What should be included in a well‑child visit for a healthy 6‑year‑old child?

Well-Child Visit for a 6-Year-Old

A comprehensive well-child visit for a healthy 6-year-old should include growth assessment, complete physical examination, vision screening, developmental surveillance, age-appropriate immunizations, anticipatory guidance on nutrition and safety, and screening for behavioral/emotional concerns. 1

Growth and Vital Signs Assessment

• Plot height, weight, and BMI on standardized growth charts to identify growth abnormalities or obesity trends. 1
• Measure blood pressure manually using an age-appropriate cuff size at the end of the visit to minimize anxiety, as this is the age when routine annual BP screening begins. 2, 1
• Blood pressure should be measured in both arms if there are any cardiovascular concerns or family history of hypertension. 2

Complete Physical Examination

Perform a systematic head-to-toe examination including: 1

• Skin examination for birthmarks, rashes, or signs of abuse
• HEENT assessment including oral health evaluation and dental caries screening
• Cardiovascular and respiratory examination
• Abdominal examination
• Musculoskeletal assessment including spine examination for scoliosis screening
• Neurological examination including gait assessment
• Genitourinary examination as appropriate for age

Vision and Hearing Screening

• Perform vision screening using age-appropriate charts (standard Snellen chart is appropriate at this age) to detect amblyopia and refractive errors. 1
• Conduct hearing surveillance through developmental milestone assessment and parental questioning about auditory concerns. 1

Developmental and Behavioral Assessment

• Conduct developmental surveillance at this visit, though formal standardized screening tools are primarily recommended at 9,18, and 30 months. 2, 1
• Screen for school readiness, academic performance, and learning difficulties as the child is likely entering or already in elementary school. 2
• Assess social interactions with peers and evaluate for behavioral concerns including attention problems or hyperactivity. 1
• Screen for emotional well-being and signs of anxiety or depression, as mental health concerns can emerge at this age. 2

Immunization Review and Administration

Review immunization status and administer any vaccines due per the current CDC schedule: 2

• MMR second dose (if not already given; recommended at 4-6 years but can be given earlier if at least 4 weeks have elapsed since first dose) 2
• DTaP fifth dose (typically given at 4-6 years) 2
• IPV fourth dose (typically given at 4-6 years) 2
• Varicella second dose (if not already given) 2
• Annual influenza vaccine if not yet received for the current season 2

Laboratory Screening

• Obtain lipid panel screening if there is family history of hyperlipidemia or cardiovascular disease, or if the child has obesity or other risk factors. 2, 1
• Hemoglobin/hematocrit screening may be indicated based on dietary history or risk factors for anemia. 1

Anticipatory Guidance

Safety Counseling

• Emphasize proper car seat/booster seat use appropriate for the child's size (typically booster seat at this age until seat belt fits properly). 1
• Discuss bicycle helmet use and other sports safety equipment. 2
• Address water safety including swimming supervision and drowning prevention. 1
• Counsel on firearm safety if firearms are present in the home (locked, unloaded, separate from ammunition). 2
• Discuss stranger danger and personal safety appropriate for this developmental stage. 1

Nutrition and Physical Activity

• Recommend limiting juice to 4-6 ounces per day and avoiding sugar-sweetened beverages. 2, 1
• Encourage consumption of fruits, vegetables, whole grains, and low-fat dairy products as sources of essential nutrients. 2
• Discuss appropriate portion sizes and avoiding use of food as reward or punishment. 2
• Recommend at least 60 minutes of moderate to vigorous physical activity daily. 2
• Counsel on limiting sedentary behaviors and screen time to no more than 1-2 hours per day of quality programming. 2

Dental Health

• Emphasize twice-daily tooth brushing with fluoride toothpaste and regular dental visits every 6 months. 1
• Discuss limiting sugary snacks and beverages to reduce caries risk. 1

Sleep and Routine

• Recommend 9-12 hours of sleep per night for this age group with consistent bedtime routines. 1
• Discuss importance of removing screens from the bedroom. 1

School Performance

• Inquire about school adjustment, academic performance, and any learning concerns. 2
• Discuss homework routines and parental involvement in education. 2

Common Pitfalls to Avoid

• Do not skip vision screening at this critical age, as early detection of amblyopia and refractive errors is essential for optimal visual development. 1
• Do not rely solely on clinical judgment for developmental assessment—use structured questioning and validated tools when concerns arise, as clinical impression alone misses up to 45% of children eligible for early intervention. 2
• Do not substitute brief sports physicals for comprehensive well-child visits, as these lack psychosocial screening, confidentiality, and miss opportunities for preventive care. 2
• Do not forget to address both parents' and child's concerns by beginning the visit with open-ended questions about their health worries. 3
• Do not overlook behavioral and emotional screening, as these issues significantly impact quality of life and academic success at this age. 2