don’t like it and wouldn’t have it later for a snack.
• To trust their child can decide when they are hungry or full and to never encourage a child to eat food they did not ask for.
• They don’t need to fix another meal if their child refuses what is offered—this encourages picky eating 

Calculations

Estimated energy requirements (kcal/d) for children 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.