There’s a lot more to your child’s annual physical than a lot of parents realize. Doctors are checking, probing and asking lots of questions to make sure that there aren’t underlying issues parents might have been brushing aside.
“When people think about well-visits, they usually think about vaccines. There’s that mindset, ‘My child is up-to-date on vaccines, so why do we have to come in?’ but a lot of what I’m assessing is around development,” said Dr. Julia Richards at Novant Health Pediatrics Denver.
While vaccines are important for keeping preventable diseases at bay, well-visits are an opportunity to track a child’s growth and development over time. Pediatricians are checking vision far before most parents might think about booking an eye appointment for their child.
And, they’re also looking for lesser known things like behavioral concerns, scoliosis and, as they get older, depression or other mental health concerns adolescents might try to hide from parents.
What is monitored often depends on a child’s age, but the bottom line is simple – these visits are crucial to maintaining wellness and catching problems early, when outcomes are better.
Infant to 3 years
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Richards finds that most parents with children under 3 years are most concerned about “sleep, food and poop.” The well-visit is an opportunity for pediatricians to make sure that sleep schedules and diet are appropriate, and that stools are normal. “A lot of what we do in the newborn to toddler phase is reassure parents that their kid is normal,” she said.
As young kids begin to get more active, Richards assesses gross motor skills like the ability to sit or crawl, as well as speech and fine motor skills such as holding a pen. She also asks if the child is drinking fluorinated water. “A lot of patients out here are on well water. We want to make sure their teeth are healthy,” she said.
Richards can prescribe fluoride drops to families on well water or parents can choose to buy fluorinated water. Beginning at age 3, a child’s vision is checked. For those in preschool, their social and emotional skills are also evaluated.
“A lot of the times it's how they're interacting. Is it a negative or positive interaction? I expect a 4-month-old to giggle when a stranger comes near them, but I expect a 1-year-old to scream and cry. That's normal. So, a lot of my assessment is my interaction with them,” Richards said.
Age 4 to adolescents
At age 4, pediatricians begin to check both vision and hearing, along with a child’s development. She finds that parents tend to “fall off” on making well-visits around this time since there are no vaccines between kindergarten and sixth grade. The Pfizer COVID-19 vaccine is now available for kids 12 and older. Pediatricians highly recommend it.
“Parents sometimes miss those checkups, but it’s still very important to have them seen because so much developmentally and emotionally changes between kindergarten and sixth grade. And it's so important to keep them up to date,” Richards said. Around age 5 is when Richards starts “doing more of those social or emotional screenings” to make sure behaviors and mood are appropriate.
“There’s a lot of things that may come out in an appointment – mood wise – that maybe parents aren't aware of. Maybe it happened at school or the child was too afraid to tell the parents or the teachers, but sometimes those screenings help us start that conversation,” she said.
Beginning at age 6, Novant Health pediatricians use something called PSC-17, or a pediatric symptom checklist, that is a general mental health screening tool. This could catch problems such as attention deficit hyperactivity disorder (ADHD) or anxiety. This is also around the time that Richards begins to look for scoliosis, a sideways curvature of the spine that occurs most often during the growth spurt just before puberty.
“Another big thing – usually between ages 9 and 11 – we chat about puberty and what's coming. I just like to make sure the lines of communication between the child and the parents are open,” she said.
Richards often shares book recommendations for kids who are going through puberty. For girls, she suggests The Care and Keeping of You: The Body Book for Younger Girls. For boys, she recommends Guy Stuff: The Body Book for Boys.
Middle school-aged kids can also receive a sports physical at their annual well-visit, preventing the need for an additional appointment. But don’t make the mistake of thinking a sports physical covers everything your pediatrician checks for. Those exams cover only a fraction of the territory pediatrician’s cover.
Children are also screened for depression beginning at age 12 and into their teenage years.
Parents are less involved in well-visits as a child enters their teenage years. While pediatricians are still monitoring things like weight, vision and hearing, they also discuss subjects that teens may not feel comfortable talking to their parents about.
“I politely ask the parents to step out of the room and we chat about the not-so-fun stuff like drinking, drugs, birth control and sex, and how to stay safe despite peer pressure,” Richards said.
Those conversations remain private unless there is a concern for their safety, Richards said. When it comes to the depression screening, she finds that more issues tend to pop up around this age. “Being a teenager is hard,” she said.
A thorough discussion about diet and school activities also takes place at a teen’s well-visit. It’s about building trust between the pediatrician, their patient and the parents.
“If they were an A student and now, they’re a C student, I ask questions. ‘What happened? Is it depression? Did something change in the home? Was there a trauma?’ It gives us a starting point to help correct the issue,” Richards said.