Your child’s doctor should be doing your child’s checkups

The Pediatric Insider

© 2014 Roy Benaroch, MD

Yearly checkups for school-aged and older kids can be a great opportunity to help your child stay healthy. Don’t skimp by relying on a cheapo sports physical at a local drug store. They cannot offer the kinds of important things your own doctor’s office can do for your child at a yearly well check.

We’ll review old issues and problems. Still getting those migraines? Last year, we talked about school problems—how is that going now? Walk-in clinics don’t have access to those old records, and don’t care what happened to last year’s problems. We do.

Speaking of old records: checking a height and weight is a crucial way to know if your child is growing as expected. But you can’t know what those numbers mean if you only check them once. We can look at the trends—is your child growing along an expected path, or has something strange happened this last year? Is puberty progressing as expected?

Following trends isn’t just important for physical growth, but also for cognitive and social development—all of these skills can be followed, to make sure your child is OK. Not everyone has to be able to do the same things at the same ages, but we should be able to see new skills developing at an expected rate. It’s not a one-time check, at least not if you want these things checked correctly.

A lack of prior records also means that the quickie clinic can’t assess your child’s vaccine status. These days, it’s especially important to keep your child protected. We’ve got great, effective, and safe vaccines to prevent cancer, pertussis, and meningitis. Let’s make sure your child has what he needs to stay safe, and also to fulfill what he needs for school.

Medical care is sometimes fragmented. A child might visit the Emergency Department for a broken wrist, and then be referred to an orthopedist. Or maybe your child is taking medications prescribed by an allergist, or an asthma specialist, or a psychiatrist. Maybe your teenager had wisdom tooth surgery, and had a reaction to the anesthetic. Your “main doctor”—your child’s pediatrician or family practice doc—has the one office where all of these records need to be. Your yearly checkup is a great time to review the year’s health issues, and make sure everything is documented clearly in one place. Coordinating care between doctors is a crucial role for your child’s primary care doc, who can help prevent medical errors and duplications of testing. We’ll help make sure nothing falls between the cracks.

An essential component of a yearly well checkup is anticipatory guidance. What challenges can you expect this year? Since all children are different, good anticipatory guidance relies on a knowledge of he child as an individual: what are her strengths, and weaknesses? What sorts of things are likely to go well, and what other things might be more of a stumbling block? For anticipatory guidance, we’ll sometimes talk about school, or diet, or exercise, or relationships. Whatever will help your child the most, and whatever will help mom and dad cope with what’s coming next. It’s not a cookie cutter approach. Guiding a family through the challenges of raising a child is not something that’s done best with checklists and preprinted sheets. Knowing a family is what makes this part of the checkup valuable.

One other thing: yearly checkups help create a bond between child and doctor. We get to know them, they get to know us. If something does go wrong, your child will feel much more comfortable working with a doctor that’s known and trusted. Children do sometimes get rare, serious, or perplexing diagnoses. Believe me, you’ll be glad that your children (and you!) feel comfortable with their doctor when it’s needed most.

Your sports physical at the quick-cheap-clinic might get you a signature on a form—and if that’s all you want, by all means, use them. You can even take advantage of their $5 off coupon. But you will get what you pay for.

Cheap doesn't mean good

Even with a discount, you’re not getting much value

Ironically, all ACA-compliant health care plans cover well checks for children with no cost-sharing—no copays, no deductibles, as long as it’s a current plan that meets federal standards. Most insured families pay nothing out of pocket for these yearly checkups, even without a coupon.

Your children deserve more than a minute at a clinic. They deserve, once a year, a visit with their own doctor, devoted to their own health. Not just a quick physical, but a comprehensive review of where they’ve been, where they are, and where they’re going. That’s what a real checkup is all about.

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2 Comments on “Your child’s doctor should be doing your child’s checkups”

  1. I agree. We had gotten into the habit of quick sport’s clinics since I had thought there was no need to go to the pediatrician’s office for teenagers, and at the time there was a cost to us. About four years ago I called and confirmed that my 17 yr old could make an appointment for a physical. We’ve been back every year now. Our doctor agreed to give my 20 yr the guardisil vaccines since I didn’t think our internist would have that available and there is a value in having all vax info from one source.


  2. Rob Lindeman Says:

    Roy, I do this for a living and I disagree. The piece reads more as an apology for the sake of franchise-protection than as a series of compelling arguments for the annual physical of the otherwise healthy child. Forgive me and please do not think I’m making ad hominem attacks when I say that these arguments are weak.

    Physicians do annual physicals because about 100 years ago we insisted that we were the only ones capable of doing them. It was nothing but claims-making by a professional class then and that’s all it is now.

    The annual physical does NOT help a child stay healthy. At best what we do is identify problems that are sometimes problems but that are usually not problems (like the high school football player whose BMI is in the 90th %-ile; You know you’re “at risk for obesity”?)

    I could go on, but a final comment on fragmentation. In the information age, we are as much of a fragment as the ED or the orthopedist. We can plead de-fragmentation, and we may insist on the “medical home” (which turns out to be whatever we want it to be) but the cold reality is that an intransigent public refuses to come home.

    We ought to retreat to the hospitals from whence we came and do what we were trained to do: care for sick children.


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