Your Child’s Checkup: 11 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 using standard testing equipment.

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

Eating. At this age, kids should begin making healthy food choices on their own. Your child’s diet should include lean protein, whole grains, fruits and vegetables, and low-fat dairy. Kids this age should get 3 cups (720 ml) of low-fat or nonfat milk (or equivalent low-fat or nonfat dairy products) daily. Aim for five servings of fruits and vegetables per day. Limit foods and drinks that are high in sugar and fat. Limit juice to no more than 8 ounces (720 ml) per day.

Sleeping. Kids this age generally need about 10–11 hours of sleep per night. Lack of sleep can make it difficult to pay attention at school. Set a bedtime that allows for adequate sleep and encourage your child to follow a relaxing bedtime routine.

Physical activity. Kids this age should get at least 60 minutes of physical activity per day. Limit screen time, including TV, DVDs, video games, smartphones, tablets, and computers, to no more than 2 hours per day of quality children’s programming.

Growth and development. By 11 years, it’s common for many kids to:

• Show some signs of puberty:
  • In girls, puberty usually starts between 8 and 13 years with breast development and the appearance of pubic hair. Menstruation usually follows about 2 years after breast development begins.
  • In boys, testicular enlargement, the first sign of puberty, generally occurs around age 11, but may start as early as 9 years and as late as 15. Penile lengthening and the appearance of pubic hair follow.
• Have oily skin and/or acne.
• Have growth spurts. For girls, it occurs about 6–12 months before their first menstrual period. Boys have their growth spurt later in their pubertal development.
• Think concretely but not connect their actions with future consequences.
• Yearn for peer acceptance and for independence.
• Focus on personal appearance and behavior (because they think all eyes are on them).

After talking with you, the doctor may request some time alone with your child to answer any additional questions.

4. Perform a physical exam. This will include listening to the heart and lungs, examining 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, but siblings should remain outside 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 receive 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, and tuberculosis and order tests, if needed.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 12 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 interest.
2. Praise accomplishments and provide support in areas where your child is struggling.
3. Provide a quiet place to do homework. Minimize distractions, such as TV and cell phones.
4. As school becomes more challenging, poor school performance may be a sign of attention or learning problems, bullying, or depression. Get to the root of the problem.
5. Peer pressure can lead to dangerous activities, such as drinking or smoking. Make sure you know who your children are spending time with and that an adult is monitoring them.

Self

1. Be prepared to answer questions about puberty and the feelings associated with those changes. Encourage your child to bring his or her questions or concerns to you.
2. In girls, the first menstrual period (menarche) usually occurs by age 13, but it can come as late as age 15. Talk to your daughter about menstruation before menarche occurs and encourage her to come to you once it does.
3. Talk openly about sex and encourage your child to wait until he or she is older to engage in sexual activity with others. Explain the risk of sexually transmitted diseases (STDs) and unwanted pregnancy.
4. Assure your son that erections and “wet dreams” are normal.
5. A growing need for independence means preteens may test the boundaries of established rules. Decide which rules can be eased and which must remain in place.
6. Encourage your child to bathe or shower daily. If body odor is a concern, have your child use a deodorant.
7. Make sure your child brushes his or her teeth twice daily, flosses once a day, and sees a dentist once every 6 months.
8. Look for signs of depression, which can include irritability, sadness, loss of interest in activities, poor academic performance, and talk of suicide.

Safety

1. Talk to your child about the dangers of smoking, alcohol, and drugs.
2. Preteens should continue to ride in the back seat and always wear a seatbelt while in a vehicle. Your child should use a belt-positioning booster seat until he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
3. Make sure your child wears a helmet while riding a bike, skateboard, or scooter.
4. Apply sunscreen of SPF 30 or higher on your child’s skin at least 15 minutes before going outside and reapply about every 2 hours.
5. Limit your child’s exposure to secondhand smoke, which increases the risk of heart and lung disease.
6. Monitor your child’s Internet usage. Keep the family computer in a place where you can watch what your child is doing. Install safety filters and check the browser history to see what websites your child has visited.
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 cannot access the keys.

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