What questions should be asked during a well-child visit for a 5-year-old patient establishing care?

Essential Questions for a 5-Year-Old Well-Child Visit When Establishing Care

The American Academy of Pediatrics recommends a comprehensive assessment that includes physical health, development, behavior, and psychosocial health for all 5-year-old children during well-child visits, especially when establishing care for the first time. 1, 2

Medical and Physical Health Assessment

• Ask about current health status and concerns from both parents and child, including any acute illnesses or injuries since their last visit with previous providers 1
• Review complete medical history including chronic conditions, hospitalizations, surgeries, allergies, and current medications 1, 2
• Inquire about immunization status and request records from previous providers 1
• Ask about physical symptoms or concerns such as headaches, stomachaches, fatigue, or other physical complaints that might indicate underlying health issues 2
• Assess growth patterns by asking about previous measurements and any concerns about growth 1
• Evaluate sleep patterns, including bedtime routines, sleep duration (8-10 hours recommended), difficulties falling or staying asleep, snoring, or bedwetting 1, 2

Nutrition and Physical Activity

• Assess dietary habits including typical meals, snacks, food preferences, allergies/intolerances, and any nutritional supplements 1, 2
• Inquire about physical activity levels, asking specifically if the child gets at least 60 minutes of moderate to vigorous physical activity daily 1
• Ask about screen time habits, including television, computer, video games, and mobile devices (recommended limit is 2 hours per day) 1, 2

Development and Education

• Assess school readiness or current school performance, including academic strengths and challenges 1, 2
• Evaluate fine and gross motor skills through questions about writing, drawing, sports participation, and coordination 2
• Assess language development and communication skills 1
• Ask about the child's ability to follow directions and complete age-appropriate tasks 2

Behavioral and Mental Health

• Screen for symptoms of anxiety, depression, or mood disorders using age-appropriate questions about feelings, worries, and emotional regulation 2
• Ask about behavior at home and school, including following rules, impulsivity, and any concerning behaviors 2
• Inquire about friendships, social interactions, and any difficulties with peers 2
• Screen for potential trauma exposure with questions like "Has anything scary or concerning happened to your child since the last visit?" 3, 2

Family and Social Environment

• Ask about family composition, including who lives in the home and any recent changes in family structure 3, 2
• Inquire about family stressors, such as financial concerns, housing stability, or family conflicts 2
• Screen for exposure to violence, substance abuse, or mental illness in the home 2
• Ask about cultural practices or beliefs that might impact healthcare decisions 2
• Inquire about tobacco exposure, including "Does anyone who provides care for your child smoke?" 3

Safety Assessment

• Ask about home safety measures, including smoke detectors, carbon monoxide detectors, and gun safety if applicable 3, 2
• Inquire about car safety, including consistent use of booster seats or seat belts 2
• Ask about helmet use during biking, skating, or other activities 2
• Screen for potential exposure to environmental hazards, including lead, mold, or secondhand smoke 2
• Inquire about internet safety practices and parental monitoring of online activities 2

Parental Questions and Concerns

• Begin with open-ended questions such as "What questions or concerns do you have today?" 1
• Ask "What worries you most about your child's health or development?" 4
• Inquire "What do you want to accomplish at this visit?" 4
• Ask "What do you want your child to be able to do that they can't do now?" 4

Special Considerations for Establishing Care

• Request and review records from previous healthcare providers 1
• Ask about previous screening tests and results 1
• Inquire about family history of medical conditions, including eye disorders, developmental delays, or mental health conditions 3
• Ask about previous experiences with healthcare providers and what worked well or didn't work well 1

Common Pitfalls to Avoid

• Focusing only on physical health while neglecting behavioral and developmental aspects 1
• Relying solely on parental report without engaging the child directly 1
• Conducting a brief "sports physical" style assessment rather than a comprehensive evaluation 1
• Missing opportunities for anticipatory guidance on emerging issues 1
• Failing to screen for social determinants of health that may impact the child's wellbeing 1

By addressing these comprehensive questions during a 5-year-old's well-child visit when establishing care, providers can develop a complete understanding of the child's health status, development, and family environment, allowing for appropriate interventions and anticipatory guidance.