What are the key components to assess and discuss during a preventative visit for a 5-year-old female?

Preventive Visit for a 5-Year-Old Female

A comprehensive preventive visit for a 5-year-old female should include developmental surveillance with attention to school readiness skills, standardized developmental screening if any concerns are identified, physical examination with blood pressure measurement, immunization review and administration, anticipatory guidance on safety and nutrition, and trauma screening. 1

Developmental Assessment

Developmental Surveillance

• Assess school readiness skills including fine motor abilities (handwriting), gross motor coordination, communication skills, and feeding abilities that promote participation with peers in group activities. 2
• Elicit and document parental concerns about development, as parental concerns are powerful predictors of developmental problems. 2
• Address any concerns raised by preschool or child care staff about motor development or other developmental domains. 2
• Watch specifically for loss of previously acquired skills, which should alert you to the possibility of a progressive disorder. 2

When to Screen with Standardized Tools

• While routine standardized developmental screening is recommended at 9,18, and 30 months, at the 4-5 year visit (which includes age 5), special attention to surveillance is warranted with screening completed if there are ANY concerns. 3
• Use validated screening tools such as the Ages and Stages Questionnaire, Pediatric Symptom Checklist, or Strengths and Difficulties Questionnaire if concerns are identified. 2, 1

Trauma and Psychosocial Assessment

Trauma Surveillance

• Ask directly: "Has anything scary or concerning happened to you or your child since the last visit?" This question should be asked at every visit as part of trauma surveillance. 2, 1
• Observe for behavioral symptoms that may indicate trauma exposure including inattention, hyperactivity, difficulty completing tasks, emotional lability, or negative affect. 2
• Assess for exposure to violence, bullying, or family stressors. 1

Behavioral and Mental Health

• Screen for signs of anxiety, depression, or behavioral concerns using validated tools when indicated. 2, 1
• Evaluate social interactions, relationships with parents and peers, self-esteem, and emotional regulation. 1

Physical Examination

Required Components

• Measure blood pressure using proper technique with age-appropriate cuff size. 1
• Complete head-to-toe physical examination. 1
• Assess for signs of physical abuse or neglect. 2, 1
• Document growth parameters (height, weight, BMI). 4

Immunizations

• Review immunization status and administer any vaccines due according to the current CDC recommended schedule. 1
• Document any vaccine reactions or contraindications. 1

Anticipatory Guidance

Safety Counseling

• Car seat/booster seat use: Emphasize proper restraint for age and size. 1
• Bicycle helmet use for all riding activities. 1
• Water safety education. 1
• Firearm safety: If firearms are in the home, they must be stored locked and unloaded with ammunition stored separately. 1

Nutrition and Physical Activity

• Discuss healthy eating habits, limiting sugar-sweetened beverages, and appropriate portion sizes. 1
• Recommend at least 60 minutes of moderate to vigorous physical activity daily. 1
• Address any concerns about picky eating or nutritional adequacy. 4

Sleep and Screen Time

• Recommend 8-10 hours of sleep per night for this age group. 1
• Provide guidance on limiting screen time and ensuring age-appropriate content. 1
• Discuss online safety and social media awareness as the child approaches school age. 1

School Readiness

• Discuss preparation for kindergarten or elementary school entry. 2
• Address any learning concerns or need for educational support. 1

Common Pitfalls to Avoid

• Do not conduct a brief "sports physical" style assessment—this misses critical developmental, behavioral, and psychosocial screening that directly impacts long-term outcomes. 1
• Do not rely solely on parental report without directly observing the child's behavior and interactions during the visit. 1
• Do not skip trauma screening—asking about scary or concerning events should be routine at every visit. 2
• Do not overlook motor development assessment—subtle coordination problems (developmental coordination disorder) often become evident around kindergarten entry and affect up to 6% of children. 2
• Do not fail to engage the child directly in age-appropriate conversation—this provides valuable information about language, social skills, and cognitive development. 1

Special Considerations

• For children with identified special health care needs, assess condition management, care coordination, and family support needs. 1
• If motor delays or concerns are identified, refer for formal developmental evaluation rather than "watchful waiting." 2
• Children exposed to trauma may require additional screening with validated PTSD screening tools and referral to mental health services. 2