Your Child’s Checkup: 9 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. 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 3 cups (720 ml) of low-fat milk daily (or equivalent low-fat dairy products). Aim for five servings of fruits and vegetables per day. Limit foods and drinks that are high in sugar and fat, and offer no more than 8 ounces (240 ml) of juice 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. Children 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 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 difficult 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 also may develop body hair in addition to testicle and penis enlargement.

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 the next routine visit when your child is 10:

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 is struggling.
3. Provide a quiet place to do homework. Minimize distractions, such as TV and cell phones.
4. As school curriculum becomes more challenging, your child may struggle academically. If this happens, work with your child’s school to determine the cause, such as an undiagnosed learning disability, bullying, or other stressors.
5. Talk to your child about the dangers of smoking, alcohol, and drugs.

Self

1. Girls usually get their first period about 2 years after breast development (between ages 9 and 16). Boys may have wet dreams and their voices may begin to deepen and crack.
2. Be prepared to answer questions about puberty and the feelings associated with those changes. Encourage your child to bring questions or concerns to you.
3. Encourage kids to bathe or shower daily. If body odor is a concern, have your child use a deodorant.
4. Tell your child that no one else should touch or ask to see his or her private areas or ask him or her to touch their private areas.
5. 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 he or she is 4 feet 9 inches (150 cm) tall, usually between 8 and 12 years of age.
2. Make sure your child wears a helmet while riding a bike, skateboard, or scooter.
3. Teach your child to swim, but do not let him or her go swimming unless an adult is watching.
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 kids are 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.