Pediatric Primary Care (33 page)

e.  Should not wear earphones while riding.

3.  Skateboard safety: children should always wear helmet and never ride near traffic.

4.  Water safety.

a.  Never allow child to swim alone or play unsupervised in or by water—even for a moment.

b.  Child should learn to swim and take lessons from qualified instructor.

c.  Backyard swimming pools should be enclosed with high, locked fence on all sides. Fences should be at least 4 ft high on all sides.

d.  Diving should not be allowed until underwater depth has been determined and checked for hazards.

e.  No swimming near boats, fisherman, unsupervised open water.

f.  Children should always wear a life jacket when in a boat.

g.  Parents should know how to perform CPR.

5.  Fire and burn accidents.

a.  Install smoke detectors, on all floors and particularly in or near sleeping areas.

b.  Keep fire extinguishers in kitchen, other areas where fire could start.

c.  Have family fire plan in place; practice regular fire drills.

d.  Discourage playing with matches, etc.

e.  To avoid scalding burns from water, heaters should never be set > 120°F (48.9°C).

6.  Home alone: most children are not old enough until age 11 or 12. Child should be learning safety, security, emergency guidelines (calling parent, neighbor, 911) in preparation for emergencies or for when the time comes that the child is old enough to be left alone for short times such as after school.

7.  Gun safety: guns, ammunition need to be stored and locked separately. Child needs to know to stay away from and alert parent should he encounter a gun at a friend's house or elsewhere.

8.  Bullying: children of this age can sometimes be the target of bullies. Child needs to know strategies for dealing with bullying. Strong friendships should be encouraged to avoid being bullied.

9.  Sexual abuse.

a.  Most sexual abuse occurs between the ages of 8 and 12.

b.  In 80% of these cases, abuser is known to child.

c.  Reinforce “good touch/bad touch” concepts and awareness of possible scenarios that may occur. Promote abuse-prevention programs at school and encourage parents to listen carefully to child who might have a concern, particularly of a sexual nature.

10.  Substance abuse.

a.  Begins with experimentation and casual use, often under peer pressure.

b.  Problem drinking often begins in grade school.

c.  Prevention of substance abuse needs to begin before adolescence.

d.  Secondhand smoke is a serious health hazard for children. Increases risk of developing asthma, bronchitis, middle-ear disease, pneumonia, wheezing and coughing spells, behavioral/cognitive problems.

e.  Children whose parents smoke are more than twice as likely to smoke themselves than are children of nonsmokers.

11.  Media.

a.  In addition to < 2 hours of screen time per day and keeping TVs and computers out of bedrooms, remind parents about the importance of careful selection, watching together, and discussing programs their children watch.

b.  Encourage parents to be knowledgeable about online and social media.

c.  Keep computers in a central area of the house where computer activities can be monitored. Parents may want to consider purchasing online programs that allow them to monitor computer activity.

d.  Encourage parents to talk often with their children about online and social media safety and responsibility.

e.  Encourage parents to set a good example by limiting their own viewing time and engaging in other healthy activities.

BIBLIOGRAPHY

American Academy of Ophthalmology.
Policy Statement: Frequency of Ocular Exams.
Revised and approved. November 2009:
http://www.aao.org/about/policy/upload/Frequency-of-Ocular-Exams-2009.pdf.
Accessed June 4, 2011.

American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology.
Policy statement: Vision Screening for Infants and Children.
Revised and approved, March 2007:
http://www.aao.org/one_passthru.cfm?link=URL&target=http://one.aao.org/asset.axd?id=2efe6879-b631-4878-b878-18bc1679114c
. Accessed June 4, 2011.

American Academy of Pediatrics and American Academy of Ophthalmology.
Joint Statement: Protective Eyewear for Young Athletes.
Revised and approved October and November 2003:
http://www.aao.org/about/policy/upload/Protective-Eyewear-for-Young-Athletes.pdf.
Accessed June 4, 2011.

American Academy of Pediatrics.
Policy Statement: Dietary Recommendations for Children and Adolescents: A Guide for Practitioners.
February 2006:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;117/2/544
. Accessed June 4, 2011.

American Academy of Pediatrics.
Policy Statemengt: Prevention of Pediatric Overweight and Obesity.
Reaffirmed October 2006:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424
. Accessed June 4, 2011.

American Academy of Pediatrics.
Policy Statement: Recommended Childhood and Adolescent Immunization Schedule, United States, January 2010.
http://aapredbook.aappublications.org/resources/IZSchedule7-18yrs.pdf
. Accessed June 4, 2011.

American Dietetic Association. Nutrition guidance for healthy children ages 2 to 11 years.
J Am Dietetic Assoc.
2008;108(6):1038-1047.

American Dietetic Association. Total diet approach to communicating food and nutrition information.
J Am Dietetic Assoc.
2007;107(7):1224-1232.

Bennett HJ.
Waking Up Dry: A Guide to Overcoming Bedwetting.
Elk Grove Village, IL: American Academy of Pediatrics; 2005.

Brooks LJ, Topol HI. Enuresis in children with sleep apnea.
J Pediatr.
2003;142(5):515-518.

Council on Communications and Media. Media violence.
Pediatrics.
2009;124:1495-1503.

Daniels SR, Greer FR, and the Committee on Nutrition. Policy statement on lipid screening and cardiovascular health in childhood.
Pediatrics.
2008;122(1):198-208.

Dietz WH, ed.
American Academy of Pediatrics Guide to Your Child's Nutrition.
New York, NY: Random House; 1999.

Ginsburg KR, and the Committee on Communications and the Committee on Psychosocial Aspects of Child and Family Health. The importance of play in promoting healthy child development and maintaining strong parent-child bonds.
Pediatrics.
2007;119:182-191.

National Association for Sport and Physical Education:
www.naspeinfo.org.

National Highway Transportation Safety Association:
www.nhtsa.dot.gov/Safety/CPS.

National Sleep Foundation: Sleep in America:
www.sleepfloundation.org.

Ogden C, Carroll M.
Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008.
Centers for Disease Control and Prevention; 2010:
www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm.
Accessed June 4, 2011.

Schor EL, ed.
American Academy of Pediatrics, Caring For Your School-age Child, Ages Five to Twelve.
New York: Bantam Books; 2004.

CHAPTER 18

Eleven- to Thirteen-Year Visit (Preadolescent)

Mary J. Alvarado and Beth Richardson

I.  GENERAL IMPRESSION

A.  Preadolescence is time of rapid change and emotional turbulence.

B.  Need support, understanding, caring from adults in particular, which is not usually what they receive.

II.  NUTRITION

A.  Nutritional requirements.

1.   Increased energy and protein requirement due to rapid growth.

2.   Require 2200-3000 calories/day.

3.   To meet increased need, increase milk and dairy products to 4 servings/ day, bread group servings to 9 servings/day.

4.   One-fourth of daily calories is typically consumed in snacks; encourage fruit, cheese, milk beverages, raw vegetables, nuts.

5.   Diet should consist of 10-15% protein, 25-30% fat, 50-60% carbohydrates.

6.   Needs 8-15 mg of iron/day; iron is most commonly deficient nutrient.

7.   A well-balanced diet does not require supplementation; irregular eating patterns and/or high-calorie/low-nutrient snacking may lead to deficiencies requiring multivitamin.

B.  Nutritional assessment.

1.   Calculate and plot body mass index (BMI) (see
Appendix D
).

2.   Evaluate 24-hour recall.

3.   Examine intake, eating patterns; ask about special diets or supplements.