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Medicine Mondays- The Importance of School Physicals

Posted Sep 19 2008 1:26am
Hi welcome back to Medicine Mondays-

As suggested by the title, each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

This week I don't have a question but rather an article about the importance of School physicals! Has your child had theirs yet??

The Importance of School Physicals

Well it’s that time of year again, school is back under way and if you haven’t got your child’s annual physical yet, make sure you put it at the top of your list of things to do.

You may think that because you take your child in frequently for that never ending cold that he’s getting enough of the doctor’s time but that’s not so. A 10-15 minute sick visit isn’t enough time to talk about your child’s short stature or the fact that he’s just went up two pant sizes. Before you go for your appointment, make sure you record any medicine they are taking, make a list of issues you’d like to discuss and bring your immunization record. At the visit the doctor will review a few key points. I’ve outlined those below.

General Health and Well-Being

One of the first things the doctor will do is screen your child by checking their height, weight, blood pressure and temperature. We’ll also place a PPD to screen for tuberculosis, check a CBC to screen for anemia and do a urinalysis to screen for infection and protein. We’ll test their hearing and vision as well as discuss their appetite and sleep habits. In addition to this we’ll also address how your child is getting along with everyone. Are they contributing to the family? Are there chores that are being accomplished? Are they receiving an allowance and finally has there been any notice of depression or mental health issues.

Review of Illnesses

A thorough head to toe physical exam is completed next. We’ll discuss any acute illnesses your child may be having such as a cold or virus. If the current illness is complex or your child is running a fever, then we’ll treat the illness and often may ask to reschedule the well visit and/or delay immunizations. Once the acute illnesses are addressed we’ll move on to discuss any chronic medical issues. This is an important time to review conditions that your child may not be resolving. Most parents can’t even begin to talk about the importance of chores or potty training if their child is having recurrent urinary tract infections. This is also the ideal time to review sub-specialist recommendations and make any changes to the treatment plan as deemed necessary.

Height and Weight Analysis

After the acute and chronic illness, the pediatrician will then review the general height and weight of your child. We’ll look to see that they are growing appropriately- at least an average of 5 cm per year. We don’t analyze the height and weight at any one time but rather we look at the trends over a course of many visits. Looking at it this way we can easily see if there are sudden spikes in the curve or if they are reaching a plateau. We’ll also look at whether your child is proportional in relation to their height and weight. A child in the 50th percentile for their height should have a relatively similar percentage for their weight. Like most things in health, we look for balance. Most everyone will receive counseling regarding healthy eating. With obesity being a growing epidemic it is never too late to talk about limiting juice and fast food consumption. If your child already has a weight issue then we may analyze it further with labs tests to screen for diabetes, liver disease and thyroid issues.

A Private Talk

If your child is older than twelve then we’ll ask to talk with them alone to address risky behavior. The teen talk is critical to ensure a teenager’s well being. The American Academy of Pediatrics in 2005 estimated that almost 50% of teenagers had engaged in sexual intercourse already and nearly 50% also had tried cigarettes smoking. Taking the time to discuss these private issues is important to ensuring their safety. All answers are confidential. Though if a child wants to hurt themselves or another person then we are required to report it. If I hear something else concerning, then I encourage the child to talk with the parents with or without me. These questions include but are not limited to:

  • Do you have a boy friend or girlfriend?
  • Have you engaged in any sexual activity
  • Do you smoke or drink?
  • Do you do any other recreational drugs?
  • How is school?
  • Do you feel safe at home?
  • Are there questions you’d like to ask?

School Issues

Next we’ll move on to review your child’s school performance. We’ll discuss grades, motivation, concentration and homework. We’ll ask how the previous year went and how the relationship with the teacher and classmates were. We’ll discuss any issues that the teachers may have had concerns with. As a child gets older and the school work becomes more difficult a child may have difficulty keeping up. They may suddenly develop behavior problems that hadn’t been present otherwise. Further testing may be needed to search for Attention Deficit Disorder or other learning disabilities.

Safety Review

One of the most important discussions we’ll have is a review of safety. This includes protecting children from head injuries, falls, and drowning. In particular we’ll review car safety and the proper ages to be restrained in the car. The American Academy of Pediatrics reports that motor vehicle injuries are the most common type of fatal injuries among children and the leading cause of death among children younger than 18 years of age.

Sports Readiness

If your child is involved in any sports then we’ll often address aspects specific to that sport. We address any past history that may be relevant including asthma, heart disease and orthopedic issues. Most importantly we’ll ask of any family history of sudden death in a person less than 50 years of age. This could indicate an inherited disease that puts your child at an increased risk.

Immunization Update

As the visit concludes we’ll review any vaccines that need to be given. By the time a child finishes high school they should have received all their shots and will only need Tdap every 5-10 years. Use the following guide to determine whether your child is up to date. This is just a guideline as some offices use a different vaccination schedule. Also make sure you review your insurance coverage; Meningococcal and HPV are not covered by all plans. Rotavirus is not on this list, though it is recommended by the AAP and given by some clinics.

  • At Birth- Hepatitis B#11 Month- Hepatitis B#2
  • 2 months- DTaP # 1, IPV #1, Hib#1, Prevnar#1
  • 4 months- DTaP # 2, IPV #2, Hib#2, Prevnar#2
  • 6 Months- DTaP #3, Hib #3, Prevnar#3
  • 9 Months- IPV
  • 12 months- MMR#1 and Varicella#1, Hep A #1
  • 15 Months-DTaP #3, Prevnar #4 and Hib#4
  • 18 Months-Hep A#2
  • 4 Years: MMR #2, Varicella #2, IPV#4, DtaP #5
  • 11 Years: Tdap, Meningococcal, HPVl#1 and 6 months later HPV #2

As you can see there are a lot of issues that could be discussed. Often it’s not possible to cover everything in one visit but with regular scheduled care during the year which includes sick visits and phone calls, we can come close to addressing it all. As the school year is about to begin you’ll find it gets harder to get an appointment.

Call today to get that ball rolling with your child’s pediatrician.

Don’t miss this valuable annual opportunity to review your child’s health

Statistic source: http://www.aap.org/advocacy/washing/Statistics.pdf
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