5 Year Old Well Child Check

Five years of life is sometimes called the golden age of childhood. However, because they are entering school, this age holds realistic promises and realistic perils for both the child and the parents.

The smoothness of that transition, what and when the child and family experience and learn in the early school years often has a long lasting effect on several areas of psychological well-being. These include future achievement or lack of achievement, personal sense of worth, ability to contribute to others, and satisfaction with life. At this age, influences of modeled and observed behavior play major effects on learning and success of an individual. The five year olds ability to master a given task gives the child a sense of competence as an individual.

Behavior

Being Five

The world of a five-year-old is still a mysterious place, but one in which she has some control. Instead of the impulsiveness she showed at four, she is able to gauge a situation before she reacts- to "stop and think" first. She may be slower to get into situations, and seems to have a serious air about her. She likes the familiar territory at home, the tried and true, and rules. She may go to great lengths to admit she's wrong. Although the five-year-old's world seems smooth on the surface, it can be stormy underneath. And the second six months of this year can be more turbulent, as your child moves closer to age six and school. It's harder for the child who has not had some initiation in group play in day-care centers or nursery schools.

Thinking

At five, your child still believes in magic-it rains because of something he did, or because the clouds were angry. He still thinks he is the center of the universe, and has trouble telling the difference between fantasy and reality. He may believe in the Tooth Fairy, Santa Claus the Easter Bunny… and in ghosts and monsters.

At this stage, he knows that words stand for ideas and objects, and likes to guess about cause and effect. Although he lives in the "now", he knows the difference between past and future.

He doesn't really understand our adult classification systems yet, and is still hazy about how days of the week, months and seasons fit into the big picture. In fact, he may make up his own systems to organize the world as he sees it. The five-year-old is on a quest for knowledge, and when he asks questions, he really wants to know the answers. The more experiences he has this year and the more you explain things, the broader his horizons will be.

If your five-year-old has a tendency to "stop and think" this year, what she thinks about is enough to stop you in your tracks. Get ready for questions like: "Why do you and Daddy close your bedroom door?" "Where do babies come from?" "Suzy said…" or "Why did ______ die?" She's just as likely to ask them in the middle of the supermarket as when the two of you are "having a talk."

The first thing to remember here is that you have a lot more information about the question than she's ready to hear. At five she has her own ideas about the world, and she still believes in "magical thinking."

The smart thing is to find out what she thinks, and tailor your answers to her perceptions. Try to be straightforward and matter-of-fact. And be prepared. Your library has sex education books for children, and it might be a good idea for you to check a few out so you know just how much to say when the question comes up.

Feelings

Some child psychologists feel that children go through extremes of behavior each year, with relative calm for six months and disruption and turbulence for about six months. They feel that the child exhibits opposite types of behavior at each stage. They would predict that for about the first six months of age five, your child will be solemn, serene, and outwardly quiet. Then, at age five-and-a-half, the child seems to be in a constant stage of tension. After something gets started-a tantrum or any negative behavior-the five-year-old has a hard time stopping it.

These child psychologists feel that temperament is already determined by two months of age, and that it's better to accept it than try to change it and make the child into something he is not. The best way to help your child grow emotionally is to be honest about your own feelings even if you don't like them. There is a big difference between hostile feelings and hostile behavior, and you should make it clear that you accept bad feelings but you expect good behavior.

Talking

Except for certain sounds-s, v, f, and th-your five-year-old is quite the little speaker. His sentences are nicely made, with plurals, pronouns, and correct verb tenses. He knows his name, age, address, phone number, and even his birthday-and over 2,000 words. He likes big new words, and may be ready to spell out road signs and short words. Because he knows his alphabet, he's always asking "What does _________ spell?"

It's this use of language that helps him clarify ideas and express himself. It will help him succeed in school and the world. It can be a problem if he talks constantly, however-quiet time and listening are important in kindergarten. Don't be fooled by your child's fluency in language-sometimes it can hide how young he really is.

Playing

Five is the age of the "edifice" complex-because five-year-olds like to build, and they like to build big. Skyscrapers, whole model cities, houses that cover the floor… all are thought out ahead of time. Five-year-olds like to dress up, too, and role play with their puppets. Because they're so imaginative, they can find a use for almost any ordinary household item in their play.

ive-year-olds also love games, but not the ways adults do. They love the rules, deciding who gets to go first, and taking a turn. Score isn't important, nor is winning or losing, or even finishing the game.

This is an expoloratory outdoor age, and it can be good for children to get dirty. If you keep a special set of clothes for outdoor things, he can play in the mud as much as he wants.

Nature study and "scientific" toys, playing store and school, and taking control as the pilot or the bus driver are right up a five-year-old's alley.

Creativity

Five is a truly creative age. The world is fresh and exciting, and your five-year-old can use his new skills in language, painting, and music to combine ideas in uniquely interesting ways.

Your five-year-old can now invent stories, music and dances, and excels at innovative drama alone and with other children. Because creativity is using the mind more than it is using many materials, simple things like art supplies, books, and musical instruments are the tools which help them grow.

He will use creativity to solve problems and come up with new solutions as long as he lives, so it's good to encourage the creativity that is so much a part of him now. And it's even more important to encourage creativity when he goes to school, because it can actually be stifled in a classroom situation.

Development

Movement
  • Stands on one foot for 10 seconds or longer
  • Hops, swings, climbs, can do somersaults
  • May be able to skip
Hand And Finger Skills
  • Copies a triangle and other geometric patterns
  • Draws person with body
  • Prints some letters
  • Dresses and undresses without assistance
  • Uses fork, spoon, and sometimes a table knife.
  • Usually cares for own toilet needs
Language
  • Recalls part of a story
  • Speaks sentences of more than five words
  • Uses future tense
  • Tells longer stories
  • Understands about 13,000 words
Cognitive
  • Likes to argue and reason; use words like "because"
  • Able to memorize address and phone number
  • Has a good attention span and can concentrate well
  • Is project minded and loves to learn
  • Can count 10 or more objects
  • Correctly names at least four colors
  • Better understands the concept of time
  • Knows about things used every day in the home
  • Becomes left or right hand dominant
Social
  • Organizes other children and toys for pretend play
  • Wants to please
  • Often fears loud noises, the dark, animals, and some people
  • Wants to be like friends
  • More likely to agree to rules
  • Likes to sing, dance and act
  • Shows more independence and may even visit a next-door neighbor
  • Aware of sexuality
  • Able to distinguish fantasy from reality
  • Sometimes demanding, sometimes eagerly cooperative
  • Enjoys collecting things
  • Sometimes needs alone time
Emotional
  • Aware of sexuality
  • Able to distinguish fantasy from reality
  • Sometimes demanding, sometimes eagerly cooperative
Indicators For Concern
  • Doesn't interact with other children or with adults through play
  • Is excessively aggressive or withdrawn with other children
  • Plays in repetitious, stereotyped ways
  • Is less physically capable than other children of the same age
  • Still speaks unclearly or is not talking in sentences
  • Is unable to follow verbal instructions
  • Is not talking during play

Growth And Nutrition

Childhood obesity has become one of the main concerns of our nation in the Twenty First Century.

Daily nutritional guide for the 4 to 6 year old

Grains - One Serving

  • 6/11 servings/day Bread, ½ slice
  • Cereal, rice, pasta cooked, 1/3 cup
  • Cereal, dry ½ cup
  • Crackers, 3 to 4

Vegetables

  • 2-3 servings/day Vegetables, cooked or canned ¼ cup
  • Salad, ½ cup

Fruits

  • 2-3 servings/day Fruit, cooked or canned, ¼ cup
  • Fruit, fresh, ½ piece
  • Juice, 1/3 cup

Dairy

  • 2-3 servings/day Milk (does not have to be whole) ½ cup
  • Cheese, 1 ounce
  • Yogurt, ½ cup

Meats and Proteins

  • 2 servings/day Meat, fish, poultry, tofu, 1 ounce (2 1 inch cubes)
  • Beans, dried, cooked, 1/3 cup
  • Egg, 1

Calcium 800 mg/day

Keep snacks healthy, encourage drinking water and keep juice to a minimum.

Common Issues And Concerns

Discipline

Discipline seems to be harder for parents who weren't happy with the way they were brought up. Parents who had a comfortable childhood simply treat their children the way they were treated.

The parents who have trouble with discipline are often more permissive, because they don't want their children to resent them or because they feel guilty about not being "superparents." But, the children who get into most trouble in the world are "spoiled" children and children who didn't get enough affection. As a parent you may want to take a look at the ways you are being too permissive and make an effort to firm up your discipline in those areas. Make the punishment "fit the crime." Keep your discipline simple, short, and consistent. Be loving but firm.

Map out rules that help your child learn to control impulsiveness and expected behavior without impairing their independence. Keep your child's developmental level in mind when you set limits and don't expect more than he is capable of achieving. Remember that you are a key role model for your child. The more even-handed and controlled your behavior, the more likely your child will be to pattern himself after you.

Reading

It is important to read to you child. Children not only love to be read to, but the story and fairy tales assist kids in working through their own fantasies, conflicts, and experimentation with roles. Book reading starts in the first year with familiarity, turning pages, and looking at and pointing to pictures and progresses from there. At the age of 3 to 4, children learn how the pictures are connected in a story and then can tell the story with no book present. By ages 3 to 5 most children are just beginning to learn the alphabet - singing the ABC's and knowing the letters of their names. Read alphabet books with your child and point out letters read. Help your child recognize whole words as well as letters. If children are read to at home, they will do better in school, have more complex vocabularies, and ask more complex questions.

Television

Even though your child is older now, it's important to realize that until age seven, television and movies are risky business. Because your child still can't differentiate between reality and fantasy, certain scenes-even in classic family entertainment movies-can terrify her and cause nightmares. Although television seems to have a calming effect on children because they watch it quietly, it is a very stimulating medium. The fast, animated pace and short segments are a suspected cause for making children impulsive and creating short attention spans, which become a problem in school. Studies have shown that although children can learn from imitating television, they do not learn to think or solve problems. It's been proven that children who watch hours of television every day lag behind their peers in development. Remember, children can't set their own limits.

The average American watches 6 or more hours of television per day, and most children over age 2 watch at least 2 hours per day. The influence of TV on young children has been a matter of concern for the past five decades. These concerns include the content of the material, and what other parts of a child's life TV displaces. Not all TV is bad. Many shows are developed with the young child's needs and interests in mind, such as pre-academic, social, and fantasy programs. Children are exposed to things, good and bad, that couldn't otherwise be available in the home.

Basic Guidelines for parent management of Television and Videos:

  • Spouses should discuss the TV plan for their child
  • Never use TV as a reward
  • Limit to 1 hour per day maximum
  • Plan what is watched
  • Turn off the television when the program ends
  • NO TV during meals
  • Consider channel lockouts or V-chips
  • Specifically suggest and set up another activity
  • Discuss programs with kids, including advertising
  • Watch TV with kids
Sibling Rivalry

Jealousy toward brothers and sisters, and occasionally angry feelings with parents are natural, and nothing for your child to be ashamed of. The basic struggle in sibling rivalry is that a child must learn to share her parents with others-a hard fact to accept. The more dependent the child is on the parent, the harder the struggle is. Often the displays of jealousy are a way to get more love. The line has to be drawn when rivalry moves into destructive behavior-whether it is physical or verbal. No matter how your child feels, she will have to find a civilized solution for it. She will have to accept the fact that neither child will have the exclusive love of the parent.

The parents have to be careful not to subtly encourage the rivalry by being amused or secretly flattered at the competition between the children. They will have to see each child as an individual instead of them as a unit, and not encourage competition by getting both children exactly the same thing, for example, instead of individual gifts.

Basically, at each step of the way in development, a child must give up some ego-centeredness to earn the love and support of her parents.

Thumbsucking

Many children resort to old habits, like thumbsucking, at five, especially when they're tired or hungry, watching T.V. or listening to a story. These habits are ways to calm down from pressure, help them concentrate, and make the transition from a hectic stage to a quiet one.

By five, your child doesn't usually resort to his habits in public, because he cares too much about what his friends think. And the habits will probably stop this year or next year unless you make a big deal about them.

When situations come up that require major adjustments-like a move or beginning kindergarten-and he starts up again, don't worry-it's just a normal, convenient way to reduce tension.

The key here is to see if the habit (and thumbsucking is only one in this category of tension relievers) is excessive. If the child uses it too often as a way to withdraw from the world, then he is unhappy and you should talk to your pediatrician.

Morals

Morals development is the way the idea of justice grows in a child. It helps create greater harmony in social situations and is the foundation for a give-and-take relationship. Morality begins to surface at the age of five. If you punish your child unjustly now, she will feel rage at the unfairness of it. At five, rules are sacred, and if she breaks them, she expects to be punished-even if no one else sees her. She sees things as good or bad: the good things get rewarded and the bad things get punished. If she does something good, she expects something good to happen to her. And if she's bad, bad things will happen.

Kindergarten

When children are ready, kindergarten is wonderful for them. Brightness is not necessarily the guideline for readiness-behavior traits are a better guide. Some experts now feel that girls should be at least age five, and boys at least age five-and-a-half. A child who is ready is healthy, independent, cooperative, and can follow directions. He can sit still and concentrate, and wait for his turn.

If a child still isn't ready for kindergarten, he can annoy the whole class. He may have to be forced to go in the morning, and may cry at separation past the first few days. Or he may blow up when he gets home. The important thing is not to set a child up for failure in school by sending him too early. You know how much a child develops in one year, and one year equals one fifth of his entire life at this age.

Health Care

Your doctor is experienced in all the stages your child will go through developmentally, and has seen may children go through the same stages. He is an excellent resource for you because he knows your child. He can be a help with behavioral problems such as negativism, temper tantrums, sibling rivalry, poor eating habits, shyness and oversensitivity, toilet training and bed-wetting. Because this is such an active age for your child, both you and your pediatrician will need to keep your eyes open for changes. The years between two and six are the peak years for childhood illnesses, especially contagious diseases, because the child is exposed to more people outside the home. You should make it a point to schedule regular checkups and an annual exam on or near your child's birthday. Eyes and ears should be examined regularly, and your doctor's office can arrange an immunization schedule so your child can be properly protected.

Remember, it's difficult to diagnose a child, so you need to be extra alert. These are the years that determine health in adulthood, so if you have any doubts at all about a fever or a change in health, call our office.

Safety

For age-specific safety tips please visit Healthychildren.org.

Bibliography

A Parent's Guide to Childhood Obesity: A Road Map to Health, 2006.

Baby and Child Care. Spock, Benjamin, New York, Pocket Books, 2004.

Caring for Your Baby and Young Child: Birth to Age 5. 4th Edition.

Caring for Your School-Age Child: Ages 5 to 12.

Encounters with Children: Pediatric Behavior and Development. Suzanne D Dixon, Martin T. Stein. Mosbys, Inc. 2000.

Guide to Your Childs Nutrition: AAP 1999 William Dietz, Loraine Stern.

The Magic Years: Understanding and Handling the Problems of Early Childhood. SH Fraiberg. New York, Charles Scribner & Sons, 1996.

Touchpoints: Both Volumes of the Nation's Most Trusted Guide to the First Six Years of Life. T. Berry Brazelton, October 2002.

Next Well Child Visit

The next routine physical examination is at six years of life.