|
Winter 2008
Health Care for Preteens Age 9-12
Gretchen Vigil,
MD, Department of Pediatrics, University of
Iowa Children’s Hospital
For a child, the preteen
years are a time of great change, physical and mental. These years are also a
time of great change for the parents of a previously dependent child who is now
developing into a far more independent teenager.
|
 |
|
Nutrition
Girls and boys at
this age are beginning to enter puberty, with its great muscle and bone growth.
Assess calcium intake, and encourage 4 servings of dairy foods each day. Foods
that are rich in protein and iron are also important. Recommend multivitamins
for girls, to supply needed iron and folic acid. Reinforce the importance of a
heart healthy diet and avoidance of junk food. Encourage fitness.
Preteens often compare
themselves to their peers -- those they see around them and those they encounter
through the media. This may lead to concerns that preteens are hesitant to
voice, and it can be helpful to discuss body image as you review growth charts
with parent and patient.
School performance
It is assumed that basic
skills in reading and writing are now present, and that students will be using
these to develop more advanced skills. Children with learning disabilities may
need more assistance. Some children may be newly diagnosed with learning
disabilities when previous coping strategies cannot keep up with increasing
demands.
Peers
Peers begin to
have a stronger influence. Children with poor social skills may find it harder
to make and keep friends. Bullying used to be a problem found most often on the
school grounds, but may now occur away from school through instant messaging,
chat rooms, and email.
Physical exam
Respect the preteen’s
privacy by using appropriate draping during the physical exam. Assess blood
pressure, height, weight, body mass index (BMI), and scoliosis at each health
maintenance visit, and screen vision as well.
|
Body mass
index (BMI) = wt
(kg) / height (m)2 |
|
Status |
Percentile |
|
Underweight |
< 5th |
|
Healthy
weight |
5th to 85th |
|
Overweight |
85th-95th |
|
Obese |
> 95th |
|
Severely
obese |
> 5 percentiles above 95th |
|
|
Puberty
The exam to
assess pubertal status demonstrates the health care provider’s comfort level in
talking about pubertal development, and shows the child that sexual maturation
is not off limits for discussion.
Females typically begin
puberty with breast budding at a mean age of 10.9 years. Menarche follows about
2 years later, usually at Tanner 4 for pubic hair, and at a mean age of 12.7
years. For girls, peak growth occurs before menses begins.
Immunizations
At the 11-12 year
exam, review the child’s immunization history and provide new as well as
catch-up immunizations. New immunizations for preteens include:
-
Tetanus, diphtheria and
pertussis (Tdap) vaccine has replaced the Td previously
given to children age 11-12 years. The addition of pertussis immunization should
provide improved resistance to this disease for preteens, as well as the “herd
immunity” so important to infant health.
- Meningococcal conjugate (MCV4) vaccine
has replaced the
meningococcal polysaccharide vaccine (MPSV4) for the 11-55 year age group. A
single-dose immunization, MCV4 is expected to give better, longer lasting
protection.
-
Human
papilloma virus (HPV) vaccine protects against 70% of
virus-caused cervical cancers and 90% of virus-caused genital warts. It is
recommended for the 11-12 age group, but may be given to women 9-26 years old.
It is given as a 3-dose series:
-
Dose 1: At the
11-12 year exam
-
Dose 2: 2
months after first dose
-
Dose 3: 6
months after first dose
|
|
ROUTINE SCREENING for preteens should include annual assessment of:
Anemia
-
If risk factors for anemia
are present, screen for anemia.
Cholesterol
- Screen with a total serum
cholesterol if either parent has high cholesterol.
Screen with a full fasting
lipid panel if, before age 55, parents or grandparents had a history of:
Angina
Myocardial infarction
Stroke
Peripheral vascular disease
|
|
Diabetes – Screen for Type II diabetes
mellitus with a fasting plasma glucose in children 10 years old, or at onset of
puberty if the child is overweight and has any two of the risk factors below:
-
Type 2
diabetes in first or second degree relatives
-
Race,
ethnicity: American Indian, African-American, Hispanic, Asian, Pacific
Islander
-
Signs of
insulin resistance, such as acanthosis nigricans, hypertension,
dyslipidemia, or polycystic ovary syndrome
A level of 110-126 mg/dL
indicates impairment; >126 mg/dL indicates diabetes. Retest impaired levels in 3
months, and repeat screening every 2 years.
ANTICIPATORY GUIDANCE
-
Discuss
dental hygiene: Brushing twice a day, flossing once a day, and
dental visits twice a year.
-
Review injury
prevention; remind preteens that it is important to:
-
Wear seat
belts
-
Sit in
the back seat of the car until 13 years old (front seats expose
preteens to risk of air bag injury)
-
Wear
helmet and other protective gear as appropriate for biking,
skateboards, sports
-
Understand the family fire safety plan
-
Talk about
stranger safety, as preteens, particularly those who arrive home
after school before their parents are home from work, may now spend
more time on their own.
-
Discuss
screen and media safety: Parents should monitor TV, video games,
and Internet use, and limit screen time to 2 hours a day.
-
Talk with
parents about
gun safety at home and in homes their child visits.
|
|
Finally, encourage parents
to listen to their preteens and to respect their opinions; to show interest in
their activities, and to be familiar with their friends. Parents should talk
with preteens about their personal values, sexual activity, alcohol, drugs, and
inhalants.
Household chores allow the
child to contribute as a member of the family team while teaching important life
skills.
Although peers play an
increasingly important role for preteens, parents also have significant input.
Regular family
activities, times when the child has the parent’s undivided attention, and
family meals will continue to be vital components of family life.
|
|
|
Resources
Bright
Futures -- Prevention and health promotion for infants, children, adolescents, and their
families
Caring for
Your School-Age Child Ages 5 to 12,
Edward Schor, MD, FAAP (Bantam, 1995)
|
|
