Back-to-school physical examinations
For many families, it’s physical examination time — as the start of school is almost here. ParentingNH reached out to several health care professionals to ask about the whens and whys of annual physical exams and about some best practices regarding sending our kids back to school healthy and ready to learn.
- Loretta Chou, MD, of St. Joseph Hospital Pediatrics–Sky Meadow, in Nashua
- Dr. Laura Miller and Jennifer Lavallee, PNP, of Merrimack Pediatrics
- Dr. Andy Westinghouse of Core Pediatrics in Plaistow
- Lydia Bennett, MD, of Derry Medical Center in Bedford.
How often does my child need a physical?
Chou: “Pediatricians routinely recommend an annual physical for children. An annual physical is very important because it focuses on preventative care; a provider may determine, by either history or the exam, an issue that may be addressed before a true problem arises. Some of these issues may be health related such as nutrition or a sleep disorder. Other preventative issues include learning disabilities or behavioral problems. Depression and anxiety are also a frequent problem among preteens and teenagers. Many of these issues not identified by family members and can be explored during a routine annual physical.”
Westinghouse: “As pediatricians, we’re here to help guide you on your child’s growth, development and health. We address diet, exercise, mental health as well as physical issues. We are very much into prevention as much as possible, and are advocates of children and families having a medical home that they are familiar and comfortable with.”
Bennett: “Ideally, your school age child should have a Well Child Check, also referred to as a Health Maintenance Visit, once a year. Many children will require this annual visit not just for general health evaluation, but also for school, sports, and camp/activity clearances. We recommend scheduling the annual visit at a time of year that meets your scheduling needs or is easy to remember, with many parents choosing birthdays as a milestone, and scheduling in advance to minimize possible delays in activities or education.”
How do an annual physical and a sports physical differ?
Miller/Lavallee: “If you are seeing your primary care provider for the visit, there likely is no difference. If you choose, however, to go to immediate care for a sports physical, this is a basic check to make sure your child has nothing that would exclude them from participating in sports. The ‘sports physical’ is not quite as thorough as the annual physical and would not count as their annual physical for insurance purposes, it is recommended that the annual physical still be scheduled.”
Chou: “Both address various areas of your child’s health, development, behavior and learning. Sports physicals additionally focus on prevention of sports-related injuries and health problems. Issues such as concussions and cardiac causes of sudden death are evaluated, and a more detailed neurological and muscular skeletal exam may be performed.”
Westinghouse: “If your child gets a brief sports physical outside of your usual office, we do recommend getting a well check with your pediatrician or health care provider as well. Some people are unaware that pediatricians take care of children from birth to age 22 — right through college.”
Bennett: “As primary care providers, and parents, we know how difficult it can be to arrange for each child to be seen yearly, so your child’s annual visit covers a multitude of topics and evaluations. In addition to sports/activity participation, it’s important to go over key factors in keeping healthy, including evaluation of musculature, pulmonary and cardiovascular health, nutrition, fitness, sleep, relationships and emotional health.”
Why are physicals important to my child’s school?
Miller/Lavallee: “Physicals are important to the school because they want to make sure every child is being cared for and is up to date on their immunizations. If a child is not up to date on immunizations, they are at a higher risk for certain illness and may place other children at risk. This also lets the school know what extra precautions they should have for certain kids with conditions such as asthma, allergies, anxiety, etc. If a child visits the school nurse, the nurse can be much better prepared knowing the student’s health history.”
Chou: “Physicals are important to your child’s school because they inform the school about your child’s vaccinations, health issues (which may require daily medication to be administered at school) and other diagnoses, which may impact a child’s learning. For example, asthma and food allergies are common health problems in school-aged children and require a school nurse to have the appropriate medication in an emergency. Attention deficit disorder with or without hyperactivity and autistic spectrum disorder are also diagnoses which significantly impact a child’s ability to learn. Schools need to know of these issues to fully support a child’s academic progress.”
Westinghouse: “Schools do encourage all children to get physicals yearly, and to be up-to-date on all of their vaccines. New Hampshire is one of the best states in the country for encouraging universal vaccines to protect children and their entire community. School nurses also want to be aware of any child that might need extra attention, such as a child with asthma, diabetes or mental health issues. Pediatricians work closely with schools and community resources to keep their children safe and healthy. Children spend a great deal of time in school and sometimes need extra supports. It is very common for pediatricians to discuss getting those extra supports through special education services.”
Bennett: “Wellness checks are important to schools for several reasons. School is an environment with many children and adults in close quarters, so ensuring that vaccinations are up to date helps to keep the school community healthier as a whole.”
How can I prepare my child for the exam?
Miller/Lavallee: “Encourage your child to be honest and open with their provider and ask questions. Let your child know that their provider is there to help them. You may also want to prepare them that the provider will need to do a full physical exam and it is only OK as long as the parents are in the room to give consent. For younger children, watching an episode of Doc McStuffins or Daniel Tiger’s ‘A Check-up at the Doctor’ prior to their visit can be a huge help and comfort.”
Chou: “You can help your child prepare for their physical exam by discussing what to expect beforehand. Explain to your child a full physical exam includes an examination of their body from head to toe, including a genitalia exam. Your child may need vaccinations and allowing your child to be prepared helps them proactively manage expectations.”
Westinghouse: “Preparing especially younger children for the doctor’s visit is always helpful. Coming in with a positive attitude and explaining necessity of procedures such as vaccines and testing for anemia and lead exposure are all very important. Having a positive spin on this is helpful, to help your child be more resilient. Doc McStuffins has been a big help to us!”
Bennett: “We have seen beneficial outcomes when parents discuss any possible vaccine needs with their child prior to the visit, so they know what to expect. A few reassuring words like ‘it’s okay to be nervous about getting a vaccine, but it’s an important part of staying healthy for all of us,’ can go a long way in reassuring your child. Teenagers should have an opportunity to talk with their primary healthcare provider privately, in case they have any particular concerns that they may be uncomfortable bringing up with more people in the room.”
Why is our family history important?
Chou: “Being aware of a child’s family history can help a provider determine what type of tests or exams to focus on during an annual physical. Hypertension, elevated cholesterol, thyroid problems and asthma are just some of the illnesses that could be detected prior to causing complications in a child.”
Is it important to ensure vaccinations are up to date?
Miller/Lavallee: “Vaccinations are extremely important to be done on schedule or very close to it. The CDC has done extensive research to determine the recommended schedule for children to maximize their immune response and cover the most critical periods of increased risk.”
Chou: “Up-to-date vaccines are extremely important for your child as well as for all children and adults they encounter. Vaccinations have been proven to prevent infections. Vaccines are effective for preventing infection in your child, but also prevent the spread of infections to others through a process called ‘herd immunity.’ Herd immunity occurs when the vast majority of children are immunized against an infection, thereby giving protection for those children who cannot receive vaccines due to certain diseases. By vaccinating your children, you are also protecting other children and adults within your community.”
Westinghouse: “One of the very most essential and important services that we provide in our office is vaccinating all children and adolescents. Immunizations have helped children stay healthy for more than 50 years. They are very safe and they work. We have reduced pediatric infectious disease by over 90 percent over the years and we are seeing far fewer admissions to the hospital and emergency room. While the Internet has been helpful in some ways, there is also quite a bit of misinformation and misleading websites that can frighten a parent unnecessarily. It is important to stay in touch with your pediatrician, someone you can trust, who knows the science and research behind vaccines and has the child’s best interest at heart.”
Bennett: “Keeping up to date with vaccines is of vital importance to your child’s health, and the health of our homes, schools, work, camp, and after school activity communities. At every annual visit, your child’s immunization record should be reviewed, and updated as needed.”
When should I schedule the annual physical?
Miller/Lavallee: “You may schedule it a year in advance at some offices, however the most important thing to remember is to schedule as far in advance as possible in order to ensure availability of an office visit, especially during busy months. Some choose to keep their annual visit soon after the birth date for ease of remembering.”
Chou: “We recommend that annual physicals be scheduled at least a month or two prior to when your child’s physical exam is due. Due to insurance criteria, physicals are usually performed a year from the last physical, not necessarily around your child’s birthday.”
My child is 15 and hasn’t had an HPV vaccination — is it too late?
Bennett: “The HPV, or Human Papilloma Virus, vaccination is scheduled to be given to girls and boys at their annual visit of 11 or 12 years of age. However, teens and young adults can and should get this vaccine series, if not done previously. This is one of the reasons that yearly checkups remain important for high school students.”
Miller/Lavallee: “It is definitely not too late and is highly recommended. Based on studies, the best immune response is built when the series is started prior to 15 years old, therefore only two immunizations are needed in the HPV series. If done after 15 years, the body still builds the immune response, however three immunizations are required rather than two. There is so much social media controversy over the vaccine, much of which has all been debunked. Please, when looking into the vaccine, check your sources to make sure they are legitimate. You may also ask your provider for more information. No question is too silly.”