Health Supervision Visits, 9 to 11 Years

Assess

• Anthropometric measurements (growth charts).
• Physical examination.
• Screen for risk for anemia (vegetarian and not taking an iron supplement).
• Lipid profile is recommended at one visit between 9 and 11 years, before pubertal changes in lipids and lipoproteins occur.
  • 15% of 6- to 11-year-olds have at least 1 adverse lipid level.
  • Atherosclerosis begins in childhood.
  • Risk factors include smoking, obesity, hypertension, elevated triglyceride level, and elevated cholesterol levels, and these are associated with cardiovascular events in adulthood.
• Assess for risk of disordered eating. 
• 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. 
  • Ask about a dental home.
• Screen for food insecurity using the validated 2-question Hunger Vital Sign tool.  

Disucss

Remind parents to

• Provide a nutritious breakfast, which is correlated with healthy weight.
• Make nutritious foods and drinks (lowfat milk, water) the usual options at home for meals and snacks.
• Avoid all energy drinks, which can be dangerous.
• Limit juice to 8 oz of 100% fruit juice per day.
• Limit sports drinks, which are high in sugar.
  • Only give after vigorous exercise lasting more than >1 hour (but even after 1 hour of exercise, a sports drink or juice may provide more calories than burned).
• Ensure sufficient calcium- and vitamin D–containing foods and beverages each day.
  • Children aged 9 and 10 years need 20 to 24 oz of lowfat or fat-free milk each day plus an additional serving of lowfat yogurt and cheese.
• Remember that dieting for weight loss can be dangerous.
• Ask about the use of herbal medicines, natural products, and botanicals.
  • The NCCIH offers safety tips on dietary supplements and mind and body practices for children and teens.

Common Natural Products Parents Give Children

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.