What are the recommended health screenings and lifestyle counseling for a 5-year-old child?

Health Screenings and Lifestyle Counseling for a 5-Year-Old Child

A 5-year-old child should receive comprehensive vision screening using age-appropriate visual acuity testing (HOTV or LEA SYMBOLS charts), fluoride varnish application, developmental surveillance, and anticipatory guidance focused on injury prevention, nutrition, physical activity, and screen time limits. 1

Vision Screening

Vision screening is the highest priority screening at age 5, as this is the critical window for detecting and treating amblyopia before treatment efficacy declines. 1

• Perform monocular visual acuity testing using HOTV letters or LEA SYMBOLS charts as the preferred method for 5-year-olds, with the fellow eye covered by adhesive patch to prevent peeking 1
• Children who fail visual acuity screening should be referred for comprehensive eye examination after the first screening failure 1
• Instrument-based screening (photoscreening or autorefraction) can be offered as an alternative for uncooperative children, though it is not superior to visual acuity testing in children who are able to cooperate 1
• Include ocular history, external inspection of eyes and lids, ocular motility assessment, pupil examination, and red reflex examination at this visit 1

The evidence strongly supports vision screening at this age because treatment efficacy for amblyopia steadily decreases after age 3 years and becomes ineffective by age 12 years, making early detection critical for preventing permanent visual impairment. 1

Dental Health

• Apply fluoride varnish at this visit, continuing the application schedule that should have begun at 6 months of age 1
• Provide fluoride supplementation if the child lives in an area with inadequate water fluoridation (less than 0.6 ppm) 2
• Screen for dental caries, which is the most common chronic disease in young children 1

Developmental and Behavioral Surveillance

• Conduct developmental surveillance at this visit, assessing school readiness and age-appropriate developmental milestones 3
• Screen for behavioral and mood problems, as these predict mental health problems in early school years with 86% sensitivity 4

Physical Measurements and Screening

• Calculate body mass index (BMI) and plot on growth charts to screen for obesity (BMI ≥95th percentile for age and sex) 2
• Measure blood pressure, as many experts recommend annual screening beginning at age 3 years despite mixed evidence 2
• Measure height and weight to monitor growth trajectory 2, 3

Immunizations

• Verify completion of all routine childhood immunizations, including MMR series, varicella series, hepatitis A and B series, and annual influenza vaccine 1
• Update any missed immunizations according to catch-up schedules 2

Lifestyle Counseling and Anticipatory Guidance

Injury Prevention

• Counsel on car seat safety: children should remain in a forward-facing car seat with harness until they reach the height or weight limit for that seat 3
• Address home safety, including supervision around water, bicycle helmet use, and prevention of falls 3

Nutrition

• Limit or avoid juice and sugar-sweetened beverages, providing only limited quantities if any 3
• Counsel on balanced diet with emphasis on fruits, vegetables, and whole grains 2
• Ensure adequate vitamin D intake of at least 400 IU daily 2

Physical Activity and Screen Time

• Limit screen time (television, computer, video games) to no more than 1 hour per day of high-quality programming 3
• Encourage at least 60 minutes of physical activity daily 2
• Assess current daily screen time and hours of sleep per night 2

Tobacco Exposure

• Screen for tobacco smoke exposure by asking if the child lives with anyone who uses tobacco, if anyone smokes in the home or car, and if caregivers use tobacco products 1
• Include questions about electronic nicotine delivery systems ("vaping") as families may not consider these as tobacco 1
• Provide tobacco use prevention counseling, as messages should start when children are developmentally ready to understand them, typically around age 5 1

Dental Care

• Assess daily tooth brushing habits and dental care routine 2
• Recommend regular dental visits 2

Hearing Screening

• Perform hearing screening, as recommended annually or every two years in school-aged children 2

Common Pitfalls to Avoid

• Do not use Snellen letters for visual acuity testing in 5-year-olds—they are less desirable because individual letters are not of equal legibility; use HOTV or LEA SYMBOLS instead 1
• Do not delay referral for failed vision screening—refer after the first failure rather than rescreening multiple times 1
• Do not overlook tobacco exposure screening, including newer products like e-cigarettes that families may not recognize as harmful 1
• Ensure proper eye occlusion during visual acuity testing to prevent peeking, which can produce false-negative results 1