Well Child Care 5 Years


Your child may enjoy helping to choose and prepare the family meals with supervision. Children watch what their parents eat, so set a good example. This will help teach good food habits. Mealtime should be a pleasant time for the family. Avoid junk foods and soda pop. Televisions should never be on during mealtime. Your child should eat 5 or more servings of fruits/vegetables a day. Limit candy, soda, and high-fat snacks. Your child should have at least 2 cups of low-fat milk or other dairy products each day.  Lower fat content in milk and other dairy products is almost always a good idea. Lowering the fat content of milk DOES NOT change any of the nutritional value of the milk.  Most families should be using nonfat or 1% milk. Your doctor will advise you if you should be using milk with a higher fat content.  Please continue your Vitamin D supplement if directed to do so.


Children at this age are imaginative, get along well with friends their own age, and have lots of energy. Be sure to praise children lavishly when they share things with each other.
Bed Wetting
Many children still wet the bed at night.  This is usually normal.  In order to help your child learn to stay dry during the night try the following:
·         Make sure your child does not consume caffeine after 4:00 PM (Coke, Pepsi, Mountain Dew, etc; tea, coffee).
·         The last thing your child should do before getting into bed is a relaxed and complete emptying of his or her bladder.
·         Monitor how often your child wets the bed.  If the frequency of wet nights is increasing, please call us.
School-age kids require 10-11 hours per night.
Five-year-olds usually are able to dress and undress themselves, understand rules in a game, and brush their own teeth. For behaviors that you would like to encourage in your child, try to catch your child being good. That is, tell your child how proud you are when he does things that help you or others. Five-year-olds should be doing simple chores such as setting the table on a daily basis.

Behavior Control

Find ways to reduce dangerous or hurtful behaviors. Also teach your child to apologize. Sending a child to time out in a quiet, boring corner without anything to do for 5 minutes should follow. Time outs can help teach important rules of getting along with others. Do not send a child to his room. A bedroom should always be a desirable location for your child. Ask your healthcare provider if you need help with your child’s behavior.

Reading and Electronic Media

It is important to set rules about television watching. Limit electronic media (TV, DVDs, or computer) time to 1 or 2 hours per day of high quality children’s programming. Participate with your child and discuss the content with them. Do not allow children to watch shows with violence or sexual behaviors. Find other activities besides watching TV that you can do with your child. Reading, hobbies, and physical activities are good choices.  Remember – do not put a television in your child’s bedroom.

Dental Care

·         Brushing teeth regularly after meals and before bedtime is important. Think up a game and make brushing fun.
·         Make an appointment for your child to see the dentist every 6 months.
·         Fluoride supplementation is important to make teeth stronger and prevent decay.  If the water in your community is fluoridated you will not require an additional supplement.  If there is no fluoride in the water your doctor will recommend a fluoride supplement for your child.  Since your child is receiving fluoride in either the water or by supplement please do not use toothpaste that contains fluoride.

Safety Tips

Accidents are the number-one cause of serious injury and death in children. Keep your child away from knives, power tools, or mowers.

All parents, caregivers and babysitters should be certified in CPR every two years.  Your local hospital may have a class available.

Fires and Burns
·         Practice a fire escape plan every 3 months.  First,  set off your smoke detectors.  Everyone in the house should walk outside and go to the same meeting place every time.  Now that your child is 5 years old, he or she can be encouraged to calmly leave the house independently.  Make sure the meeting place is at least 20 adult paces from your home so that your children are not standing in smoke.
·         Check smoke detectors and replace the batteries as needed.
·         Keep a fire extinguisher in or near the kitchen.
·         Teach your child to never play with matches or lighters.
·         Teach your child emergency phone numbers and to leave the house if fire breaks out.
·         Turn your water heater down to 120°F (50°C).
·         Never allow your child to climb on chairs, ladders, or cabinets.
·         Do not allow your child to play on stairways.
·         Make sure windows are closed or have screens that cannot be pushed out.
Car Safety
Your child should use a forward facing car seat as long as possible, up to the highest weight and height allowed by the manufacturer.   Your child must ride in the back seat.
All children whose weight or height has outgrown the forward-facing limit for their car seat should use a booster seat until they are 4 feet 9 inches tall and are at least 8 years old. 
·         NEVER buy any motorized vehicles for your child to drive.
Pedestrian and Bicycle Safety
·         Always supervise street crossing. Your child may start to look in both directions but don’t depend on her ability to cross a street alone.
·         All family members should use a bicycle helmet, even when riding a tricycle.
·         Do not allow your child to ride a bicycle near traffic.
·         Purchase a bicycle that fits your child well. Don’t buy a bicycle that is too big for your child. Bikes that are too big are associated with a great risk of accidents.
Water Safety
·         ALWAYS watch your child around swimming pools.
·         Consider enrolling your child in swimming lessons.
Teach your child to take medicines only with supervision.
Teach your child to never eat unknown pills or substances.
Keep the POISON CONTROL number (1-800-222-1222) on all phones.
·         Discuss safety outside the home with your child.
·         Teach your child her address and phone number and how to contact you at work.
·         Teach your child never to go anywhere with a stranger.
·         Teach your child that no adult should tell a child to keep secrets from parents, no adult should show interest in private parts, and no adult should ask a child for help with private parts.
·         Children who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.


The virus that causes influenza (which is also called the flu) changes every year.  Children over 6 months of age should receive an annual flu vaccine starting in late September.  Many offices offer both tradition flu shots as well as Flumist (which is a painless squirt in the nose without any needles

Acetaminophen and Ibuprofen Preparations

There is a risk of accidental overdose when using ibuprofen or acetaminophen containing products due to different concentrations of infant drops and infant liquid for both preparations. The most common ibuprofen containing products are Advil and Motrin. This risk is due to the availability of different concentrations of liquid ibuprofen. This is similar to the risk of accidental overdose for acetaminophen products that contain different concentrations of acetaminophen.
We suggest parents only use ibuprofen liquid products that contain a concentration of 100mg ibuprofen/ 5ml of liquid. This concentration on the label is listed as 100mg/5ml. Discard liquid formulations that contain an infant’s concentration 50mg/1.25ml.
We suggest you only use acetaminophen liquid products that contain a concentration of 160mg/5ml of liquid. This concentration is listed on the label as 160mg/5ml. Discard liquid formulations that contain an infant concentration (drops) of 80mg/ 0.8ml
Here is a summary of ibuprofen medications you might find on a shelf:
Infant drops: 50 mg (1.25 ml) per dropper / 1.875 ml (50 mg) per syringe (shake well before using). Note: The drops come with either a dropper or a syringe, depending on the brand. DISCARD!
Children’s liquid: 100 mg (5 ml) per teaspoon (shake well before using)
Children’s chewables: 50 mg each
Junior-strength chewables or caplets: 100 mg each
Adult regular-strength tablets: 200 mg each
For acetaminophen products we suggest only using the new infant liquid and old children’s liquid concentration of 160mg/5ml. Discard liquid formulations that contain an infant’s concentration of 80mg/0.8ml. These were the old infant drops.
Here is a summary of acetaminophen medications you might find on a shelf:
Infant drops: 80 mg/0.8 ml per dropper (shake well before using). DISCARD!
New infant liquid: 160 mg/5 ml per included syringe (shake well before using)
Children’s liquid: 160 mg/5 ml per teaspoon (shake well before using)
Children’s chews or meltaways: 80 mg each
Junior-strength chews or meltaways: 160 mg each
Adult regular-strength tablets: 325 mg each
We suggest you discard the old infant drops that contain 80mg/0.8ml so you do not make a mistake with the liquid preparation

Burn and Electrical Safety

What can I do to prevent my child from getting burned?
  • Do not handle hot liquids (coffee/tea/coca) if your child has easy access to it.  This includes trying to carry both your child and a hot liquid at the same time.
  • Protect your child from “hot” appliances such as fireplaces, irons, space heaters and stoves by either removing them from the area or by strict supervision if access is available.
  • Turn your hot water heater to 125 degrees.  Children can turn on hot water faucets very easily, but 125 water temperatures will prevent an immediate scald.
  • Do not let your child have access to matches, lighter or burning cigarettes. Be sure all such objects are stored away from sight and out of reach of children.
  • Make sure your home has functioning smoke alarms in hallways and sleeping quarters. Check the alarms monthly for battery charge.
  • Fire drills should be conducted by families to know where to go and what to do in case of a fire in your home.
  • Prevent electrical burns by covering all electrical outlets with plastic safety caps and keeping electrical cords away from children.
  • Protect children from scalds by keeping hot pots and pans back burners and turning pot handles inward and out of reach.
  • Use flame retardant sleepwear and blankets.

Car Safety

What can I do to protect my child while riding in our car?
  • Children should never travel in a car without fitting properly into a car seat, or an appropriate lap or shoulder restraint.
  • Make sure our care seat is approved by Federal Motor Vehicle Safety Standards.  The date of a manufacture should be after January 1981.
  • Infant car seats are used from birth to 1 year and should always face rearward.
  • Toddler and convertible seats for toddlers from 20 lbs. to 40 lbs. can be forward facing.
  • Follow installation instruction of the car seat very carefully.  Not all car seats match all cars and not all car seats match to seats belts the same way. Make an appointment with your local State Police Office to inspect your car seat.
  • Cover your car seat with a towel or covering in hot weather to prevent metal clips from burning your child’s skin.
  • Try to praise your child for using the car seat.  If your child is bored or is fussy, do not remove him from the car seat.  It is better to stop and take a break instead of reinforcing the idea that he can get out of the seat if he makes a fuss.
  • The infant car seat shoulder harness should be securely tightened allowing only 2 fingers widths of space between the hardness and the baby.
  • The car seat should be securely fastened to the car with the seat belt.  A locking clip may be required to tighten the seat belt to prevent movement of the car seat.  Give a hard “tug” in the lap portion of the belt.  If it pulls loose, a locking clip may be the solution.
  • Ask your physician for instructions or information on how to properly install and use a car seat.

Pennsylvania’s Seat Belt Law

  • Under Pennsylvania´s primary child passenger safety law, children under the age of four must be properly restrained in an approved child safety seat anywhere in the vehicle.
  • Children from age four up to age eight must be restrained in an appropriate booster seat.
  • Children from age 8 up to age 18 must be in a seat belt.

Car Seat Recommendations for Children

  • Select a car seat based on your child´s age and size, and choose a seat that fits in your vehicle and use it every time.
  • Always refer to your specific car seat manufacturer´s instructions; read the vehicle owner´s manual on how to install the car seat using the seat belt or LATCH system; and check height and weight limits.
  • To maximize safety, keep your child in the car seat for as long as possible, as long as the child fits within the manufacturer´s height and weight requirements.
  • Keep your child in the back seat at least through age 12.
  • Visit a PennDOT approved Child Safety Seat Fitting Station for advice.

The following information can be found at http://www.drivesafepa.org/:

Birth-12 Months

Your child under age 1 should always ride in a rear-facing car seat. There are different types of rear-facing car seats: Infant-only seats can only be used rear-facing. Convertible and 3-in-1 car seats typically have higher height and weight limits for the rear-facing position, allowing you to keep your child rear-facing for a longer period of time.

1-3 Years

Keep your child rear-facing as long as possible. It´s the best way to keep him or her safe. Your child should remain in a rear-facing car seat until he or she reaches the top height or weight limit allowed by your car seat´s manufacturer. Once your child outgrows the rear-facing car seat, your child is ready to travel in a forward-facing car seat with a harness.

4-7 Years

Keep your child in a forward-facing car seat with a harness until he or she reaches the top height or weight limit allowed by your car seat´s manufacturer. Once your child outgrows the forward-facing car seat with a harness, it´s time to travel in a booster seat, but still in the back seat.

8-12 Years

Keep your child in a booster seat until he or she is big enough to fit in a seat belt properly. For a seat belt to fit properly the lap belt must lie snugly across the upper thighs, not the stomach. The shoulder belt should lie snug across the shoulder and chest and not cross the neck or face. Remember: your child should still ride in the back seat because it´s safer there.

Child Safety Seat Fitting Stations:

PennDOT provides funding for more than 75 fitting stations where trained technicians will check that the child safety seat is properly installed. To find a fitting station near you, search the Fitting Station directory. Use your city and state to find a certified child passenger safety technician through the Safe Kids Website.

Acetaminophen Dosage Table

Acetaminophen (Tylenol) Dosage Table

Child’s Weight (pounds)
Infant Drops 80 mg/0.8 ml
Syrup: 160 mg/5 mL (1 tsp)
Syrup: 160 mg/1 teaspoon
1 1/2
2 1/2
Chewable 80 mg tablets
1 1/2
Chewable 160 mg tablets
1 1/2
2 1/2
Adult 325 mg tablets
1 1/2
Adult 500 mg tablets
Indications: Treatment of fever and pain.
Table Notes:
  • CAUTION: In May, 2011, a move to one standard concentration (160 mg/5 ml) of liquid acetaminophen medicine for infants and children was announced. Up until that time, there were mainly 2 concentrations: 80 mg/0.8 ml (Infant Concentrated Drops) and 160 mg/5 ml (Children’s Liquid Suspension or Syrup). Old concentrations (80mg/0.8 ml) of infant acetaminophen may still be available in some homes. Therefore, if it is an older product, please have the caller confirm the correct concentration of infant acetaminophen.
  • AGE LIMIT: Don’t use under 12 weeks of age (Reason: fever during the first 12 weeks of life needs to be documented in a medical setting and if present, your infant needs a complete evaluation.) EXCEPTION: Fever from immunization if child is 8 weeks of age or older. Avoid multi-ingredient products in children under 6 years of age. (Reason: FDA recommendations 1/2008).
  • DOSAGE: Determine by finding child’s weight in the top row of the dosage table
  • MEASURING the DOSAGE: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medicine. If not, medicine syringes are available at pharmacies. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 ml and that ½ teaspoon equals 2.5 ml.
  • FREQUENCY: Repeat every 4-6 hours as needed. Don’t give more than 5 times a day.
  • ADULT DOSAGE: 650 mg MAXIMUM: 3,000 mg in a 24-hour period.
  • BRAND NAMES: Tylenol, Feverall (suppositories), generic acetaminophen
  • MELTAWAYS: Dissolvable tabs that come in 80 mg and 160 mg (jr. strength)
  • SUPPOSITORIES: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories (the rectal dose is the same as the dosage given by mouth).
  • EXTENDED-RELEASE: Avoid 650 mg oral products in children (Reason: they are every 8 hour extended-release)
Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information. .
Copyright: Copyright 1994-2012 Barton D. Schmitt, M.D. Author and Senior Reviewer: Barton D. Schmitt, M.D. Last Revised: 8/16/2011 1:57:36 PM Content Set: Pediatric HouseCalls Symptom Checker
Version Year: 2012

Ibuprofen Dosing Table

Child’s Weight (pounds)
Infant Drops 50mg/1.25 ml
Liquid 100 mg/ 1 teaspoon (tsp)
Liquid 100 mg/ 5 milliliters (ml)
Chewable 50 mg. tablets
Junior-strength 100 mg tablets
Adult 200 mg. tablets
Indications: Treatment of fever and pain.
Table Notes:
  • AGE LIMIT: Don’t use under 6 months of age unless directed by child’s doctor. (Reason: safety not established and doesn’t have FDA approval). Avoid multi-ingredient products in children under 6 years of age (FDA recommendations 1/2008).
  • DOSAGE: Determine by finding child’s weight in the top row of the dosage table.
  • MEASURING the DOSAGE: Syringes and droppers are more accurate than teaspoons. If possible, use the syringe or dropper that comes with the medication. If you use a teaspoon, it should be a measuring spoon. Regular spoons are not reliable. Also, remember that 1 level teaspoon equals 5 ml and that ½ teaspoon equals 2.5 ml.
  • IBUPROFEN DROPS: Ibuprofen infant drops come with a measuring syringe
  • BRAND NAMES: Motrin, Advil, generic ibuprofen
  • ADULT DOSAGE: 400 mg
  • FREQUENCY: Repeat every 6-8 hours as needed
Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Copyright: Copyright 1994-2012 Barton D. Schmitt, M.D. Author and Senior Reviewer: Barton D. Schmitt, M.D. Last Revised: 8/16/2011 Content Set: Pediatric HouseCalls Symptom Checker Version Year: 2012

Sleep Needs in Children and Adolescents

Research supports the need for children to get adequate sleep if they are to be
healthy. An insufficient quantity or quality of sleep causes negative effects on
your child’s physical and mental health, ability to learn and behavioral and
academic success. Numerous studies have shown the negative effects of sleep
restriction. and the positive effects of sleep extension have also been well

Toddlers need about 12-14 hours of sleep; preschoolers 11-13 hours; and school
aged  children 10-11 hours.

Sufficient sleep allows your child to think more clearly and complete more complex task easier than when they are drowsy or fatigued. When your child is sleepy he is more irritable and less prone to succeed in performance related activities at home and at school.

Adolescents as a group are at high risk for sleep deprivation and the serious
consequences of sleepiness. Some of the most troubling risks include the
decreased attention patterns that effect cognitive and school performance as
well as the potential risks from a delayed response while driving. Drowsiness
and fatigue are principal causes of traffic accidents each year and other
unintentional injuries. Young drivers are especially prone to fall-asleep

Adolescents require as much sleep as they did prior to adolescence.
In general adolescents require 8.5 to 9.25 hours each night. They
also prefer to go to bed later and wake up later than they did when they were
younger, Unfortunately, this conflicts with school schedules and places them at
a higher risk for difficulty falling asleep even when they try to arrange their
schedule to allow them to go to bed earlier. They also have to wake for school
when their body is telling them they need to sleep in longer. This phase delay
on top of other behavioral and schedule issues that cause them to stay up later
increases their sleep debt. Average sleep durations in early adolescence is 8
hours and later adolescence is 7 hours. Neither of these are adequate. Only
about 15% of adolescents report they sleep 8.5 hours or more each night. They
also have an extreme variability between weekday and weekend sleep schedules.
This further disrupts the quality and quantity of their sleep.

All children are different and sleep needs vary but most children do not get
adequate sleep. The best way to tell if your child is getting adequate sleep is
to look for signs of insufficient sleep. Is he difficult to wake in the morning?
Does he wake on his own? Does he sleep in on weekends and vacations? Is he extra
tired on Monday mornings? Does he show daytime sleepiness or become irritable
and short tempered when he is tired? Does he look rested? These are just some of
the clues to determine if your child is getting adequate sleep.

You should also look for healthy sleep practices. Regular bedtimes and bedtime
routines should be followed at all ages. Caffeine should be avoided and bedtime
electronics should be left out of the hours prior to going to bed. Try to fade
the intensity of light your child is exposed to and avoid vigorous exercise
during the 2-3 hours before bedtime. For the preschool and older child
it often helps to take a hot bath or wear extra clothes one hour before bed.
This warms up the body surface and helps them to relax. During the ensuing hour
before bed allow his surface temperature to drop by wearing light weight
pajamas. He should start to feel “cold” and want to get in bed between the
covers to warm up.  Once in bed he will begin to feel “warm and toasty”.
This encourages and prepares your child to fall asleep.

Your goal is a pattern of healthy sleep habits and a consistent sleep schedule that
is tailored to your child’s age and developmental level. Sleep environments must
be dark, cool, quiet and relaxed. For the younger child set a daily sleep
schedule and a consistent routine and follow through with it. For the older
child keep televisions and computers out of the bedroom and try to keep a
consistent schedule on weekends and weekdays.

Feeding Tips

  • Most children require exposure to food 10-15 times before they “like it”.
  • The more frequently a child sees a food, the greater chance they will “like it”.
  • Parents who eat many fruits and vegetables are more likely to have children who enjoy fruits and vegetables.
  • Girls who have physically active parents are more likely to eat more fruits and vegetables.
  • Children can tell when you are being truthful in your enjoyment of fruits and vegetables.
  • Children who eat a family breakfast are more likely to eat fruits and vegetables.
  • Praise your child when they eat fruits and vegetables but be sincere.
  • Food portions change with age. Check out www.choosemyplate.gov.
  • Providing tangible rewards when your child eats healthy foods does increase acceptance.
  • Using dessert as a reward does not increase your child’s willingness to eat healthy foods. It actually decreases your child’s liking of the food you are trying to get them to eat.
  • Peer modeling encourages healthy intake.
  • Eating meals together as a family decreases the risk of obesity and increases fruit and vegetable intake as well as less soda pop consumption.
  • The amount of food and calories a child eats is related to portion size.
  • The size of the plate used when your child eats affects the amount of food eaten.
  • Remove unhealthy foods from your child’s reach. Self-control is over rated.
  • Keep healthy foods in full view.
  • Remove reminders to eat from your child’s environment.
  • Keep the TV out of the kitchen and bedroom.
  • Make sure everyone in the family supports the pursuit of a healthy diet.
  • Never pressure your child to eat or clean their plate.
  • Never use food as a reward or as comfort to soothe your child.
  • Be a model of healthy eating for your child.

CT Scans of Children

Although estimates vary a CT scan of the chest is equal to several hundred chest X-rays. Due to their age and the sensitivity of their developing organs children are more vulnerable than adults to radiation. A dose of radiation that does not harm an adult can place a child at an increased lifetime risk for cancer. Another issue concerns CT accessibility. CT scans have been available for many years but now they are much faster than in the past. Consequently, when a CT scan was ordered in the past sedation was often needed. Today, distraction is often successful and this is a smaller roadblock to obtaining a CT. Two areas where CT scans are frequently obtained and are unnecessary are for minor head injury and for abdominal pain.

Many children who experience a head injury and are seen in an emergency room do not need to have a head CT done. they can be managed by taking a careful history, performing a thorough exam and providing close follow-up. Although a parent may be reassured by the normal result the reassurance does not justify the radiation their child is exposed to.

Another situation concerns the use of an abdominal CT scan in the diagnosis of appendicitis in children. Although CT scans are very good at making the diagnosis of appendicitis clinical diagnosis and the use of other non-radiation tests such as ultrasound can be very successful in the diagnosis and CT scans can be used on a limited basis depending on clinical course and examination findings.

CT scans are also frequently obtained to evaluate children who have their first seizure. In this situation as in the above examples the most important determinant of whether a CT actually needs to be obtained is the history and physical examination. If the history and physical examination do not point to structural problem with the brain a CT scan is not needed.

What should you do as a parent? Ask questions and listen to the answers. If you feel a CT is being done for reasons that do not justify the risk discuss your concerns with your child’s doctor. Almost always such a discussion will allow your child to receive the best care possible. If there is justification to do the test then do it.  If not, seek more advice and another opinion. As always, trust yourself and trust your doctor.


The United States Centers for Disease Control reports an estimated 2 million patients get a hospital-realated infection each year and 90,000 die from their infection. In terms of admissions that is 1 infection for every 20 patients. Proper handwashing techniques are the fastest and most important way to decrease the spread of communicable illness in children, teens and adults.

Every parent must play an active role in preventing the spread of microorganisms that cause disease. This is important in your home, your child’s daycare or school, your workplace, public places and in the hospital. The use of body and hand protective garb including gowns, gloves and eye protection are vital in a hospital setting; but, the first and most important protection is handwashing.

The first step is to make hand washing a habit. Every time you are in contact with someone who is ill wash your hands. Always remember to wash before eating, after using the bathroom, after coming in from outside, after touching a pet or animal, after sneezing and covering your mouth with your hand and whenever your hands look dirty. The more often you wash the safer you will be.

The best handwashing is with warm water and regular soap. Start out with wet hands and then apply the soap to serve as a lubricant and a degreaser to lift off any dirt. Rub the hands vigorously together and then rinse well for 15 seconds to wash the germs and grime down the drain. Antibacterial soaps are not needed and alcohol based hand sanitizers should not be used when the hands are visibly dirty. If no sink is available then hand sanitizers should still be used.