Posted tagged ‘check-ups’

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

July 29, 2014

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.

Don’t split the vaccines

September 7, 2008

Brook asked a good question: “I am curious to learn more about the timing and combining of multiple vaccines. As a disclaimer, may I please add – I do not fear vaccines, and I certainly think they are helpful and necessary as opposed to harmful to my children. I read that the CDC recommends that the MMR, DTAP, IPV, & Varivax vaccines be administered between the ages of 4 years and 6 years. My pediatric group recommends that all four vaccines be administered at the same visit at the age of 4 years. I wonder why they aren’t spaced such that 2 shots are given at 4 years and 2 shots at 5 years or something similar. Are there advantages to spacing the vaccines? Are there risks in administering multiple vaccines in one visit? Are the shots administered in each of the limbs? Any insight you could offer would be greatly appreciated. I am not sure if I should request that the vaccines be administered over 2 or 3 visits to make sure my child’s immune system isn’t overburdened and he fully benefits from them.”

Giving these vaccines poses no added risk versus giving them all at once, and as a pediatrician who has supervised vaccinations for many years, I’ll tell you that it’s much, much easier on the child to get them all over with at once. (more…)