What is expected during a 10-year pediatric visit?

Components of a 10-Year Pediatric Well-Child Visit

A comprehensive 10-year pediatric well-child visit should include physical measurements, screening tests, immunization updates, and age-appropriate anticipatory guidance to assess growth, development, and overall health status.

Physical Assessment Components

• Growth measurements:

  • Height, weight, and BMI calculation with plotting on appropriate growth charts 1
  • Calculate BMI percentile to identify potential weight concerns 1
  • Compare with previous measurements to assess growth trajectory

• Vital signs:

  • Blood pressure measurement (missed in approximately 33% of preventive visits) 1
  • Heart rate and respiratory rate
  • Oxygen saturation if clinically indicated 1

• Complete physical examination:

  • Head-to-toe assessment including:
    • Vision screening (one-time screening between 3-5 years recommended) 2
    • Dental health assessment (last dental visit) 3
    • Skin examination (acanthosis nigricans, etc.) 3
    • Thyroid palpation 3
    • Cardiovascular and respiratory assessment
    • Abdominal examination
    • Musculoskeletal assessment
    • Neurological screening
    • Pubertal development assessment (beginning of puberty often occurs around this age)

Laboratory Screening

• For all 10-year-old children:

  • Consider lipid profile screening based on family history and risk factors 3
  • Hemoglobin/hematocrit if not done previously

• For children with specific risk factors:

  • Fasting lipid profile for children with family history of premature cardiovascular disease 3
  • Liver function tests if overweight/obese 3
  • Thyroid function tests if symptoms present 3

Immunization Review and Update

• Review immunization status and administer as needed:
  • Annual influenza vaccine
  • Catch-up on any missed childhood vaccines (Hepatitis A/B, MMR, Varicella, Polio, DTaP/Tdap) 1
  • Tdap booster if not previously administered 3

Developmental and Behavioral Assessment

• Psychosocial/behavioral screening:
  • School performance and learning difficulties 1
  • Depression and suicide risk assessment 1
  • Bullying experiences 1
  • Screen time habits (recommended limit: 2 hours per day) 1, 2
  • Sleep patterns 3
  • Early signs of substance use/experimentation 1
  • Social determinants of health (food security, housing stability, transportation access) 3

Anticipatory Guidance

• Safety counseling:

  • Car safety (proper booster seat use if needed based on height/weight) 1
  • Helmet use for bicycling and sports 1
  • Water safety 1
  • Firearm safety if applicable 1

• Nutrition guidance:

  • Healthy eating patterns with emphasis on fruits, vegetables, and whole grains 1
  • Limiting foods high in saturated fats, trans fats, and added sugars 1
  • Limiting sugar-sweetened beverages 2

• Physical activity:

  • Recommendation for 60 minutes of moderate to vigorous physical activity daily 1
  • Discussion of organized sports participation and physical activity preferences

Family Assessment

• Family history update:

  • Changes in medical/family history since last visit 3
  • Family history of autoimmune disorders 3
  • Family history of premature cardiovascular disease 1

• Social history:

  • Family dynamics
  • Identify existing social supports 3
  • Screen for changes in home environment

Common Pitfalls to Avoid

• Failure to calculate and interpret BMI correctly:

  • Many providers measure height and weight but fail to calculate BMI, leading to missed opportunities for identifying weight concerns 4
  • Use age and sex-specific BMI percentiles rather than absolute BMI values 5

• Inadequate blood pressure screening:

  • Blood pressure is missed in approximately 33% of preventive visits 1
  • Use age, height, and sex-specific percentiles for interpretation

• Incomplete immunization review:

  • Failing to check for missed vaccines that could be administered at this visit
  • Not discussing the importance of annual influenza vaccination

• Missing psychosocial concerns:

  • School-aged children may have unidentified learning difficulties, bullying experiences, or early mental health concerns that require screening

By following this comprehensive approach to the 10-year well-child visit, healthcare providers can effectively monitor growth and development, identify potential health concerns early, and provide appropriate guidance to support optimal health outcomes.