Jayme Heath, M.D.
Now that summer is over and we’re getting back to getting things done, it’s time to think about your kids’ annual checkup. Jayme Heath, M.D., is assistant clinical professor at the David Geffen School of Medicine at UCLA and a pediatrician at UCLA Medical Center, Santa Monica, and has some great advice about making the most of those visits.
What is the best timing for an annual checkup for kids?
When you’re making an appointment for your child, keep in mind that child’s schedule and what the best time of day for them is. Try to avoid regular nap times or meal times. If there are siblings, bring someone who can sit with them in the waiting room to limit distractions during the visit, and turn your cell phone on silent. Make sure you’ve budgeted enough time for the visit, so you aren’t feeling rushed and can have all your questions addressed.
After the early toddler years, checkups graduate to a yearly schedule. Try to keep it around the child’s birthday, since that is easy to remember. Another common time for the yearly checkup is right before the start of the school year, especially for student athletes who often need forms for participation completed. This is often a busy time in the doctor’s office, so try to schedule it early, and send any documents in ahead of time so they can be completed with the appointment.
What should happen during an annual checkup?
For well visits, we’re going to measure the height and the weight, discuss how the body is growing in terms of the percentiles they’re at and how it compares to prior visits, and check vital signs including blood pressure, pulse and heart rate.
We do a thorough exam from head to toe involving the head, the eyes, the ears, nose mouth, listening to the heart, the lungs, the abdomen, checking flexibility, screening for scoliosis, discussing any problems with elimination in terms of voiding dysfunction or constipation, and evaluating for pubertal development in the adolescent age group – breasts and pubic hair in girls and hernia and testicular exams in boys. We check vision and hearing, and review exercise, nutrition and school performance, behavioral or emotional concerns and any family issues that have come up.
If there were any new diagnoses made, you should expect the doctor to explain them, and treatments that are going to be recommended, and provide you with referrals in case that need special expertise.
What information should parents gather to bring with them to the visit?
Bring a list of questions that have come up since you last saw the pediatrician, and prioritize them, so that your most pressing concerns are the things that are discussed first, ensuring that you get them addressed.
If it’s your first visit to the office, bring any important past medical documentation: immunization records and growth charts, medication lists and doses, allergies, and records from past hospitalizations or surgeries. These things are helpful for the doctor to know in taking care of your child.
Let the doctor know about any new family medical problems – especially in immediate relatives, siblings, Mom and Dad or grandparents – that have been diagnosed since your last visit, so that the doctor’s aware of what other things they might need to consider. Things like cancer, thyroid problems or a heart condition that may run in the family may be important to know in terms of screening the child for that condition.
Definitely take notes during the visit, and expect to be given a handout at the end that summarizes the main points of the visit and what to expect in the coming year, especially regarding physical, social and emotional development. If there are any questions or concerns after the visit, you can follow up with an email or phone call for clarification.
How should parents prepare a preschool or early-elementary age child for a visit to the doctor?
There’s lots of stuff out there that can help families to prepare. There are books for various ages that explain what to expect when you go to the doctor and what a checkup entails. I recommend getting a doctor play kit for kids when they’re in their early toddler years, so they can practice doing checkups on their family members and their stuffed animals, and become more familiar with the equipment that’s in the office and hopefully not as fearful of it.
It’s important to be honest with your child about what’s going to happen during the visit. If you don’t know whether they’re going to have shots, don’t tell them that they will not be getting any shots. And if they are having shots, let them know what it may feel like in terms of a bee sting or a pinch, and that the reason for the vaccine is to help the body to stay healthy and to prevent them from getting sick.
Let children know what types of things are going to be done in terms of measuring their height and their weight, checking their blood pressure and their pulse, and examining the body to make sure that they’re growing and developing appropriately for their age. I also like to tell parents that they should have a calm, reassuring attitude. Talk about the doctor in a positive way prior to the visit. Let the child know that the doctor is there to check their overall health and development and answer any questions or concerns that come up. Let the child know that they’re going to have an opportunity to ask questions, and that the parent is going to be in the room with them, and that they’ll be told what’s going to happen prior to it happening.
I also recommend that parents bring something that helps the child to cope. Sometimes that is a favorite toy or a special drink cup or something that they find comforting, and the pediatrician should have a little bit of a treat or reward for being brave during the visit.
What can kids who are tween or teen age do to prepare for and participate in their visit?
As kids enter into their adolescent years, it’s really important for the doctor to develop a more personal relationship with the patient and allow that patient to ask and answer questions on their own, as opposed to Mom and Dad answering for them. I like the family to let the teenagers know that they will have the opportunity to ask questions on their own, with parents present if they would like, but definitely with parents absent as you get into those later adolescent years, because sometimes there can be questions that kids feel a little uncomfortable or nervous asking about in front of Mom or Dad.
We want to talk about pubertal development and answer questions about changes in their body and what they may expect with onset of puberty. In the later adolescent years, they should expect to be asked about peer and family relationships, sexual activity, exposure to drugs, alcohol and cigarettes, driving safety, and mood changes.
I also like to prepare families to let the teens know that for young women, there’s going to be discussion about their periods and pregnancy-prevention counseling. And for young men there’s going to be an examination that involves checking for hernias and screening for testicular cancer.
If there’s a particular topic of concern that the parent would like to discuss with the doctor, or that the child would like to discuss with the doctor, what should they do to make sure they are able to do that?
Make sure that the concern is brought up early in the visit, so that enough time can be budgeted to discussing that topic. If it’s a large topic or there’s a lot of background information that may be helpful to know ahead of time, consider emailing or calling, or maybe even dropping off a letter or documents to the office in advance so that the doctor can be aware of the issue prior to the visit. Or if there’s a particular treatment or study that you’re interested in asking the doctor’s opinion on, bring it in prior to the appointment.
If it’s a complex topic, or requires additional information to be collected, know that you may have to schedule follow-up visits.
