What preventive screening, immunizations, and anticipatory guidance are recommended for a healthy 6‑year‑old during a well‑child visit?

Screening and Well-Care Tools for a 6-Year-Old

A comprehensive 6-year-old well-child visit should include growth and vital sign assessment, vision screening, developmental surveillance, immunization review with catch-up vaccines as needed, and anticipatory guidance on safety, nutrition, physical activity, and screen time. 1

Growth and Physical Examination

• Measure height, weight, and body mass index (BMI) and plot on growth charts to assess growth trajectory and identify obesity or failure to thrive 1
• Measure blood pressure annually using proper technique with age-appropriate cuff size 2, 3
• Perform a complete head-to-toe physical examination including assessment of skin, cardiovascular system, respiratory system, abdomen, musculoskeletal system, and neurological function 1

Vision and Hearing Screening

• Perform vision screening at this age to detect amblyopia, as the U.S. Preventive Services Task Force recommends a one-time screening between three and five years of age 1
• Consider hearing screening if not previously performed or if concerns exist 1

Developmental and Behavioral Assessment

• Conduct developmental surveillance at this visit, reviewing school readiness, academic performance, social interactions, and behavioral concerns 1, 4
• While formal developmental screening tools are recommended at 9,18, and 30 months per AAP guidelines, ongoing surveillance continues throughout childhood 1
• Assess psychosocial functioning, including peer relationships, family dynamics, and any behavioral concerns 4

Immunization Review and Administration

• Review immunization status and administer any catch-up vaccines needed to complete the childhood series 5
• At age 6, children typically receive vaccines as part of the 4-6 year schedule, which may include DTaP (diphtheria, tetanus, acellular pertussis), IPV (inactivated poliovirus), MMR (measles, mumps, rubella), and varicella if not previously completed 6
• Administer annual influenza vaccine, which is recommended for all children 6 months and older 5, 7
• Ensure hepatitis B series is complete (3 doses) and hepatitis A series is complete (2 doses) 5

Anticipatory Guidance

Safety

• Emphasize proper car seat use: children should remain in a booster seat until they reach the height and weight requirements for adult seat belts (typically 4'9" tall and 8-12 years old) 1
• Discuss helmet use for bicycling, skating, and other wheeled activities 2, 3
• Address water safety, including swimming supervision and pool safety 1
• Counsel on firearm safety if firearms are present in the home, emphasizing secure storage 2, 3

Nutrition

• Recommend limiting juice intake to no more than 4-6 ounces per day and avoiding sugar-sweetened beverages 1
• Encourage healthy eating patterns with fruits, vegetables, whole grains, and appropriate portion sizes 2, 3
• Discuss the importance of family meals and limiting fast food consumption 1

Dental Health

• Recommend fluoride use through fluoridated water or supplements if water is not fluoridated, and encourage twice-daily tooth brushing 1
• Ensure the child has established dental care with regular dental visits 1

Physical Activity and Screen Time

• Recommend at least 60 minutes of moderate to vigorous physical activity daily 2, 3
• Limit screen time to 1-2 hours per day of quality programming, avoiding screens during meals and before bedtime 2, 1
• Encourage outdoor play and limit sedentary activities 1

Sleep

• Assess sleep patterns and ensure the child is getting adequate sleep (9-12 hours per night for this age group) 3, 1
• Discuss bedtime routines and sleep hygiene 1

Screening Tests

• No routine laboratory screening is recommended for healthy 6-year-olds unless specific risk factors are present 1
• Consider lipid screening only if there is a family history of early cardiovascular disease or hyperlipidemia 2, 3
• Hemoglobin/hematocrit screening may be considered if dietary concerns or risk factors for anemia exist 2

Common Pitfalls to Avoid

• Do not skip developmental surveillance even though formal screening tools are not required at this age; ongoing assessment of school performance and social functioning is critical 1, 4
• Do not conduct abbreviated "sports physicals" instead of comprehensive well-child visits, as these miss opportunities for preventive care and anticipatory guidance 2, 8
• Do not forget to update the immunization record and provide documentation to parents and schools 5
• Avoid providing generic anticipatory guidance; tailor counseling to the specific child's and family's needs, risks, and concerns 1, 9