Well-Child Visit: 5 Years

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child's weight and height, calculate body mass index (BMI), and plot the measurements on a growth chart.

2. Check your child's blood pressure,vision, and hearing using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your child's:

Eating. Schedule 3 meals and 1–2 healthy snacks a day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don't force them to eat.

Bathroom habits. By now, your child should be able to go to the bathroom alone. Constipation may become a problem because some children are embarrassed to use the bathroom at school. Remind your child to take regular bathroom breaks and not to "hold it." Talk to your doctor if you have concerns about your child's bathroom habits.

Sleeping. Kids this age generally sleep about 10–13 hours each night. Most 5-year-olds no longer nap during the day. To help your child get enough sleep, you might need to set an earlier bedtime.

Development. By 5 years, most kids:

• can talk to another person and have more than 3 back-and-forth exchanges
• tell a story with at least 2 events
• answer simple questions about a book or story after being read to or told
• follow rules and take turns when playing games
• do simple chores
• count to 10
• identify some letters and numbers
• write some letters of their name
• hop on one foot
• button some buttons

Talk to your doctor if your child is not meeting one or more milestones, or you notice that your child had skills but has lost them.

4. Do an exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking with your child to assess language skills.

5. Update immunizations.Immunizations can protect kids from serious childhood illnesses, so it's important that your child get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may check for anemia, lead, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child's next checkup at 6 years:

Eating

1. Serve your child a well-balanced diet that includes lean protein, whole grains, fruits, vegetables, and low-fat dairy products.
2. Kids this age should get 2½ cups (600 ml) of low-fat milk or fortified soy milk (or other low-fat dairy products) daily.
3. Limit 100% juice to no more than 4–6 ounces (120–180 ml) a day. Avoid food and drinks high in sugar, salt, and fat.
4. Make time to eat together as a family. Turn off the TV and put away phones and other devices.

Routine Care

1. Allow plenty of time for physical activity and free play every day. Be active as a family.
2. Limit screen time (time spent with TV, smartphones, tablets, and computers) to no more than 1 hour a day of quality children's programming. Watch with your child, when possible. Keep TVs and devices out of your child's bedroom.
3. Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule regular dental checkups as recommended by the dentist. To help prevent cavities, the doctor or dentist may brush fluoride varnish on your child’s teeth 2–4 times a year.
4. To help prepare your child for kindergarten:
   • Practice counting and singing the ABCs.
   • Encourage drawing, coloring, and recognizing and writing letters.
   • Keep consistent daily routines and times for meals, snacks, playing, reading, cleaning up, waking up, and going to bed.
   • Allow your child to take some responsibility for self-care, including going to the bathroom, washing hands, brushing teeth, and getting dressed. Offer reminders and help when needed.
   • Teach your child your home address and phone number.
   • Read to your child every day.

Safety

1. Teach your child the skills needed to cross the street independently (looking both ways, listening for traffic), but continue to help your child cross the street until age 10 or older.
2. Make sure your child always wears a helmet when riding a bicycle (even one with training wheels) or scooter. Do not allow your child to ride in the street.
3. Make sure playground surfaces are soft enough to absorb the shock of falls.
4. Always supervise your child around water, and consider having them take a swimming class.
5. Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside to play and reapply about every 2 hours.
6. Protect your child from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapors from e-cigarettes is also harmful.
7. Keep your child in a belt-positioning booster seat in the backseat until they're 4 feet 9 inches (150 cm) tall. Kids usually reach this height when they're 8–12 years old.
8. Teach your child what to do in case of an emergency, including how to call 911.
9. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids can't get to the keys.
10. Discuss appropriate touch. Explain that some parts of the body are private and no one should see or touch them. Tell your child to come to you if someone asks to look at or touch their private parts, is asked to look at or touch someone else's, or is asked to keep a secret from you.
11. Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your child? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.