Winter 2010
 

Bright Futures Anticipatory Guidance

Stacy McConkey, MD Department of Pediatrics
University of Iowa Children’s Hospital

Bright Futures breaks anticipatory guidance into five categories:

1. School readiness
2. Mental health

3. Oral health

4. Nutrition and exercise
5. Safety

SCHOOL READINESS

• If the family has recently immigrated, are there any language concerns for the child or parents?

• Does the family understand how the local school system (i.e., AEA) works?

• For a child with special healthcare needs, is the family aware of how to initiate an IEP or 504 plan?

• Encourage families to attend the back-to-school night and school conferences.

7 to 8 years old

• If school is not going well for a child by this age, consider asking teachers for an evaluation for specialized help or tutoring.

9 to 10 years old

• Set aside a specific time for homework, providing a well-lit space, free of distractions.

5 to 6 years old

• Establish important routines for your family, and be consistent.

• Show affection.

• Listen to and respect your child.

• Encourage teaching the difference between right and wrong and the skills to manage anger without violence.

• Encourage parents to be good role models for anger management, self discipline, and impulse control.

• Promote responsibility by assigning chores that are appropriate to the child’s developmental level.

• Encourage competence, independence, and self reliance by not doing everything for your child; rather, help them do well.

• Show affection and pride in your child’s special strengths and use praise liberally.

• Establish reasonable consequences for assigned chores not completed within a deadline.

• Answer a child’s questions about pubertal changes honestly, simply, and at the child’s level. Review information the child receives at school on the subject.

9 to 10 years old

• Provide your child with a personal space.

• Anticipate early adolescent behavior changes in communication, moodiness, challenges to rules, refusal to join family activities, and increased risk-taking behavior.

• Supervise activities of groups of children know your child’s friends.

• Help your child learn respectful behavior toward others.

• Encourage your child to ask questions about sexuality and be prepared with an answer indicating what you deem acceptable. Encourage children to delay sexual activity.

• Talk about/advise against the use of alcohol, tobacco, inhalants, and other drugs.

• Discuss your child’s body image do they feel they are too fat, too thin, or just right?

5 to 6 years old

• Breakfast—research shows that eating breakfast helps kids learn and behave better in school.

• Help your child choose appropriate foods: at least five servings of fruits and vegetables per day.

• Avoid foods that are high in fat, sugar, and calories, and low in nutritional value.

• Children 4-6 years old need 16 ounces of low fat milk or dairy products per day.

• Limit intake of whole fruit juice to 4 to 6 ounces per day.

• Encourage 60 minutes of exercise per day, which can be divided into shorter units of time.

• Find activities the entire family can enjoy.

• Limit screen time (TV computer, games) to 2 hours per day. There should not be a TV in your child’s bedroom.

• Eat meals together. Turn off the TV during meals.

9 to 10 years old

• It is almost never appropriate to lose weight while growing—discuss dieting with physician.

• Make physical activity a part of child’s routine, not the exception.

5 to 6 years old

• Brush teeth twice daily with a pea-sized amount of toothpaste. Floss once per day.

• See a dentist every six months

• Use a mouth guard during sports activities

SAFETY

5 to 6 years old

• Teach your child to safely cross streets, looking right, left, and right again. A child should not cross alone until 10 years old.

• An adult should supervise getting on and off buses, including where to stand, wait, and when to board.

• Use a belt positioning booster until a child is 4’ 9” tall and 60-80 pounds. The child’s bottom should be in the seat crease, knees bent over edge of seat, and seatbelt across chest and legs.

• A child should stay in back seat until 13 years of age.

• Helmets should be used with all bikes, scooters, skateboards, ATV riding, horseback riding, skiing, etc.

• Teach your child to swim and never leave them alone while swimming. Do not permit swimming in fast moving water or diving, unless the depth is checked by adult.

• Children should wear life vests while riding in boats.

• Wear sunscreen SPF 15 or higher, reapply every 2 hours.

• Discuss private parts (areas covered by swimming suits) with your child Teach them it is never okay for another adult to ask for help with their private parts or to see child's unless a parent is present (such as during a visit to the doctor.) In addition, teach them it is never okay for another adult to ask a child to keep a secret from parents.

• Install smoke detectors on all levels of your home and frequently check and change batteries. Install CO detectors on all levels of your home with bedrooms.

• Have a fire escape plan and a place to meet outside; practice it.

• If guns are in the home, have ammunition locked up separately. Ask parents of your child’s friends about guns in their homes.

• Computers should be located where they can be monitored. Check internet history frequently to see web sites visited and consider using parental safeguards or filter. Discourage online chatting and providing personal information.

7 to 8 years old

• Ensure that your child understands how and when to call 911 and what to do in case of fire or other emergency.

• Tell them it is okay to ask to go home if they feel uncomfortable at someone’s house.

• Teach your child the rules of the road for bikes. No riding after dusk.