Your Child’s Health: a user’s guide to well-child visits

Printed in The Family Post: Fall Issue 2006

The American Academy of Pediatrics suggests that every child be taken to see the doctor within the first week, at 1, 2, 4, 6, 9, 12, and 18 months and then at 2, 3, 4 and 5 years. Why take a healthy child to the doctor? There are lots of reasons, but the most important one is to catch any problems early. If your child’s development is delayed or health is impaired for some reason, identifying that delay or problem means that your child can get some kind of intervention as early as possible. The beauty of intervention with young children is that they are changing and developing so rapidly that intervention can have a huge impact; many children with slight to moderate developmental delays can be helped to get back on track developmentally with just a little intervention. And the impact of more severe developmental disorders can be minimized through intervention.

But a well-child visit is so much more than just checking that your baby’s health and development are on track and keeping his immunizations up to date. It’s your chance to ask your pediatrician about any problems, questions or concerns you may have about your child’s health, development and behavior and to learn about what to expect in coming months. Your pediatrician and his or her staff can also direct you to all kinds of resources, from books on discipline to child care help to parent support groups to smoking cessation programs.

Dr. Ken Cutler, Truckee pediatrician, has this advice for parents who are preparing for a well-child visit:

“One of the keys to a successful well-child visit is for the parent or guardian to come prepared: bring a list of medicines including over-thecounter and alternative ones that your child takes, a list of known or suspected allergies, and important questions that you want addressed in the visit.”

“A brief doctor’s visit cannot compare to the parents’ close attention to their child over time in being able to sense certain problems, especially developmental ones. Parents’ intuition is very important. So don’t be afraid to ask questions or raise concerns; a wellchild visit should be more than just a physical exam and shots.”

“Feel free to ask what types of changes are anticipated between this well-child visit and the next one. Also, if any answers you get are not to your understanding or satisfaction, politely say so.”

“If you don’t feel comfortable with English, arrange for a trusted translator to come with you to the visit.”

“Finally, it is important to know how to contact your child’s physician if your child is not well, especially after office hours and on weekends.”

Writing your questions down ahead of time can help you remember them during the busy time of a well-child check. Also, bringing your spouse or a friend along can help when your child is still a baby—so that you can concentrate on talking with the doctor while someone else dresses and undresses the baby; your spouse or friend can help you open doors, sign in, carry the diaper bag, and help you learn to get around with a baby, which can be a challenge at first! Having a second pair of ears there can also make it easier to remember what was said.

Before you visit the doctor, talk to young children about what will be happening. By nine months of age, a child will begin to understand and you can make a habit of preparing them for what is coming. Just a simple, “Today you are going to the doctor” will do at first. By the time the child is a year, you might try role-playing a doctor visit during the two days before a well-child check. A play doctor’s kit can be a great asset in this, but even without one you can imitate what a doctor does: “And the doctor will look at your tummy, and in your eyes, and in your ears . . .” and naming and touching all the parts the doctor will check can be a fun game. It’s a whole lot less frightening to have the doctor give you a check-up if you know what to expect. And if your child is going to get shots, let him know ahead of time—you can say honestly that it will hurt a little bit, but that we do this to keep him from getting sick. You can also plan a treat for afterwards and teach your child about getting through something unpleasant that you have to do by looking forward to something pleasant afterwards, a fine coping skill. So plan a trip to a playground, or go out to lunch, or do something else your child likes and let her in on the plan.

Here’s what you can expect at a wellbaby visit:

The doctor or nurse will weigh and measure your child and will measure your child’s head. These measurements will be plotted on a chart that shows normal growth curves and can help the doctor judge whether your child is growing normally. The doctor will check the baby’s soft spots on her skull. He or she will feel the baby’s abdomen to make sure that there are no enlargements or masses or tenderness on the internal organs. The doctor will check the baby’s ears and eyes by looking into them with a scope and will listen to breathing and heart sounds to check for any abnormalities or difficulties. The doctor will also check the baby’s genitals for any unusual lumps, tenderness or infections; boys will be checked to see if their testicles are descended and if their circumcision is healing correctly. The doctor will also move your baby’s legs to check for hip problems and watch her take a few steps once she is walking. Finally, the doctor will ask you about developmental milestones: is the baby smiling, rolling over, sitting up, grabbing objects.

By being prepared, and helping your child be prepared, you can get the most out of a well-child check