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
• Injury Prevention Article

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)