If you've ever looked forward to your child's well visit so you can ask the pediatrician a question that's been bugging you—What's behind my 3-year-old's night terrors? Why does my 5-year-old complain so often that her stomach hurts? Is my kid going to eat a vegetable, ever?—you probably also know how easily a visit can fly by and you haven't gotten to what was on your mental list. The average checkup is 18 minutes long; before you know it time's up and your kids are skipping out the door with their SpongeBob stickers.
Talk about a missed opportunity! Pediatric well visits are about so much more than getting shots and plotting your child's climb up the growth chart. "That's just part of it," explains Charles Shubin, M.D., director of pediatrics at Mercy Family Care in Baltimore. "There are also child safety issues to discuss and whether anything out of the ordinary is going on in the home. Plus there's a whole other level to the exam, where we're looking for age-appropriate developmental skills." This means evaluating how your toddler stacks blocks or whether your grade-schooler's attention span is on track. "In addition to detecting delays early, pediatricians need time to give what we call 'anticipatory guidance,' " says Barbara Howard, M.D., assistant professor of pediatrics at the Johns Hopkins University School of Medicine, in Baltimore. "That's why your doctor will talk about everything from addressing common household dangers when your baby starts crawling, to switching to lower-fat milk to reduce the risk of obesity, to discussing whether it's time to move up to the next-size car seat."
Pediatricians say that their number-one ally in making the most of any well visit is you. With that in mind, we went straight to pediatricians and pediatric nurse practitioners to ask them what you can do to help the process along. Consult this checklist before your child's next well exam.
Speak up right away.
It might seem polite to wait until the eye exam and hearing screening are out of the way before bringing up your kid's pellet-size poops. But the docs we interviewed said first thing is better. No question is too minor, says Dr. Shubin: "If it's something that worries you, ask. Then we can look into it, and we'll get it out of the way." Try not to feel self-conscious about asking questions, even if you have a bagful of concerns. If your pediatrician makes you feel that way, it's probably time to find a new doctor.
Tell the truth!
Lie to the pediatrician? Who, you? No one steps into an examining room intending to fudge the facts about her child. But is there ever a more tempting time to omit the details about a preschooler's diet of sugary snacks than when your child's doctor is asking about her veggie intake? Pediatricians want you to know they've heard much worse—truly. "Having a child who doesn't eat well makes even the most secure mom or dad worry that there's something wrong with the child or that they may be an inadequate parent," says Cathy Ward, M.D., a pediatrician in New York City. "Most often, their kid's diet is actually normal and age-appropriate." Of course, for some children it's quite possible that they're at an unhealthy weight—and a good pediatrician will help a parent find ways to address that, notes Dr. Ward.
Another topic a parent might skip, intentionally or not, is unusual stressors at home that may be affecting her child's mental or physical well-being: the sickness or death of a family member, a separation, a move, or depression. "We know that a mother's depression can affect a child's health as well," says Christina Bethell, Ph.D., professor at Oregon Health & Science University and director of the Child and Adolescent Health Measurement Initiative, in Portland. More research is focusing on the role of paternal depression too, which is especially crucial in cases where the father is the primary caregiver. The American Academy of Pediatrics now encourages pediatricians to screen for postpartum depression. As doctors increasingly become aware of mental-health issues, don't be surprised if your child's pediatrician asks how you've been feeling at your next well visit.
Push the paperwork right away.
Many offices will ask you to fill out a pre-exam questionnaire, which will tip your doctor off to any special areas to watch for. But dealing with it in the waiting room with a kid or two hanging on you can be difficult. Some practices are offering forms to download from their website; if yours doesn't, call the office ahead of your visit and ask if they will e-mail or mail any of the needed forms to you.
Physicians in 28 states use an online tool called CHADIS (Child Health & Development Interactive System), which allows parents to complete a previsit questionnaire. The results are then scored for the doctor to review well in advance of the appointment. Because it's Web-based, information can easily be stored and referred to later, says Dr. Howard, who helped develop CHADIS. Another strength of the tool is its particular emphasis on developmental issues, which has been helpful for more accurate screening for disorders such as autism. "The earlier a doctor can pick up on delays, the quicker she can help guide parents to intervention," says Dr. Howard. "We're trying to bring pediatrics into the 21st century."
Show up as a team.
In an ideal world, both parents would be at every well visit. Although it may not always be possible, going together will give the doctor a more complete picture of your child's health. "I prefer it if both parents are there for checkups because I often get additional perspective," says Dr. Ward. Sometimes, a little debate of the he said/she said variety will break out in the exam room. "Two people often see their child's issues a little differently," says Dr. Ward. One parent might say, "He cries during homework every night," while the other will say, "That isn't true." To parents, that can feel like pointless squabbling, but it can yield relevant information to the doctor.
Make sure your pediatrician is updated.
You'd think a specialist would relay any findings about your child back to your pediatrician. But that's often not the case. To keep your doc in the loop, stop at the front desk of any specialist and ask to sign the necessary release forms. And take an extra copy of your ped's business card (including fax number, mailing address, and e-mail, if available) with you to an appointment with any specialist so it will be as simple as possible for office staff to get a copy of your child's report in your pediatrician's hands. After such appointments it's smart to make a follow-up call to the office—just to be on the safe side.
Get a few minutes alone.
It's not easy to have a meaningful discussion around a young child, and it's just as tricky to raise tough issues (like bedwetting or picky eating) in the presence of an easily embarrassed older child. If you need a few private minutes with the doctor, mention it to the receptionist or office nurse ahead of time—most offices are prepared for just this sort of thing and will ask a staff member to step in and engage your little one. Barring that, bring a family member or a friend to sit with your child in the waiting room so you and your partner can get a few private minutes with the doctor.
Bring your backup.
If you want to ask about a piece of advice you've heard, it will help for your doctor to know the source. "Parents often want us to verify something they have read or that they heard secondhand," says Benjamin Weintraub, M.D., assistant professor of pediatrics at Albert Einstein College of Medicine, in Bronx, New York. He's sympathetic to parents in this 24-hour-media age: "It can be hard for a parent to tell what is good information, because so much out there can often be misleading or incorrect." Come in with a printout or cite the source, if possible, so your pediatrician can make an informed comment (or check it out later).
Your secret weapon: the nurse
She's the unsung hero in the pediatrician's office and plays a major role in your child's health. A pediatric nurse can conduct previsit interviews in the office or by phone (and in a few forward-thinking practices, via e-mail), take vital signs and necessary measurements, administer medications (including shots), and answer questions when you call.
If your practice has a family nurse practitioner (FNP), she or he can also be your go-to person for your child's well care. "FNPs can do many of the things a pediatrician can do," says Jacqueline Kelderhouse, an FNP at Montefiore School Health Program, in Bronx, New York. "They're trained in a more holistic philosophy; their focus is on the family and total well-being of the child."
Originally published in the February 2011 issue of Parents magazine.
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