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The goals of the health maintenance visit in school-aged children (five to 12 years) are promoting health, detecting disease, and counseling to prevent injury and future health problems. It is also an opportunity for family physicians to stay connected with children and their families. Health maintenance visits should focus on evidence-based screening and counseling interventions that have a beneficial effect on children's health. This article, part I of a two-part series, discusses history, physical examination, screening, and immunization recommendations for health maintenance in school-aged children.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Clinical recommendation | Evidence rating | Comments |
---|---|---|
School-aged children should be screened for obesity by measuring body mass index. Those with obesity (i.e., body mass index at or above the 95th percentile) should be offered resources and referral for comprehensive, intensive behavioral interventions.13,14,18 | B | Based on studies showing that intensive (more than 26 contact hours) behavioral interventions can result in reduced weight; evidence for less-intensive interventions is inconclusive |
The American Academy of Pediatrics recommends annual blood pressure measurements in school-aged children, or at every health care encounter in those who have risk factors.12,17 | C | Based on expert opinion from the American Academy of Pediatrics; the U.S. Preventive Services Task Force, however, found insufficient evidence to assess the benefits and risks of universal blood pressure screening in children and adolescents15 |
Children living in areas with inadequate fluoride in the water supply (0.6 ppm or less) should take a daily fluoride supplement.27,28 | B | Based on expert opinion and a small number of placebo-controlled trials |
School-aged children should receive age-appropriate immunizations, as well as catch-up immunizations if needed.29,30 | A | Based on consistent evidence from randomized controlled trials showing reduced incidence of disease and complications when children receive immunizations |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to
History
During a health maintenance visit for a school-aged child, the history should include screening questions and address any concerns raised by the child and parent or guardian. The patient's medical history, including...