First-time mom Andrée-Anne Martel learned about the difference a doctor visit can make when her 7-month-old son developed a bad cough. “It was a cold, and it just kind of kept going,” she says. The baby had been sick for a month when she took him to her pediatrician.

After only a brief exam, the doctor told Martel her baby needed a nebulizer – a machine that medicates the lungs with a mist, and is normally used to treat asthma. Two weeks of nebulizer treatments didn’t help the cough, and the baby developed an eye infection as well, so Martel’s husband and son returned to the pediatrician – still without success.

“The baby was coughing his lungs out the whole visit with the doctor, but he just gave him eye drops and let him go,” she says. “He was just doing the least possible.” The next day, Martel, who lives in Los Angeles, took her son to an urgent care clinic where he was diagnosed with pneumonia. Shortly thereafter, she found a new pediatrician.

Martel’s experience wasn’t with what doctors call a “well-child visit,” but it illustrates what can go wrong when parents and pediatricians aren’t on the same page. And because there is so much ground to cover when kids come in for regular checkups, it is even more important for moms, dads and doctors to work together to get them right.

What Happens At a Checkup

“There are a variety of things that we typically don’t address during illness visits that are important long-term,” says Carlos Lerner, M.D., a pediatrician at UCLA Children’s Health Center and professor of pediatrics at UCLA’s David Geffen School of Medicine. These include behavior and child development, safety, and discussion of upcoming health issues. During an illness visit, “we have a fixed length of time and we have an agenda,” Lerner explains. “During a well-child visit, there’s the time and the focus both.”

Some of the time is taken up by measuring – height, weight, blood pressure – and some by immunizations against a host of preventable diseases. You’ll be asked questions, or even to fill out a questionnaire, to help the doctor tell if your child is hitting developmental targets. But much of the visit should be devoted to discussion.

“At 2 months we’ll talk about carseats. At 8 years we’ll talk about booster seats,” says Joseph F. Hagan, M.D., FAAP, co-editor of the Bright Futures Guidelines BrightFutures.aap.org from the American Academy of Pediatrics (AAP), the gold standard for what should happen at well-child visits. “It’s about having a conversation with the child and their parents about health,” says Hagan.

The Parents’ Agenda

How long do these conversations last? On average, visits are 30-60 minutes long, with some of that time spent in the waiting room and some with a nurse or other caregiver who measures weight, height, etc. Actual face-time with the doctor averages about 18 minutes, according to Hagan.

Lerner advises writing out your questions and concerns and sharing them at the beginning, rather than the end, of the visit, “so we know how we’re going to use what we know is a fixed amount of time.”

But don’t just make a laundry list. “If there are 12 issues that you want addressed, realize that they might all get short shrift,” says Lerner. Instead, prioritize and tackle the most important items first.

Other ways to maximize your 18 minutes:

• Arrive early enough to fill out the pre-visit questionnaire, so the doctor begins the checkup with the needed information.

• Consider leaving siblings at home, so they don’t interrupt your conversation with the doctor.

• Silence your cell phone. “I don’t mind it ringing,” says Hagan. “But if you’re going to answer it – the clock’s ticking.”

And consider scheduling a second appointment if you don’t get through everything during the first.

Getting To Know You

Building a relationship with one pediatrician means the doctor can more easily track your child’s health over time, and is more likely to spot problems early. “It’s one of the most powerful ways to be effective at what we do,” says Lerner.

The person bringing the child to the doctor also has an important role to play. If someone who doesn’t normally take care of the child is pitching in to help, they’ll need to do some homework. “Make sure they come prepared to address the things we’d like to know about the child,” advises Lerner. How are they eating, sleeping, peeing and pooping? Have they learned a new word or a new motor skill? Are there any concerns at daycare, preschool or school? If the child’s teacher has given you any sort of written evaluation, bring that along to the visit.

As well-child visits have changed over the years, there is more and more for doctors to address – from asking about the presence of firearms in the home, to looking for signs of domestic violence, to bicycle helmet use.

“The list is so long that it would be literally impossible to complete at every checkup,” says Lerner. So doctors try to tailor the visit based on what they already know about the family, and on concerns brought up by parents. “We depend on families to do their share,” he says.

And that includes speaking up when something doesn’t seem right. Hagan wants parents to let their pediatricians know if they don’t understand something, don’t feel comfortable with something, feel rushed or haven’t had their questions answered. “If you’re not satisfied,” he says, “you should say so.”