Why Bother with a Regular Check-up?

It's summer! In my office there is less coughing, and more bug bites. Poison ivy, sunburn, heat rash, cuts, scrapes, swimmer's ear, allergies, and swimmer's itch all make themselves known again. While in the winter months I have to move fast in order to tend to a larger group of younger sick children, in the summer I have more time scheduled to devote to physical exams for school-age children and teenagers.

Regular check-ups are important. They establish a good doctor-patient relationship, empower children by helping them understand their bodies, screen for important health problems, monitor ongoing illnesses, and address new concerns.

I love having the opportunity to spend more time with my patients and listen to their concerns. I think that seeing usually healthy children and teens regularly (at least every two years after age five) gives me the chance to establish a solid, health-enhancing relationship with my patients. A relationship like this is based on familiarity, good communication, accurate expectations of what will happen in the office visit, and trust.

For a perfectly healthy child a physical exam can be a boost to her self-esteem by showing how well she grew and gained weight over the last year or two. It can be interesting to find out what the blood pressure means, and that a normal blood pressure is a good sign that her heart is healthy. These very personal bits of data can make a child feel strong and healthy, proud of himself and his ability to take care of his body. I believe that regular, positive interactions with his own doctor can be empowering for a child, laying the footing for him taking responsibility for his own health for a lifetime.

At a regular check-up I can reinforce what many parents are already telling their children. I emphasize the importance of eating fruits and vegetables, and of limiting time in front of a TV or other "screens". I talk about safety, such as wearing a bike helmet or seat belt. For older children and teens I might discuss how the choices they make and the influence of their peer group can affect their health. I also talk about hygiene! Including deodorant, showers, washing hair and faces, and shaving.

I talk about puberty at check-ups. Most pre-teens and teens want to know if their body is developing normally, how it compares to other kids their age, whether things are too big or too small, if it's starting too early or too late, or when certain events are likely to happen. Normally, for girls, I talk with parents at their daughter's age of seven about the eventuality of breast development--something that can start to happen close to age nine. At nine I start talking to girls directly about this topic, at whatever level they might need (maybe their friends are wearing bras, maybe they need a bra, maybe they don't know where to get a bra, why they might want to wear one, etc.). And my discussion becomes more advanced as the patient gets older.

A check-up involves checking all parts of the body. If a child has been having regular check-ups with me from the beginning, this is not a surprise to them. After all, I've been checking their private parts since they were born, why would I stop checking once they are five, or seven, or nine, or eleven, or thirteen..? They know I will make sure they have privacy, are covered up, and have only agreed-upon family members in the room. They know how I will check them, how long it will take (usually seconds), and they probably know exactly what I will say. If puberty has started I can also give them an idea of how far into it they are and what will come next.

At my office a check-up includes an external genitalia exam only. Girls would be referred to a gynecologist for a pelvic exam and pap smear if there are problems identified, within two years of becoming sexually active, or by age twenty-one.

One important screening that takes place at a regular check-up is the examination of the spine for scoliosis. Ideally we should identify scoliosis before a child's rapid growth spurt occurs. If I see a child at age five, and then not again until they need a sports physical for high school, it might be too late to treat scoliosis. Screening for normal blood pressure, vision, and growth can identify problems early, as well. Starting at age three we calculate a body mass index (BMI) for every patient during their well visit. This can identify children at risk for obesity. The child's immunization record is reviewed, and anything needed will be given at the end of the check-up.

For a child who has a chronic illness, or takes regular medication for a condition, a check-up will include a review of that condition. I will look at the impact of that condition on the child's health over the last year, evaluate the severity of the condition and the need for any further evaluation or adjustment in treatment. I will refill necessary medications.

Sometimes a patient has a new problem being brought up during a regular well exam. The detail involved in the well exam helps establish a better context for the problem. Sometimes the regular questions and information provided in an otherwise healthy child well exam must be abbreviated to properly address the new problem. There is no specific formula for this, we will do what we must do to address the most important concerns. The complete physical exam would still be performed.

Sports physicals are done along with a regular physical exam. I do not have a separate appointment for a sports physical available. If a teen is there for a sports physical we will do the whole physical exam. Parents and patients will notice that the checklist on the sports physical form is quite comprehensive, and includes all body parts, anyway! If needed, I will complete the forms at the time of the check-up, or up to twenty-four months after the check-up if there have been no changes in health or injury status during that time, and there are no chronic illnesses we have been monitoring.

I have one more thought for you as a parent helping your child on his or her journey to a lifetime of personal responsibility for good health. When do you think you should encourage your child to have a few minutes to talk to the doctor on her own? Usually I have initiated this at age 13, encouraging parents to wait in the waiting room (not just the hallway) while I do the physical examination part of the visit.

By high school I really think it is a good idea for the teenager to have a little time with the doctor without a parent present. Teenagers, who are now thinking for themselves, need to learn how to talk to, and listen to a doctor. Parents, this means you might have to trust me to talk to your teen alone. Why would you bring your child to me if you don't trust me? When I talk to your teen the discussion will be focused on establishing rapport, on physical and mental health, on making good choices, and on bringing family and parent-teen relationships together. By having you (the parent) out of the room it is very likely that I will be reinforcing things you have already discussed with your teen. You will look much smarter and more reliable to your teen if he realizes the same information is coming from the doctor!

So, call and schedule your child's well exam soon. Get on at least an every other year schedule (every year for monitoring chronic conditions). Let's think long term about promoting a healthy life for your child. And yes, I will read those little notes you pass to me secretly before the check-up and along with my usual advice I will emphasize whatever health rule you think needs a little extra reinforcement at home.

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