Growth Milestones – 6 Years

“The Big First Grader”

Your child has changed from a little one, protected by home, to a first-grader who now must meet the demands and competition of school life. A 6-year-old is eager, active and likes to be on the go. A youngster this age is eager to act independently, but he or she is not yet able to consistently make wise decisions. A 6-year-old needs parental approval, understanding, praise and encouragement. When parents or school push too hard or expect too much, the child may become tense and nervous and develop physical symptoms such as stomach-ache, headache, fatigue and irritability.

Possible Questions for Your Child’s Doctor

Some of the questions or concerns you may have about your 6-year-old can be raised at this checkup. These might include:

  • Hyperactivity which interferes with school performance.
  • Inability to get along with peers or siblings, or lack of friends.
  • Poor school progress or school avoidance.
  • Being overweight.
  • Bed wetting or soiling.
  • Recurrent nightmares, tics, aggressive behavior, fears.
  • It is not unusual for a 6-year-old to steal money or enticing objects. Speak to your physician if you are concerned about this.
Parenting and Behavioral
  • Parenting and Behavioral
  • Adults play important roles in the life of children at age 6. Children will develop close relationships with teachers. It can be upsetting to a child when adults they love (including teachers) go through difficult times or changes.
  • Establish rules to be followed at home with respect to: bedtime, TV watching, helping with chores such as setting the table, keeping their room neat.
  • The TV can become a major pastime for the 6-year-old. Don’t let it. Television can be a positive resource if watched in small and controlled doses. Always watch TV with your child and explain the differences between reality and fantasy.
  • Spend active time with your child on a daily basis if possible. Especially show interest in your child’s daily school activities.
  • At this age, an adult should be present at home (or other arrangements made for adult supervision) when the parents are absent.
  • Praise and encourage the child’s activities. Build the child’s self-esteem. Show affection. If there are siblings, promote the individual strengths of each child.
  • Promote activities outside the home. Remember that the goal of these activities is to have fun and develop oneself to the greatest capacity. Winning and losing should receive limited attention.
  • Encourage reading. Read to your 6-year-old. Let him or her read to you. Read together. Your example will help reinforce that reading gives pleasure. If you haven’t already done so, get a library card and use it.
  • Can bounce a ball 4-6 times; throws and catches.
  • Skates.
  • Can ride a bicycle.
  • Can tie shoelaces.
  • Can count up to 100, print first name, print numbers up to 10 and print a few letters.
  • Knows right from left.
  • Can draw a person with six body parts.
  • Begins to learn some specific sports skills like batting a ball or kicking a soccer ball.
Oral Health
  • Ensure that your child brushes his or her teeth twice a day with a pea-size amount of fluoridated toothpaste. Regularly supervise tooth brushing.
  • Give your child fluoride supplements as recommended by the your youngster’s physician based on the level of fluoride in your drinking water.
  • Learn how to prevent dental injuries and handle dental emergencies, especially the loss or fracture of a tooth.
  • Flossing the teeth before bedtime is recommended.
  • If your child regularly sucks his or her fingers or thumb, begin to intervene gently to encourage discontinuation.
  • Schedule a dental appointment for your child every six months, unless the dentist determines otherwise based on your child’s individual needs/susceptibility to disease.
  • As the child’s permanent molars erupt, ensure that the dentist evaluates them for application of dental sealants.
  • Your child may develop strong food preferences. A 6-year-old may refuse to eat some foods. This will gradually change as the youngster is exposed to different foods outside your home.
  • Try not to use food as a reward for good behavior. Praise is better. Ensure that your child eats three regular meals and two nutritious snacks per day.
  • Make mealtimes pleasant and companionable. Encourage conversation.
  • Provide nutritious snacks rich in complex carbohydrates. Limit high-fat or low-nutrient foods.
  • Model and encourage good eating habits.
  • Serve a variety of healthy foods and avoid excessive junk food, especially those with “empty” calories such as soft drinks, chips, candy and cookies.
  • Help your child learn to choose appropriate foods, including five servings of fruits and vegetables daily.
  • Encourage your child to eat a balanced breakfast or ensure that the school provides one.
  • Ensure that your child eats a nutritious lunch at school, either through the school lunch program or by packing a lunch.
  • Good table manners take a long time to develop. Model good table manners for your child.
  • Ensure that your 6-year-old child gets adequate sleep. For children 6-10 years of age, the suggested bedtime is 8-9 p.m.
Health Promotion
  • Be a role model for your child by having a healthy lifestyle.
  • Encourage regular physical activity.
  • Limit television watching to an average of one hour per day of appropriate programs. Watch the programs together and discuss them.
  • Reinforce with your child’s personal care and hygiene.
  • Discourage interest in tobacco products. Parents are very influential in teaching children to avoid tobacco. If a parent smokes, the parent should set a quit date and stop smoking. Modeling nonsmoking is a powerful example with important health consequences. Tell your child that smoking is related to the cause of death for 1 in every 5 people in the U.S.
Immunizations Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child’s health care provider concerning your child’s vaccine schedule.
  • Annual flu vaccines for children with chronic illnesses like asthma and heart defects. Check with your doctor.
  • Vision and hearing, as well as blood and urine, are usually checked at this visit. Other screening done at this age may include a tuberculin test (if indicated) and blood pressure. If there is a family history of elevated cholesterol, some physicians will also obtain a screening blood test.
  • By this age, most children have received the following immunizations:
  1. 5 doses of DTaP vaccine
  2. 4 doses of HIB vaccine
  3. 2 dose sChickenpox vaccine
  4. 4 doses of pneumococcal vaccine (if born after 1999)
  5. 3 doses Hepatitis B vaccine
  6. 2 doses of MMR vaccine
  7. 4 doses of the Inactivated Polio Vaccine
  8. 3 doeses of the rotavirus vaccine
  • Enforce consistent, explicit and firm rules for safe behavior.
  • Continue to ensure that he or she wears a seat belt in the car at all times.
  • Reinforce with your child the safety rules for swimming pools. Teach your child how to swim.
  • Ensure that swimming pools in the child’s community, in your apartment complex or at your home, have a four-sided fence with a self-closing, self-latching gate. Children should be supervised by an adult whenever they are in or near water.
  • Teach your child how to put on sunscreen before he or she goes outside to play or swim.
  • Continue to keep your child’s environment free of smoke.
  • Test smoke detectors to ensure they work properly. Change batteries yearly.
  • Reinforce with your child the safety rules for the home. Conduct fire drills at home. Lock up poisons, matches and electrical tools.
  • Ensure that guns, if in the home, are locked up and ammunition is stored separately. A trigger lock is an additional important precaution.
  • Reinforce with your child the safety rules for getting to and from school. Reinforce with your child pedestrian and neighborhood safety skills.
  • Reinforce with your child the safety rules for bicycles, including use of proper traffic signals. Ensure that he or she always wears a helmet when riding a bicycle.
  • Reinforce the importance of playground safety.
  • Ensure that your child is supervised before and after school in a safe environment.
  • Reinforce with your child the safety rules for interacting with strangers (e.g., answering the telephone or the door, never getting into a stranger’s car). Ensure that your child’s school curriculum includes information on how to deal with strangers.
  • Teach him or her about sports safety, including the need to wear protective sports gear such as a mouth guard or a face protector.
  • Answer questions at a level appropriate to the child’s understanding.
  • Have age-appropriate sexual education books in the home that will answer some questions and encourage your child to ask others.
The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics’ Guidelines for Health Supervision and Bright Futures’ Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.. Updated 05-08-07