Well-Child Visit: 9 Years

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child's weight and height, calculatebody mass index (BMI), and plot the measurements on a growth chart.

2. Check your child's blood pressure using standard testing equipment.

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

Eating. Schedule 3 meals and 1–2 healthy snacks a day. Serve your child a balanced diet that includes lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 3 cups (720 ml) of low-fat milk daily (or other low-fat dairy products or fortified soy milk). Aim for 5 servings of fruits and vegetables per day. Limit foods and drinks that are high in sugar, salt, and fat. Don't give more than 8 ounces (240 ml) of 100% juice per day.

Sleeping. Kids this age need 9–12 hours of sleep each night. Lack of sleep can make it hard to pay attention at school. Set a bedtime that allows for enough sleep and encourage your child to follow a relaxing bedtime routine. Keep TVs and devices like tablets and smartphones out of your child's bedroom.

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

Growth and development. By 9 years, it's common for many kids to:

• show more independence from family and begin to prefer being with friends
• have friends of the same gender
• read to learn about a topic of interest
• handle increasingly hard tasks in school, like gathering and organizing information into a book report
• begin to take on chores at home and handle more homework
• begin to show the signs of puberty (oily skin, acne, body odor). Girls may start breast development and grow hair in the armpit and pubic area. Boys may develop body hair and have testicle and penis enlargement.

4. Do an exam. This will include listening to the heart and lungs, look at the back for any curvature of the spine, and checking for the signs of puberty. A parent, caregiver, or chaperone should be present during this part of the exam. Siblings should stay in the waiting room to give your child privacy.

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 check for anemia, high cholesterol, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your child's next checkup at 10 years:

School

1. Encourage your child to participate in a variety of activities, including music, arts and crafts, sports, after-school clubs, and other activities of interests. But try to avoid overscheduling and allow for some downtime.
2. Praise accomplishments and provide support in areas where your child struggles.
3. Provide a quiet place to do homework. Minimize distractions, such as TV and devices.
4. As schoolwork gets harder, your child may struggle academically. If this happens, work with your child's school to find the cause, such as learning or attention problems, bullying, or other stressors.
5. Talk to your child about the dangers of smoking, vaping, alcohol, and drugs.
6. Teach your child to use technology wisely. General rule: Don't text, post, or send pictures online that you wouldn't want a grandparent to see.

Self

1. Spend time with your child every day. Share mealtimes and be active together. Talk about things that are important to your child.
2. Set rules and let your child know your expectations. Use fair consequences for breaking the rules. Praise your child's good choices.
3. Be prepared to answer questions about puberty and the feelings that come with those changes. Encourage your child to bring questions or concerns to you. Girls usually get their first period about 2 years after breast development. Boys may have wet dreams and their voices may begin to deepen and crack.
4. Encourage kids to bathe or shower daily. If body odor is a concern, have your child use a deodorant.
5. Let your child know that it's never OK for an adult to ask them to keep a secret from you. No one should look at or touch your child's private parts, or ask them to look at or touch theirs.
6. Kids should brush their teeth twice daily, floss once a day, and see a dentist once every 6 months.

Safety

1. Your child should continue to ride in the back seat of the car and use a belt-positioning booster seat until they're 4 feet 9 inches (150 cm) tall. Kids usually reach this height when they're 8–12 years old.
2. Make sure your child wears a helmet while riding a bike, skateboard, or scooter and the right protective equipment, like mouth guards and pads, when playing sports.
3. Teach your child to swim, but do not allow swimming unless an adult is watching.
4. Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside and reapply about every 2 hours.
5. Protect your child from secondhand smoke.
6. Monitor your child's Internet use. Keep the family computer in a place where you can watch what your kids are doing. Install safety filters and check the browser history to see which websites your child visits. Teach your child not to share personal information.
   
7. 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 can't get to the keys.
8. 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.