Bright Futures Middle Childhood 5 10 Years

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Bright FuturesMiddle Childhood5 - 10 Years
We need to do a better job of weaving a safety
net of understanding, appreciation and guidance
in the family, in the community and school. We
need to start thinking of health and education as
interlocking spheres. -- C. Everett Koop,
M.D.Former Surgeon GeneralU.S. Public Health
Service
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How to Use Bright FuturesDevelopmental Sections

• Each Developmental Section Includes
• Developmental Overview
• Developmental Charts Family Preparation
  forHealth Supervision
• Strengths and Issues of theChild, Family and
  Community

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...How to Use Bright FuturesDevelopmental
Sections

• Health Supervision Topics
• "Portrait" of the child and family
• Health supervision questions
• Developmental surveillance and milestones (or
  developmental surveillance and school
  performance)
• Observation of parent-child interaction
• Physical examination
• Additional screening procedures
• Immunizations
• Anticipatory guidance for the family
• Opportunities for building partnerships

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Middle ChildhoodPhysical Development

• Physical Development
• Cognitive Development
• Social/Emotional Development
• Moral/Spiritual Development
• Health Behaviors

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Middle ChildhoodCognitive Development

• Physical Development
• Cognitive Development
• Social/Emotional Development
• Moral/Spiritual Development
• Health Behaviors

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Middle ChildhoodSocial/Emotional Development

• Physical Development
• Cognitive Development
• Social/Emotional Development
• Moral/Spiritual Development
• Health Behaviors

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Middle ChildhoodMoral/Spiritual Development

• Physical Development
• Cognitive/Linguistic Development
• Social/Emotional Development
• Moral/SpiritualDevelopment
• Health Behaviors

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Middle ChildhoodHealth Behavior

• Physical Development
• Cognitive/Linguistic Development
• Social/Emotional/Behavioral Development
• Children withSpecial Health Care Needs
• Health Behavior

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Middle Childhood Developmental Chart
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Family Preparation for MiddleChildhood Health
Supervision

• Be prepared to give updates on the following at
  your next visits
• Be prepared to provide the following information
  about your family
• Prepare and bring in questions, concerns about
• Other

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...Family PreparationProvide Family Information

• Be prepared to give updates on the following at
  your next visits
• Be prepared to provide the following information
  about your family
• Prepare and bring in questions, concerns about
• Other

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...Family PreparationBring Questions, Concerns

• Be prepared to give updates on the following at
  your next visits
• Be prepared to provide the following information
  about your family
• Prepare and bring in questions, concerns about
• Other

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...Family PreparationOther Information

• Be prepared to give updates on the following at
  your next visits
• Be prepared to provide the following information
  about your family
• Prepare and bring in questions, concerns about
• Other

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Strengths Child

• Child
• Has good physical health and nutrition
• Has good eating habits Is developing a sense of
  responsibility for personal health
• Has regular oral health care
• Engages in physical activities Has positive
  attitude
• Feels loved and valued by parents and other
  adults
• Has one or more close friends Is developing
  social competence

• Expresses feelings
• Enjoys life and has joyful experiences
• Participates in social activities
• Has personal sense of competence
• Has high self-esteem and expects personal success
  
• Has opportunities for new challenges
• Feels comfortable asking questions of parents and
  teachers
• Works hard in school
• Has positive role models

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...Strengths Family

• Family
• Meets child's basic needs (food, shelter,
  clothing, safety, health care)
• Provides strong, nurturing family
• Provides safe environment (e.g., smoke alarms,
  car booster seat or safety belt)
• Enjoys child
• Responds to child's developmental needs
• Encourages good communication
• Spends individual time with child
• Praises and takes pride in child's achievements

• Affirms child's feeling of being loved
• Helps child develop social competence
• Possesses working knowledge of child health and
  development
• Serves nutritious family meals regularly
• Reinforces health as a family priority
• Allows age-appropriate autonomy
• Protects child against excessive stress
• Provides value system, good parental role models
• Promotes cooperation among siblings
• Has support of extended family and others
• Encourages participation in community

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...Strengths Community

• Community
• Provides quality schools and educational
  opportunities for all families
• Provides supervised programs for children
  (recreational, sports, educational, social,
  cultural)
• Provides activities for families
• Promotes physical activity (e.g., safe
  playgrounds, parks)
• Encourages participation of children in organized
  groups
• Provides support for families with special needs
  (school meal programs, educational programs)

• Provides outreach to identify uninsured or
  underinsured children facilitates enrollment in
  health insurance programs access to care
• Provides neighborhood/school settings with
  supervised before- and after-school activities
• Provides an environment free of hazards
• Ensures safe neighborhoods
• Provides affordable housing and public
  transportation
• Develops integrated systems of health care
• Fluoridates drinking water

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Issues Child

• Child
• School concerns (learning disabilities,
  underachievement, difficulty completing homework,
  frequent school absence or tardiness/school
  avoidance)
• Behavioral concerns (hyperactivity, inability to
  concentrate, temper outbursts, lying, aggression,
  fighting, stealing, vandalism, cruelty, violence)
  
• Peer concerns (inability to get along with other
  children, lack of friends, excessive shyness)

• Emotional concerns (separation problems,
  depression, anxiety, low self-esteem, threat of
  suicide)
• Risk-taking behavior (sexual activity, use of
  alcohol, drugs, or tobacco)
• Weight and height concerns (short stature,
  obesity, eating disorders)
• Physical inactivity
• Chronic illness
• Physical complaints
• Tics
• Developmental delays

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...Issues Family

• Family
• Parents or other family members with serious
  problems (depressed, mentally ill, abusive,
  overly critical, overprotective, incarcerated)
• Severe marital problems
• Domestic violence (verbal, physical, emotional,
  or sexual abuse)
• Frequently absent parent
• Rotating "parents" (parents' male or female
  partners)
• Inadequate child care arrangements
• Family health problems

• Substance use (alcohol, drugs, tobacco)
• Financial insecurity
• Homelessness
• Family transitions (moves, births, divorce,
  remarriage, incarceration, death)
• Lack of knowledge about child development
• Lack of parenting skills, parental self-esteem,
  or self-efficacy
• Intrusive family members
• Social isolation and lack of support
• Neglect or rejection of child

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...Issues Community

• Community
• Poverty
• Inadequate housing
• Environmental hazards
• Unsafe neighborhood
• Discrimination and prejudice
• Community violence, gangs
• Few opportunities for employment
• Inadequate or unsafe schools
• Lack of supervised programs before and after
  school
• Lack of programs for families with special needs

• Inadequate outreach to uninsured and underinsured
  children and failure to facilitate enrollment in
  health insurance programs and access to care
• Lack of social support
• Isolation in a rural community
• Lack of social, educational, cultural, and
  recreational opportunities
• Lack of access to immunizations and to medical
  and oral health services
• Inadequate public services (lighting,
  transportation, garbage removal)
• Inadequate fluoride in drinking water

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Health Supervision Five Year Visit - Questions
for Parent(s)

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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...Five Year VisitQuestions for Child

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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...Five Year VisitDevelopmental Surveillance

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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Five Year VisitObservation

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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...Five Year VisitPhysical Examination

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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...Five Year VisitAdditional Screenings

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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...Five Year VisitAnticipatory Guidance

• Questions for the Parent(s)
• Questions for the Child
• Developmental Surveillance and Milestones
• Observation of Parent-Child Interaction
• Physical Examination
• Additional Screening Procedures and Immunizations
• Anticipatory Guidance For the Family
• Promotion of Healthy and Safe Habits
• Promotion of Social Competence
• Promotion of Constructive Family Relationships
  Parental Health
• Promotion of Community Interactions
• Promotion of Successful School Entry

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Middle Childhood 5 - 10 Years

• Summary of Health Supervision Visits
• Five Year Visit
• Six Year Visit
• Eight Year Visit
• Ten Year Visit

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Building Partnerships During Middle Childhood

• What Else Should We Talk About ?
• Summarize findings at theend of each visit.
• Arrange Continuing Care
• Before the Next Visit
• Other Care
• Strengths

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...Building Partnerships

• What Else Should We Talk About ?
• Summarize findings at the end of each visit.
• Arrange Continuing Care
• Before the Next Visit
• Other Care

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Periodicity Schedule
For the 29 Recommended Health Supervision Visits
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Bright FuturesPocket Guide
New design to come
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To order additional materials and to find out
more about Bright Futures, contact

• Bright Futures Project
• National Center for Education in
• Maternal and Child Health
• Georgetown University
• 2000 15th Street, North, Suite 701
• Arlington, VA 22201-2617
• Tel [phone]
• Fax [phone]
• E-mail BrightFutures_at_ncemch.org
• Bright Futures Web site www.brightfutures.org