Published April 2010 in the Tri-City Herald
Once your child reaches school age, his or her yearly “check up” is less about vaccinations and more an opportunity to communicate with your pediatrician. For your pediatrician, the “well child” visit is a way to look at the child as a whole… not just an ear infection, curious rash or sprained ankle. And the visit is more than weighing, measuring and listening to the heart. It is an opportunity to evaluate your child’s social, emotional and physical development.
Ideally, the well child visit is a chance for you and your child’s doctor to have a two-way conversation. It’s an opportunity for you to get validation around your child’s behavioral, cognitive and physical norms as well as for the doctor to evaluate your child.
Some parents are surprised when I ask how life is at home. I ask to learn more about the child’s home social environment. I am not trying to find out what the parent is doing wrong. I want to identify if the child is exposed to any risk behaviors that perhaps a parent is not aware of.
For example, if a child comes in and seems depressed, I may ask how life is at home. Are there arguments? Is someone bothering the child? I am not trying to be intrusive – I want to find out what the child is seeing and feeling. I find most kids are brutally honest, as long as we adults are willing to ask the questions and listen.
The well child visit is actually a chance for a three-way conversation when the child is included. The doctor’s office can be an eye-opening experience. More than once I have asked a child “Do you wear your helmet when you are on your bike?” I can see the parent nodding yes, and the child says “No.” I ask why, and the child says the strap is broken or it is lost or doesn’t fit – and had never mentioned it to the parent.
My job as a pediatrician goes beyond the health of the child. I really feel an obligation to the health of the whole family. Take nutrition. Kids aren’t the ones buying groceries. Parents need to know what is appropriate. Many times I will ask a child how much juice he or she is drinking; many are surprised that more than a glass a day is too much.
I will also ask if there is a gun in the home. If there is, is it in a gun safe, with ammo stored separately? A gun in the home is a risk factor; whether accidental or intentional. Again, I am truly not asking questions to admonish the parent. I only want to identify where positive changes can be made. It is up to the parent to decide if anything should change.
Occasionally, a parent asks me not to discuss sexuality or drugs, saying “we handle those questions at home.” This puts me in a tough spot – I am an advocate for your child. That is what I do. And if I don’t ask the question, I can’t know the answer. I do know that a simple intervention early on can lead to healthier outcomes. When I talk to children about these more sensitive topics, it is always age-appropriate and in the best interest of the child.
For example, there have been times that from me asking are there any children in the neighborhood doing drugs, some surprising information that the parents were not aware of comes up.
Managing the health of children is an honor to me. Patients invite me to be a small part of their lives for many, many years and I view this as a great privilege and do not take it for granted Taking time during the well child visit is a great opportunity to get answers, discuss concerns or verify that every thing is going smoothly.
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