The AAP Guide to Making the Most of Your Child's Annual Checkups
Early in the pandemic, many families put doctors' visits that weren't crucial on hold, and there was a 53 percent drop in kids' annual checkups, according to a study in Academic Pediatrics. Few parents were eager to enter a waiting room where they could potentially get infected with COVID-19. And given how often standard checkups seem to fly by in a flash ("It's over?"), it may have felt as if you weren't missing much.
Sick visits, too, were way down—an added benefit of mask wearing, social distancing, and frequent handwashing, which reduced the spread of typical kid illnesses like colds and strep throat.
But we're seeing the light at the end of the tunnel now, and returning to regular well visits is essential, health experts say. Not only have pediatricians been concerned that missed diagnoses and delayed immunizations could lead to outbreaks of preventable diseases, they are also worried about children who have been struggling, untreated, with learning difficulties, sleep problems, and mental health challenges.
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Well visits, pediatricians say, are more than just height and weight checks, a peek in the ears, shots, and school forms—they are a way to view a child's health through a longer lens. "When I see a patient, whether a baby, a toddler, a kid, or an adolescent, I'm thinking not just about their short-term health but also their long-term health," says Katherine Williamson, M.D., a pediatrician at Children's Hospital of Orange County, in California. "Over time, I can watch for subtle signs, whether they're physical or mental, and know what that child's normal is and when there might be a problem."
Go Prepared With Questions
You probably have concerns that pop into your mind from time to time, but it's easy to forget them the moment you walk into the doctor's office. Several days before the checkup, make a list of any issues you want to discuss. Maybe you've been wondering if your child's teeth grinding is normal, or you're worried about their picky eating. Think, as well, about specific details you can share with the doctor. "If you have weight concerns, for example, it can be helpful to complete a basic food diary—about a week's worth—of all meals, snacks, and beverages your child consumes so we can get an idea of their typical intake and discuss from there," says Jessica Lazerov, M.D., a pediatrician at Children's National Hospital, in Washington, D.C. For things like snoring or other physical symptoms, it can be helpful to provide the doctor with a video or a photo, she says.
Once you've made your list, narrow it down to three topics in order of importance. At the beginning of the visit, it's a good idea to mention that you have questions. You might say, "Dr. Richards, when you finish the exam, I'd like to discuss teeth grinding," or indicate that you have questions about your child's night terrors. "By prioritizing what's important to you, it means maybe we won't spend as much time talking about something that's going well and can instead focus the time on what's most meaningful for you and your child," says Douglas Lincoln, M.D., a pediatrician at Metropolitan Pediatrics, in Portland, Oregon.
If you want to discuss an issue without your child in the room, let the office know a few days beforehand, Dr. Williamson suggests. The doctor may call you or schedule a telehealth appointment before the checkup or have a medical assistant occupy your child on the day of the appointment. And if you have many questions or don't get to address everything, ask if the doctor can give you a call, schedule a follow-up appointment, or discuss the issue with you through the patient portal.
Talk About Mental Health
"This past year, I've seen much higher rates of anxiety, depression, and eating disorders, even in young children," Dr. Lincoln says. Isolation, grief from the loss of a loved one, and sadness over missed experiences can lead to issues like bedwetting, sleep problems, regression, moodiness, and behavioral problems in many kids. Some children are also experiencing stress due to recent racial and political tensions. In addition to providing support and advice, pediatricians can screen kids for depression, anxiety, and other behavioral health concerns. Some practices have social workers available to see patients the same day, or the pediatrician can make a referral to a mental health specialist. Dr. Lincoln warns that the full impact of the pandemic on kids' mental health may not be evident for some time. So even if you haven't noticed issues yet, keep an eye out and contact your pediatrician if you have concerns.
Know That Doctors Can Help in Unexpected Ways
Many pediatricians can provide services parents aren't always aware of, including applying fluoride varnish to a child's teeth or making recommendations if a kid is dealing with learning problems or has trouble making friends. Some offices have lactation specialists to help with breastfeeding issues. If you aren't sure whether your pediatrician offers a specific service, ask. Pediatricians can also often connect parents with specialists or organizations that can help, whether it's regarding food-allergy support, family law issues, literacy organizations, or other services.
Be Honest With the Pediatrician
It's tempting to fudge the truth about things you think will make you or your child look bad, whether it's not-so-great sleep habits or a serious sweet tooth. Instead, think of the pediatrician as your ally, says Candice W. Jones, M.D., a pediatrician in Orlando. "We can't recommend the best health decisions if we don't have the correct information." For instance, you may not want to fess up to owning a cat if your child has asthma. "But if you don't share that, the doctor will miss an important piece of their asthma management," Dr. Jones says. Your pediatrician isn't there to judge or lecture you; the focus will be on your child's health, which means the doctor could, for example, suggest ways to limit your child's exposure to the cat.
It's important to be open about other things as well, such as if your family is struggling to afford food, you're going through a divorce, or you've had other major changes at home, Dr. Lazerov says. Those things can affect kids, and the doctor can offer assistance or resources for help. "The best time to bring it up is near the beginning of the visit so the doctor has time to understand the situation and provide support," Dr. Lazerov notes. You might say, "We recently moved to a new home because Sidney's father and I got divorced. I just want to make you aware in case that affects anything we talk about today."
If You're Confused, Say So
Doctors are notorious for using medical jargon that sounds like gibberish to anyone who isn't in the health care profession. So if anything is unclear or doesn't make sense, it's perfectly fine to ask additional questions or request the doctor to repeat it or say it another way, says Chris Etscheidt, M.D., a pediatrician in Waukee, Iowa. "Don't feel as if any question is a dumb question." For example, if the doctor gives your child a prescription with vague instructions, get clarity on how long your child needs to take the medication, if it should be taken with meals, and what any possible side effects are. The goal of the well visit is to make sure that you have—and you understand—all the information you need to best care for your child's health.
Things to Know Before Your Child's Checkup
1. Schedule the visit for the right time.
The best time is when it's most convenient for your child. That means avoiding naptime or mealtime so your child won't be sleepy or hungry (and cranky). Try not to plan anything right after the appointment so you don't have to rush.
2. Prepare your child.
Older kids already know the drill. But for a toddler or a preschooler, you could say, "Tomorrow we're going to the doctor for a checkup. Dr. Anderson will check your height and weight, look into your eyes and ears, listen to your heart, and ask us questions."
3. Be up-front about vaccines.
Tell your child if they'll be getting vaccinations (you can call the doctor's office and ask). Be honest and put a positive spin on it: "You have to get a shot. It will feel like a little pinch, but it shouldn't hurt for long. The shot is going to help you stay healthy so you can go to kindergarten."
4. Ask if your kid has questions for the doctor.
Even seemingly silly ones can help build a trusting bond between the two of them that will last for years.
Stay in Touch With Your Pediatrician
One pet peeve of pediatricians: when parents come to a checkup with questions or problems from weeks or even months before. "It's always okay to call us or schedule an appointment when an issue comes up rather than saving it for the annual checkup," Dr. Chris Etscheidt says. There's not enough time to adequately address a long list of issues at a well visit, and it's better to handle a problem sooner rather than later, when it could potentially be worse. The pediatrician wants to know right away:
- If your child has been treated in the E.R., in urgent care, or by a specialist
- If a specialist has prescribed new medications
- If your child has worrisome or unexplained symptoms
- If you have any questions or concerns about your child's health, behavior, or development
This article originally appeared in Parents magazine's September 2021 issue as "The Insider's Guide to Checkups" Want more from the magazine? Sign up for a monthly print subscription here