School-age physicals: What to know before you go

Although well-child visits are most frequent during infancy — when development is most rapid — your doctor also should see your older child periodically to make sure his or her development is progressing at the proper pace. Because there really isn't time to do this type of exam during an office visit when your child is sick, you should make an appointment specifically for a general health assessment.

School physicals

Some schools require a physical exam and proof of up-to-date immunizations before children can enter certain grades or participate in sports. Check with your school district to see what's required.

In the past, many such physicals were conducted en masse in a gymnasium, where a doctor might check as many as 60 children in an hour. Mass screenings in crowded conditions offer little privacy and no opportunity to ask confidential questions.

Taking your child to your pediatrician or family physician is a good idea for several reasons:

• Your doctor is already familiar with your child's medical history.
• An office visit provides more time for a more thorough exam.
• A parent is available to answer questions if needed.

Checkups: When to have them and what they involve

The American Academy of Pediatrics has established a basic schedule of well-child visits for grade school students. Many medical practices adapt this schedule for their own patient population, but it typically includes a well-child visit every other year from age 5 through age 11. Your family's health insurance may also affect the number and timing of these visits.

What happens during checkups is also variable, depending on your child's age and your doctor's style of practice. In general, though, a checkup includes a physical exam and development assessment.

The physical exam.
The doctor will check your child's:

• Height and weight
• Blood pressure and heart rate
• Teeth, gums, tongue and throat
• Reflexes
• Eyes, ears, nose and skin
• Heart, lungs and abdomen
• Fine-motor development, such as the ability to pick up small objects or tie shoes
• Gross-motor development, such as the ability to walk, climb stairs or jump
• Spinal alignment for signs of curvature (scoliosis)
• Genitalia, confirming a normal level of maturation and checking for hernia, infection and other possible problems

Preventive screenings
Several potentially serious conditions that affect children can be detected on routine examinations and tests. Regular exams increase the chance that such conditions will be found early.

• Lead poisoning. Blood tests may be needed for young children who have been exposed to lead paint, which can be found in older houses. Some doctors use a questionnaire to determine who should be tested.
• Tuberculosis. Skin tests may be needed for children who have lived in places where tuberculosis is more common — such as shelters, institutions or countries in which tuberculosis is prevalent. Some doctors use a questionnaire to determine who should be tested.
• Cholesterol. Blood tests may be needed for children who are overweight or obese, or who have parents or grandparents who developed heart disease before the age of 55.

Immunization update
Every checkup is an opportunity to make sure your child is up-to-date on immunizations. Ask for a copy of the immunization dates for your child — many schools require that information. Also keep an immunization record at home.

Behavioral development
In addition to a physical exam, your doctor may also ask a series of questions concerning your child's intellectual and behavioral development. These questions will vary by your child's age:

• 5-year-olds. Can your child get dressed without help? Count to 20 and print his or her name? Can he or she ride a bike with training wheels? Is there any speech impediment?
• Ages 6 to 8. Is your child keeping up with schoolwork? What are some of the things he or she is good at? Does he or she talk about what goes on at school? What happens when your child is frustrated or angry?
• Ages 9 to 11. How does your child get along with other family members? How are his or her grades at school? Any changes with behavior at home, at school or when playing with friends? Is your child proud of his or her achievements?

Safety issues
Your doctor may also make sure you're following the right seat belt and car seat recommendations for your child's age and size. Tips for bicycle and skateboard safety — particularly helmet use — also merit review. Safe storage of any firearms in your home is important as well. When your child reaches the upper grades of elementary school, you'll need to talk about how to reduce your child's risk of abusing alcohol, tobacco, street drugs and inhalants.

Children in preschool and the early elementary grades may benefit from a matter-of-fact reminder that their bodies, particularly their genitals, are private. Your doctor or nurse can pitch this message in terms your child will understand — reassuring, not scary or embarrassing.

Also, older children need to be prepared for the changes that occur at puberty. As your child matures, he or she may want to speak to the doctor alone about sexual concerns.

A value-added proposition

Well-child checkups can reveal problems early and reinforce healthy behavior. In addition, they establish a relationship with your child's doctor. With up-to-date information at hand, your doctor can assess your child's condition more readily, perhaps even addressing future routine questions by telephone. Finally, your child's trusting relationship with his or her doctor may help establish a lifelong pattern of healthy habits and appropriate utilization of medical care.