6 Year Old Well Child Check

The six year old child stands on a threshold of exciting new cognitive and social experiences.

With regular school attendance actually required for the first time, this age marks the beginning of a lifetime of obligations and adherence to schedules and rules imposed outside of the familiar family environment. This time of transition may present a crisis to the child or their family, while at the same time providing an opportunity for rapid cognitive, social, and emotional growth.

The six year old is the center of his universe. He wants and needs to be first, to be loved best, to be praised, and to win. He cannot lose gracefully or accept criticism. For these reasons he often has difficulty getting along with others. He can be defiant toward his mother, bossy toward his younger siblings, teased by his older siblings, and rude to his grandparents. Tensional manifestations reach a peak between five-and-a-half to six and include screaming temper tantrums and striking at the parent. Keep in mind that these obnoxious behaviors are a developmental stage rather than a life long personality trait. Gentleness, a sense of humor, limiting criticism, and composure will usually head off conflict and emotional outbursts. Parents will find that impersonal discipline techniques such as counting, isolation, distraction and preventive planning to be the most useful. Because the six year old is very responsive to praise, try to catch her being good and to comment on what she is doing that pleases you.

At the same time that all this emotional turmoil is occurring, the six year old is also becoming more happy and joyful. She begins to love certain activities and approaches those activities with enthusiasm. This is the perfect time to begin after school activities that the child enjoys such as art and music lessons, dance, gymnastics, or Scouts. As she develops these seeds of competence she begins to be able to control her emotional outbursts better and to plan ways to act better.

Behavior

Being Six

Being six is tricky. After the golden age of five, when things seem to be under control at home, the six-year-old becomes a beginner all over again in the "grown-up" world of school. At an age when he's full of energy, he has to learn to sit still, raise his hand to get permission to go to the bathroom, and manage to conform to a structured day. He's also feeling torn between his mother and his teacher, and is trying to be good in school all day. Because he feels pulled in all different directions, for a while six can be difficult for everyone.

But take heart. With praise and patience, six can be kept under control, and six-and-a-half is a very different story indeed. If your typical six-year-old could have anything she wanted, the last thing on her list would be to sit still. At six, even her teeth are moving-the baby teeth are coming out and the first grown-up teeth are moving in. Six is another adventurous age, and your child likes to get her hands on anything new, and into everything, too. She can be rowdy and restless, especially after a day of being cooped up in school. Because the energy level of six is so high, it's a good time to encourage outdoor play and excursions, to compensate for the inactive periods of the day. If your six-year-olds coordination and attention span don't seem as controlled as they were at five, don't worry. It's just those growing pains children get during periods of rapid change. A preliminary gymnastics program may be a way to foster improved coordination.

Thinking

By about the end of first grade, your child will make major changes in the way he is able to think. By age seven, he'll be able to think about more than one thing at once, and understand that a short, fat piece of cake can be just as big as a tall, thin one. He'll be able to understand that if you pour a cup of milk back and forth between two different size glasses, the amount of milk stays the same.

And by the end of the year, and for the first time in his life, he will be able to take your point of view into account, as the feeling that the world revolves around him begins to disappear.

There will be things he won't be able to do-such as abstract or "scientific" thinking, or thinking about his own thoughts and feelings-but these things will come, in time.

Feelings

Many of the feelings your child has this year will have to do with school. During the first month or so, almost every child reacts to the stress of first grade. Irritability, crying, bed-wetting, thumb-sucking and nail-biting, or a change in eating habits can all be considered "tension relievers" or a way to let off steam. After the first month, if the problem persists, or if your child really doesn't want to leave for school in the morning, you should probably talk to your pediatrician.

Incidentally, as a parent, you may go through some new feelings, too. You may feel that you are losing your child, that he's growing up too fast, that your child won't get enough attention in a classroom. And you may not get a play-by-play account of your first-grader's day. In response to the question "What did you do in school today?" he may say "Nothing." He is beginning to be more independent and to use children his own age as role models, so first grade can be very bittersweet for parents.

Talking

Although you may find it hard to believe, six-year-olds like to talk even more than five-year-olds. In show-and-tell, for example, they will tell all if given a chance. Your six-year-old loves to let you know exactly what's on her mind, and in fact, it's very important that she do just that. It's important, too, that a child learn to take turns talking, and to listen.

Some psychologists feel that language is a key factor in intellectual development. It's definitely necessary for a child to be able to express herself clearly and to understand other people-and it's a real advantage in school where the emphasis is on verbal directions and oral recitation. The flip side of the coin concerning language in the primary grades is that it's often used aggressively, boastfully, and to talk "dirty." The best way to handle aggressive language is to not overreact. Tell your child calmly that you don't like that kind of language, and you don't want to hear it in your house. That way you don't have to get caught in the trap of explaining why the words aren't nice.

Playing

At six, children love games with rules, and they love to play the new games they learn at school. Games like "Captain may I?," tag, hopscotch, jump rope, marbles, and jacks, all have rules, which children love to clarify.

At this age, your child will probably like to ride his bike, rollerskate, do tricks on monkey bars, and play in the dirt. He'll be big on cowboys and Indians, space wars, and cops and robbers, and he'll like race cars, construction toys, and train sets.

Children of this age love to play with dolls, and all the accessories are a very important part of the role play. They can be very busy with activity books and paper dolls later this year.

Both sexes like simple games like checkers and "go fish," but they're so competitive that they may change the rules to win. In fact, at your six-year-old's birthday party, it's a good idea to see that everyone gets a prize.

Morals

Morality is the internal system of justice in a child. It helps create social harmony, and sets the foundation for give-and-take relationships.

Your six-year-old is still in the process of only being able to see her own point of view, and can only think of one thing at a time… until the age of seven. And, at this stage, she thinks the rules are sacred.

During the grade school years, many children are guided by the fear of physical consequences (punishment) or by their respect for power and authority (trying to stay out of trouble). It isn't until about the end of elementary school that a child is able to make her own independent moral judgments. At that point she is able to decide which rules are the most realistic, and take her own ethical principles and conscience into consideration.

Truly moral behavior comes later than six, so don't feel that your child is destined for a life of crime if she steals, lies, or cheats, or won't take the blame for something bad she's done.

Development

Movement
  • Enjoys testing muscle strength and skills
  • Good sense of balance
  • Can catch small balls
  • Can be reckless (does not understand dangers completely)
  • Is still improving basic motor skills
  • Begins to learn some specific sports skills like batting a ball
Hand And Finger Skills
  • Uses crayons and paints with some skill, but has difficulty writing and cutting
  • Enjoys copying designs and shapes, letters and numbers
  • Draws person with body
  • Can tie shoelaces
  • Prints some letters
  • Uses fork, spoon and (sometimes) a table knife
Language
  • Language has vastly improved
  • Common to have word reversals or letter reversals. This is the result of perceptual motor skills that are not quite fully developed and are not necessarily an indication of dyslexia
  • Recalls part of a story
  • Speaks sentences of more than five words
  • Uses future tense
  • Tells longer stories
  • Says name and address
Cognitive
  • Enjoys planning and building
  • Doubles speaking and listening vocabularies
  • Reading may become a major interest
  • Increased problem-solving ability
  • Interested in magic and tricks
  • Longer attention span
  • Enjoys creating elaborate collections
  • Able to learn difference between left and right
  • Can begin to understand time and the days of the week
  • Likes taking responsibility for simple household chores
  • Likes to make simple decisions
  • Counts to 100
  • Asks endless "how-what-when-where-why" questions
  • Continues to refine concepts of shape, space, time, color, and numbers
  • Begins to understand the difference between intentional and accidental
  • Begins to understand differences in opinion
  • Still has a short attention span (about 15 minutes maximum)
  • Enjoys dramatic play
Social And Emotional
  • May have unpredictable mood swings
  • Is quite sensitive to criticism
  • Has a problem admitting a mistake
  • Evaluates self and friends
  • Begins to impose rules on play activities
  • Has difficulty considering the feelings of others
  • Values independence
  • Being with friends becomes increasingly important
  • Interested in rules and rituals
  • Girls want to play more with girls and boys with boys
  • May have a best friend and an enemy
  • May begin to see things from another child's point of view, but still very self - centered
  • Finds criticism or failure difficult to handle
  • Views things as black and white, right or wrong, wonderful or terrible, with very little middle ground
  • Seeks a sense of security in groups, organized play, and clubs
  • Generally enjoys caring for and playing with younger children
  • May become upset when behavior or school work is ignored
Indicators For Concern
  • Can not tie their shoes
  • Can not dress themselves completely without help
  • Can not catch a small bouncing ball such as a tennis ball
  • Can not copy a circle
  • Can not tell his age correctly
  • Can not repeat 4 numbers in proper sequence
  • Can not skip with both feet

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

Reading

Some psychologists feel that a child isn't truly ready to read before age seven… but again, that depends on the individual child. Reading requires skills different from repeating words heard in conversation. A child needs to be able to associate a visual symbol (word) with a sound and meaning she already knows.

The good news is that many school systems are bringing phonics back into the curriculum. Phonics is a method of sounding out words that can turn reading into a guessing game. A child can use phonics as a method to sound out words for the rest of her life. Books are wonderful for the imagination, and a great way for a child to experience things outside her normal everyday world. If your child doesn't already have one, getting her a library card would be a wonderful thing for both of you this year. She can have the options of lots of books to choose from, and you can have peace and quiet as she reads.

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, Videos, and Computers:

  • Never use TV as a reward
  • Limit to 1 hour per day maximum
  • Plan what is watched, what games are played, what websites are ok.
  • 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
  • No computers or TV recommended in child's bedrooms
Friendships

Although a six-year-old can be very critical of her friends, she can also want to be like them. And she may act like them, too, so you may notice a new "uncouthness" at the table and a tendency to try to get away with more boisterous behavior. Although six-year-olds get along better with just one other person, your child may try to start a club this year-with much of the meeting time spent on deciding who can and can't be a member.

Given the competitiveness of six, and the stubborn need to be "right," friendships can tend to be turbulent this year. Making friends is important for children, and you can encourage friendships. Be friendly to the children she brings home, and include them in special outings. Let your child dress and act like the other children her age, so she can fit in.

Independence

Because you know how much your six-year-old can do, it's frustrating to see how little he will do.

At six, he's pretty independent. He's able to dress and undress himself, and can use a knife and fork. He can also brush his teeth and comb his hair, and help around the house.

But six is a turbulent age, and often routines are areas of rebellion. One way that may show up is a messy room. The best coping mechanisms you can have at this age are to lower your expectations for a while, and accept the fact that things won't always go like clockwork. If you can ignore things like bad table manners, for example, your meals might go a little smoother.

Try not to let his little habits get to you, either. Much of the resistance will disappear like magic as your child makes the transition of adjusting to school.

Healthcare

Your doctor is experienced in all the stages your child will go through developmentally, and has seen many children go through the same stages. He is an excellent resource for your child. He can be a help with behavioral problems such as negativism, temper tantrums, sibling rivalry, poor eating habits, shyness, and oversensitivity.

Because six 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, especially in school.

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 do 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.

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.

Safety

Because your six-year-old is an adventurer, accidents can happen easily. Six-year-olds seem to be accident prone. And because he's clumsier than he was even six months ago, and can get carried away, you may see lots of scrapes, bruises and slivers.

At six, your child should have a good set of safety guidelines-rules for riding a bicycle, crossing the street, playing on the playground, and swimming. But accidents will happen, and to deal with the unexpected, you should know some first aid. Get a good first aid book for children, and keep a copy on hand for your family.

Now that your child is in school, it's sometimes a temptation to think she can do more than she is really capable of. Six is still too young, for example, to cook on a stove unsupervised, to be left alone with a baby, or to spend time alone in the house. It's also important to protect your child in the neighborhood, on her way to or from the store or school. She should be alert on the street, and never have anything to do with strangers.

For more 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 seven years of life.