Your Child's Checkup: 6 Years

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child's weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child's blood pressure, vision, and hearing using standard testing equipment.

3. Ask questions, address concerns, and offer advice about your child's:

Eating. Schedule three meals and one or two nutritious snacks a day. Serve your child a well-balanced diet that includes lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 2½ cups (600 ml) of low-fat milk daily (or equivalent low-fat dairy products or a fortified milk alternative).

Limit foods and drinks that are high in sugar and fat, and offer no more than 4–6 ounces (120–180 ml) of 100% juice per day. If you have a picky eater, keep offering a variety of healthy foods for your child to choose from. Kids should be encouraged to give new foods a try, but don't force them to eat them.

Bathroom habits. Bladder and bowel control is usually mastered by this age. Bedwetting is more common in boys and deep sleepers, and in most cases it ends on its own. But talk to your doctor if your child was previously dry at night and is now wetting the bed.

Sleeping. Kids this age need about 9 to 12 hours of sleep per night. Lack of sleep can cause behavior problems and make it hard to pay attention at school. Set a bedtime that allows for enough sleep and establish a relaxing bedtime routine. Turn off the TV and digital devices at least 1 hour before bedtime, and keep them out of your child's bedroom.

Physical activity. Children this age should get at least 60 minutes of physical activity per day. Set limits on screen time, including TV, DVDs, video games, smartphones, tablets, and computers.

Development. By 6 years, it's common for many kids to:

• walk heel-to-toe
• tie their shoes
• start reading, spelling, and doing simple addition and subtraction
• write their first and last names and short sentences
• begin to know the difference between fantasy and reality

4. Do a physical exam with your child undressed while you are present. This will include listening to the heart and lungs, observing motor skills, and talking with your child to assess language skills.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it's important that your child get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child's risk for anemia, high cholesterol, lead, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child's next checkup at 7 years:

1. Praise your child's accomplishments and provide support in areas where he or she is struggling.
2. Reinforce rules and set appropriate limits. At this age, it's normal for kids to test the boundaries of established rules. Decide which rules can be eased and which must remain in place.
3. Teach your child the skills needed to cross the street independently (looking both ways, listening for traffic), but continue to help your child cross the street until age 10 or older.
4. Make sure your child always wears a helmet when riding a bike (even one with training wheels). Don't allow your child to ride in the street.
5. Make sure playground surfaces are soft enough to absorb the shock of falls.
6. Always supervise your child around water, and consider enrolling your child in a swimming class.
7. Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside to play and reapply about every 2 hours.
8. Protect your child from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful. 
9. Keep your child in a belt-positioning booster seat in the back seat until he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
10. Teach your child what to do in case of an emergency, including how to dial 911.
11. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.
12. Discuss appropriate touch. Explain that certain parts of the body are private and no one should see or touch them. Tell your child to come to you if someone asks to look at or touch his or her private parts, is ever asked to look at or touch someone else's, or is asked to keep a secret from you.
13. Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your child? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.