“I’m fine! I don’t need to go to the doctor!”

Most parents know that they need to bring their children in for immunizations, but often neglect the routine yearly well checks during non-required immunization years. You may wonder why we need to see your healthy child every year.

What are you checking for? My child is healthy!

• Growth
We measure your child’s height, weight, and body mass index and plot it on a standardized growth curve. This allows us to see if your child is “growing along their curve”, or if growth is not proceeding as expected, gives us a chance to investigate with detailed family history, dietary history, and bloodwork and/or referral to a specialist if needed. Unintentional weight loss or gain may not be noticed by those who live with the child every day as the change is so gradual. This can reveal eating disorders, hormone imbalances, or lifestyles in need of healthy changes. As recommended by the American Academy of Pediatrics, we screen all children with bloodwork for cholesterol levels at age 12 or sooner if high BMI or family history risk factors are identified.
• Pubertal changes and menses
Puberty that occurs too early can lead to obvious social difficulties as well as advanced bone age, leading to early closure of growth plates and short stature. Both early and late puberty can be caused by genetic abnormalities, hormonal imbalances, tumors, deformities of the reproductive organs or hormone control centers, infections, or trauma. We will ask detailed questions about menstruation and check for anemia with an in-office blood test for 12- and 16-year-old females.
• Scoliosis
During periods of rapid growth, the spine may become asymmetrical. If noted and clinically significant, we will get a baseline spine x-ray and monitor every 6 months.

Why does my child have to put on a gown?

The American Academy of Pediatrics recommends that “…at each visit, age-appropriate physical examination is essential, with infant totally unclothed, older child undressed and suitably draped.” This allows us to see all of your child’s skin and monitor for skin disease, internal disease that can manifest as skin abnormalities, look for any signs of physical abuse or self-harm, and monitor birthmarks. We will point out anything that is concerning to you so you can monitor it as well.

Why do I have to leave the room during the adolescent well check?

Part of the adolescent visit, starting at age 11, involves taking a complete psychosocial history. Often adolescents are physically healthy but are entering a stage of life that encourages independence and risk-taking behaviors. It is our responsibility as physicians to assess this part of their development. After the initial portion of the well visit, we will ask you if you have anything you need to add before we have you step into the waiting room for a few moments. We then complete the interview with your child. The format we use is called HEEADDSS, used by adolescent medicine specialists since 1985 and updated periodically to reflect our changing world. It covers Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence.
Your child may not reveal problems with you in the room as she might feel uncomfortable burdening you with her concerns, or afraid of your reaction. Any indication that your child is in danger from self or others currently or in the recent past will be immediately shared with the parent and is outside the realm of patient confidentiality. We also use other screening questionnaires to identify adolescents at risk for substance abuse, depression, anger issues or inattention.

Brought to you by Bee Well Pediatrics – Austin Texas Pediatricians.