Health Supervision Visit, 6 Years

Assess

• Anthropometric measurements (growth charts).
• Physical examination.
• Screen for risk for anemia (vegetarian and not taking an iron supplement).
• Screen for dyslipidemia risk factors.
• Perform lead testing if no previous test or if risk factors are present. 
• If the child does not receive fluoride in their primary water source, offer supplements.
  • Assess fluoride intake carefully because the risk of fluorosis is high. 
  • Fluoride varnishes applied every 6 months can reduce caries.
• 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 insecurity. (Table 3) 

Discuss

If child is at risk for anaphylaxis from food allergies, assist parents in submitting a written plan to the school and provide a prescription for auto-injectable epinephrine.

Remind parents to 

• Make nutritious foods and drinks (lowfat milk, water) the usual options at home for meals and snacks. 
• Limit foods and drinks that are high in calories and low in nutrients. These include ice cream, baked goods, salty snacks, fast foods, pizza, and soda and other sweetened beverages.
• Limit juice to 4 to 6 oz of 100% fruit juice each day.
• Provide calcium- and vitamin D–containing foods and beverages each day. Children this age need 12 to 16 oz of lowfat or fat-free milk each day plus an additional serving of lowfat yogurt and cheese.
  • Options for lactose-intolerant children are fortified foods (cereals) and beverages (fortified orange juice). 

Additional Resources

• AAP resources regarding Nutrition in Schools are available. 
• The AAP Institute for Healthy Childhood Weight provides clinical practice guidelines and other nutrition resources for pediatricians. 
• 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.