Well-Child Visit: 11 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 using standard testing equipment. Your child's hearing may be checked.

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

Eating. At this age, kids should begin making healthy food choices on their own. Your child's diet should include lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 3 cups (720 ml) of low-fat or nonfat milk (or of low-fat or nonfat dairy products or fortified soy milk) daily. Aim for 5 servings of fruits and vegetables per day.

Sleeping. Kids this age need about 9-12 hours of sleep per night. Lack of sleep can make it hard to pay attention at school. Set a bedtime that allows for enough sleep and encourage your child to follow a relaxing bedtime routine. Keep TVs and all electronic devices out of your child's bedroom.

Physical activity. Kids this age should get at least 60 minutes of physical activity per day. Set daily limits on screen time, including TV, video games, smartphones, tablets, and computers.

Growth and development. By 11 years, it's common for many kids to:

• Show some signs of puberty:
  • In girls, puberty usually starts when they're between 8 and 13 with breast development and the appearance of pubic hair. Periods usually start about 2 years after breast development begins.
  • In boys, testicular enlargement is the first sign of puberty. This happens around age 11, but may start as early as 9 and as late as 15. Then the penis lengthens and pubic hair grows.
• have oily skin and/or acne
• not always connect their actions with future consequences
• want to be independent and fit in with peers
• focus on personal appearance and behavior
• want to engage in risky behaviors

After talking with you, the doctor may request some time alone with your child to answer any other questions.

4. Do anexam. This will include looking at the skin, listening to the heart and lungs, checking the back for any curvature of the spine, and checking for the signs of puberty. A parent, caregiver, or chaperone should be present during this part of the exam. Siblings should stay in the waiting room to give your child privacy.

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 your for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child's next checkup at 12 years:

School

1. Encourage your child to participate in a variety of activities, including music, arts and crafts, sports, after-school clubs, and other activities of interest.
2. Praise accomplishments and provide support in areas where your child struggles.
3. Provide a quiet place to do homework. Minimize distractions, such as TV and smartphones.
4. As schoolwork gets harder, your child may struggle. If this happens, work with the school staff to find the cause, such a learning or attention problem, bullying, or other stressors.
5. Peer pressure can lead to risky behaviors, such as drinking or smoking. Make sure you know who your child spends time with and that an adult is monitoring them.

Self

1. Spend time with your child every day. Share mealtimes, be active together, and talk about things that are important to your child.
2. Set rules and explain your expectations. Have fair consequences for rule-breaking. Praise good choices.
3. Be prepared to answer questions about puberty and the feelings associated with those changes. Be open to questions about gender identity and sexuality. Encourage your child to bring questions or concerns to you.
4. Encourage your child to wait until older to engage in sexual activity with others. Explain the risk of sexually transmitted diseases (STDs) and unwanted pregnancy.
5. Encourage your child to bathe or shower daily. If body odor is a concern, have your child use a deodorant.
6. Make sure your child brushes their teeth twice daily, flosses once a day, and sees a dentist once every 6 months.
7. Look for signs of depression, which can include irritability, sadness, loss of interest in activities, poor grades, and talk of suicide.

Safety

1. Talk to your child about the dangers of smoking, vaping, alcohol, and drugs.
2. Preteens should continue to ride in the back seat and always wear a seatbelt while in a vehicle. Your child should use a belt-positioning booster seat until they're 4 feet 9 inches (150 cm) tall. Kids usually reach this height when they're 8–12 years old.
3. Make sure your child wears a helmet while riding a bike, skateboard, or scooter. Your child should wear the right protective equipment, like mouth guards and pads, when playing sports.
4. Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside and reapply about every 2 hours.
5. Protect your child from secondhand smoke.
6. Monitor your child's Internet use. Keep the family computer in a place where you can watch what your child is doing. Install safety filters and check the browser history to see what websites your child visits.
7. Talk to your child about online safety and cyberbullying. Warn of the risks of sharing personal information.
8. 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.
9. 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.