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What Constitutes a Child's Yearly School or Camp Physical

Posted Jun 15 2010 4:02pm

In my Blog yesterday about Avoiding Store Mini-Clinics, I did not have space to add what should be done on a child's camp or school annual physical. One of the most important things is to have the child undressed down to shorts or underwear with a gown offered if desired. No physical examination should ever be done on anyone without the patient undressed. Next a detailed history should be taken and immunizations checked. If a child's tetanus shots are not up-to-date and he or she has an injury at camp or a serious burn, this information is very important to know. A urinalysis should be done to check for diabetes or kidney disease and a basic blood count is important.

If a child arrives at camp with undetected diabetes and develops problems, there could be serious consequences. Also, if a child has an elevated or abnormal blood count and is sent to a camp which lasts a week or longer, there could also be problems.

I did a routine urinalysis on a child who was not feeling well, but had plans to go on vacation with her family,. The urinalysis was negative, but something made me ask the mother to bring the girl back the next day. I was afraid I might be missing something, even though I couldn't find anything on physical examination. The next day, I asked for another urine specimen, but, her mother said, "You did one yesterday." "Yes," I said, "but I want another one and I won't charge you."

When the girl handed me her urine specimen, I saw a urine that was dark brown. Under the microscope I could see many  red blood cells and knew  she had a serious kidney disease or glomerulonephritis. If my patient had left on vacation or gone to camp there could have been serious consequences. Fortunately, with treatment there were no bad effects, but there certainly could have been if I had not asked for the second urinalysis. This is not the kind of care that can occur at a store Mini-Clinic and the American Academy of Pediatrics, of which I am a Fellow, has spoken out strongly against these clinics for kids.

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