July Week 3 Anticipatory Guidance

Articles and Resources:

AAP Committee’s Guidelines on Bicycle Helmets
AAP guidelines for Car Safety Seats
AAP’s Healthy Living Factsheet
AAP’s Healthy Living Prescription

Case 1

You are seeing a 9 month old boy and his 3 yo sister for their well visits. The boy has been in a rear-riding rear-facing car seat until now, and his sister is in a forward facing seat with a harness.

At what age and weight can the parents turn his car seat to face forward? (1 yr or 20 lbs) 
At what age and weight can the sister transition to a booster seat? (4 yrs, usually 40-80 lbs depending on manufacturer) 
When can children transition out of booster seat to just a seat belt alone? (8-12 yo, when the child’s knees can bend 90 degrees when back is against seat, and shoulder belt is across chest – not at neck, lap belt is across hips/thighs – not belly) 
When can children sit in the front seat if the car has an airbag? (12) 
Case 2

A 12 yo girl and her mother come to you for her well visit. Her BMI is in the 96%ile. She does not do any physical activity since her bike has flat tires and mom admits the family eats a lot of junk food and fast food. Both mom and the patient are interested in learning more about diet and exercise.

What do you recommend as minimum number of servings of fruits and vegetables per day? What do you tell them about fast food? 
How much screen/electronic time per day is okay before being at risk for obesity? 
How much activity should she get each day? 
What 2 factors are strongly associated with bike helmet use in young children? (if their parents wear one and if there is a helmet law)