The Five-Year Checkup

Six-year-old Claire Schultz, of Seattle, loves her doctor and was a trouper at her checkup last year -- until the surprise ending.

Like most doctors, hers saved the worst part for last. After examining Claire and talking to her and her mother, he let the nurse play "bad cop" and give the shots. Startled when the nurse pinched her arm, Claire suddenly vomited. "She recovered quickly and braved the shots," says her mother, Gail. "But we were all caught off guard."

In most ways, the fifth-year checkup is just another in a long line of routine well-child visits. But it's often rockier than usual -- for kids, parents, and doctors -- because there are more tests than at any other age. The pediatrician's to-do list includes checking blood pressure, vision, hearing, and kindergarten readiness, in addition to giving as many as three booster shots. (See Five-Year Checkup Checklist.) Many kids, like Claire, haven't had a shot since their 18-month checkup and may have heard scary stories about them from friends or siblings. And depending on where you live and your child's health, she may receive as many as five other needle pricks.

For 5-year-olds, a sense of being in control is extremely important. If the doctor's visit happens after a long day at preschool or camp, without time for a snack, your child may already be tired and a bit cranky. Although he is unlikely to say so, he may secretly fear that the doctor is poking and prodding him to find some hidden flaw or "badness." Fortunately, taking the following 10 steps can help your child's fifth-year checkup go as smoothly as possible.

1. Schedule the appointment far in advance. Avoid August, when even the best-run pediatrician's office may resemble a zoo. Because schools require immunizations for entry, too many parents schedule last-minute checkups for their kindergartners.

2. Prepare your child. Mention the visit a day or two beforehand -- not too early, because 5-year-olds lose track of time and may just spend the extra days worrying. Explain that the purpose of the visit is to make sure that he's healthy. Remind him what happened at the last checkup, emphasizing the fun parts, such as getting stickers at the end. It's also a good idea to read a book about the experience, such as Going to the Doctor (Perseus, 1996), by T. Berry Brazelton, M.D.

3. Play doctor. Your child can use a doctor kit -- or improvise with other toys and household objects -- to practice using the stethoscope and reflex hammer. He'll feel more in control if you let him pretend to be the doctor and examine you or a stuffed animal.

4. Write down all your questions and concerns. That way, you won't forget them once you're there. Examples: How much sleep does a 5-year-old need? (Eight to 12 hours.) Is occasional bed-wetting still normal? (Yes.)

5. Be honest about the shots. Explain that they're needed for protection from some bad diseases and that the tiny needle may hurt when going in but it's all over quickly. Tell your child that it may hurt less if she exhales while getting the shot and that it's okay to shout or cry. Never use the shots as a threat or a negotiating point, advises Allan Lieberthal, M.D., chief of pediatrics at Kaiser Permanente Medical Center, in Panorama City, California. "I've heard parents say, 'Be good, or the doctor will give you a shot.' That's not fair to the child or the pediatrician."

6. Speak to the receptionist. When you arrive, tell her if you want to talk to the doctor privately about anything that might make your child uncomfortable. Also let her know if your child has to go to the bathroom, in case he'll need to supply a urine sample.

7. Let your child talk directly to the doctor. Try to avoid answering questions for your child. This will help build her rapport with the doctor and make her feel that she has power over what happens in the office and over her own health.

8. Respect your child's privacy. He may feel uncomfortable taking off his clothes, especially if modesty has set in early. The doctor can use a drape to cover your child and then explain gently that although private parts should be kept private, it's her job to check that the whole body is healthy.

9. Avoid embarrassing your child. If she tells the doctor that she loves eating vegetables, for instance, resist the temptation to chime in, "Since when?" Let your child answer first, and then you can amplify afterward, if necessary, advises Margaret Wheeler, M.D., an associate clinical professor of pediatrics at the University of Washington, in Seattle.

10. Plan a treat for afterward. Let your child know that you'll do something enjoyable -- get an ice-cream cone, for example, or see a movie -- after you leave the doctor's office.

If you have a calm, upbeat attitude, this year's checkup can actually be a positive learning experience for your child. As Katherine Grimm, M.D., a clinical associate professor of pediatrics at Mt. Sinai School of Medicine, in New York City, observes, "Even shots are good practice for bigger challenges later on."