Why are Physicals Important!?

Development Surveillance
Detect and prevent developmental delays and possible diseases so they can be treated early

Both growing too slowly or too fast may indicate a nutritional or other health problem.


   – Lead 
     Toxic Lead Levels cause behavioral and learning difficulties, anemia, seizures and other medical problems. 

   – Vision 
     Performing well at school can be very difficult if a child has vision problems.

   – Blood Pressure / Hypertension  
     Reducing blood pressure during childhood and adolescence will result in a reduced risk of heart disease and death in adulthood.

   – Oral Health
     Dental sealant or a topical fluoride is crucial in preventing tooth decay

Keeps you from getting and spreading the diseases such as, Measles or polio, which cause life-altering changes or death. 

Behavioral Assessment
Mental health problems affect about 1 in 10 children and young people; they include depression, anxiety and conduct disorder. 

Anticipatory Guidance 
A crucial part of pediatric care and has been shown to reduce caregiver anxiety and ER/Urgent Care Visits.

Get access to community resources
Having access to resources such as food banks, shelters, mental or behavioral health experts ect.

What to except during a 9 Year Old Physical?


  • Demonstrates social and emotional competence
  • Engages in healthy nutrition
  • Engages in physical activity behaviors
  • Uses independent decision-making skills
  • Forms caring and supportive relationships with 
  • Family members
  • Other adults
  • Peers
  • Displays a sense of self-confidence and hopefulness


  • 4Psychosocial/Behavioral Assessment


  • History
    • Initial/Interval
  • Measurements
    • Length/Height and Weight
    • 1Body Mass Index
    • 2Blood Pressure.
  • Sensory Screening
    • 3Vision*
    • Hearing*
  • Oral Health
    • 11Fluoride Supplementation*
  • 6Procedures
    • 8Anemia*
    • 9Tuberculosis*
    • 10Dyslipidemia
    •  9 Years Thru 11 Years


  • Recommended age for certain high-risk groups
    • Meningococcal (MenACWY-D ≥9 mos; MenACWY-CRM ≥2 mos)
    • Hepatitis A (HepA)
    • Pneumococcal polysaccharide (PPSV23)
    • Haemophilus influenzae type b (Hib)
    • Pneumococcal conjugate (PCV13)
    • Human papillomavirus (HPV)
    • Meningococcal B
  • Recommended age for catch-up immunization
    • Hepatitis B (HepB)
    • Hepatitis A (HepA)
    • Inactivated poliovirus (IPV: <18 yrs)
    • Measles, mumps, rubella (MMR)
    • Varicella (VAR)
    • Tetanus, diphtheria, & acellular pertussis (Tdap: ≥7 yrs)
    • Influenza (IIV)
    • Annual vaccination 1 or 2 doses
  1. Screen, per //pediatrics.aappublications.org/content/120/ Supplement_4/S164.full
  2. Blood pressure measurement in infants and children with specific risk conditions should be performed at visits before age 3 years. 7 //pediatrics.aappublications.org/content/140/3/e20171904).  
  3. A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. Instrument-based screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age. //pediatrics.aappublications. org/content/137/1/e20153596 
  4. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver depression, and social determinants of health. //pediatrics.aappublications.org/content/135/2/384
  5. At each visit, age-appropriate physical examination is essential, with infant totally unclothed and older children  undressed and suitably draped. See “Use of Chaperones During the Physical Examination of the Pediatric Patient”   (//pediatrics.aappublications.org/content/127/5/991.full).
  6. These may be modified, depending on entry point into schedule and individual need.
  7. Every visit should be an opportunity to update and complete a child’s immunizations. //redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. 
  8. Perform risk assessment or screening, as appropriate, per recommendations in the current edition of the AAP Pediatric Nutrition: Policy of the American Academy of Pediatrics (Iron chapter).
  9. Testing should be performed on recognition of high-risk factors. Tuberculosis testing per recommendations of the AAP Committee on Infectious Diseases. 
  10. See //www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm
  11. If primary water source is deficient in fluoride, consider oral fluoride supplementation. //pediatrics. aappublications.org/content/134/3/626

9 Year Anticipatory Guidance

Social determinants of health

◊ Risks (neighbor­ hood and family violence, food security, family substance use, harm from the Internet) ◊ Strengths and Protective Factors (emotional security and self-esteem, connectedness with family and peers)

  • Teach your child nonviolent conflict-resolution techniques.
  • If concerns at school, ask for help from teacher/ principal; discuss bullying.
  • Talk with parents/trusted adult if you are bullied
  • Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more?
  • Contact community resources like SNAP for help with food assistance.
  • Don’t use tobacco/e-cigarettes.
    • Call 800-QUIT­ NOW (800-784-8669) for help to quit smoking. Talk with me if you are worried about family member drug/alcohol use.
  • How much do you know about your child ‘s Internet use?
    • Put family computer in easily seen place; monitor computer use; install safety filter. 
  • What would you do if you went on a site that scared you?
    • Don’t give out personal information online. 
  • Encourage new opportunities, activities, helping out at home/in community.
  • Spend time with your child. Discuss changing responsibilities within family. Clearly communicate rules, expectations.
  • Get to know child’s friends.
  • Making and keeping friends is an important life skill.

Development and mental health

 Temper Problems ◊ Setting Reasonable Limits ◊ Friends ◊ Sexuality (pubertal onset, personal hygiene, initiation of growth spurt, menstruation and ejaculation, loss of baby fat and accretion of muscle, sexual safety)

  • Anticipate new adolescent behaviors, importance of peers.
  • Reinforce values; encourage discussion of thoughts /feelings, appropriate anger management; provide personal space at home. Be a role model for positive behavior.
  • Supervise activities with peers.
    • What do you and your friends like to do together? What do you do when your friends pressure you to do things you don’t want to do?
  • How well do you and your partner agree on how to talk with your child about sexual development and sexuality? How would you respond if your child asked you about homosexuality? What questions do you have about the way your body is developing?
    • Answer questions about puberty/sexuality; counsel to avoid sexual activity; teach rules for how to be safe with adults: (1) no adult should tell a child to keep secrets from parents; (2) no adult should express interest in private parts; (3) no adult should ask a child for help with his/her private parts.


 School Attendance ◊ School Problems (behavior or learning) ◊ School Performance and Progress ◊ Transitions ◊ Co-Occurrence of Middle School ◊ Pubertal Transitions

  • What are some things you are good at?
    • Show interest in school performance/activities; if concerns, ask teacher about extra help.
  • Create quiet space for homework.

Physical growth and development

◊ Oral health (regular visits with dentist, daily brushing and flossing, adequate fluoride, avoidance of sugar­ sweetened beverages and snacks) ◊ Nutrition (healthy weight, disordered eating behaviors, importance of breakfast, limits on saturated fat and added sugars, healthy snacks) ◊ Physical Activity (60 minutes of physical activity a day, after-school activities)

  • Visit dentist twice a year.
  • Give fluoride supplements if dentist recommends.
  • Brush teeth 2 minutes, twice a day; floss once.
  • Wear mouth guard during sports.
  • What concerns do you have about your weight? How do you feel about how you look?
    • Help child choose healthy eating (provide healthy foods, eat together as a family, be a role model).
  • Eat breakfast; eat vegetables/fruits/whole grains/ low-fat or nonfat dairy/lean protein.
  • Eat when you’re hungry; stop when you’re satisfied.
  • Limit foods/drinks high in sugar/saturated fats/ refined grains.
  • Talk with me before trying to lose weight.
  • Be physically active often during the day.
  • Consider making family media use plan (www.healthychildren.org/MediaUsePla n), which can help balance child’s needs for physical activity, sleep, school activities, and unplugged time; decide on rules for media time in time left over after all other activities; take into account quantity, quality, location of media use.


◊ Car Safety ◊ Safety during Physical Activity ◊ Water Safety ◊ Sun Protect Ion ◊ Knowing Child’s Friends and Their Families ◊ Firearm Safety

  • The backseat is the safest place to ride. Switch from booster seat to seat belt in rear seat when child is ready.
  • Use safety equipment (helmets, pads).
  • Teach child to swim; supervise around water.
  • Use sunscreen; wear hat; avoid prolonged exposure when sun is strongest, between 11:00 am and 3:00 pm.
  • What would you do if you felt unsafe at a friend’s house?
    • Know child’s friends; make plan for personal safety.
  • Have you considered not owning a firearm because it poses a danger to the family? What have your parents taught you about firearms and firearm safety?
    • Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition separate. Homicide and completed suicide are more common in homes with firearms.

Goals For 9 Year Check up:

◌ Be gentle and patient ◌ Get more sleep ◌ Make a budget ◌ Leave your work at the office ◌ Focus on self-care ◌ Meditate as a family ◌ Find an outlet ◌ “cell-free” zone ◌ Spend more time with your partner ◌ Take more baths ◌ Have a girls’/boys’ night ◌ Be more flexible ◌ See your child for who they are ◌ Teach your child to speak up ◌ Help those less fortunate ◌ Drink more water ◌ Find 30 minutes a day of “me” time ◌ Challenge yourself ◌ Focus on experiences, not things ◌ Make health a priority ◌ Start—or finish—a degree ◌ Inform yourself ◌ Maintain balance ◌Laugh often ◌ Cook dinner more frequently ◌ Ask for help ◌ Have designated “cheat” days ◌ Stop having FOMO ◌ Say “I love you” more often

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