Well Child Care, 5-Year-Old

PHYSICAL DEVELOPMENT

Your 5-year-old should be able to skip with alternating feet and can jump over obstacles. Your 5-year-old should be able to balance on one foot for at least 5 seconds and play hopscotch.

EMOTIONAL DEVELOPMENTY

  • Your 5-year-old should be able to distinguish fantasy from reality but still enjoy pretend play.

  • Set and enforce behavioral limits and reinforce desired behaviors. Talk with your child about what happens at school.

SOCIAL DEVELOPMENT

  • Your child should enjoy playing with friends and want to be like others. A 5-year-old may enjoy singing, dancing, and play acting. A 5-year-old can follow rules and play competitive games.

  • Consider enrolling your child in a preschool if he or she is not in kindergarten yet.

  • Your child may be curious about, or touch their genitalia.

MENTAL DEVELOPMENT

Your 5-year-old should be able to:

  • Copy a square and a triangle.

  • Draw a cross.

  • Draw a picture of a person with a least 3 parts.

  • Say his or her first and last names.

  • Print his or her first name.

  • Retell a story.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (Doses only obtained if needed to catch up on missed doses in the past.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (The fifth dose of a 5-dose series should be obtained unless the fourth dose was obtained at age 4 years or older. The fifth dose should be obtained no earlier than 6 months after the fourth dose.)

  • Haemophilus influenzae type b (Hib) vaccine. (Children older than 5 years of age usually do not receive the vaccine. However, any unvaccinated or partially vaccinated children aged 5 years or older who have certain high-risk conditions should obtain vaccine as recommended.)

  • Pneumococcal conjugate (PCV13) vaccine. (Children who have certain conditions, missed doses in the past, or obtained the 7-valent pneumococcal vaccine should obtain the vaccine as recommended.)

  • Pneumococcal polysaccharide (PPSV23) vaccine. (Children who have certain high-risk conditions should obtain the vaccine as recommended.)

  • Inactivated poliovirus vaccine. (The fourth dose of a 4-dose series should be obtained at age 4–6 years. The fourth dose should be obtained no earlier than 6 months after the third dose.)

  • Influenza vaccine. (Starting at age 6 months, all children should obtain influenza vaccine every year. Infants and children between the ages of 6 months and 8 years who are receiving influenza vaccine for the first time should receive a second dose at least 4 weeks after the first dose. Thereafter, only a single annual dose is recommended.)

  • Measles, mumps, and rubella (MMR) vaccine. (The second dose of a 2-dose series should be obtained at age 4–6 years.)

  • Varicella vaccine. (The second dose of a 2-dose series should be obtained at age 4–6 years.)

  • Hepatitis A virus vaccine. (A child who has not obtained the vaccine before 2 years of age should obtain the vaccine if he or she is at risk for infection or if hepatitis A protection is desired.)

  • Meningococcal conjugate vaccine. (Children who have certain high-risk conditions, are present during an outbreak, or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

TESTING

Hearing and vision should be tested. Your child may be screened for anemia, lead poisoning, and tuberculosis, depending upon risk factors. Discuss these tests and screenings with your child's doctor.

NUTRITION AND ORAL HEALTH

  • Encourage low-fat milk and dairy products.

  • Limit fruit juice to 4–6 ounces (120–180 mL) each day. The juice should contain vitamin C.

  • Avoid food choices that are high in fat, salt, or sugar.

  • Encourage your child to participate in meal preparation.

  • Try to make time to eat together as a family, and encourage conversation at mealtime to create a more social experience.

  • Model good nutritional choices and limit fast food choices.

  • Continue to monitor your child's toothbrushing and encourage regular flossing. Help your child with brushing if needed.

  • Schedule a regular dental examination for your child.

  • Give fluoride supplements as directed by your child's health care provider or dentist.

  • Allow fluoride varnish applications to your child's teeth as directed by your child's health care provider or dentist.

ELIMINATION

Nighttime bed-wetting may still be normal. Do not punish your child for bed-wetting.

SLEEP

  • Your child should sleep in his or her own bed. Reading before bedtime provides both a social bonding experience as well as a way to calm your child before bedtime.

  • Nightmares and night terrors are common at this age. If they occur, you should discuss these with your child's health care provider.

  • Sleep disturbances may be related to family stress and should be discussed with your child's health care provider if they become frequent.

  • Create a regular, calming bedtime routine.

PARENTING TIPS

  • Try to balance your child's need for independence and the enforcement of social rules.

  • Recognize your child's desire for privacy in changing clothes and using the bathroom.

  • Encourage social activities outside the home.

  • Your child should be given some chores to do around the house.

  • Allow your child to make choices and try to minimize telling your child "no" to everything.

  • Be consistent and fair in discipline and provide clear boundaries. Try to correct or discipline your child in private. Positive behaviors should be praised.

  • Limit television time to 1–2 hours each day. Children who watch excessive television are more likely to become overweight.

SAFETY

  • Provide a tobacco-free and drug-free environment for your child.

  • Always put a helmet on your child when he or she is riding a bicycle or tricycle.

  • Always limit access to pools with self-latching gates. Enroll your child in swimming lessons.

  • Continue to use a forward-facing car seat until your child reaches the maximum weight or height for the seat. After that, use a booster seat. Booster seats are needed until your child is 4 feet 9 inches (145 cm) tall and between 8 and 12 years old. Never place a child in the front seat with air bags.

  • Equip your home with smoke detectors.

  • Keep home water heater set at 120° F (49° C).

  • Discuss fire escape plans with your child.

  • Avoid purchasing motorized vehicles for your child.

  • Keep medicines and poisons capped and out of reach.

  • If firearms are kept in the home, both guns and ammunition should be locked up separately.

  • Be careful with hot liquids ensuring that handles on the stove are turned inward rather than out over the edge of the stove to prevent your child from pulling on them. Keep knives away and out of reach of your child.

  • Street and water safety should be discussed with your child. Use close adult supervision at all times when your child is playing near a street or body of water.

  • Tell your child not to go with a stranger or accept gifts or candy from a stranger. Encourage your child to tell you if someone touches him or her in an inappropriate way or place.

  • Tell your child that no adult should tell him or her to keep a secret from you and no adult should see or handle his or her private parts.

  • Warn your child about walking up to unfamiliar dogs, especially when the dogs are eating.

  • Children should be protected from sun exposure. You can protect them by dressing them in clothing, hats, and other coverings. Avoid taking your child outdoors during peak sun hours. Sunburns can lead to more serious skin trouble later in life. Make sure that your child always wears sunscreen which protects against UVA and UVB when out in the sun to minimize early sunburning.

  • Show your child how to call your local emergency services (911 in U.S.) in case of an emergency.

  • Teach your child his or her name, address, and phone number.

  • Know the number to poison control in your area and keep it by the phone.

  • Consider how you can provide consent for emergency treatment if you are unavailable. You may want to discuss options with your health care provider.

WHAT'S NEXT?

Your next visit should be when your child is 6 years old.