Well Child Care, 6-Year-Old

PHYSICAL DEVELOPMENT

A 6-year-old can skip with alternating feet, jump over obstacles, balance on one foot for at least 10 seconds, and ride a bicycle.

SOCIAL AND EMOTIONAL DEVELOPMENT

  • A 6-year-old enjoys playing with friends and wants to be like others, but still seeks the approval of his or her parents. A 6-year-old can follow rules and play competitive games, including board games, card games, and organized sports teams. Children are very physically active at this age. Talk to your caregiver if you think your child is hyperactive, has an abnormally short attention span, or is very forgetful.

  • Encourage social activities outside the home in play groups or sports teams. After school programs encourage social activity. Do not leave your child unsupervised in the home after school.

  • Sexual curiosity is common. Answer questions in clear terms, using correct terms.

MENTAL DEVELOPMENT

The 6-year-old can copy a diamond and draw a person with at least 14 different features. He or she can print his or her first and last names. A 6-year-old knows the alphabet. He or she is able to retell a story in great detail.

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. The child may be screened for anemia, lead poisoning, tuberculosis, and high cholesterol, depending upon risk factors. You should discuss the needs and reasons with your caregiver.

NUTRITION AND ORAL HEALTH

  • Encourage low-fat milk and dairy products.

  • Limit fruit juice to 4–6 ounces (120-180 mL) each day of a vitamin C containing juice.

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

  • Allow your child to help with meal planning and preparation. Six-year-olds like to help out in the kitchen.

  • Try to make time to eat together as a family. Encourage conversation at mealtime.

  • Model good nutritional choices and limit fast food choices.

  • Continue to monitor your child's toothbrushing and encourage regular flossing.

  • Continue fluoride supplements if recommended due to inadequate fluoride in your water supply.

  • Schedule a regular dental examination for your child.

ELIMINATION

Nighttime bed-wetting may still be normal, especially for boys or for those with a family history of bed-wetting. Talk to the child's caregiver if this is concerning.

SLEEP

  • Adequate sleep is still important for your child. Daily reading before bedtime helps a child to relax. Continue bedtime routines. Avoid television watching at bedtime.

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

PARENTING TIPS

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

  • Recognize the child's desire for privacy.

  • Maintain close contact with the child's teacher and school. Ask your child about school.

  • Encourage regular physical activity on a daily basis. Talk walks or go on bike outings with your child.

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

  • Be consistent and fair in discipline, providing clear boundaries and limits with clear consequences. Be mindful to correct or discipline your child in private. Praise positive behaviors. Avoid physical punishment.

  • Limit television time to 1–2 hours each day. Children who watch excessive television are more likely to become overweight. Monitor your child's choices in television. If you have cable, block channels that are not acceptable for viewing by young children.

SAFETY

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

  • Children should always wear a properly fitted helmet when riding a bicycle. Adults should model wearing of helmets and proper bicycle safety.

  • Always enclose pools with fences and self-latching gates. Enroll your child in swimming lessons.

  • Restrain your child in a booster seat in the back seat of the vehicle. 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 6-year-old child in the front seat with air bags.

  • Equip your home with smoke detectors and change the batteries regularly.

  • Discuss fire escape plans with your child. Teach your child not to play with matches, lighters, and candles.

  • Avoid purchasing motorized vehicles for your child.

  • Keep medications and poisons capped and out of reach.

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

  • Be careful with hot liquids and sharp or heavy objects in the kitchen.

  • 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. Never allow your child to swim without adult supervision.

  • Discuss avoiding contact with strangers or accepting gifts or candies from strangers. Encourage your child to tell you if someone touches him or her in an inappropriate way or place.

  • Warn your child about walking up to unfamiliar animals, especially when the animals 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.

  • Make sure your child knows 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.

  • Make sure your child knows both parents' complete names and cellular or work phone numbers.

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

WHAT'S NEXT?

The next visit should be when the child is 7 years old.