Ask the experts: annual examinations
The days are growing shorter, which means annual wellness examinations will soon be submitted to school administrators. ParentingNH reached out to several health care professionals to learn about the importance of annual physical exams and about some best practices regarding sending our kids back to school healthy and ready to learn.
- Elizabeth Melendy, MD, of Core Pediatric & Adolescent Medicine in Plaistow; and Denise Toshach, MD, of Core Pediatric & Adolescent Medicine in Exeter.
- Heather Merrill, APRN, St. Joseph Hospital Pediatrics, in Milford.
- Ann Barlow Barry, DO, of Derry Medical Center, in Windham.
What is included in a well-child check, when should I have it, and why is it important?
Merrill: “I strongly recommend routine physicals annually for school-aged children and teens. These appointments are important because they cover all the bases of health and wellness including, but not limited to, growth and development, preventative care and behavioral/mental health. Having yearly appointments also helps build and maintain an open, communicative, trusting relationship with your pediatric provider.”
Why is it important to assess growth and nutrition during a physical examination?
Toshach: “Assessing growth and nutrition is the wellness part of the physical. There are many things we can do to help our children live the healthiest best possible life. Maintaining a healthy weight with good nutrition and adequate exercise is a good beginning. At each physical, fruits and vegetables will be discussed. The bigger variety and colors of vegetables and fruits your child eats, the healthier they will be. You frequently will hear the physician talking about ‘eating the rainbow’ as essential to a healthy lifestyle. We know a diet with fresh whole foods and less sugar and processed foods leads to a healthier life.”
Barry: “We measure height and weight at each well-child visit to make sure your child is growing at the rate they should. Their health can be measured by meeting percentiles in growth and if they are falling off or exceeding their previous percentiles, we need to follow this closely. By asking what and how much the child is eating or drinking, we may be able to spot problems early on to get them back on track. Children should be following the 5-2-1-0 rule: five fruits and vegetables per day, two hours or less of screen time, one hour of physical activity outside in the sunshine and zero ounces of sugary beverages. I also emphasize the importance of a regular bedtime and getting enough hours of sleep each night.”
Other than physical screening, what can be learned from an annual examination?
Melendy: “A large part of being a pediatrician is addressing both behavioral and developmental concerns. We regularly screen for both of these. In younger children (less than six-years-old) we ask developmental questions at every well visit. We also do a more formal assessment in the form of ages and stages questionnaire at 9, 18 and 30 months. We also have assessment tools for autism which are reviewed at 18-months and two-years of age. We also screen older children for depression at every well visit starting at 12-years of age (or sooner if indicated).”
Barry: “My favorite part of the well-child examination is discussing behavioral and developmental milestones. At each visit, a developmental screen should be administered. Some screening tools are handed to parents to fill out, others are discussed with the provider. The sooner a developmental delay is identified, the sooner a child can access resources in their community and benefit from them. In New Hampshire, there are many agencies for early intervention, even before a child enters into the local school system. A developmental delay can be identified as learning, language, behavior or motor skills. The response to intervention is the greatest before a child has reached school age, therefore screening becomes paramount while they are still babies/toddlers. Children who have developmental delays, as well as their families, can suffer immensely if not introduced to early interventions at the appropriate time. As the child grows older, having access to emotional and behavioral therapies also becomes a priority. If you are concerned about your child, talk to your child’s doctor. We are here to assess and address every aspect of your child’s health which includes their social, emotional and physical well-being.”
What are some common developmental milestones, and what should I do if I’m concerned about my child’s development?
Toshach:“Developmental milestones are motor, language and behavioral skills your child learns over time. At one month, infants can focus on a parent’s face and lift their head. At two months, most babies are smiling, and then laughing at four months. At six months, infants sit and babble. By a year, they are generally walking, responding to their name and saying some words. You can ask your doctor for guidelines or track your baby’s milestones on the CDC Milestone App. If you have questions or concerns about your child’s development you should call to speak to your physician or discuss it at your visit.”
What are some emerging health concerns you’ve seen in children in recent years?
Merrill: “In recent years, I have noted a significant increase in the time kids spend with screens and a notable increase in the sedentary lifestyles of children. In my opinion, these poor lifestyle choices are directly linked to many health issues including difficulty sleeping, attention deficits and obesity.
“I’ve also observed an increase in the use of electronic cigarettes among our school-aged population. Many people refer to this as ‘vaping’ or ‘JUULing.’ It is important for parents, health care providers and teachers to be aware of the many forms of e-cigarettes as they often present as everyday items (USB drives, pens etc.) and to do their best to educate kids on the risks associated with using them. Most e-cigarettes contain nicotine, which is highly addictive and can harm adolescent brain development.”
Melendy: “Vaping or e-cigarettes are a very common issue. Much of the advertising for vaping seems targeted to youth and offer flavors that are appealing to younger people. Teenagers can hide vaping easier than smoking tobacco because there is no longer the smoke scent that lingers. It can be done in bathroom stalls at school without easily being detected. However, vaping carries with it risks of nicotine addiction and possible transition to smoking tobacco.”
What are some concerns children have prior to physical exams, and how can I help ease those concerns?
Melendy: “The most common worry a child has is about getting shots. Every child is different, but I think most children respond well to preparation (may be even months in advance) and firm guidance from parents about the importance of vaccines. If a child perceives that the parent feels uncomfortable with the shot then often the child becomes more anxious about getting it.”
Merrill: “Prior to physical exams, children are often concerned about what to expect during their appointment, including but not limited to vaccinations, screenings and the physical examination itself. To ease these concerns, it is best for parents to communicate expectations before the appointment. Your pediatric office is a safe space and providers will proactively work to build the trust between themselves and their patients and their families.”
Why should I have my child immunized?
Barry: “Immunizations are one of the most beneficial and important preventative health measures to date. Every child who is vaccinated has a direct benefit of being immunized, and even children (and adults) who cannot get vaccines due to other health reasons, benefit indirectly through herd immunity. By having your child vaccinated you could be saving their life, as well as the lives of everyone around them.”
Should I have my child get the HPV vaccine, how many doses does it require, and at what age should they have them? Should I have my son get the HPV vaccine?
Melendy: “Yes, all children (male and female) should receive the HPV vaccine starting at age 11. It is a two shot series between the ages of 11 and 14. It is a three shot series above 14 years of age. The two shots are given six months apart.”
How can I tell if my child has normal back-to-school anxiety or if it’s something more?
Merrill: “It is not abnormal for a child to have some back-to-school anxiety due to the anticipation and unknowns that come along with the start of a new school year. A child experiencing occasional anxiety is a normal part of life. However, if this anxiety does not fade or begins to interfere with day-to-day functioning or even causes school avoidance, I’d recommend parents contact their child’s provider and make an appointment.”